Has Andrew Little been sold a pup on health?
The steps to get from the structure to the resolution of longstanding problems are missing.
Andrew Little appears convinced the announced restructuring of the health system will achieve major improvements in equity, consistency, and health outcomes.
However, there is absolutely no explanation of how this will happen. The steps to get from the structure to the resolution of longstanding problems are completely missing.
Melissa Vining, who has campaigned for faster access to care, pointed out: “There’s no immediate plan to address long delays for cancer care, pressure in EDs and … pressure in people being delayed or going without surgeries.”
Bringing DHBs into one organisation (Health NZ) won’t make these problems go away. It will still be hard to attract GPs and specialists to certain parts of the country, to galvanise the hospitals to deliver services in a much more timely and consistent way, and improve services for people with disabilities.
Little said the reform was “about doing better with what we have”. However, it is not realistic to think significant improvement will happen without additional funding.
Nine to Noon’s Kathryn Ryan put her finger on it when she asked her IT expert why we didn’t already have a national IT system for health: “Why are we now thinking that a massive massive restructuring is suddenly going to resolve that we’re short of specialists, that we’re short of GPs, or that our IT systems are out of date?”
A major restructure won’t resolve these issues. The main impact will be a long delay in progress on any front while the deckchairs are rearranged.
The Ministry of Health is being pulled apart, its functions split between a new ministry, Health NZ, and a Ma¯ ori Health Authority. The new Ma¯ ori Health Authority will “work alongside the ministry on strategy and policy, and partner with Health NZ to craft care...”
It is hard to see how this can work because the functions of the organisations are too closely related. For example, the investment in prevention, the overall funding of the system, and the service delivery objectives for Ma¯ ori and for the wider population, are inextricably linked.
When organisations have to codesign and partner, where does the accountability actually sit and what happens when they can’t agree?
Disparities in access and outcomes for Ma¯ ori, long waits, and people missing out on medicines or services, have persisted under many different health structures. Blaming the structure is a mistake, and looking for the perfect structure is a waste of time.
All the strategy, plans, and accountability levers to achieve the Government’s aims are already there.
Significant progress has been made through incremental change, eg to the way primary care is organised and funded, and more recently through the investment into mental health. The review of Pharmac will be another positive example if it gives us better and more timely access to medicines.
Problems can be addressed if there is a willingness to use the levers to make the system work, and to invest.
Effort and energy should be focussed on solving the most important problems.
Identify the highest priorities for improving access and outcomes for Ma¯ ori; set a target of removing the disparities within two years; commit to everyone being able to see a GP within seven days for a routine appointment.
Recruit GPs to parts of the country with poor access — now, while NZ is a particularly desirable place to live.
Develop a unified IT system and reinstate regular public reporting on the system’s performance, including access to GPs, timeliness of specialist appointments and planned surgeries, satisfaction with disability support services, and reports on how the large injection of funding into mental health is being used.
A major restructure will take everyone’s focus off the end game.