Scenarios of Current Patient Experience Issues Identified Patient Experience Under the New Proposed Model Benefits 1. A patient with hand injury requiring hand surgery at HVDHB on different occasions. The patient had known mental health issues and was required to be away from family and the local social support system. Travel and accommodation costs were incurred by the patient and family, and the DHB of domicile. The treatment was not a one-off event, but rather required on-going care to rehabilitate the hand. Hand therapy was an important and integral aspect of the treatment programme and this should be done in a multidisciplinary setting including the plastic surgeon and hand therapist closer to home. Multiple journeys were made to access surgical care, surgical follow- up, nursing care and hand therapy. There were communication and process issues. Out of town patients usually remain longer as in-patients. Discharge delayed due to difficulties of organising local support from a distance. The patient could have all the treatment provided locally. CRISP should provide complete patient records to aid communication and transfer of care. Continuity of care and established local relationships and supports are not disrupted. Improved relationship between collaborating clinical specialties and allied health professionals. Multidisciplinary management plan developed. Quality of care improved through involvement of local mental health team and social support. Strengthened, integrated support for access to secondary services. Regional decision making on best care options. 2. A female patient with breast cancer requiring breast cancer surgery and immediate breast reconstruction. Fast decision process was required. The local general surgeon was required to travel with No relationship between patient and plastic surgeon at HVDHB. Relationship dependant on general surgeon travelling as at present. Assessment done twice as no shared records. Continuity of care and local support. Better outcomes emotionally and psychologically which build confidence through existing relationships. Short and long-term planning and follow up arranged by a local multidisciplinary team. GPs as part of the local collaborative team. More effective use of clinicians’
TABLE 1 Regions in 2011 Regional pop in 2011 Number of PRS 2012 Pop of 20 DHBs in 2027 12 Possible Services in 2027 Region pop in 2027 PRS need 2027 Northland 157,350 1 180,146 Northland 180,146 3 Middlmore region 1,478,000 26 614,911 Waitemata 614,911 10.2 515,536 Auckland 515,536 8.6 561,674 Counties Manukau 561,674 9.4 Waikato region 837,490 7 422,504 Waikato/Lakes 539,967 9 240,526 Bay of Plenty 240,526 4 117,464 125,089 53,237 Hawkes Bay /Tairawhiti 230,280 3.8 Wellington region 993,770 12 177,043 66,861 Mid-Central Whanganui Taranaki 374,385 6.2 182,435 46,115 Hutt Valley Wellington Wairarapa 553,294 9.2 164,633 342,546 158,107 NMDHB & West Coast 195,579 3.3 Canterbury region 596,890 9 37,472 581,824 Canterbury & South Canterbury 645,891 10.8 64,067 Southern region 303,800 2 208,138 Southern region 347,812 5.8 139,674 TOTAL 4,367,3001 57 5,000,0001 5,000,000 83.3 This analysis does not account for current unmet needs due to existing lower levels of RPS service provision in provincial centres (i.e., where a RPS service centre does not exist currently).
expected finding as the Unit based at Hutt Hospital provides secondary as well as tertiary services to its local population). Giving the close geographical proximity and the absence of an alternative tertiary service provider, Wairarapa DHB (WDHB) also had equal intervention rates to that of CCDHB. Whereas the more remote DHBs had significantly lower intervention rates compared to that CCDHB and WDHB (Figure 1). There is an inverse relationship between distance and intervention rates (Figure 2) which shows that access to RPS services (intervention rate) reduces with increased distance from the Unit based at HVDHB. Figure 1 Access to RPS Services vs Distance from Hutt Hospital Figure 2 Overall Access to RPS Services Relative to CCDHB Key: Blue – population normalised intervention rate is equal to that of CCDHB Green – population normalised intervention rate is significantly greater than that of CCDHB Red – population normalised intervention rate is significantly lower to that of CCDHB