Still down under
I have now exchanged the hot east coast of Australia (see my previous blog here) for the not so hot south coast of New Zealand’s South Island. My home for the next few weeks is the University of Otago, centrally located in the city of Dunedin on the banks of the River Leith (see above). Dunedin is gaelic for Edinburgh and the city is proud of its Scottish heritage. The original Victorian buildings are now surrounded by modern glass and steel edifices that educate over 20,000 students of all disciplines with a thriving medical school. Although some departments are still housed in the domestic Victorian buildings, for which the area is famous (see below left).
I gave my lecture on ‘Creating sustainable health care systems through the application of evidence and shared values’ in the Department of Primary care and Rural Studies’. To view the presentation click here.
In my presentation I described how all healthcare systems are facing increasing demands with limited resources. Most countries are now introducing systems to assess ‘value for money’ and prioritising health services provision. Priority setting requires technical judgements of clinical effectiveness (what works) and cost effectiveness (is it worth the money), but these judgements are embedded in a wider set of social (societal) values that underlie justifiable reasoning about priorities, including transparency, participation and justice.
Even when these decisions are based on the best available evidence they face legal, political, methodological, philosophical, commercial and ethical challenges. Through international, multidisciplinary, and collaborative working I am attempting to develop new ways of addressing these concerns. I have created an online interactive decision making audit tool (DMAT) that is based on a social values framework which consists of a series of questions that will allow internal and external audits of how an institution is incorporating values into its decision making. We are currently testing this approach in developed and developing countries, and to bring the issue alive for the UK public I have produced a film ‘The Lottery of Devolved Cancer Care‘.
The film uses the variation in access to expensive cancer drugs in the UK as a relevant case study. It is based on the circumstances that led Ifron Williams to move from Wales to England to get his cancer treatment.
However, it is now the weekend and after watching Wales lose once again to Australia in the rugby we escaped to the country. Lake Te Anau was our destination – starting to look like a Lord of the Rings film set (see below).
First though, we had to stop off first in Balclutha to return a loom. Let me explain: as I was to be in the southern hemisphere for many weeks we had agreed that my wife Tercia should accompany me. As she had held a lifelong desire to learn how to weave, where better than in the “land of wool”? It was therefore on Saturday that she was welcomed to the Creative Arts Centre by the South Otago Weavers to learn their secrets, and whilst the others learnt how to dye, she had a personal tutorial with a traditional commercial weaver (see below).
Tercia progressed so rapidly that she took the loom back to our flat to finish her work. We returned the loom to her teacher’s house on the way to the Fiord region, where we saw evidence of a lifetime’s creative endeavour. We were invited to see a pictorial history of the teacher’s designs and her loom in the studio where she still works everyday – not bad for a 78 year old!
We finished the weekend with a kayaking expedition on Milford Sound (see below). Once again the day started with dark foreboding clouds only for the sun to break through by lunch time.
PS. Tercia has just received an email to inform her that she has been unanimously voted onto the South Otago Fibre discussion group. However, we were not altogether surprised, as all the others in the group had taken time out from their dyeing to come across and give Tercia encouragement – what a friendly country.