The departing head of Wellington's deeply-indebted district health board says tight funding has forced it to become highly efficient.
Debbie Chin Photo: RNZ / Karen Brown
Debbie Chin leaves at Christmas after four years as chief executive of the Capital & Coast DHB.
Mrs Chin, an accountant, took on the job in 2013 on an interim basis, taking over from Mary Bonner who was hired to rein in the DHB's soaring debt, reported at the time to have led to the resignation of two previous chief executives. She took on the role permanently in 2015.
Mrs Chin said the DHB, with a $24.7 million deficit last year, is on track to cut that to $21m this year.
In order to do that the DHB has had to drive changes to become much more efficient, she said.
Mrs Chin is leaving for a new challenge that's as yet unspecified. She wouldn't be drawn in an interview with RNZ about speculation in the sector that she has a difficult relationship with DHB chair Andrew Blair. She received widespread praise at a farewell at Wellington Regional Hospital on Monday, from medical and nursing staff, Maori and Pacific representatives on the DHB and others.
Wellington Regional Hospital provides hospital care to 300,000 people in Wellington City, Porirua and parts of the Kapiti Coast. It also provides specialist services including neurology, oncology and neonatal intensive care to 900,000 people in the upper South Island and lower North Island.
That's funded under a population-based funding formula which provides less to the DHB per capita than other health boards because of the composition of the population in the district.
"We receive funding at 89 percent of the average per capita funding of any other DHB in the country, and that's because we are wealthier [as a district]. We have less Maori, less Pacific and we're not rural. So all of the extra funding that other DHBs may get for any of those, we don't get it.
"It means we have to be super-efficient, the most efficient hospital, and even more efficient than we are, to balance the books".
Mrs Chin said funding for the DHB under the formula was even tougher for it in the previous two financial years, when it received the lowest funding increase per capita in the country.
She supported the model but believed it needed "some refinement". She was working with the Productivity Commission "to identify what is productivity, what is efficiency, what are the measures of success. Because being really efficient but being financially still in deficit ... is not logical."
Mrs Chin said the DHB had was now a leader nationally in working closely with family doctors and general practice to keep people "safe and well in the community". It means fewer people needed to be admitted, and those who were were able to be discharged home more promptly without needing to be readmitted.
Mrs Chin said these advancements - part of a movement known as the Health Care Home - were among her greatest achievement in the job. Another was a major reorganisation of hospital and community laboratory services. "Now we have a laboratory which is modern, more efficient and more effective and lower costs to run and operate than the old way of operating".
The lab project had saved DHBs in Wellington, Hutt Valley and Wairarapa $7m-$8m a year.
Mrs Chin said the DHB had had to look hard at the services it provides at times because of the tight funding. "It's about where we should get the best value for money for the investment that's gone into health. And when we've done that we've usually replaced it with something else or modernised the practice or changed the practice."
In terms of surprises over the past four years, the biggest was "the gift of a children's hospital" by local philanthropist Mark Dunajtschik. "How often does somebody come along and offer you a cheque for $50m?