Why we need a doctor in the house

What happens when the officials get more ideological than the Government? Health Minister Jonathan Coleman has launched an extraordinary attack on the holders of the Government’s purse strings, accusing Treasury of trying to knobble a life-saving bowel cancer screening programme.

The long-running bowel screening pilot scheme at Waitemata DHB was largely hailed as a resounding success but Treasury has panned the project – even, it’s understood, resorting to trying to discredit the science, after failing to dent the project by pointing out its ill-prepared business case.

Of course, Government versus Treasury bickering is not new. Canterbury Recovery Minister Gerry Brownlee called its analysis of the Christchurch rebuild ‘‘utter tripe’’; Finance Minister Bill English has long trumpeted the pragmatic line that it’s Treasury’s job to provide advice, but ‘‘that

What does it mean when a National Government committed to spending cuts, is beginning to criticise much of Treasury’s advice?

doesn’t mean we have to take it’’; and in 2005, Labour’s Finance Minister Michael Cullen branded a Treasury call for tax cuts an ‘‘ideological burp’’.

But what does it mean when a National Government committed to spending cuts begins to criticise much of Treasury’s advice?

On bowel screening, two things are clear: New Zealand desperately needs a programme, and the Ministry of Health business case has been a massive rush job.

The rush alone does not mean the programme will fail – though it doesn’t bode well – but is Treasury’s only problem with bowel screening the quality of the business case?

A dump this week of hundreds of supporting documents to this year’s Budget paints a picture of a Government struggling to bring Health under its investment approach.

If evidence-based investment is what they’re after, it would be difficult to argue spending upfront on bowel screening now wouldn’t save millions on costly cancer treatment later on. This is the sort of spending that saves lives and money in the long-term.

So is Treasury’s spending anathema getting in the way of strategy? Or is it seeking to apply its own strategy in the extreme?

‘‘Strong political resolve will be required to allow DHBs to make changes (like closing hospitals or ending specialist services) that seriously alter the overall balance of the system,’’ one document said. ‘‘Even then, the scope to withdraw services deemed to have a low return on investment in order to reallocate spending to other parts of the social sector is likely to be quite limited. This does not mean that the status quo is optimal.’’

The document from which the above was taken was a general discussion around how the investment approach could be applied to Health so it has to be understood that Treasury was not recommending DHBs be given the power to close hospitals, it was simply kicking around ideas. But, still, these are the sort of ideas that Treasury is kicking around.

In Coleman, New Zealand has for the first time an experienced doctor as Health Minister. And, as Treasury flexes its ideological muscles over spending, having a doctor in the house has never before seemed so valuable.