What can England’s NHS learn from Canterbury New Zealand?
BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6513 (Published 29 October 2013) Cite this as: BMJ 2013;347:f6513
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I have a high regard for Robin Gauld, and the essential point he and his colleagues make is correct. All sources of funding should be transparently declared.
What I rather resent is the innuendo that lards their letter. It falsely states that the board, not the Fund, wrote the report. It makes unwarranted accusations of manipulation, along with overblown comparisons of selective reporting by the pharmaceutical industry. And they rather gleefully relate that they have revealed this through an FoI request, implying a conspiracy.
They could simply have picked up the phone and asked. We would have told them. We have nothing to hide here. In all our presentations in the UK and New Zealand we made clear that the Canterbury District Health Board commissioned this work. It might be seen to be implicit in the acknowledgements, but it should indeed have been explicit. An unfortunate act of omission does not however spell conspiracy. Nor does it involve one. The King’s Fund retained full editorial control throughout, as stated in an agreement that the study was to be warts and all. The Fund, not the board, wrote the report, and the view of Gauld and his colleagues that it is “overly positive” is a matter of judgement and debate around the available evidence.
As for unmet need, it is clear that Canterbury is meeting more clinical need than it was, and I would be intrigued if Gauld and colleagues could name any health system, including their own, that does not have unmet need. Their core point is valid. I am slightly surprised that it takes five academics to make it.
Competing interests: None, other than that I work for fund on contract.
Dear Editors:
We read the King’s Fund report on Canterbury, New Zealand with great interest when it was issued in September 2013 and we noted the Editorial commissioned by the BMJ on this.1 2 We write now – in May 2014 – as new information about the King’s Fund report has come to light. Concerned about what could be perceived by many New Zealand health professionals and members of the public as an overly positive report by the King’s Fund on the ‘impressive progress’, as the Editorial described it, made by Canterbury we asked further questions under New Zealand’s Official Information Act about the sources of funding. These were not revealed by the King’s Fund in their report, and the Editorial appears to have simply taken the Fund’s findings as those of a genuinely independent evaluation with no transparency with respect to the Canterbury District Health Board’s involvement in the initiation, funding and writing of the report. It now transpires that the Canterbury District Health Board management paid NZD186,000.00 (GBP96,000.00) for and, presumably, commissioned the King’s Fund report. In contrast, evaluations of four other New Zealand integration sites, more revealing in terms of the ‘progress’ and challenges involved, were undertaken independently in a process managed by the New Zealand Health Research Council.3
The BMJ has led the way as a champion of transparency on funding sources and on conflicts of interest. Trials published in it and other medical journals are now subject to considerable scrutiny and authors must reveal all sources and potential conflicts. We believe BMJ readers expect the same level of scrutiny when it comes to studies on which you commission Editorials and suggest a protocol for this is developed. This, in turn, should be adopted by the International Committee of Medical Journal Editors. Indeed, BMJ now has an opportunity, perhaps an obligation, to lead the way here. The King’s Fund may have reported some useful lessons for those interested in health system integration but, unfortunately, did not acknowledge among other less positive indicators the level of unmet need for health care in Canterbury which is ongoing.4 Rather, as in the case of the pharmaceutical industry, notorious for selective reporting of clinical trials,5 we believe public perception has been manipulated. A transparency protocol for reports such as the King’s Fund’s and Editorials on them would, in future, reduce this possibility.
1. Timmins N, Ham C. The Quest for Integrated Health and Social Care: A Case Study in Canterbury, New Zealand. London: The King's Fund, 2013.
2. Mays N, Smith J. What can England's NHS learn from Canterbury New Zealand? British Medical Journal 2013;347:f6513.
3. Lovelock K, Martin G, Cumming J, Gauld R, Derrett S. The Evaluation of the Better, Sooner, More Convenient Business Cases in MidCentral and the West Coast District Health Boards. Report to the Health Research Council. January 2014. University of Otago and Victoria University of Wellington, 2014.
4. Bagshaw P, Maimbo-M'siska M, Nicholls M, Shaw C, Allardyce R, Bagshaw S, et al. The Canterbury Charity Hospital: an update (2010-2012) and effects of the earthquakes. New Zealand Medical Journal 2013;126(1386):31-42.
5. Goldacre B. Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients. London: Fourth Estate, 2012.
Competing interests: No competing interests
I moved from being a general practitioner to a medical administrator in the early 1980s and initiated some integrated hospital board funded, community-based services in Canterbury, New Zealand. I was disappointed to see them destroyed as a result of the competition introduced by the health reforms of early 1990s. I was delighted to see the integration that we tried to put in place has now been more fully implemented. Perhaps Nicholas Mays' work for the New Zealand Treasury promoted his interest in the development of effective policies.
Competing interests: No competing interests
Ruth Buddicom points the finger..
The article stated "impossible to quantify is the effect of the 2011 Christchurch earthquake in reducing hospital capacity in the city by over 100 beds, bringing health and social care staff together to develop innovative solutions.. "
There is nothing quite like an earthquake to bring about seismic change !
But in my part of Wales it seems that our Local Health Board is doing its best to bring about 'the shift closer to home' by collapsing our hospitals.
And now the Audit Commission repeats the mantra that our hospitals admit 40% of patients 'unnecessarily' !! But where is the alternative ??
Surely there is a better way to 'integrated care', which DOES involve getting hospitals to efficiently do what they do best ?
Competing interests: NHS Wales ?
Your praise of "impressive progress" within the health system in Canterbury New Zealand overlooks one critical factor, namely, that we now require a charitable hospital to supplement services within the region where such an institution was previously unnecessary. If the NHS is to learn anything from our system, then it is imperative that full regard be had to the actual reality and costs of this progress(sic).
Yours faithfully,
Ruth Buddicom,
Barrister,
Christchurch NZ
Competing interests: No competing interests
Re: What can England’s NHS learn from Canterbury New Zealand?
The contribution of Buddicom ( Nov 2013) seems to have been ignored. Yet, to me, it is important. Buddicom states that a " charitable hospital" was needed to meet the needs. Previously, there was no such need.
England's NHS could plead with the well-endowed churches, both RC and CofE, the Aga Khan, the billionaire businessmen residing in London, to establish and operate charitable hospitals in the major conurbations. These hospitals could, if they so wished, operate a "passport system" to treat only patients of particular denominations.
This would alleviate some burden from the drooping shoulders of the NHS.
The donors could be rewarded with a peerage, perhaps? Why not? Politicians and party donors get peerages.
On the face of it, the suggestion might seem a joke. However, in Bombay, now Mumbai, the Tatas endowed wonderful hospitals. The Aga Khan has been munificent in Karachi and Kenya.
Competing interests: Old man, needing NHS treatment