Everything is not okay in the NZ health system, writes Ian McCrae.
Everything is not okay in the NZ health system, writes Ian McCrae.
OPINION
It is now less than two weeks from election day, which means someone will soon be waking up as the newly appointed (or reappointed) Minister of Health with a truly daunting job ahead.
Six months ago I stated that “the whole system is quickly descending into hell in a handbasket and every day the news gets worse”. Well, that’s happened as any chronically ill patient waiting in the public system or health worker will tell you.
We would know the full extent of the crisis if we had the usual reporting of waiting list numbers, surgery cancellations, ED and GP wait times, etc.
However, Te Whatu Ora and the Health Minister have conveniently paused all reporting until October 31, 2023, two weeks after the election. I have been told privately that the numbers are appalling and senior doctor conversations confirm this.
It’s an absolute debacle and Labour’s ridiculous gravity-defying claims that “there is no crisis” and the health reforms will fix everything are farcical and just insulting to everyone.
This road accident situation is so serious that a “steady as she goes” and “take a couple of aspirins” approach will, and is, resulting in a serious degradation in the quality of life for many and untimely deaths far greater than we saw from Covid. Urgent interventions are required.
An immediate first step has to be getting regular quarterly reporting of the numbers (good and bad) restarted, with an emphasis shift to measure outputs/results rather than inputs (what was spent).
There are no band-aid quick fixes and the health equation necessitates that capacity (being resources with an efficient organisation) matches demand (driven typically by lifestyle and intervention timeliness).
When this is out of kilter, patients not receiving timely treatment become more acute and consume more resources, staff get overworked and leave the profession, and the whole health system enters a disastrous spiral.
On the resourcing front, many commentators glibly state that the answer is to simply train (or hire offshore) more doctors and nurses. There is no doubt that we need more health professionals but that’s going to take a decade or more to deliver.
Meanwhile, waiting lists continue to grow and the public system has no chance of clearing these anytime soon. So we need to seriously explore how private services might help without cannibalising public health.
Then we should look at wastage.
We should be getting rid of the expensive consultancy firms (their advice is mostly rubbish), the hundreds of communications experts and a good chunk of Wellington bureaucracy. Call time-out on some of the crazy Government boondoggle projects that never went to proper procurement and have never delivered and this should all free up a fair amount of money to give doctors and nurses well overdue pay increases.
However, more resources are only part of the solution. In spite of the UK NHS reporting employing 4700 more doctors and 10,500 more nurses in the 14 months to January 2023, the BBC reports that “hospitals are carrying out 12 per cent fewer operations and treatments than they were before the pandemic”.
This is where organisation efficiency is vital and New Zealand has two extreme examples of good and terrible. Firstly, Labour’s single centralised health system (Te Whatu Ora) has been a terrible failure. It will deliver more bureaucracy, stymie innovation, frustrate the coalface workforce and deliver a less productive healthcare system. Though they have solved the postcode health problem, as right across the country everyone now gets the same rubbish healthcare.
Christchurch Hospital. Canterbury’s response to the region’s post-2011 earthquake health crisis was outstanding and globally acclaimed.
The other extreme example and the complete antithesis of Labour’s reforms is Canterbury’s outstanding and globally acclaimed response to the region’s post-2011 earthquake health crisis.
The Canterbury approach has been well documented and involved extreme subsidiarity (devolving responsibility to frontline workers), expanded scope of practice, (so pharmacists, nurses and GPs do more), standardised protocols and much more.
The reasons the Canterbury approach hasn’t been rolled out nationally are mainly health sector politics and ego which a “new broom” Health Minister could easily sort out.
Labour has got us into this pickle by sidelining or ignoring many of the very experienced pragmatic health leaders whose advice is respected all over the world. An obvious early step for the next Minister of Health is to pull together some of these experts to help with a turnaround as this Herculean task is too big for one person.
An unfortunate change made by former Health Minister Andrew Little was to merge and centralise the 20 well-established DHBs, leaving New Zealand bereft of the regional leadership essential for making significant health system changes. Reversing this is too hard and a sensible alternative would be to create 10-12 regional divisions within Te Whatu Ora with local leadership, which is how large multinationals are organised. It fosters regional accountability and responsiveness with centralised administrative systems, etc.
Next, I believe quaternary care (highly complex and very expensive surgery) should be separated and funded nationally with standardised referral/treatment protocols across the country.
National has a plan to replace the Three Waters debacle called “Local Water Done Well” ... I really hope the next Minister of Health prescribes something along those lines for care delivery.
On the demand side of the equation, we need to sort out the financial crisis in the rest home sector, which has caused many to close with residents ending up hospitalised and bed-blocking, often for several weeks. This economic lunacy should be fixed immediately.
Finally, the contentious Te Aka Whai Ora / Māori Health Authority, which at first blush seems to be an organisation that disadvantages non-Māori and another wasteful $300 million Wellington bureaucracy.
The less-than-positive Hauora Māori Advisory Committee’s August 2023 review reinforced the negative views of many in the general population.
The real shame is that there is an extensive network of Māori health providers throughout the country delivering damn good healthcare to both Māori and non-Māori. Furthermore, many of the Te Aka Whai Ora staff are working with these providers far more actively than some of the DHBs or MoH did previously.
Both National and Act have announced their intention to disestablish Te Aka Whai Ora should they be elected and the trick here is to make sure that the baby is not thrown out with the bath water.
The good aspects of Te Aka Whai Ora should be retained and the good works of Māori health providers extended to all regions or ethnicities with poor health outcomes today. Then serious resourcing should be invested into these providers to start closing disparities in healthcare as well as curtailing demand.
After 30 years in health, I am extremely disappointed with this sad state of affairs when once we led the world. I now have my fingers and toes crossed that we have some brave sensible health leadership post-election that will turn things around.
