Let’s not quibble about a typo – instead we should admire Little’s readiness to list achievements with mental health spending

We trust Health Minister Andrew Little got his numbers right when he addressed the Association of Salaried Medical Specialists at a Virtual Conference on Equity of Health Outcomes for New Zealand.

One figure in the speech posted on The Beehive website seriously inflates the extra spending earmarked in this year’s Budget for Pharmac (obviously it’s an innocent typo). 

The team at Point of Order long ago learned to be wary, if not downright suspicious, when politicians bandy numbers.  More often than not the figures they brag about will be challenged by political opponents who produce contradictory data or put matters into a very different perspective.   

For example, earlier this week we reported a statement by Jacinda Ardern, Minister in Charge of Child Poverty Reduction: 

“Our plan is based around making progress in three key areas: increasing incomes for families, reducing housing costs and other pressures on low-income households, and changes to support the wider wellbeing of families.

“Budget 21, which included main benefit increases of between $32 and $55 per person, is an important part of this.”

Since the Government introduced child poverty reduction targets, reductions have been achieved across all nine child poverty measures, Ardern said, and the first three-year target for the after-housing-cost measure has already been exceeded by lifting 43,300 children out of poverty.

She didn’t mention (not that we can recall, at least) another side to the welfare story.  

More children are on benefits.

Social issues blogger Lindsay Mitchell drew our attention to the graph below while reminding us there is a wealth of research that shows benefit dependence leads to poorer outcomes for children.  

Andrew Little’s speech was about the state of our health system and the restructuring he is masterminding to make things better.

 Our hospitals are under unprecedented pressure.

We are seeing spikes in presentations at hospitals and GP clinics, and as clinicians are pointing out, we are only at the beginning of the winter season.

In many emergency departments, higher proportions of patients are not being sorted out within the target six-hours of arrival.

The health and disability system reforms for which he is responsible are intended to address the challenges.

These were the product of years of under-investment in health, Little said, trundling out a bundle of numbers to illustrate the point (and – no doubt – to show himself and his government in a glowing light):

Over nine years, from Budget 2009 to Budget 2017, National increased operational spending on health by $3.7 billion.

In just four years, the Labour Government has boosted operational spending by an extra $5.8 billion. This year we will spend a record $22.8 billion on health.

Our record on capital expenditure also stands up well: in the eight years between Budget 2010 and Budget 2017, National put $1 billion into infrastructure.

In just half that time – between Budget 2018 and Budget 2021 – we’ve committed $3.9 billion, with another $1.4 billion set aside for the new Dunedin Hospital, described as the most complicated “vertical” construction project this country has ever seen.

That’s a total spend of $5.3 billion – in just four years, and there are still more significant hospital builds in the queue, which we will consider later this year.

Then he brought the government-s drug-purchasing agency into considerations and said the government has increased Pharmac’s budget by 25 per cent to a record $1.1 billion.

That includes an extra $200,000 million over four years announced in Budget 2021, which will help an estimated 370,000 people get access to more medicines.

 This more than somewhat over-states the actual increase in the Pharmac budget, which – like most appropriations – is never enough to satisfy the beneficiaries.

In  this case, Stuff reported the dissatisfaction under the headline Budget 2021: Pharmac boost of $200m ‘nothing short of disgraceful’

But wait.  There’s more.

Little went on:

Just this year, we’ve committed $385 million for a nationwide health IT system upgrade.

And on workforce issues, we’ve increased the number of people working in the public health systems, and will continue to address the longstanding remuneration issues and workforce development issues as expeditiously as we can.

Then he boldly turned to mental health.

We identified even before we formed a government in 2017 that New Zealand’s mental health and addiction services were under extraordinary pressure.

We set up the review of these services in 2018.

Following the report at the end of that year, we made the single biggest investment in mental health ever – $1.9 billion over four to five years.

Contrary to the assertion in the ASMS report last week that not much of that funding has been spent, two years into the programme, we’re making good progress:

    • Of the $1.1 billion allocated to Health, $748 million has been spent or committed.
    • 520 fulltime-equivalent roles have been added to primary healthcare, covering an enrolled patient population of 1.4 million people and dealing with those with mild-to-moderate mental health issues, which the review said was the gap that had to be filled as a matter of priority. In May this year, more than 20,000 sessions were delivered under this programme.
    • Four out of five rebuilds or upgrades of acute facilities have been approved, and detailed design and planning is under way, with construction due to commence next year.
    • New services have been funded for kaupapa Māori providers, Pacific providers and specialist youth providers. Contracts are currently being let for services in the rainbow community.

I say this not to suggest we can rest on our laurels, but to account for progress so far. There is plenty more to be done to expand frontline primary-care services, and there is more to do to address the problems at the acute end.

But whoa.  

This contrasted with Little’s remarks to the New Zealand Herald after the newspaper had disclosed acute mental health units were  running at capacity and Newshub had reported just five extra acute mental health beds have been added as a result of the Government’s record mental health investment.

According to the Herald’s report, in Budget 2019 the Government announced $1.9b for mental health, with $235 million set aside for building mental health and addiction facilities.

National’s mental health spokesperson Matt Doocey revealed just $500,000 of $235m set aside for new mental health facilities in Budget 2019 had been spent, or 0.2 per cent.

Little said he was “extraordinarily” frustrated that despite making commitments and setting aside funding they seemed to be a “long way behind actually getting a shovel in the ground”.

 “I am still trying to understand why. I am not expecting facilities to be completed or fully staffed but we seem to be a long way behind actually getting a shovel in the ground.

“We made the decisions, commitments, the money is there but the design and execution is out of our hands.”

According to the Herald, nearly a third of beds in acute mental health units were occupied by long-term patients who should be treated in the community, reducing the spaces for people who need urgent care.

Acute mental health units regularly operated at full capacity, when 85 per cent was considered the maximum safe level.

Newshub also reported on Monday the lack of spending had seen just five extra acute mental health beds been added, with patients forced to sleep on mattresses on the floor because there were no mental health beds left.

 In his speech to the salaries specialists, Little said of his governments health spending 

This is a significant undertaking. It was a Labour Government that in 1938 established our public health system, and this Government is committed to putting in place a health system fit for the 21st century.

 Here’s hoping it is delivered before the 22nd century arrives.

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Speech to Association of Salaried Medical Specialists – Virtual Conference on Equity of Health Outcomes for New Zealand

Health Minister Andrew Little talked about the public health system and what he expects to result from the reforms he announced in April to achieve, updated the association on progress with the reforms, and gave “a mid-project review” of the changes being made in the field of mental health care.


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