Access: How many agencies does it take to change a light bulb?
143 Responses
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B Jones, in reply to
There are 20 DHBs, about 15 NASCs and numerous power companies in New Zealand. You would think there was a standard process for dealing with these issues.
Well, that's the problem right there. The more people there are responsible for an outcome, the less likely that outcome will be achieved.
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Angela Hart, in reply to
There are 20 DHBs, about 15 NASCs and numerous power companies in New Zealand. You would think there was a standard process for dealing with these issues. Or that one could be developed.
yes, my thinking too. But it requires leadership from somewhere as well as a comprehensive understanding of the range of medical dependency and safety measures. A focus on patient safety rather than expediency or financial cost. A recognition that life is worth living even if it isn't the kind of life you might choose.
As with many situations we encounter, a properly thought through and applied solution is likely to be much more cost effective as well as better than the ad hoc situation we seem to have. -
Unbelievable. We are not permitted to install a poxy $4000 server without a battery backup, where I work. Yes, down to the server that hosts the library catalogue. Nothing critical to life (quality).
I'm amazed that in-home medical equipment actually comes without a battery backup - even if only half an hour's duration. I'm even more amazed that the health authority has no guidelines or provision for recommending/providing additional backup equipment for precisely this scenario.
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Thinking about the way health economics works, it might be possible to make a case for the $120 backup for every machine, thanks (alas) to the death of Wayne Haamia. Wayne died at 28. The average New Zealand life expectancy is, what, 81 years? So that would be 53 years of life lost, at the New Zealand value of a life year now costed at $150,000, that's $7,950,000. That would buy 66,250 of those $120 AGM batteries at retail price, and the Ministry of Health would be able to buy in bulk and get them cheaper. Even if not, I doubt very much that there are 66,250 people in NZ using BiPap machines.
Reading that news item, it's so very clear that the solution suggested by the Haamia family is far more sound and reliable than their predicted Coroner's recommendation. If your lines company calls you at 4.30am saying "halp, soz, the electricities have stopped working", that's not giving you a lot of time to find an alternative power souce: you really do need the backup power ready to go then and there. -
Berinthia Binnie, in reply to
As with many situations we encounter, a properly thought through and applied solution is likely to be much more cost effective as well as better than the ad hoc situation we seem to have.
But it wouldn't bode well for GDP (Gross Dithering & Procrastination) What would happen if the Wheel Reinventing machine was to shut down?
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Pharmac is moving into into medical devices as well as drugs - so the single purchaser model is coming, but not there yet. How they'll prioritise reliability of service, electrical backups etc. compared to least cost per patient is another question.
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Moz, in reply to
How they'll prioritise reliability of service, electrical backups etc. compared to least cost per patient is another question.
I really suspect (having worked with a variety of medical devices) that the portable UPS is actually a better solution in almost all cases, just because it's flexible. Rather than one battery per device you have one battery per ward and a pile somewhere for customers (or whatever they call patients these days). It also means that the workshop/outsourced contractor has fewer different types of devices to deal with.
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Moz,
24v DC, 1.25A(FG), 3.75A (sys)
I'm going to guess that it has two modes of operation, and somehow FG is one and sys is the other. But even 3.75A at 24V is only 90W, so a modern lithium battery should be able to power it for a while. If you have an e-bike an adapter would be probably $100 and you should get at least 3 hours out of it (it depends on the exact power consumption).
But this is real geeky stuff, you would likely find it easier to buy something like this photography tool for $AU500 and accept that you only get a couple of hours out of it. I just found that online, and by coincidence vaguely know the owner, but I've never really looked at this stuff before today so that's not a "buy this one" recommendation (OTOH, I live in Sydney so if you wanted me to deal with that shop I'd be happy to)
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OK, a $70 inverter from dick smith, plugged into a car battery, is the minimum requirement. But it would have done the job.
The next level of back up would be:
(1) a $120 AGM battery, which are bog standard, and sealed. They are easy to move around.
(2) an inexpensive battery charger to keep it toped up.
(3) and a more fancy inverter, just for fun.
Did any of the people from any of the agency’s say any of that?
Nup. What we got was they can't do that (turn the power off), go to your GP, haven't you any rellies you can stay with, and no, you can't use Ministry of Health funding to solve this problem.
Thanks very much for this detailed list Steven, I will definitely explore the possibilities here. I have hesitated because the machine is not ours and obviously I don't want to damage it. But a reliable, ready to go back-up is a bloody good idea.
The immediate difficulty I think of with an off the shelf battery is how to connect it to the machine. On our current one there's no DC input port. The proprietary battery has the same plug as the mains adapter http://www.amazon.com/CPAP-Battery-Pack-ResMed-S9/dp/B007D270C4
I guess I could buy that kind of plug but then the issue would be ensuring the wiring was correct, without a wiring diagram- too risky unless there's a standard for which wires carry juice- red and black? -
This reminds me of the time that our street had a physical outage in phone service – a Watercare worker broke a drain which flooded the ancient paper-insulated copper at the corner.
It took a week to repair and our very unwell elderly neighbour, George, became quite distressed as he had a medical alarm that relied on the phone line. I acted after talking to him and Telecom actually got it and were as helpful as they could be. From memory, we gave him one of the boys’ mobile phones and I think they even zero-rated the calls. It didn’t replace the alarm but it was better than nothing.
What struck me was the way no other bugger helped him – not the DHB nor his landlord, Housing NZ. How often must this stuff happen?
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izogi, in reply to
The piece of medical kit should have a back up battery built into it.
In recent times I’ve only experienced the delivery and post-natal areas of Wellington’s DHB, but my impression of that was that much of the equipment was dated and not always working reliably. In all the times we visited it was common to see staff grab a machine from the corridor which didn’t run properly, push it out the door and find (or wait for) another one known to be more reliable.
Later we spent a night in NICU. The stay would have been longer in quieter times but trying to handle 40-something babies at this time of year when it’s only funded for about 3/4 of that meant we were bumped out to a ward, as for us it was still possible to do the necessary monitoring remotely. We didn’t feel there was an unusually high risk, but mostly because the whole experience was taped together by a highly professional expert staff, who knew how to work with the often-flaky resources they had. Many of those staff, especially the likes of midwives, probably cost the DHB much less to keep around than purchasing, maintaining and eventually replacing reliable specialist equipment.
If that experience was anything to go by, I could easily imagine that DHB purchasing equipment with backup batteries or UPSs, but maintenance would be lacking. Sooner or later half of it wouldn’t work properly, and those machines would forever be allocated to less critical scenarios or sitting in a queue of machines in a cupboard somewhere waiting for maintenance.
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Ian Dalziel, in reply to
What would happen if the Wheel Reinventing machine was to shut down?
Unemployed 'spokes-people'?
A Hub to nowhere...
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Angela Hart, in reply to
portable UPS is actually a better solution in almost all cases, just because it’s flexible.
I'm unclear how I'd actually connect a UPS but I'll investigate further. When I asked an electrical firm about UPS some time ago, they checked things out and said it would be impractical because of cost. But that was the previous Bipap machine which may have needed more power.
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power to the people...
Dependence on proprietary electricity supply is an evolutionary dead end - it is fast becoming something we can't take for granted or afford... -
What if we all had solar panels on the roof or our own wind turbine in the garden?
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Angela Hart, in reply to
professional expert staff, who knew how to work with the often-flaky resources they had.
yup, same here in Auckland. The DHB's have been starved for too long and hospital equipment is often troublesome. Unfortunately it'll probably take a publicised needless death or two for the resourcing situation to be addressed sensibly.
http://www.stuff.co.nz/national/health/73584901/every-dhb-facing-cost-pressures-of-millions--labourAt the same time though, and I'm not focussing on the DHBs here, the way the Ministry of Health allocates its spending and restricts how funds can be used often results in far greater expense. We see them refuse to allow experts to use their professional judgement because they must stay within strict MOH imposed guidelines. Costs to the health system further down the line are exponentially magnified because of this cost centric rather than patient centred approach.
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Angela Hart, in reply to
The cheap inverter from dick smith, gives you a normal 240 plug output socket for the appliance, and red and black jumper leads for the car battery.
Great, that’s a practical solution which only needs manual connection as required. If I had your address I’d send you a cake! Thanks Steven.
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Angela Hart, in reply to
What if we all had solar panels on the roof or our own wind turbine in the garden?
Trouble is you need batteries to store your solar power so you can use it at night, that seems to be where the major cost is for independence of supply now. Although batteries are getting cheaper and better all the time.
The craziest thing about solar at the moment is that if mains power goes off and you're grid connected, you loose your solar as well. Because of risk to linesmen if there is unexpectedly power on the line when they try to fix it. You'd think the system could be rigged to automatically disconnect from the grid and be reconnected, possibly manually, when power is restored.
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Rosemary McDonald, in reply to
Solar panels...have two 85W on the roof of our Bus. Four (don't ask how many amphours, guys) deep cycle batteries. We have a doohick to take excess power generated from the engine(once the cranking battery is topped up) and dump that into the deep cycle batteries.
We have a pure sinewave inverter...which, when the volts are about 13.4, we can plug in a 240V appliance. If the appliance draws heaps..(love these technical terms) like heating an element...the inverter beeps, flashes lights and shuts down...it is programmed to protect the deep cycle batteries. If the sun is shining directly overhead, the solar panels are clean, we can suck up about 15A from the panels. Feed that into the batteries and use it to charge Peter's emotion wheels, cellphones, laptop. There is a little smiley/sad face icon on our solar controller (the brains of the system) to let me know that all is well.
We would like a small, portable wind turbine. One that we can wire through our solar controller. For those days when the sun don't shine, but the wind is threatening to blow us over.
Then...we would probably never have to plug into the mains ever again.
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Rich of Observationz, in reply to
There's rather a lot of sunk cost in dams, windfarms and geothermal. Are you suggesting we demolish them all in favour of home solar panels and wind turbines?
Not to mention that it's rather more efficient and sustainable to generate power as a community resource rather than individually (and given that growing and slicing silicon ingots at home is a bit ambitious, home generation just moves the dependency on a central resource into manufacturing).
Just because the system of central power generation is currently organised to exploit the many for the benefit of the few doesn't mean that it isn't a good idea per se.
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Angela Hart, in reply to
But I really do want a Tesla battery, becouse I just want one.
I understand the attraction, I'll put one in with the cake :-)
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Angela Hart, in reply to
Our GP friend struggled with an antiquated computer, till we encouraged her to buy a brand new plug and play Macintosh.
Our GP was perfectly comfortable with his Mac based practice, but was obliged to change to the Dark Side in order to have compatibility with DHB systems, apparently.
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It's a problem when anything gets so complicated that people have to specialise. Your average electrician would have few professional opportunities to think about their service from the point of view of a person needing 24/7 medical equipment. Your average disability support worker would have few professional opportunities to muck around with a car battery and an inverter. They might know what people do in hospitals, but not in server rooms. And your bureaucrat might be good at getting all the stakeholders in a room, nutting out a solution and socialising it so that one person's innovation can spread, but they may not have any visibility of the problem at all, plus no direct experience with medical equipment or car batteries. This kind of group discussion is rare in meatspace.
The solution? Meetings :-) Or at least, making sure that in our complicated lives there are plenty of opportunities for people with different skill sets and priorities to shoot the breeze and look at something through a different pair of eyes.
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Rosemary McDonald, in reply to
Kinda like we're doing here?
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Sacha, in reply to
your bureaucrat might be good at getting all the stakeholders in a room, nutting out a solution and socialising it
That skillset (and organisational permission to use it) is lacking. Part of the problem is that the Public Finance Act etc makes it too hard for agencies to share responsibility for anything. Govts have been told this for over a decade. Whanau Ora is an example of solving it.
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