People in cars queueing to get into Whanganui Hospital.
People in cars queueing to get into Whanganui Hospital.
Opinion by Rob Campbell
OPINION
The health news of wait lists, staff shortages, pay inequities and all other health issues is unceasing.
It scarcely varies around the world across any number of health systems. It can seem hopeless, even overwhelming for those who are or should be patients or who are or could be working in healthcare roles.
The only people who benefit are those consulting about new ways to organise health services or those administering the continuation of legacy systems.
In Aotearoa we share the symptoms. We are even living through one of the periodic restructurings aimed at addressing the symptoms. But we are all guilty of impatience with progress and perplexed by the apparent complexity.
Things do change as we all respond to the symptoms of a health service system which does not meet our needs or expectations in various ways. Much of the change is outside of the public delivery system, from the insurance-funded private sector through the private responses to the incentives and disincentives of public funding process, to the community/iwi services which fill gaps in both public and private services.
It’s hard to see much enthusiasm for lifting the depth to breadth of public health service delivery. This has been extensively degraded under successive governments and while no one really advocates for this continuing, the largest parties show no sign of reversing this trend. I would like this to be otherwise, eg a public general practice service in poor communities, but that’s not the point of this comment.
The issue is what can be done if such an option is not on the agenda.
This boils down to funding. There are myriad structures through which public funding can flow, each of which has a range of positive and negative aspects. We have got tied up in these options and their complexities and the transition costs involved in creating and implementing them. I was there, albeit briefly, and can attest to the problem.
My reflection now is that we have to cut through this unnecessary complexity if we are to make demonstrable and acceptable progress. This does not require any significant further management restructure – just decisive leadership and shutting down some of the administrative (in)activity that gets in the way of simple change.
The best response to shortages is to pay more.
Why has neo-liberalism not understood this basic concept of price and competition? If nurses are not joining or are leaving their roles, they should be paid more. The same goes for GPs and other skilled roles. Incentives are often quite direct and simple. It is absurd that so much of our economic system runs on how much pricing matters and is efficient, but we hold down public-funded pay where skills are short and muck about with migration and training policies instead of responding to the price signal we are getting.
It may be more fun and exciting for bureaucrats to have a debate on capitation systems or new schools for doctors but in what world is that better than meeting the market for pay? Ditto for nurses and pay equity. Repeat the prescription across the sector. Not doing this introduces the distortions we see and it extends to how private investment interests respond to the opportunities they see in our unwillingness to meet the market. You cannot resolve a lack of apples by juggling the ones you have.
Similar issues apply to inequities on the other side of the health relationship. People who cannot afford to access health services do not need a restructuring. They need to money to pay. People who find access difficult, physically or culturally, need to have support provided for that access more than they need a new name on the door or a new management system. We find in practice that if the resources are available, people are neither helpless nor wasteful. As the pandemic experience showed, communities will respond if only the resource is there. Take resource away and no amount of restructuring will bring back the effectiveness we saw.
In regard to inequity for Māori, which is such a pressing issue, there is really no complexity. The willingness of hapū and iwi to deliver is there. Te Aka Whai Ora and Whānau Ora are able to give all the guidance and oversight required. They just need to be freed and funded to act.
Rob Campbell.
The system we now have is far from perfect. But there is no reason why it will not work if waste and procrastination are stripped out of the administration and the necessary money is made available and accountable. Just keep it simple, Shane.
Rob Campbell is a professional director and investor. He is chancellor at AUT, chairman of Ara Ake, chairman of NZ Rural Land and an adviser for Dave Letele’s BBM charity. He is also the former chairman of Te Whatu Ora (Health New Zealand).
