Friday, March 29, 2024

ALTERNATIVE VIEW: Health reform misses the mark

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I’ve been interested in the recent health reform announcements and the reaction to them. Simply, the Government intends to abolish our 20 District Health Boards (DHBs) and replace them with a single health authority.
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I’ve differing views on the issue. The first is that in the Wairarapa we have a good DHB. My experience has been that it functions well with the resources it has.

The news stories that regularly come out suggest many other health boards don’t share that commitment to their local communities.

Further, we can elect local people to DHBs. That gives me some assurance that the organisation is locally-focused.

The broader issue is, however, that the current system isn’t working, as shown by the regular horror stories coming out of the health sector. DHBs have been around in their current form for 20 years, but essentially for much longer.

They were first mooted in the 1970s. The Muldoon government introduced Regional Health Boards and then Labour morphed them into DHBs.

Logically that tells me that the DHBs time has come. They were designed for another world and they’re not working in this one. In addition, the total population of New Zealand is similar to many medium-sized international cities. Would an international city of five million people have 20 health authorities? I think not.

I have two major issues. The first is that the devil is in the detail. There’s a lot we just don’t know. Health Minister Andrew Little told us that the new system will “do away with duplication and unnecessary bureaucracy”, and I support that. 

He added that “we need more health professionals and a bigger health spend”. That’s reassuring.

However, what we don’t know is what the new system will achieve that the existing system doesn’t.

The second is that while I can accept axing DHBs having a central authority, casting pearls to the provincial swine fills me with horror.

There are many examples of central authorities showing a complete lack of knowledge and understanding of rural communities, and essential water would have to be one.

We had worthy bureaucrats in Wellington deciding what they think is best for you and me, with blissful ignorance of the issues and practicalities.

The shambles of gun licencing is another.

Farmers need firearms to control the many pests occurring in NZ in addition to sporting needs. The police, by their gun licencing protocol, don’t have a clue.

Getting back to health. 

While I accept there will be four regional hubs with further offices, I remain unconvinced they will understand rural needs.

In an excellent article in last week’s Farmers Weekly, Gerald Piddock talked to Rural GP Network chief executive Grant Davidson. He made some extremely valid points.

The first is that rural GPs need to be included at the design stage of any new system. I agree. It will be interesting to see if the Government picks it up.

He also suggested that a rural lens needed to be put over the new systems implementation. That needs to happen.

He told us that the current system is not working in rural areas, and that tells me there needs to be change.

We’re told that the 700,000 rural people deserve a good system. I accept it costs more to service rural people than those in the city, but we’re told that rural people are reluctant to seek medical health unless they absolutely need it.

The Davidson king-hit is his statement that “if we want equitable (rural) health outcomes, we need inequitable inputs to get there”.

So, what we’re going to have is a central system as against a regionally-based one. We’re told our present system is “fragmented and convoluted”. The review of the system, led by Helen Clark’s former chief of staff Heather Simpson, states that it had led to “inequitable outcomes in health for Māori and Pacific communities, as well as disabled people”.

I’d add rural.

Ubiquitously, in my view, we’re going to have one central agency plus one for Māori, yet the Simpson report tells us that it is Māori, Pacifica and the disabled that are failed by the current system.

The Rural GPs tell me that the present system disadvantages “the 700,000 rural people”.

Why then have a separate system for Māori, when the Government’s own research says that it is not just Māori but Pacifica and the disabled that are missing out? And I’ve just added rural.

There’s a further question I have. Is it because of racial or socio-economic issues and, in both cases, why? I’d suggest we just don’t know.

While I’ll support the thrust of the reforms, doing away with the DHBs and their duplication, I remain unconvinced that a single, centrally-based organisation will provide better outcomes.

I also remain unconvinced that concentrating on Māori while ignoring Pacifica, the disabled and rural is fair and equitable.

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