News / New Zealand demonstrates benefits of integration (Convergence 2017)

05 July 2017

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Canterbury Health Board on New Zealand's South Island has 10 years’ experience of running integrated services. Carolyn Gullery, the board's general manager for planning, funding and decision support, told the HFMA Convergence conference that the clear message was that the approach – integrating services around patients – works.

Ms Gullery (pictured) said the drivers for change back in 2007 for Canterbury were similar to those facing the NHS currently. Canterbury, already in deficit, had recognised that its services were not sustainable in the face of an ageing population and growing levels of chronic illness.
CarolynGullery

'What drove the transformation in Canterbury was an understanding of what would happen if we didn't change,' she said. 'If we kept on doing what we were doing then by 2020 we were going to need another 450-bed hospital, another 2,000 aged residential care beds and 25% more GPs,' she said. With the trend line also suggesting a doubling of the workforce would be needed, the 'do nothing' option was neither affordable nor achievable.

Over 10 years later, the health system does not have an extra hospital – in fact it has just 30 beds more than its original number. This is despite the population increasing by more 11% in the same period. Within that the over-65 community has grown by more than 30% and there has been a 17% increase in the number of over 75-year-olds.

Ms Gullery said the system now worked on the basis of 'one system, one budget'. While this is not factually the case, with numerous providers working in an alliance to deliver services, it was the basis for the way the system now worked. The partnership's successes can be seen in avoidable admission rates and emergency department attendance rates that are well below the national average.

While the health board still has financial challenges – mainly relating to a legacy of major earthquakes in 2010 and 2011 – Ms Gullery said the system had also proved to work financially. Additional expenditure on community services and primary care have been more than compensated by savings on acute care. In total she said the approach had created system efficiencies of $38m compared with New Zealand standardised expenditure.

This has been delivered by an acute demand management system, which sees GPs managing patients in the community with support from community services and advice from hospital specialists. Referrals are informed by development of clinician-created health pathways. Paramedics are also supported to access the new services rather than transport patients to the emergency department. Another initiative focuses on community rehabilitation following hospital admissions.

Me Gullery said empowered GPs were at the heart of the new approach, with general practice redesigned to free up doctors' time.

She acknowledged that the health economy had been broken with an 'impossible to deliver scenario'. This required a bold response. 'We made the decision to do something different to deliver a different outcome,' she said. 'You can't leap a chasm one step at a time. You just have to jump.'

See Healthcare Finance article on Canterbury's experience of integration here