Last week’s report on the health system will, if adopted, have a massive impact on all of us who live outside the cities.
I support the thrust of the review.
Our population has increased and we’re living longer.
At an annual cost of $20 billion our health system does require regular scrutiny and I rate Heather Simpson as a scrutineer.
She describes our health system as complex, fragmented and in need of reform.
It has been run down over the last decade leaving our district health boards more than a billion dollars in debt. Something has to change.
Our health infrastructure is shot. We need $14 billion to fix 1100 buildings.
The report is critical of boards but realistically some are better than others.
The issue in the past has been investigated with lots of huffing and puffing with little being achieved.
We’ve had reports, changes in structures, funding models and focus groups with little real progress.
The problem is that health is an emotive issue as National found out in the 90s when it tried to close hospitals. Change won’t be easy.
That the system is broken on a national scale is self-evident.
My concern is basing reforms on the problems incurred by the few and foisting changes on the entire sector.
I’m more than happy with the health care we enjoy in Wairarapa. Our experiences have been all good.
In the recent covid-19 crisis our board performed incredibly well. With testing it was far ahead of the big city organisations.
Inevitably, the rationalisation of boards will see our local, provincial organisation absorbed into Wellington with the problems and issues that provider has.
In any area of shortage that will mean Wellington gets the resources and Wairarapa won’t.
Taking the number of boards from 20 to from eight to 12 in a short time will mean the organisations becomes city-centric.
There are 140 people elected to boards. In our case they are locals with local knowledge and understanding.
With half the boards that will halve the board members but what is worse is that those elected members will be replaced by appointed members, taking decisions away from the local community to a political process from Wellington.
The reported justification from Health Minister David Clark that people often didn’t know the candidates they were voting for is supercilious and offensive.
The report says the new boards will be required to have comprehensive community engagement strategies and rural services should be specifically planned to recognise the unique challenges of geography and distance.
I found that reassuring but will wait to see what it looks like in practice.
We have a Health Ministry that has performed superbly over the covid-19 crisis.
It’s now suggested we create an additional authority, provisionally called Health NZ, to focus on operational delivery of health and disability services and financial performance. The organisation will have 50% Crown appointees and 50% Maori representation.
We’re also going to have a Maori Health Authority, which I have issues with. The rationale is that 40% of Maori live in socio economic deprivation compared with 13% of Europeans and 54% Pacifica.
If you extrapolate those figures, taking population into account, you have 455,000 Europeans suffering social deprivation, 306,000 Maori and 210,000 Pacifica.
Those deprived people present a serious national issue not just a racial one and we should be handling that over all the ministries and not just health.
So, instead of the well-performing Ministry of Health we enjoy now we’re going to have Health NZ and the Maori Health Authority each doing their own thing.
In addition, we’re going to have a ministerial committee appointed politically to provide ongoing expert advice.
We’re also going to have an implementation team administered by the Department of Prime Minister and Cabinet.
Clark said we need to deliver a truly national health and disability system.
For truly national I read centrist.
Will all that help and support frontline health services?
I have my doubts but it will improve the career opportunities for public servants.
The report also recommends greater integration between primary and community care and hospital/specialist services and I support that as I do the training section on health care workers.
The primary issue I have is access to top health and disability services at a local level. That means local representation and not prescribed by a committee or person in Wellington.
I’m reassured the changes will be driven by a team of ministers including the Prime Minister and Minister of Finance.
The system does need reform but as Auckland City can attest, big isn’t always better.
