Health’s shape must be considered, now

NEW Zealand’s medical profession has performed prodigious deeds to halt what loomed as a spiralling Covid19 crisis and bring the country back to Alert Level 3.

While doctors, nurses and other health staff enjoy a welldeserved lap of honour, recognition of a job well done cannot cloud realisation that there are serious systemic issues with New Zealand’s health system, many of which have been highlighted by the present crisis.

For example, it is wildly incongruous that at a time when frontline health workers such as GPs and practice nurses are being praised, their workplaces are suffering extreme financial hardship.

While the complete picture is somewhat more complex, in general terms much of doctors’ surgery income is derived by patient visits.

The wellspring for many of those visits is the accident compensation system, be that initial assessment, referrals to specialists or ongoing treatment.

One fortunate side effect of Alert Level 4 lockdown is that accidentprone Kiwis have not been tripping, falling or slipping at their usual rate, meaning the ACC well which supplies practices with around half of their income has run dry, with unfortunate pressures on GPs’ bottom lines.

While medicine is not alone among professions in seeing revenues plummet during Alert Level 4, a health system which runs the risk of an essential part of service delivery potentially going broke in the midst of health crisis is flawed.

More broadly, the call to retired medical professionals to reenter the workforce when it appeared New Zealand verged on being overwhelmed by Covid19 illustrated an issue medical unions have highlighted for years – the ageing workforce in their profession.

In the next 10 years, almost half of all GPs are forecast to retire; nurses and surgeons expect similar losses.

Mental health has also been a concern during this worrying time, and the slender numbers in that sector were revealed when the Government responded to the report into that sphere last year; more programmes and more buildings were mooted, but finding the people to staff them was another matter entirely.

While this has been public health’s time in the sun, recent less severe epidemics had already highlighted this was a creaky system before Covid19.

Mumps, measles, syphilis and whooping cough are among the diseases to have challenged doctors in recent months, and the health system as a whole is also confronted with an everincreasing number of cancer patients.

With all those issues on the table, and they are but a sampling from the smorgasbord of travails afflicting the health system, there is a clear case for an overall review.

Happily, exactly such a thing has already been carried out.

An eminent committee chaired by former Prime Ministerial adviser Heather Simpson, has spent many months investigating the sector as part of a comprehensive review of the health system.

The first part of that review, an audit of the system as it stands, was released last year to little fanfare, but it stands as a valuable helicopter view of where we were.

The second part of the review, where the panel thinks New

Zealand should go next, now sits on a desk outside Health Minister David Clark’s office; his staff say it will receive his attention when the Covid19 crisis has abated and ministry officials are freed up from pandemic duties to offer advice.

That is reasonable, but what is less reasonable is for that report to languish at a time when the health system is stretched in a manner not seen for a century.

Right now, not in however many months it takes for the report to reach the top of the ministerial intray and then finally be released publicly, is when the shape of the health system needs to be considered.

Prime Minister Jacinda Ardern said yesterday that the health system needs to be rebuilt.

All the more reason that this report, which will be the foundation of that work, be debated now rather than some later date.