Outsourcing hospital & Meals on Wheels meals - why this is a dumb as move.

Thanks 3News for the pic!

If you have had the "pleasurable" experience of a hospital stay you will know all about the food.  It is mass produced and has been known to arrive in a tepid state, but for the majority of hospital stays the food has been cooked within the resident hospital kitchen or in a kitchen within a short drive.

 

Tony Ryall, the former Minister of Health from December 2008 until he stepped out of politics into a flash as job at the September 2015 election, was on a drive to cut costs in the health sector and "streamline" systems.  He set up a Crown company called Health Benefits Ltd (HBL) with the goal of  making cost savings in the health sector.  One of those cost cutting efficiencies he looked into was catering of patient meals by hospital kitchens. 

 

In April 2013, the Labour claimed that Mr Ryall was looking at outsourcing patient meals and closing 50 hospital kitchens.  It would come at the cost of 1300 jobs.  (Govt may close all NZ hospital kitchens.  NZ Herald 10/4/13).

 

Tony Ryall - former Minister of Health

At the time Mr Ryall said that they were merely consulting the unions on streamlining services, but believed efficiencies could save more than $10 million per year and be channelled back into "frontline health services".

 

What is more "frontline" than feeding your patients?

 

The Greens also warned against the outsourcing of patient meals (Outsourcing hospital food will cost NZ in the long run.  www.greens.org.nz, 10/4/13).

But this article in the Otago Daily Times Frozen meals - sent from Auckland (13/4/15) shows that not a lot of thought has been put into the practicalities of it at all. 

Meals on wheels will be made in Auckland and trucked to Dunedin and Invercargill under a proposal to outsource hospital food services, the Compass Group confirmed yesterday.
The Southern District Health Board is yet to decide whether to approve the proposal.
The meals on wheels would be frozen, and reheated in local hospital kitchens.
Patient meals would be prepared on-site, using components driven ''around New Zealand'' in trucks, Compass said.
A stock of pre-prepared meal components would be held at a Dunedin distribution centre.
''The pre-prepared components of the meals will be prepared by specialist suppliers based in a number of different regions of New Zealand [including] Tauranga, Mt Maunganui, Dunedin, Auckland.''
Asked if Compass planned to subcontract meals on wheels to another provider, the food giant said: ''Compass Group is working with an Auckland-based supplier to supply the individual snap frozen meals for the meals on wheels solution''. Asked how often the meals would arrive in trucks, Compass said it was yet to be determined.    
Asked what contingency plans were in place for adverse weather, Compass said it was part of planning work that would happen with the health board.
Since the proposal was announced nearly two years ago, it has been unclear where meals would be produced.
Last week, health board members relented to union demands and deferred the final privatisation decision by a month to the May meeting.
Service and Food Workers Union organiser Anna Huffstutler, of Southland, said producing meals on wheels in Auckland reduced the amount of work available for local staff.
She also questioned the logistics of transporting meals during a civil defence emergency.
''What's the back-up plan?''
Ms Huffstutler is pleased about the deferment of the final decision, saying unions had lacked enough information to form a counterproposal.
The counterproposal would include suggestions on how money could be saved. Securing the extra month had given a sense of hope the board might be willing to listen to a proposal from unions, she said.
The Compass Group says it can save the health board $7 million over the 15-year contract.

Considering how long this proposal has been worked on, you really have to wonder why there are no answers to the questions raised by Anna Huffstutler, the SWFU organiser.  It also does not appear that much consulting has been done with the unions over how this proposal will work considering Mr Ryall said in April 2013 that was on the agenda.  And not even saving half a million dollars a year for the Otago District Health Board?  Have they not considered the wider costs to the patients and the community?  By the way, you really should click on the article to read the comments under the article - they're pure gold!
 

No one supports this idea because it is a bad idea.  Like I just said above, have they considered the impacts to the wider community of what Tony Ryall has envisioned for the whole country?  I have, and here is why it is flawed:

• How can a health board justify supplying frozen meals to patients and Meals on Wheels clients instead of freshly made meals on a health basis?
• The practicalities, cost and environmental impact of trucking these components around the country! And don't we have enough trucks on our roads already?
• The personal touch to food preparation will be gone and the likelihood of some food allergy not being catered for increases.
• Who likes mass produced food? Patients and Meals on Wheels clients may as well go get a frozen meal out of the New World (et al) freezer!
• The jobs lost to the catering staff and the impact on their families.
• What about the impact on local suppliers and growers when everything in centalised to Auckland?
• What happens during bad weather or a natural disaster when the "components" can't get through?  (As pointed out by the SFWU organiser).
• So if we're getting rid of the catering staff for patients and Meals on Wheels clients does that mean cafeterias for staff and visitors will also be replaced with a vending machine selling frozen meals and a pay by the second microwave?
• Compass, the company charged with making it happen, has a "colourful" history (horse meat in your hospital meal sir?).
• Considering the cost saving is merely $7 million over 15 years for the Otago DHB (that's less than half a million per year!), how does that compare to the costs of the unemployment benefits that will need to be paid to the redundant catering staff nationwide? And did they consider the impact on the tax take of more workers being unemployed and paying less tax as a result?

As with many ideas from Tony Ryall, this one is a dog with fleas and now he's gone and isn't there to bully push them through the truth is slowly coming out.  In fact his flag ship HBL is now under investigation by the Auditor General (Scheme can't pay back loans, Stuff, 19/4/15):

The Government's flagship health cost-cutting scheme has taken out millions of dollars worth of taxpayer-funded loans, despite concerns it could not pay a cent back, new documents reveal.
Once dubbed a government "ponzi scheme" by district health boards (DHBs), Health Benefits Limited (HBL) has been granted more than $10 million in loans by the Government. HBL was also given three separate extensions to the deadline to pay the money back, amid concerns the original deadline would leave the crown entity insolvent.
The final deadline for HBL to pay at least $10.2 million back is now March 31. If the money isn't paid back, it is likely to be recovered from the already cash-strapped budgets of DHBs.
The organisation is now the subject of an investigation by the auditor-general.
HBL was set up by former health minister Tony Ryall in 2010 to save DHBs $750 million over six years by establishing shared contracts for key hospital services.
But documents show the group took out an initial $8m "short-term credit facility", or a low-interest loan, from the Government in July 2013 so it could develop three detailed business cases for its food services and linen and laundry services and its National Infrastructure Platform programmes.
In a June 2013 letter HBL chairman Ted van Arkel told the Government the loan would be an "interim step" while the group worked with both the Ministry of Health and Treasury to establish a "long-term capital structure".
Van Arkel said it was expected the three projects would deliver $189.7m in savings across the health sector, once the contracts had been filled. It was proposed the money loaned would be paid back through the successful contract providers, but, failing that, DHBs were liable.
Ryall and Finance Minister Bill English approved the loan, with a deadline for repayment set at April 30, 2014.
But subsequent documents show the HBL board had to ask the Government for an extension, after project delays meant it could not afford to repay its loans.
In an email to English's economic adviser Simon Carey, Ministry of Health chief financial officer Mike McCarthy warned that if the loan was outstanding at June 30, "we would have a possible legal issue".
"I have now spoken to the [chief financial officer] and interim [chief executive] of HBL, they advise if the loan is not extended they will not be able to make payment as they have insufficient cash reserves and will be insolvent," he wrote.
On June 24 last year Ryall wrote to van Arkel approving an extension to March 31 this year.
In August, HBL requested the Government lend it more money so it could meet its forecast costs; hoping to increase its $8m debt to $15.1m. Ryall only approved handing the group an extra $2.2m, taking the total loan value to $10.2m.
But a ministerial report shows DHBs were not forewarned of the amount, despite their liability for the loans.
Ryall retired from politics at the election.
HBL is being wound down by Health Minister Jonathan Coleman in June, with its programmes transferred to Auckland regional DHB-led services provider HealthAlliance.
Neither the Government nor HBL has been able to provide any information over whether the loan has been, or is being, paid back.
Labour health spokeswoman Annette King said she had been concerned about HBL for more than two years.
"And I'm delighted the the auditor-general has agreed to my request for an inquiry."
In June 2014, a memo between some DHB chief financial officers branded the organisation a ponzi scheme, calling it the biggest threat to the public health system in a generation.
Coleman has said that HBL had delivered $300m in savings. His office has not yet answered questions and a spokesman for van Arkel refused requests for comment.

 - The Dominion Post

This not only raises questions about the management of Tony Ryall and why he conveniently left parliament at the last election for a job in the private sector with Simpson Grierson, but it raises questions about our Minister of Finance, Bill English, and his ability to actually understand numbers and how money works.

There'll be some horror stories to come yet in the health system from the decisions Tony Ryall made.  I predict there will be some particularly nasty stories in regards to the waiting lists.

This is yet another example of how the National led government is really not qualified to led this country based on its own trumpet blowing of being the best managers of the economy.  This is yet another example of how the National led government has failed to meet the standard yet again.

I just opted out my health details from the Cloud.

On Monday July 29th 2013 all your health details held by your GP went live in the Ministry of Health's new Cloud storage system.  You have a National Health Identity Number under which your details are stored.

This system will store the basics of your information:

• name
• date of birth
• address
• contact details

The above details will be available for anyone authorised who accesses your details on the cloud.  This is what the receptionist at your GP can see.

What else will be stored on the cloud:

• your allergies
• medications you take regularly
• medications you've taken for specific illnesses
• your clinical history broken down into categories

The people who can access this are the practice manager of your GP medical centre, or any other centre or hospital facility, any doctor or nurse.

So this begs the question, just how safe are your details?  Who can and can't look at them?  When can they look at them?  What happens if someone accesses your health details without proper purpose?

The first security issue I have in regards to the Cloud is hacking.  The Midlands DHB has been telling their medical centres that your data on the cloud is as safe as your banking details.  Hmmmm.  Have they not heard about Nigerian princes?  Have they not heard about people skimming peoples' credit cards through Eftpos machines, ATM or even a gadget that can scan your credit card details as your credit card lies idle in your wallet by walking beside you in a shopping mall?

My second security issue is in regards to the people who should ethically access your clinical record for reasons directly related to your care they are responsible for, not for "joy riding" purposes such as the following.

We are all aware of the case at Auckland Hospital of the man who was admitted with an eel somewhere it really shouldn't have been and the resulting disciplining of staff who accessed his clinical records and how it went viral in public.

And the Jesse Ryder incident in the Canterbury DHB was topical.  People from throughout the organisation, from Christchurch to the West Coast were checking out his clinical record.  Seven people were consequently disciplined for their unauthorised accessing of Ryder's clinical record.

Of course New Zealand organisations don't have a great track record of privacy in the last few years, thinking of.... ACC (numerous occasions), MSD (aka WINZ), IRD, the defence forces and the Ministry of Education (through Novopay) have all had some sort of privacy lapse in various guises in the last two or three years.

Which leads us to the whole who else could access our personal health data and how could they use it.  We all saw Paula Bennett access the details of two WINZ clients and use their details when they criticised her cutting the benefit that got Paula to where she is today.  We all saw how Hekia Parata replied to teachers, who expressed their concern as private citizens and parents over the class sizes issue in 2012, by CCing the replies to their principals and BOTs.  And we saw how Bronwyn Pullar was treated when she exposed the privacy breaches at ACC and that a year after she alerted ACC to their breaches they have continued to happen.  And there was that case of the police man who was married to a woman engaged in a custody battle with her ex-husband who accessed the police database to find out some dirt.

So what is to stop a government minister using their powers to access an individual's health record to use it against them?  Or an insurance company somehow gaining unauthorised access?  Or possibly even your employer?  Perhaps a psycho ex?  Maybe even your employer?  All they have to do is know someone who can access the data as part of their job who isn't very ethical.  And if you are a government minister, I guess you have the SIS and GCSB to do their dirty work.

So did you know this was happening?  Did your medical centre inform you that your records were heading to the Cloud?

Probably not.  I did a google search and nothing came up in the news media.  Medical centre staff from two different clinics have told me that they have concerns for privacy.  The training they received from Midlands DHB clearly said that they should not promote the knowledge that the data is now to be stored in the Cloud and not to leave opt out forms in open view of clients.  My doctor didn't even know that patient data was to be stored in the Cloud and had to check with the practice manager when I told her I wanted to opt out.  They only had four forms given to them by the DHB, and I was the third person to request to opt out in the first two weeks.

Clearly the DHBs have not met the standard on informing patients about their data now being stored in the Cloud.  The DHBs have also not met the standard on informing patients about their rights to opt out of the Cloud to protect their privacy.

The DHBs have failed the standard.  They can only hope that the cartoon below doesn't apply to them in the coming months and years.