Health: Nice bucket, shame about the contents
Public health needs new ideas, not the same tired old prescription
There is an old and crude saying, which translates for our purposes as “same stuff, different bucket”. It describes what happens when you change jobs, living circumstances or location, only to wake up and find your issues have followed you to your new environment.
I was reminded of that saying with the release this week of the grandly titled “Planned Care Taskforce Reset and Restore Plan”, which contained 101 “actions” to apparently sort out what has clearly become a crisis in elective surgery performance in our public health system.
Courtesy of the Health Minister, we have a shiny new bucket that goes under the name Te Whatu Ora — Health New Zealand, but a dawning realisation that nothing else has changed.
This report simply records the same set of issues and the same list of proposed solutions which could have been written, and often was, under the old, apparently broken beyond repair, health system.
Of its 101 recommendations, apart from some dubious ones to prioritise treatment on ethnic grounds, it’s pretty much same old, same old. Roughly 20 per cent of the recommendations talk about collecting, measuring and analysing data better, another bunch talk about nationally standardising various treatment pathways, which often just means more box ticking for clinicians, and the whole thing includes liberal use of terms like “explore the use of ”, “consider”, “review” and “establish a process”.
On the strength of this report, plus another one released yesterday, if the Health Minister is waiting for the Health New Zealand cavalry to save him from the poor state of the sector under his watch, then I have sad news for him. The horses are still back in the stable and they haven’t yet been saddled up.
Meanwhile, the healthcare crisis gets worse. Emergency care is a mess. Waiting times are tortuous and stories appear almost daily of people who miss out on care with often tragic consequences.
As for planned care (previously known as elective surgeries), the one thing the taskforce usefully highlights is how much the throughput of specialist assessments and surgeries has dropped in the public system over the past few years. There is a lot of pain and suffering behind those numbers.
This is not a criticism of the people working in the system, who are often doing heroic work in under-staffed hospitals and other facilities. Covid-19 has also placed a lot of additional strain on the health system which it wasn’t designed for. But that has been known about for two-and-a-half years now. Forget the structural changes, where’s the real response?
The lack of urgency, innovative ideas, or even occasional fresh thinking from the minister and the Government to address the crisis that Covid has helped create, is hairraising.
Andrew Little’s stock answer has been to point to his shiny new bucket as the answer to all things, and act as if his part of the job is now pretty much done. Then it’s back to blaming the previous Government, which left office more than five years ago, for leaving what he says was a mess.
Well, if he wants to play the comparison game, under that Government, performance targets were set and largely met, health workers were receiving moderate but regular increases in real wages, and new hospitals were being built, not fast enough perhaps but at least being built.
Pretty much none of that is happening now, although some new hospital construction is belatedly getting under way.
There are three things that are needed immediately if we are to tackle the huge and growing pile of unmet need in our health system. We need more people in the health workforce, we need more facilities, and we need targets and goals for the facilities we already have.
When a shortage of construction
The lack of urgency, innovative ideas, or even occasional fresh thinking from the minister and the Government to address the crisis that Covid has helped create, is hair-raising.
workers threatened to derail the postearthquake rebuild, the Key Government had to think outside the square to get stuff done. We worked with providers and temporarily shortened and intensified the training of builders and carpenters.
We relaxed immigration settings to bring workers in from all over the world, and yours truly was dispatched to recruit Kiwis out of Australia with job fairs in Sydney, Melbourne, Perth and Brisbane. And it worked. Nothing like that energy and urgency has been brought to any aspect of this current health workforce shortage.
The pressing need for extra facilities has also been ignored. Again in Christchurch, temporary facilities were built in record time, to do things like provide shelter for families, companies and workers. All around the world extra temporary health facilities were stood up to deal with Covid. Here, nothing. What about an innovative plan to contract private care facilities, or temporarily refit existing buildings for electives, or both?
And what about performance targets and goals? One useful thing the taskforce raises is a proposal to reintroduce performance targets.
They are coy about it, they don’t want to offend the minister after all, but several recommendations propose “benchmarking”, “volume targets” and “key metrics”. They are not alone. Emergency doctors themselves made a plea this week for the reintroduction of performance targets, saying that without them there was no organising goal to train the system towards. They are right.
Meanwhile, back in Parliament, Andrew Little floundered around when asked to explain why Covid immunisation targets were good but ED performance targets and elective surgery targets were “arbitrary” and bad.
Our Health Minister looks more and more like a tired one-trick pony. His only initiative was to rearrange the bureaucracy and slap a new coat of paint on it, then stand back to wait for it solve the world’s problems.
He ignores that it is infeasible a bureaucracy in Wellington, roundly derided by most who work in the health system, should suddenly be the solution because it is now called “Te Whatu Ora”.
Particularly as it exhausted itself changing all the deckchairs around and few people within it yet seem to know how the new entity works. Cue a reminder that this should never have been done in a pandemic.
Our health sector needs new thinking, not hidebound technocracy. It needs to be led by someone new with energy and enthusiasm, who is prepared to roll sleeves up and lead from the front.
Someone who stands up for patients and their families, visibly backs the doctors, nurses and other professionals and is prepared to take on entrenched interests like the health unions and medical school duopolies.
We don’t need a tired paper pusher. He needs to go.