DHBs healthy? How will we tell?

How will we judge Clark’s changes without the means to measure what is delivered?

In the Aussie comedy The Castle, lawyer Dennis Denuto is a little out of his depth. Representing Aussie battler Darryl Kerrigan in the High Court, Denuto is asked what evidence he has to justify his claim that the Crown’s compulsory acquisition of his client’s ‘‘castle’’ breaches the constitution. ‘‘Evidence?’’ he says, momentarily flustered. After a quick rustle of legal papers he tells the judge: ‘‘It’s just the vibe of the thing.’’

Evidence. That pesky stuff you can present before a court of law or public opinion; that you can touch, hear, see. Understand. Without it, all you’ve got left is the ‘‘vibe’’.

Health Minister David Clark is scrapping National Health Targets that publicly address district health boards’ success or failure in achieving, among other things, reasonable treatment times, numbers getting surgery, waiting times in emergency departments, and immunisations.

Incredibly, the National Patient Flow project, which monitors the number of people turned away from surgery, and which Labour supported while in opposition, also appears to have been sidelined.

Clark has indicated other, new targets may follow, but it is unclear what these will measure or whether they will be available to the public.

In making these changes, he has criticised the ‘‘perverse incentives’’ created by the previous monitoring regime. Also, Labour has intimated that the DHBs and the previous National government padded the statistics with easier procedures, that they gamed the system. Trouble is, there’s no evidence. Just a ‘‘vibe’’, it seems.

Which makes it at least ironic, and certainly hypocritical, when this Government decides it will ditch publicly verified evidence of the health boards’ progress in delivering essential services.

Even if some suspected that the targets were not as robust and transparent as they could have been, at least those numbers gave the public and the sector’s various watchdogs some insight into the health of its operation. There was some basis on which to inquire or investigate.

Clark is concerned these ‘‘perverse incentives’’ created a system whose output was inefficient, overly expensive, a race to the bottom with potentially dangerous consequences for patients. He believes there was a greater focus on numbers and a lesser interest in quality and outcomes. He may be right, but how will we judge his changes without the means to measure what is delivered? And will removing the yardstick allow the Government to reset agendas within the health sector according to ideology or political expediency, all without public oversight?

Remember, those numbers sometimes sparked uncomfortable questions for DHB chief executives and their political masters.

This Government has set aside an extra $31.5 million for elective surgery; Clark insists that will mean more operations and that the Ministry of Health’s delivery of those will be monitored. But we just won’t have the public updates to help verify that.

What we do have is the minister’s assurances that more operations will be done, at lower cost, with better outcomes. He appears to be asking us to simply trust him. It’s about the vibe, apparently. Although that didn’t work for Darryl and Dennis. They lost the case.