Broken DHBs need more than money
The Government came riding to the rescue of the beleaguered district health boards yesterday with a $3.9 billion rescue package. The money will be spent over the next four years, working out at $980 million a year.
Big numbers tend to get lost at Budget time. It’s difficult to tell a big investment from what the Government would like you to think is a big investment.
The DHB cash injection, make no mistake, is massive. It equates to just under a third of all new money that will be spent in this Budget, if you take Finance Minister Grant Robertson’s December Budget Policy Statement as a guide.
But it won’t be enough, and simply throwing money at a problem won’t necessarily make it any better.
A philosopher will tell you that we’re all dying, just at different speeds (that’s probably why it’s a good idea not to put a philosopher in charge of the health system); health is considered a hospitalpass Cabinet portfolio simply because, no matter how much money you throw at it, you’ll never fix it — people will still die, medicines will still go unfunded.
But that shouldn’t stop governments from doing their best. The health role has broken many ministers, but it’s also made them: Bill English, Helen Clark, Annette King, and Tony Ryall all survived their brush with it.
Clark’s mythic chief of staff, Heather Simpson, is currently polishing off her review of the entire health and disability sector. The final recommendations, due in March, were understandably delayed.
Her interim report is insightful. It gives some credence to Labour’s ‘‘nine years of neglect’’ complaint about National’s lack of investment, saying the ‘‘relatively slow growth in expenditure’’ in health in recent years had ‘‘added to stresses within the system’’.
Last year, the DHBs clocked up more than $1b in deficits. It’s a fearsome figure, although it shouldn’t be over-egged, given a substantial portion of it comprised oneoff payments owed to staff after they had been underpaid holiday pay.
But low spending is only part of the problem. DHBs are too fragmented, the report notes, and services are too often duplicated or, worse, they’re available at one DHB but not another. This throws up a dreaded postcode lottery of care outcomes, rather than a fair spread throughout the country.
Twenty DHBs in a country of five million has always seemed somewhat ridiculous. The focus of healthcare seems to have drifted too far towards the local, with little care for what more centralised services can offer. In a country of New Zealand’s size, there’s good reason for more centralised planning to avoid waste.
The Ministry of Health is known to grumble that it’s smaller than the DHBs it looks after. The fact that it and its celebrated director-general, Ashley Bloomfield, have performed so well in this crisis will probably add to calls for more powers and functions to be concentrated in Wellington.
The other area that needs to see a bit of extra money is capital spending. The true cost of underfunding in health has been DHBs diverting investment in new capital projects and the sweating of assets. Simpson is very clear that the system needs ‘‘significant’’ spending in new hospitals and other capital projects.
The Government has doled out some significant capital spends in its previous Budgets. It could be reluctant to do the same this time around, given the increased fears of a debt blowout.
Simpson will no doubt be bold in her recommendations about what to do with DHBs. They look likely to survive, although some could be amalgamated.
A big shakeup couldn’t come soon enough. The Government is lucky it has the balance sheet to throw money at a problem to make it better. Future administrations may not be so lucky.