Let’s see what Andrew Little prescribes to remedy structural weaknesses in NZ’s health system

One  of the biggest  challenges  facing the  Ardern  government  is in  public health.   New Zealand  may have  escaped the  pressures heaped on other  health  systems by the Covid-19 pandemic but  its  health service has had  its problems, not  least those  exposed  in the  first  report from Heather Simpson and her team   and subsequently in  the Simpson-Roche report revealing deficiencies in  handling  aspects of the response to Covid-19

Both  of  those reports underlined  structural weaknesses  within  the system,  not  only in the  district  health  boards,  but in the  Ministry of  Health.  To  repair  them  would be  a  singular challenge  for any minister. It is  notable  the Prime  Minister  nominated Andrew Little  as the  one  with  the  know-how  to get to grips  with  those particular headaches.

But even with the skills he has, reforming  district  health boards will be a severe test for Little. Some of  them are under enormous financial stress  while others  are  failing to provide  the  full range  of  services  in a  timely manner.  And  let’s not forget the  government  has  yet  to make  significant  progress  in overcoming  the deficiencies  it has  acknowledged in the country’s mental  health services.

Beyond  that  there  are  other pressing  challenges  in health, for example  with diabetes.

Meanwhile  NZ  has  to  absorb   the  lessons  which  overseas  health services have taken  from the  impact  of the Covid-19 pandemic. The London “Observer”  in an insightful  article   has  pointed  to doctors and  designers – in the  wake of  Covid-19 – radically  adapting their  thinking  about  what  healthcare can be  and what it  should  deliver.

The pandemic  has accelerated  some trends,  such  as the one towards  “hospitals  without  walls”—the  hospital conceived  as a digitally connected  community rather than a circumscribed  physical space. The  twin pillars of  digital health  are  electronic health records which allow patient health information to be  shared  across  health systems, and  telehealth which  allows  patients  and physicians to communicate at distance.

While  some  countries  in  the  wake  of the  severe acute respiratory syndrome  (Sars) adapted  their hospitals,  equipping them  and developing protocols  so that they could be transformed  quickly in the event of  an epidemic,  an  alternative solution is  to  rapidly build  a facility  dedicated to the detection and  treatment of  epidemic patients where  it is needed, as  the Chinese did  during Sars.

They replicated  that feat  several times  this  year, building Wuhan’s Huoshenshan  hospital in 10 days, for example.  Made out of prefabricated units, Huoshenshan  incorporated  testing  and  research  labs and accommodation  for  personnel.

Other  countries built  fast, too, in response to Covid-19. Surge  hospitals went  up all over the US,  while  the UK constructed  the Nightingale  hospitals.  But many of these  were underused or  not used  at all, sometimes  because  they were understaffed.

One  authority   argued  the  lesson  is that a  systematic  approach  must be followed.  That  involves   organising on-site stores of medical and protective   equipment, maintaining a roster of qualified staff  and  setting up  a  command centre to oversee the execution of the disaster  plan.

Whether  NZ’s  health system   could  do  that  is  a  moot  point.   Fortunately  it  has not been put  to the  test .

Adaptability  will be  the watchword  in  the post-Covid-19  world and  Point of  Order  has  no  doubt  the  medical  personnel  in NZ’s  health  service  have that adaptability.  But what about the bureaucracy –  the  Ministry of  Health  or,  for that matter, its political bosses?