KEY POINTS:
Hard as it is to find positives in the economic downturn, there is hope that it could provide the catalyst for radical healthcare changes in New Zealand.
The Government recently appointed a ministerial group to investigate cutting health sector bureaucracy. At one level, the community sector hopes this will provide an opportunity for NZ to take a more creative approach to healthcare provision.
Worldwide, governments and communities are investigating new approaches. In Britain and Canada pioneering work is being carried out in social innovation, finding and developing new ways of meeting health needs and looking at how communities can take responsibility for their wellbeing.
In Australia, health authorities in Victoria are finding exciting solutions by involving communities in primary health. In Queensland, there is investment in community mental health organisations to provide a wide range of new services.
Yet here, rather than looking to the community sector as a solution, its role is being reduced. In 1999-2000 community organisations in New Zealand received a third of the mental health budget to provide a range of diverse services. Sadly this is now decreasing and services are being cut.
Instead of investing in the community sector, district health boards claw back services that would be provided more appropriately, for much better value and with less overheads, within the community.
New Zealanders have great faith in government to "fix it". But recent experience has shown government doesn't have the capability to fix complex problems where patients face more than one issue.
New Zealand is incredibly fortunate to have a diverse and experienced community sector. About 400 non-government organisations are contracted through DHBs to provide mental health and addiction services.
These employ more staff than the public mental health and addiction services and play a vital role in preventing hospital admissions and enabling hospital discharges.
They are comfortable working in complex situations and the wide-ranging interventions and activities they provide are essential for the functioning of an effective health system. Yet they face significant challenges in areas of funding and sustainability, bureaucratic contracting, purchasing and monitoring practices and lack of investment in sector research, development and innovation.
Long-established mental health and disability organisations report that each time they apply for funding they are treated as if it is the first time they have worked for government.
There is extensive duplication, particularly in applications for funding. Organisations have to compete against one another and undergo long bureaucratic processes even for tiny sums.
Platform, the national collaboration of community organisations providing mental health and addiction services, recently commissioned an independent survey regarding contractual issues that mental health and addictions non-government organisations face in contracting with DHBs.
Service providers reported enormous frustration with the contracting environment and the way DHBs manage contracts and relationships with organisations that are providing this essential support.
The community sector's ability to deliver flexible social support solutions (necessary when working with people with complex social and health needs) has been compromised, often by poor funding and contracting practices and lack of future-focused planning.
New Zealand's response to our health workforce problems needs to move on from committees and strategies, or relying on recruiting more doctors.
The entire world wants more medics. We must seek other solutions, particularly as our ageing population will have multiple diagnosis or complex chronic conditions requiring responsive community-based support services. This will need a larger community support workforce able to operate with confidence in a range of settings.
There has been talk of Government Private Partnerships. We would like to see the community sector as partners in health service planning, development, delivery and community leadership.
These organisations are ideally placed in experience, knowledge, networks and community legitimacy. National called for smarter use of the private sector. There also needs to be smarter use of the community sector. With regard to mental health and addictions, the Government should take urgent action to bring community sector leadership into the planning framework.
New Zealand needs to seed good ideas, make funding available for innovation in a way that is not tied down by bureaucracy. And to create a complete community package, not one that is split.
Organisations need to be trusted as stewards of cost. We don't want further incidents such as Auckland DHB's siphoning off of $2.5 million from a restricted pool of mental health funding to cover other costs.
Some New Zealand DHBs have done excellent innovative work with communities.
Counties Manukau DHB has decentralised clinics, provided seed funding and been bold and courageous in trusting communities to come up with solutions they need rather than employing bureaucrats to carry out endless consultations. But these are little pockets.
The approach needs to be systemic. In a population of four million surely we can share our ideas. There has been little exploration in New Zealand of innovation or alternatives, investment in research or development of diverse solutions.
Providing new and different health services is risky and governments generally don't want to take risks. But the hard fact is, the current system isn't working. It hasn't worked for a long time and we have to find a new approach. The opportunity to reduce bureaucracy and redirect funds is here now.
* Marion Blake is CEO of Platform, the national collaboration of community organisations that provide mental health and addiction services.
