Jonathan Simon: Third World on its way

Opinion

At the end of last month there was a quiet launch of a revolutionary discussion document. It has disappeared almost without a trace.

Yet, this is one of the most important documents about our health sector that has been published in 30 years.

It is called Fit for Purpose - Fit for Practice, a report from the Health Workforce Advisory Committee.

It examines the issues facing New Zealand in the development of our health workforce for the future. In this examination, one has to understand what a good health system would look like in 10 to 20 years' time.

The committee has identified the most critical issues facing our health sector and has proposed a way forward.

We need an efficient, effective health sector that is focused on the needs of the people and capable of delivering services in a way that integrates the skills of the health providers within innovative care pathways.

We need a sector that delivers the most appropriate services, by the most appropriate health provider, at the most appropriate time, in the most appropriate place at the best price.

For example, a person needing a gastroscopy might have the service delivered by a highly trained nurse-endoscopist, within 30 days of referral, in a travelling endoscopy van for a price 40 per cent less than is available now.

Another person could have a cataract extraction performed by an operative health technician within three months of referral in a local day-stay unit for 60 per cent less than is paid now.

Lastly, a person needing a hip replacement could be admitted to hospital and be operated on by an orthopaedic surgeon. A trained nurse anaesthetist could give the anaesthetic. After two days he or she could be transferred to the care of their general practitioner in a rest-home hospital bed where they could be looked after until they are ready to go home with a mobilisation programme.

The document demonstrates the importance of innovation, flexibility and fundamental changes to medical education that will be needed to support these developments.

In correspondence in the Herald, two out of three letters expressed concern about the possibility of nurses/technicians delivering services. In fact, they saw these developments as moving New Zealand towards a Third World health system. We will have a Third World health system within 15 years if we do not move in this direction very fast.

* Dr Jonathan Simon is working as a locum GP on the North Shore.