In praise of health reforms

TALKING POLITICS

How did a country of only five million people ever imagine it would be a good idea to meet its health needs by creating 20 different organisations, each with separate bureaucracies and funding allocations?

That’s why last week, few people shed tears over Health Minister Andrew Little’s decision to scrap the DHBs, and to fold all their functions into one new organisation called Health NZ.

Besides ending the pointless duplication, the new agency will be expected to ensure a consistent level of health delivery across the entire country, in accord with policies set by a streamlined Ministry of Health.

In addition, Little announced a new, independent Ma¯ ori Health Authority, with its own funds and commissioning powers.

Some people may baulk on principle at the creation of two separate health agencies. Yet obviously, the current public health system has been failing Maori for decades.

On average, Ma¯ ori die seven years younger than non-Ma¯ ori, and are more likely to die of heart disease, strokes, and cancer.

The logic involved in creating the MHA is much the same as with the successful model of Wha¯ nau Ora – which says that

Ma¯ ori have to manage the delivery of the health solutions for Ma¯ ori, if significant gains are to be achieved.

To deliver those gains, the MHA will have to be adequately funded, but funding details will not be revealed until closer to Budget Day, May 20.

While Ma¯ ori comprise 16 per cent of the population, they reportedly account for 25 per cent of the patients within the public health system.

Logically then, the MHA could need a quarter of the current health budget (roughly, $5 billion) to do its job properly.

Anything like that sum would require a vast infusion of new money.

Obviously, there is precious little scope for shifting money across from our currently stretched hospital system, and into the MHA.

Yes, a certain amount of local democracy (i.e. the ability to elect people onto district health boards) will be lost, as power gets re-concentrated into one central agency.

However, since Health NZ will be responsible for managing health funds, this should prevent the ‘‘blowouts’’ within inadequate DHB budgets that led to spiralling debt and to further cuts in services.

In the end, the ability to elect a few local people to health boards did very little to stem the tide of unmet needs within public health, and it could not prevent the systematic underfunding of the public health system that occurred between 2010 and 2018.

Overall, the reforms will seek to shift health resources into primary and community care, thereby (hopefully) lifting some of the burden from our stretched hospital system, which has major shortfalls in staffing and training that also need to be addressed.

The new system is the biggest shake-up in public health for over 30 years, and it should be up and running by July 2022.

Implementing fresh solutions for serious and entrenched social needs is exactly what voters elected this government to do.

After months of seeming inaction, the government has delivered what a bold and progressive blueprint for public health.

That’s assuming of course that the new structures eventually receive the funds they need to do the job.

The proposal calls for replacing 20 district health boards with one national agency.