Geraint Martin

Hospitals are great at dealing with acute crises, but fall short when it comes to managing chronic diseases. That’s according to Geraint Martin, the CEO of Counties Manukau District Health Board in Auckland, New Zealand, who believes that health systems need to be approached in new ways to ensure patients receive the best possible care, now and in the future.

"We have been analysing our population and have identified that in counties in particular, there are about 25,000 to 30,000 people who have got three or more chronic diseases," he explains.

"Conditions like bad chests, gout, and diabetes. The evidence shows that if you have three of those conditions, your demand for hospital services and your demand on the cost of the health system goes up very, very significantly.

"The twentieth century was the century when people’s life expectancy and their health greatly improved. We could do hip replacements, cancer treatments, as well as provide antibiotics and other pharmaceuticals. As a result, people’s life expectancy of course increased. In the early twentieth century, it was, on average, 50 to 55 years, and now it is nearly 85. The problem is that people are living an extra 30 or so years, but they are having to deal with chronic disease such as diabetes or dementia. The challenge is: How do we develop health systems which aren’t curing people but are helping them to live really well with the conditions they are developing as they get older? At the moment, we are still in the early days of working that out. Currently, too many of these people are defaulting to being admitted to hospital because that is where a lot of our health systems are based or focused on. A hospital is actually a very dangerous and a very expensive place for patients with non-communicable or chronic diseases. They are precisely the wrong place to go. Hospitals are best at providing very complex acute care."