Health targets need to be published
For a party that campaigned strongly on the need for child poverty targets, Labour in government has been surprisingly quick to dispense with targets on other things. It dropped National’s precise public service performance measures soon after coming to power and last week appeared to dispensed with health targeting too.
Health Minister David Clark said the targets — for things such as waiting times for emergency attention, elective surgery and cancer treatment — had “perverse outcomes”, meaning poorer health overall. He seems to be echoing the doctors’ union secretary, Ian Powell, who said, “They have led to superficial assessments of how the system has performed, they grossly mislead the public and they had had, especially in the context of underfunding, very perverse outcomes.”
The next day the minister retreated somewhat, saying the performance data would still be collected but it would no longer be published. That is a copout. Targets have to be published to have their desired effect. They impose a discipline on ministers and their departments to produce results, but only if the Government has to answer to the public if the targets are not reached.
A great deal of taxpayers’ money is poured into the public health system every year, $17 billion this year. It is very hard for governments, let alone the public, to know whether it is being used for as many operations and other services as it could possibly provide. Targets provide a check on whether we are getting as much value for that money as the Government had reasonably expected.
Health targets were not invented by the last Government, they were introduced by the previous Labour Government to “achieve the best possible outcomes for all New Zealanders”, said its Health Minister, Pete Hodgson. If the new Health Minister thinks published targets did not produce that result, he needs to offer an alternative way to ensure public money is being well spent.
Health professionals who provide services free to the public can always do more with more money, which is why they always say their service is “underfunded”. Dr Powell’s Association of Salaried Medical Specialists probably want the only measure of their services to be the amount of money put into them. Politicians are much the same. It is easier for them to trumpet an increase in funding than to produce desired results. Obviously, a set of targets cannot cover everything. But giving the system stated expectations in some areas focuses the whole system on its output. Otherwise it just works to routines regardless of results. Institutions like that are comfortable places to work but frustrating for those waiting for services.
The decision to stop publishing health performance data did not go before the coalition Cabinet reportedly. It ought to have done so. The Health Minister says, “We’re developing new measures that will be taken to Cabinet in due course.” Any new performance measures should be published. That obviously carries a political risk, but without that risk the targets will be too soft.