Old woes return to the surface
The month of July has been bookended by two major changes in New Zealand’s health system. One was more visible and immediately obvious than the other, but the less obvious change will be more significant in the long run.
On July 1, New Zealand’s 20 district health boards were disestablished, to be replaced by two new national bodies, Te Whatu Ora – Health NZ, and Te Aka Whai Ora – Mā ori Health Authority.
The greatest structural change in the public health system in two decades coincided with the worst pandemic in a century. One day we might ask if we could have done things differently, but it seems clear that such a rationalisation and streamlining had to happen, and the diverse regional responses to the Covid-19 outbreak were a further illustration of the rationale.
The workforce shortages that have plagued our public health system for years, but have been thrown into stark relief by a grim winter of Covid and flu, should also be mitigated by the new structure. Experts, including academics at the University of Otago, warn that the reform will have been pointless if workforce shortages are not addressed.
We have become too dependent on imported medical staff and must find ways of generating more of our own. Bottlenecks in education and training must be dealt with quickly.
Stuff has run a series this week about the state of our health system. A picture emerged of stressed and burnt-out medical staff, overcrowded emergency departments, distressing individual stories, surgeries cancelled and waiting lists that keep growing. One possible solution for the latter is to pay private hospitals to pick up some of the slack.
It is clear that the Government inherited longstanding workforce shortages, and the nursing sector warned of a crisis at least 15 years ago. It is galling to see some of the very same criticisms of the sector were made by National in opposition as long ago as 2008, when it warned about an overreliance on imported staff and even used the dreaded word ‘‘crisis’’. Cynics might wonder if National, which is talking again about a crisis while in opposition, could have done more to solve the problems during its subsequent nine years in government.
In other words, this current crisis has exposed deeper issues that already existed but were masked by a dedicated workforce that has been stretched beyond reasonable limits.
The problems are also international in scope. We can see near-identical headlines in the UK, Australia, the US, Canada and elsewhere. But that does not mean the Government is off the hook.
We hope Health Minister Andrew Little develops a warmer and less combative relationship with the sector, especially its unions. Little has many admirable qualities but his brusque manner is not one of them.
If a different personality style is required, he could look to outgoing director-general of health Dr Ashley Bloomfield, who became the nation’s favourite son during the long days of the initial Covid lockdown but ended his stint a year early. His last day in the job was the other bookend to an eventful July. Despite his popularity, Bloomfield’s time in the role was not perfect. He apologised for ‘‘overestimating’’ the ministry’s capacity to do PCR tests. He was required to apologise to the health select committee after providing incorrect information about a United Nations worker with Covid19. Yet the image that endures is of a public servant who operated with integrity, modesty and seriousness, and who seemed embarrassed by the fame forced upon him by a population that sought reassurance.
The notion that politicians and public servants can sometimes reassure the public is a lesson Little could learn.