Our state of health — as Minister Andrew Little sees it

expectation is that we will have a system that will better enable us to do that in a matter of two or three years’ time, but it will take us time to get the processes set up.”

Little argues the shift from the 20 regional district health boards (DHBs) to Te Whatu Ora — Health New Zealand will provide consistency and reduce “transaction costs in order to get reasonably simple things done”.

Across the DHB network, he said, a lot of things were “just rolled over” in terms of contracting suppliers.

“So, not a lot of scrutiny necessarily into: Are we getting what we paid for? Do we even need this any more? Are there other ways we can do it?

“So, I think there is a big job of work to do to provide some very close scrutiny of all those contracts.”

Although, “to be honest, I couldn’t tell you the quality of procurement. Apart from what I hear anecdotally.”

‘Legitimate criticism’

Despite the funding commitments, neither patients nor practitioners are happy right now.

Emergency department horror stories continue to emerge, nurses are yet to accept a pay deal and primarycare providers are complaining of getting a far lower rate of funding increase compared with hospitals.

Is it disheartening to see this criticism, when he’s adamant that funding has increased significantly?

“I don’t want to be unkind about anybody in the health sector. But it’s pretty much a daily occurrence that someone puts their hand up to say ‘we need more funding for x’.

“I think, to an extent, underpinning that criticism is that, whenever we do a big set of increases in funding, so much of it gets absorbed in the hospital end of the system, in the most expensive end of the system.”

Dollar-for-dollar, he accepts that investment in primary care “if it leads to more GPs, nurse practitioners, nurses and others, is more likely to have a bigger impact than ploughing even more dollars into the hospital system”. “That is a legitimate criticism, that is something that I intend that we address over time, and that’s part of the reforms, to put a greater emphasis on primary care.”

Part of the challenge is distributing the workload.

“GPs have this thing that they should be doing everything,” he said. “They don’t need to be doing everything. There are other health professionals we can rely on to do stuff.

“There are things that pharmacists can do that you shouldn’t need to have to go to a doctor for, like minor ailments and skin ailments.”

Throughout BusinessDesk’s sitdown interview, Little spoke about increasing the workforce. This year, his ministry has unveiled several initiatives aimed at recruiting and retaining doctors and nurses.

But it’s an uphill battle when it’s being reported that nurses can earn significantly more across the Tasman and the Victoria state government is directly targeting Kiwi nurses for mental-health roles.

Little argued that this is a global problem. “The labour market for health workers generally — specialists, doctors and nurses — is very competitive. The shortages and the inward forces are chronic and acute. “Health workers going to Australia need to know that they’re going into a health system that is probably more understaffed than ours. They should be going in with eyes wide open.”

With many health outcome metrics worsening, is he frustrated that the potential improvements may not register with voters in the year leading up to an election?

Reforms were planned to be implemented sooner, he said, but “it was a pretty diabolical winter”.

“And I said, we don’t want to do the organisational change that is going to just cause more disruption and stress on an already stressed workforce.

“So, it is about picking the time to make a change. I would say over the next six months we will start to see more discernible change.”

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