I’m not sure which of these clichés better describes how one should assess the Government’s health reforms announced this past week … ‘the devil is in the details’ or ‘déjà vu’ all over again’. The National Party reduces it to one word, ‘reckless’.
Firstly, regarding the ‘details’, there are very few. Minister Little swept in at 50,000 feet and announced some high level structural changes and shifts of responsibility without any ground-level specificity to speak of.
Terminating 20 District Health Boards and replacing them with a single Health NZ to run hospitals and dole out funds for all other care was the big bombshell. Reduction in number had been indicated, but not total elimination.
The ‘déjà vu’ irony of this is that a Clark Labour Government created the local DHBs in 2000 to the consternation of the National Party which had abolished their predecessor elected boards in the 1990s. Now a new Labour Government is killing its offspring to the shrieks of the Nats, staunch defenders now of local prerogatives … hence ‘reckless’!
Two other structural changes had been already floated and promised – a separate Māori Health Authority and a National Public Health Authority (replacing 12 public health units around the country). So no surprises there, although clearly the creation of a separate Māori entity is controversial.
Unwell citizens probably don’t give a hoot about how the deck chairs are placed, as long as they get care that is equally prompt, responsive and competent wherever they happen to live – no more health care by ‘postcode lottery’.
This isn’t to say that structure isn’t important to outcomes. At the very least they communicate how priorities have been weighed and addressed, and here are the three priorities as I see them:
Efficiency – in planning, capital investment, procurement, innovation and technology adoption, cost containment – getting rid of 20 DHBs each struggling with all these things on their own is a no-brainer. We must spend better the 20 cents of every Government dollar currently devoted to health … setting aside for the moment the sufficiency of that allocation.
Equity – absolutely no one can dispute that our Māori health situation is a national disgrace. Creating a separate Māori Authority is meant to put an exclamation point on fixing that … the strongest possible statement of intent. Whether it will produce any better health outcomes is a matter of speculation. Any improvement in health will be a result of accessible, sensitive programme delivery on the ground by clinicians and health educators, not bureaucrats.
Prevention – for years now, health planners have talked about giving far more priority to preventive health care. It’s the biggest ‘Duh!’ around. So now we get a Public Health Authority aiming to keep people – especially young children – healthy in the first place, which means tackling smoking, poor nutrition, alcoholism so these lifestyle realities don’t simply guarantee shorter lives and greater demand for expensive treatment down the road, swamping both primary care providers and hospitals.
These structure changes do reflect such priorities, and who can argue with efficiency, equity and prevention?
But at the end of the day doesn’t it still come down to:
- The dollars actually spent at the coalface (e.g., how many headlines and complaints still over the vaunted $1.9 billion in mental health funding in 2019 ‘well-being’ budget, yet to be seen on the ground?); and tied to that,
- A health care labour force sufficient in numbers and not incapacitated by stress;
- A healthy ‘ecosystem’ (meaning conditions like healthy homes, liveable incomes, safe water, etc); and,
- The biggest of all – taking personal responsibility for our lifestyles.
Structure change by itself will have minimal impact on these factors. The cliché I’m fondest of is, ‘Follow the money’! And BayBuzz will stay tuned on that.
Meantime, if you’re the impatient sort, focus on #4!
You can read the Government white paper explaining these plans here.