VIEWPOINT FOR 9 APRIL 2009
FROM DR RICHARD TAYLOR

I was in New Zealand from 29 March until 2 April on a Health Select Committee visit as part of our inquiry into patient safety. 

We chose New Zealand as it has a similar health service to ours and is known to be actively studying patient safety. It must be recognised that NZ with a population of just over 4 million and many areas of low population density has, in some ways, greater problems than we do, but overall with a smaller population and health service the problems of uniformity and addressing basic issues of quality of care are probably less than ours.

We had four very busy days with meetings and working meals with a wide variety of people within the health and social care services.
________

Meetings with patient safety leaders, the Director-General of Health and the NZ Royal College of GPs (NZRCGP) left us in no doubt that to them quality of care and patient safety are inseparable. 

Their Quality Improvement Committee (QIC) uses a broad definition of “quality” including_

• safety, 
• value for money, 
• people-centred care, 
• high performance,
• best practice,
• affirming that quality in healthcare is always everyone’s business.

The QIC’s key tasks include_

• collaboration with the Health and Disability Commissioner, 
• review of the annual reports of the national mortality review committees, 
• provision of advice on priorities for education and research. 

Their initial priorities are some of the issues to be addressed to improve patient safety, which include_ 

• safe medication management, 
• management of healthcare incidents, 
• optimising the patient’s journey, 
• infection prevention and control, 
• national mortality review systems,
• strengthening the consumers’ voice.

________

A marvelous and noticeable feature of NZ culture is the complete acceptance without discrimination of all races. 
This dates back to the treaty of Waitangi when Maoris were integrated into NZ life. This means that Maori words are frequently used.

Whakawhanaungatanga 
(Wha - ka - whan - a - un - ga- tan - ga)

which means .. excellent relationships at all levels leading to meeting, joining and working together so crucial for quality health care.
________

The NZRCGP highlighted the hot spots for poor quality – 

• medical records, 
• test results, 
• sterilization of equipment, 
• drug therapy, 
• out-of-hours care, 
• confidentiality,
• boundary issues including patient transfers 

and stressed the importance of rewarding demonstrable quality and not just its measurement.
________

We met representatives from the Accident Compensation Corporation which is an organization to which, I believe sadly, we have no equivalent.

This runs the NZ scheme for no fault compensation for injury from any cause and the claims process always includes independent review. 
How we could do with such a body in the face of the enormous costs of litigation because, here, no one dares admit liability.
________

Meetings with the Health and Disability Commissioner, referred to above, and the Chair of the QIC were especially valuable. 
The Commissioner oversees the independent complaints system and through out-reach advocates is easily accessible to patients and concerned staff giving patients and other complainers a powerful voice. 
He works closely with the Chair of the QIC who dismissed the often heard excuse that one “is too pushed to do better” as rubbish. It was refreshing to hear him say that to health service staff job satisfaction is more important than pay.
________

The purchaser/provider split was tried in NZ and abolished as it did not work! 
Oh to be in NZ!

R.T.

© Independent Kidderminster Hospital & Health Concern 1995-2009
(webdesign@chaddesley-corbett.co.uk)