Call to prioritise services, staff

More than $2 billion could go towards making us better and keeping us well in Budget 2022, according to the Association of Salaried Medical Specialists (ASMS).

But, with major reform of our health system in the early stages, many will be looking carefully at how much of the spending boost will be on reforming the health system – as opposed to improving health services.

‘‘Robertson has signalled a large portion of the $6 billion increase in operational expenditure pencilled in for Budget 2022 will go towards reforming the health system,’’ ASMS executive director Sarah Dalton said.

‘‘It will be important to examine how much of the one-off hike is in fact going to a major one-off long-term investment in health.’’

Traditionally, the majority of health spending goes to the country’s 20 district health boards (DHBs), but they are being dissolved on July 1.

The DHBs are being replaced by Health NZ and the Māori Health Authority, with a number of entities at a local level – ‘‘localities’’ – established over the next two years.

In April, the first nine localities were announced – O¯ tara/Papatoetoe, Hauraki, Eastern Bay of Plenty, Taupo¯/ Tu¯ rangi, Wairoa, Whanganui, Horowhenua, Porirua and West Coast. ‘‘People and organisations with influence over community health and wellbeing will collaborate on what outcomes they want to see for their community,’’ the transition website says.

Three-year locality plans will be the basis for procurement decisions made by locality commissioning teams.

It was unclear if the new localities would have different boundaries to the DHBs.

‘‘The boundary lines may follow existing boundaries defined by local government or mana whenua; it will simply depend on what works best for each area.’’

New localities are expected to be announced each quarter over the next two years.

Whether it is through a health board or a locality, health experts and commentators are agreed more needs to be spent to improve our health system.

University of Otago professor Robin Gauld was confident more would be spent on the sector in today’s Budget, but said it may not solve the problem of inequitable access to care.

Gauld said he would like to see a commitment to a social insurance model for health in the Budget. This would mean establishing an investment fund, enabling everyone to access the care they need from both public and private providers.

‘‘It’s a national scandal, people are really suffering, and it’s really a ‘who pays’ system. If you’ve got money you will get your hip or your knee or your cataract done next week or a dermatological problem, there’s often a shortage, and it’s not available publicly.’’

New Zealand Council of Trade Unions (NZCTU) economist Craig Renney said Robertson needed to make it clear how much was being spent on actual health services – rather than infrastructure for the new health system, capital projects and debt.

Health NZ will take on at least $711 million worth of longrunning health board deficits, in unaudited figures for the 2020/21 financial year, which included $20m in Covid-19 related costs.

‘‘If you repeatedly underinvest in health capital you don’t notice it straight away but over time you build up this deficit, and you keep kicking the can down the road, and you make it someone else’s problem in the future,’’ Renney said. ‘‘You need to create that secure pipeline of funding into the future to help deliver the longterm need.’’

Renney hoped to see funding for health staff pay prioritised in the Budget.

‘‘We know for nurses alone we have over 4000 vacancies.’’

Dalton said the Government seemed to have a blind spot around the health workforce.

‘‘It’s obvious we don’t have enough of them and yes, there’s a taskforce being set up to look at workforce under Health NZ, but most health unions are still engaged in what feels like a blood sports with the DHBs and the ministry . . . in trying to settle collective agreements.’’

‘‘It’s a national scandal, people are really suffering.’’ Robin Gauld University of Otago professor