Canterbury, New Zealand’s quest for integrated care Nicholas Timmins, The King’s Fund September 2013

Vision 2020

If nothing changed, Canterbury would need....

a hospital twice the size

20 per cent more GPs

2,000 more aged residential beds (40% increase).

This was neither affordable nor achievable.

Tools for re-thinking

Vision 2020

Xceler8

One system, one budget

The Health Services Plan

‘When you first talk to doctors about using lean, they say ‘Hang on a minute, we are not making cars or baked beans here ... these are real people.

‘But a core part of lean is thinking about it from the product’s perspective. You don’t want them stacked up in a pile, or falling off the production line, or having defects. And that is even more important from the patient’s point of view ….

‘Being in a pile waiting is not good. Falling off the production line is not good. Having a defect is not good.

‘So we came up with the idea of not wasting the time of the product … that if we valued the patient’s time as the most important thing, we would start to get results.’

– Dr Nigel Millar, Chief Medical Officer

More tools…

Showcase 2009

Xcelr8

Collabor8

Particip8

So what else mattered?

First: The vision

Second: The tools

Third: The money

How did the money change?

1. Ideas that saved patient time got funded

2. Price/volume schedule scrapped

3. Alliance contracting

‘The biggest waste we have in the heath system is patient time … removing waiting time can make far better use of the existing resource … We are convinced that 30 per cent of what we do is wastage.’

– David Meates, Chief Executive, Canterbury District Health Board

So what has happened as a result?

Hospital/GP/ community interface:

– Health Pathways – ADMS – CREST – ERMS – Electronic shared record – Falls management – Medication management

Within the hospital:

– Efficient radiology – Surgical assessment unit – Medical assessment unit – Demand predictor – Improved pharmacy

management

Was it just the earthquake?

Was it just the earthquake?

No.

The earthquake accelerated some things.

But none of that would have happened – or at the speed it did – without the huge amount of groundwork that had already been laid.

So what is the outcome of all this?

Canterbury has always had a low standardised acute medical admission rate – but it has improved.

Acute medical length of stay versus readmission rate

Acute surgery

Elective surgery

Hospital bed occupancy, 2012

Emergency department attendances, 60–80 year olds

Emergency department attendances, 80 years +

Primary care activity …. is UP Pipelle biopsy

2007 all 104 done in hospital

2012 711 procedures, 47% in primary care

Spirometry

2007 All done in hospital

2012 1,500 of them (22%) performed in primary care

Skin lesions

2007 1,142 publicly funded procedures, all in hospital

2012 5,711 procedures, 39% in primary care

Use of the most costly social care … is DOWN

As is aged residential care spend

What this has not done

Aside from a loss of beds from the earthquake, this has not shrunk the hospital base.

‘What we are doing is flattening the demand curve. In some areas we have actually reduced it, and over future years that is billions of dollars in capital that does not have to be spent.’

– David Meates, Chief Executive, Canterbury District Health Board

Conclusions

Has the Canterbury heath system been transformed? No.

Is it transforming? Yes.

Is what it is doing transformational? Certainly…

But in Canterbury – as everywhere else – there is still a way to go.

Find out more:

www.kingsfund.org.uk/canterbury