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LITTLE'S HEALTH REFORMS

Forty years ago, when I first became Labour’s spokesman on health, I recall George Gair, the then Minister of Health, saying that if health spending continued to rise at the current rate there would come a time around 2030 where the entire national budget would be given over to health care. Scarcely surprising, when I think back: an ageing population, more and more sophisticated (and costly) drugs and interventions, and rising public expectations about what people were entitled to from the public purse. Like National ministers, I turned my mind in the early 1980s to structural reforms that could reduce costly overheads within the health system. I recall becoming convinced that combining regional departmental services with Hospital Boards and forming area health boards would significantly reduce budgets. I put this to the then Director General of Health when I became Minister in July 1984. A wise old dog, Dr Ron Barker looked at me and said – very properly – “Minister, while little bits can be saved around the edges by structural changes to the health services, they won’t make health care more accessible to people in remote areas, or to working folk, or to Maori or Pacific Islanders. They need easier access to primary health care - access to GPs. And you can’t deliver hospital care to people in remote parts without better transport and air services, and they are very expensive”.


Nearly forty years later Ron Barker’s wisdom still holds. As I watch the new Minister, Andrew Little, enthuse over his proposed structural reforms, I shake my head. All the wailings about a “fragmented service” have been heard before: a need for “better primary and community care, hospital and specialist services”, and these days, burble about Treaty obligations. However, no amount of structural reform will conjure up an ideal service. We’ve been there before: the old city and small-town hospitals were pulled into hospital boards in the 1950s, and then into area health boards in 1988, and then after Alan Gibbs’ report on hospital structures, a more centralized system in the 1990s where funding and purchasing of services were conducted by separate entities. By the time Helen Clark came to office in 1999 and gave us district health boards, health delivery to our citizens was much more efficiently delivered than it had been twenty years earlier. But costs kept on mounting steadily. And they will continue to do so despite Little’s structural changes. The new Public Health Agency sounds rather like a return to the 1990s. Whether the new Maori Health Authority makes much difference to Maori health outcomes remains to be seen. There is a great need for more Maori engagement with health care and the MHA needs to set targets for immunization, vaccination and smoking cessation so that the public can measure the effectiveness of this new structure.


Once more we are promised stronger primary health care to take the pressure off hospitals, more concentration on prevention in preference to treatment of health problems, and better management at the Ministry of Health that struggles to deliver assurances given by Dr Ashley Bloomfield. We’ve heard it all before too. I’ll believe the improvements when I see them. Incrementally, things have developed over the years since my extra government subsidies to GPs to make care more affordable for children, trade-union clinics for working folk, nurse practitioners, and then free immunization for the elderly, and now free Covid testing with immunization coming up. But in the end, much of it comes back to money. And while this government has been acting recklessly with the purse strings, that’s the only way they seem to know in a time of inflated expectations.


Money alone, however, cannot deliver better health care. New Zealand is seriously short of health care personnel: from specialist care, to nurses, to GPs, to paramedics. Our training systems are excellent, but too many graduates depart. Today we are heavily dependent on skilled immigrants in every nook and cranny of our health system. There is already a serious shortage of GPs, especially in the areas of greatest need outside the main centres. The last Minister of Health promised millions for mental health. How much of that has been delivered? To what effect? That is an area where the need for extra facilities and people to deliver the services has been unfulfilled for decades. Does this minister have any answers?


I believe that no amount of structural change will meet today’s challenges. Most of the fat has long since been squeezed out of the health system. Exponentially increasing demand for services is our principal problem. It’s high time we started to discuss a new way of incentivizing people to pay more attention to their personal health, and open up discussion on what can reasonably be expected from the public system. As well, everyone wants a better education system, more police, additional new social housing, and enhanced environmental and conservation policies. No country anywhere has managed to achieve all that while operating an open-ended entitlement to health care as well. Andrew Little’s structural shake-up, unfortunately, provides slender cause for optimism. Ron Barker could have told him that nearly four decades ago.


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24 Comments


Pointoff Viyv
Pointoff Viyv
May 01, 2021

Imposing US style healthcare on this country to save a few dollars is not the answer.

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wigramtaylors
wigramtaylors
May 02, 2021
Replying to

This commenter doesn't want anything of the sort.

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larry
larry
Apr 28, 2021

QUOTE:


"There is a great need for more Maori engagement with health care and the MHA needs to set targets for immunization, vaccination and smoking cessation so that the public can measure the effectiveness of this new structure".


Many will say ... Fat chance of "that"!


A fat chance that is, of this useless government implementing performance targeting and reporting on ... "anything!" ... let alone for the notoriously freedom to spend-Maori ... "anything!"

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tjalling.jonker
tjalling.jonker
Apr 26, 2021

the vaudeville show called “health care”.


during the early ‘80s health care in new zealand functioned as it should: if a person presented themselves at their general practitioner with a health issue and it was outside the realm of expertise of that gp, the person was referred to a specialist at (usually) the local public hospital for assessment, diagnosis and appropriate treatment. this part of the process was free; collectively, the tax-payer funded it.


my own experience, then, related to a small growth I had noticed appearing from nowhere. consultation with my gp resulted in a referral to a public hospital where it was surgically removed and subsequently analysed. the outcome was the growth was benign. some years later…


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alanw
alanw
Apr 27, 2021
Replying to

My wife was a senior nurse practitioner in South Africa who came here a decade ago. She says the NZ public medical system is third world compared with what she was used to with far too much bureaucratic control and poor standards.

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On a recent visit to Dunedin I discovered why so many dunners don't get the health service they pay for, Liebour has cleverly disguised the new Hospital as a Chocolate Factory. But still the dunners continue to vote for the same plonkers who continue to fail them, says much about the intelligence/IQ of dunners, must be something in the water.

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John Hurley
John Hurley
Apr 26, 2021

Remember back to the Penn affair where a mouthy student nurse Anna Penn rebelled against cultural safety and was held back because (as she put it) she "failed a hui".

That program was set up by Professor Paul Spoonley (and Irihapeti Ramsden), who also helped set up the HRC; who has had 57 media interviews as at 2019. He is also an expert on the far-right (pot calling kettle black). We should be very careful of infiltration by the (ahem) far-right.

...........................

In this developing debate, there were some significant editorial statements that summarised the views of the key media people involved_ The focus here is primarily on the Press and the Dominion because they carried more material than an…

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roger
roger
Apr 27, 2021
Replying to

How incredible to recall what the both the Press and the the Dominion said all those years ago. Now they wouldn't even report it if someone else said it! So in 28 years we have slid even further down the slippery slope of political correctness to our huge disadvantage in all aspects of life. Sad. I wonder where Anna Penn is now and what she would have to say. Doubt that we will ever know because no one would report it.

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