Health change welcomed
SOUTHERN cancer care advocate Melissa Vining is preparing to farewell another person close to her who has been failed by the healthcare system and says change cannot come fast enough.
Ms Vining’s late husband, Blair Vining, was responsible for New Zealand’s largest cancer petition.
Now, Ms Vining said a dear friend had been diagnosed with lung cancer. It was curable when it was first detected.
‘‘And due to the unnecessary delays, she’s just been told she’s incurable,’’ Ms Vining said.
‘‘That just breaks my heart, because Blair fought so hard to ensure that those waits didn’t happen to anyone else.
Health Minister Andrew Little yesterday announced a raft of changes to the health system, including the scrapping of all 20 district health boards in favour of one national organisation, Health New Zealand, by July next year.
It was a gratifying acknowledgement of the disparity of healthcare New Zealanders received based on where they lived, Ms Vining said.
But change needed to happen faster, and more people would die during the transition, she said.
‘‘We’ve got people in our region, now, dying because of these waits, and there was nothing to suggest that there was going to be any immediate relief for these people and their families.’’
Ending the bureaucracy of having 20 different chief executives for 20 different DHBs was welcome.
‘‘I think that’s a big part of why, for us in Southern, we get such a short end of the stick compared to the rest of the country.’’
People had to question the wisdom of a country of five million people having 20 health boards, Central Otago Mayor Tim Cadogan said.
But he had just returned to work after ‘‘toprate’’ care in the current system.
He waited fewer than three months from cancer diagnosis to surgery, though it could have been that he had ‘‘the right cancer in the right DHB’’.
‘‘I also appreciate that my experience is not the reported experience of a lot of people,’’ Mr Cadogan said.
‘‘I’m all for anything that gets us the same level of service across the country, but I do get nervous about where the local voice is in a centralised organisation.’’
Clutha Mayor Bryan Cadogan said there was understandably a lot of nervousness around a proposal for such largescale change.
While he could not comment on the details of the reforms, it was important all New Zealanders had equal access to health care, he said.
‘‘The present system was causing a lot of challenges,’’ Bryan Cadogan said.
‘‘That’s the definition of insanity, isn’t it? — to just keep doing the same thing.’’
Waitaki Mayor Gary Kircher said most DHBs were running deficits and remote hospitals such as Oamaru Hospital had to fight for funding.
Still, the cost for people from the Waitaki, making multiple trips to Dunedin for care, remained high.
It was unrealistic to expect every area would have the same services, but it was important to make sure people further from main centres were given more priority, not less, Mr Kircher said.
In Lumsden, after losing a battle to stop a maternity downgrade, Gemma Sloane said she was on the fence about the reforms.
The Northern Southland Medical Trust member said she personally held fears that, with a more centralised system, rural areas with low populations might have less of a say in their healthcare.
But if there was to be an investment in primary healthcare, it would be better late than never.
University of Otago general practice and rural health department head Carol Atmore said the reforms had the potential to ‘‘strengthen the voice of rural communities’’.
Critical to the success of the new system would be the amount of funding diverted into primary care, Dr Atmore said.
‘‘There are very willing people in primary and community services, who are working really hard, but they’re actually being asked to do more than they have got the resources to do.
‘‘As services are being shifted out of hospital and into communities the funding needs to follow so the services can be provided.’’
Clutha Health First chief executive Ray Anton said the reform was bold, but well signalled.
‘‘They’ve heard us when we talk about how rural seems to be the poor child,’’ he said.
What the new system looked like, and especially how it differed from what was already in place locally, remained to be seen, he said.
IF the ideal health system for a small country was being created from a blank canvas, there is no doubt it would be closer in design to the blueprint Health Minister Andrew Little outlined yesterday than the hodgepodge that exists now.
However, the blueprint goes a lot further in two important respects than the Heather Simpson review of the health and disability system on which it is based.
One is easily addressed — getting rid of the 20 district health boards in order to have a national health service run by a single authority, Health New Zealand, which will commission health services.
The other is the proposed commissioning and veto powers of the Maori health authority, which is likely to be the most contentious issue within the blueprint.
Ms Simpson’s view was that the Maori health authority not have a significant function in commissioning health services for Maori, a suggestion rejected by Mr Little and the Cabinet, but they went further and also want it to cocommission services alongside Health NZ for the whole population.
The Cabinet paper approving the blueprint sets out the expanded role.
It says the Maori health authority will be the lead commissioner of health services targeted at Maori and that it will ‘‘act as cocommission for other health services accessed by Maori, working jointly with Health NZ to approve commissioning plans and priorities’’.
Mr Little says in the paper that in terms of national service planning, it is his expectation the Maori health authority should have a colead role in relation to national planning and in designing the key operating mechanisms that the system will use.
The Maori health authority’s design is not spelled out as it will be designed by Maori.
But there are already calls for it to follow the design of
Whanau Ora — a social service delivery model set up by the Maori Party and National in which the government funds three private commissioning agencies, which in turn commission providers.
It should be relatively easy for the Government to say that what is happening now is not working and that a Maori health authority is required.
The emphasis should be on its ability to work with the system, not separate from it.
The real debate will be around its powers, the lines of accountability, to what extent it will duplicate the general health system and, most importantly, the transparency of the authority.
If the authority’s proposed powers actually make a big improvement in health outcomes, it would be worth supporting.
But it must be transparent enough for anybody to see how their money is being spent and what the outcomes are.
Those questioning it should prepare to be labelled racist for even asking the question. But the answers are more important.
Transparency across the whole system is absolutely vital in order to measure the success of the reforms.
The other Simpson recommendation that was rejected was to cut the number of DHBs. But that debate is not going to get legs.
It makes sense to have none, rather have a halfway house between a national system and a fragmented regional system.
Regional priorities will not be ignored. The new system will have to have regional offices which will set priorities.
The failures of the current system have been laid bare in Covid19.
While New Zealand has performed well, it has been in spite of structural deficiencies.
The 20 DHBs had their own public health units and operated as silos, even hiding personal protection equipment in the early days from the national inventory in order to protect their patches.
The system incentivises focus on individual performance of silos and duplication rather than having a good, sound, healthy system as a whole. Change is needed.