4. Hon TONY RYALL (National—Bay of Plenty) Link to this
to the Minister of Health
Does he agree with Health and Disability Commissioner Ron Paterson, who said that the report on sentinel events “probably underestimated” the true number of events, and why?
Hon DAVID CUNLIFFE (Minister of Health) Link to this
The Quality Improvement Committee figures released showed a rate of 2.2 serious and sentinel events per 10,000 discharges, whereas the earlier Davis study showed cases meeting the wider adverse effects definition to be 12.9 percent of all hospital admissions. Mr Paterson may have been alluding to that broader definition.
Why should the public rely on the Minister’s list of sentinel events, which reports failures at 0.02 percent, and not rely on the case note - based research of Dr Peter Davis, who says that the true level of sentinel events is in fact ten times higher than that, which would mean 1,800 sentinel events, not the Minister’s 180?
Hon DAVID CUNLIFFE Link to this
The release made this week has been based on extensive research amongst all district health boards, and on a consistent set of definitions. I have no reason to doubt the accuracy of those figures.
Jill PettisHon DAVID CUNLIFFE Link to this
Yes. Although our hearts go out to the patients and families represented in the data, I am confident that every member of this House would agree that every effort should be made to avoid a repetition of such tragic incidents. Release of the data goes some way towards that by assisting clinicians to learn the lessons that need to be learnt.
Sue KedgleyIs he aware that on top of the 14 sentinel or serious events that Capital and Coast District Health Board reported yesterday, there were a further 1,009 adverse events in that district health board alone last year that caused harm to patients; will he therefore require all district health boards to publish specific data such as their medication error rates, surgical death rates, and hospital-acquired infection rates, rather than just sentinel events, as the Health and Disability Commissioner has been calling on him to do for some years; if not, why not?
Hon DAVID CUNLIFFE Link to this
If the Health and Disability Commissioner had been calling on me to do that for some years he would have been extremely assiduous, as I have not been in this job for very long. [ Interruption]
Madam SPEAKERHon DAVID CUNLIFFE Link to this
I am glad the member has raised that question. It is my expectation that following the work of the Quality Improvement Committee a nationwide set of reporting standards will apply to all district health boards.
Has he seen the comments of Dr Mary Seddon of Counties Manukau District Health Board, who said that a number of sentinel and serious events are discussed at peer review meetings at that hospital, that that is done under privilege in her hospital, and that those events have not been included in the sentinel events information at this stage; how many other sentinel events were not included by other district health boards in yesterday’s litany of disasters?
Hon DAVID CUNLIFFE Link to this
I have no briefing to hand on that matter, and I am happy to follow it up for the member at a later occasion.
Given that he said yesterday that the time has come to ensure there are nationally consistent definitions, nationally consistent data reporting, and nationally consistent monitoring of systems, why did the Government not implement those matters when it was recommended in the 2001 report of the Ministry of Health working-group on these very sentinel events?
Hon DAVID CUNLIFFE Link to this
That is a repetition of yesterday’s question, when I explained to the member that following the 2001 report a series of supports was put in place for district health boards to develop the capability to provide that reporting. Further work was done in 2003 and 2004. The Quality Improvement Committee was set up in 2006 and funded in that year’s Budget. That committee’s work is resulting in the development of guidelines that will apply to all district health boards.
Is the Minister aware that today an external review has severely criticised mental health services at the Auckland District Health Board following a series of deaths, including suicides; when there has been review after review and millions of dollars of extra funding, why are mental health services in Auckland still in such trouble?
Hon DAVID CUNLIFFE Link to this
It is my view that in general the Auckland District Health Board is performing very well at the moment. I am aware of that report, and I am also aware that the Auckland District Health Board has taken clear steps to improve the systems and has made some personnel moves in that department.
Dr Jonathan Coleman Link to this
Does the Minister realise that for each of the last 3 years the number of people who died preventable deaths at Waitemata District Health Board was greater than the number of people killed on the roads in North Shore City, and what assurance will he give that fewer people will die needlessly at the board’s hospital in this coming year?
Hon DAVID CUNLIFFE Link to this
The whole burden of our work on this issue in the last few months and years has been to minimise the number of preventable deaths, and that continues to be my overriding objective.
I seek leave to table severe criticism of the Auckland District Health Board mental health services, released today in Auckland.
Dr Jonathan Coleman Link to this
I seek leave to table figures that show that for each of the last 3 years there were more preventable deaths at Waitemata District Health Board—