Centralisation is prescribed for our health system – but funding is an issue and see what has happened in transport and education

Health  Minister  Andrew  Little  says   the reforms the  government has  announced this week will  mean for the  first time  New Zealand will  have  “a  truly national  health  system”.

The  new  system  will consist  of  a  national  health  organisation,  a  Maori health authority,  and a  new  public  health authority to  centralise  public  health  work. The  Ministry of  Health  will remain  in  over-arching  control.

It  is  a  major  structural  reform, going even  further  than the  raft of initiatives proposed in the Heather Simpson  report.

So  will  Andrew  Little  be  top of  the  pops, the  only  minister (so far) in the  Ardern  government to deliver  a  radical new policy  to  reform  a  key  government  service?

Initial  reactions  seemed  highly  in favour.  The  Dominion-Post’s headline ran “Overhaul of  DHBs Welcomed”.  The NZ  Herald  was  even  more  vivid  in  its  imagery:  “The  faces  of  failure”, it  shouted, “Health overhaul  to end ‘postcode lottery’  comes too  late  for  these  loved ones”.

The  message  was  clear:  good  riddance  to  the  district health boards (generally known as DHBs).

But will  a centralised  direction  provide   the  vastly  better  health  service  New  Zealanders  now  expect?

In  the  new  system, under  Health NZ, there will be  four  regional  organisations.

Guess who  will be  staffing  them?  None  other than the people now working for DHBs. As  part  of  the  transition  they  will  transfer  to  the new Crown  entity, probably working  in the same offices  as  they do  now.

Possibly – and hopefully – there  will  be  some   efficiency  gains, but the critical issue is whether that means more surgeons, oncologists and so on will be  on the job.

Beyond  that,  critics  point to how  dismally  centralised  bureaucracies  have  performed – for example – in  transport  or  education.  Only  this week  ministers were  stigmatising  their predecessors  for  the huge  cost over-runs in the Tranmission  Gully  highway project  while  others were  flinching at  the  Ministry  of  Education’s  failure  to  do  anything about conditions  that rendered  half of  Hutt  Valley  High  School  uninhabitable.

This  scarcely suggests  a  centralised  health system  will do much better  providing  more beds  in  more salubrious  hospitals.

Virtually every  health  lobby   has cited  under-funding  as  a fundamental cause  of  problems   in  staffing, particularly  identifying   shortages  of midwives, nurses, and medics. The  expectation  is  the new  system will  provide  an enormous  leap  in funding, and much  higher  salaries.

Yes,  there  may  be  more  cash  in the pipeline. But don’t forget that most  DHBs  have  been running  very  substantial  deficits.

Maybe  the  government  will  just  write off  those deficits—but it still  has  to  fund  the  health service (as the jargon puts it) ”going forward”.

As  they  deliberated  in  Cabinet – and  with  their teams  of media  advisors supporting them – did  the ministers  appreciate  that  every  case  of medical misadventure  or failure to  apply appropriate  treatment will  be  feasted  on   by the  media,  and the   blame laid  at  their  door?. There won’t be  any buck-passing to a DHB.

One  informed  critic  of  Little’s  reforms points  to a  fundamental  issue:  the  emphasis  is on structure rather  than  output  for  dollars  spent.  Measurement of  productivity in the health system  has  never  been  attempted.

Perhaps  this  should be  (belatedly)  sent  across  to the  Finance Minister’s  ally   at  the Productivity Commission, Ganesh  Nana, to  carry  out.  Then  the  taxpayer might get  some idea if whether he, she or whatever is getting value  for  money in the health service.

The “us” and “them” concept of a separate Maori Health  Authority raises its own set of issues. It will have the  power to  commission  new  services, monitor the state of  Maori health,  and  “develop new policy”.

It  is  intended  to  overcome “inequities” in the system  which  are  said  to  be  at  the root  of  poorer health  outcomes  for Maori.  Already its  advocates  are insisting it  should get  special  funding to be spent as it  chooses on  “new policy”.

It  seems  those  advocates believe this racially based authority can   ignore   the responsibility of  Health  NZ  as a  Crown entity  to account  for  every dollar spent to  Parliament.

One thought on “Centralisation is prescribed for our health system – but funding is an issue and see what has happened in transport and education

  1. Reblogged this on The Inquiring Mind and commented:

    Increasingly we are likely to be the beneficiaries of a major cluster ***k, but because of the new Health code of conduct, authoritarian government and a supine media we may not hear very much about it


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