Broadsides: Building a better health system

Labour MP Jacinda Ardern and National MP Nikki Kaye.

Opinion

Labour's Jacinda Ardern and National's Nikki Kaye on what can be done to improve New Zealand's health system.

JACINDA ARDERN

There's a reason why the Health portfolio in politics is considered a bit of a poisoned chalice. People get sick, and not all of it can be prevented. Now more than ever, health is becoming a much harder area to manage. We are essentially paying for a 1970s Mini and expecting a brand new Porsche, a reality we are yet to fully acknowledge, but expect the health sector to deal with on a day to day basis.

The same pressures that we face managing an impending boom in the number of supernatants are some of the same pressures we face in health. We have an aging population who are living longer. Couple that with the fact that health technologies have improved but are costing us more, and you have a perfect storm.

It won't surprise you that I disagree with the Government's current approach to health. Almost as soon as National came into power, the focus shifted away from preventative healthcare, the very thing that stops an illness from escalating from a cough, to respiratory issues, to a hospital admission, and instead focused on things like elective surgery targets. Of course, making sure waiting times are brought down is important, but a mere 1.3% of the health budget is spent on primary healthcare. It's no wonder then that 5000 children were admitted to hospital last year for avoidable conditions such as skin infections and respiratory illness.

Case in point: rheumatic fever. This is a third world issue; a sore throat that, if left untreated, can damage a young child's heart for life. We have an epidemic of rheumatic fever in parts of New Zealand. The first DHB to try and tackle this issue did so by squeezing money out of an already stretched budget, but saved the health system millions in the process. This is the kind of initiative that all DHBs should be properly supported to undertake but Instead, the government has created false hope by announcing a rheumatic fever prevention programme and then failed to fund it properly. An area like Counties Manukau, which has nearly half the cases of rheumatic fever, is receiving less than a third of the total funding.

True preventative healthcare cannot be seen in isolation; it also means addressing social deprivation. I remember hearing the story of a family where the father had lost his job. Both parents were struggling to support their family when they were struck down with a bout of scabies. They were unable to afford a doctor's visit until the infection meant the kids could no longer attend school. When they finally did scrape together enough for treatment, a lack of power meant they did not have hot water to wash their bedding and clothes and get rid of the infestation altogether.

There is no question that poverty and health are linked. Last year the Regional Public Health Unit in Wellington found, for instance, that a family on the minimum wage would need to spend 51% of their weekly income to put a healthy meal on the table. Addressing healthcare issues also means addressing the gap between rich and poor in New Zealand. Labour's focus on creating a fairer tax system; making the first $5,000 everyone earns tax free; raising the minimum wage to $15 an hour; and removing the GST off fresh fruit and vegetables: all of these will make a difference. But so will a greater focus on preventative healthcare.

You won't hear Tony Ryall stand up and acknowledge that there are limits to our health dollar though. In fact, instead of facing our limitations and having a fundamental look at where that dollar is best spent, the current Minister of Health seems more concerned with making false claims about the health budget, such as: "we're spending a record amount on health." The reality is that funding in the last two Budgets fell millions of dollars short of meeting the growth in population and costs for delivering our health services, leaving district health boards with a shortfall that can only be met through service cuts. It's time the Minister acknowledged that just like every other area, the health spend is all about priorities.

I make no apologies for the fact that Labour takes an end to end approach to healthcare, and that, of course, means our focus will also stay on the public system. But I also acknowledge that we have a private system in New Zealand, and we should not ignore that. That means leveraging off it where appropriate, but my bottom line is that I never want to see here what I saw in India, a man collapse outside of my hostel and the staff refuse to call for help because "who would pay?" No one's access to healthcare should be determined by their wealth, but nor should wealth determine a person's wellness and, currently in New Zealand, there's no denying that it does.

If we want a health system where the dollar goes a little further and where people are supported and can take charge of their own health and wellbeing, we have to look at the bigger picture. Let's start with the basics and, maybe one day, health won't be that poisoned chalice.

Jacinda Ardern is on Facebook and Twitter @jacindaardern

NIKKI KAYE

With countries around the world grappling with ageing populations and the rise of the cost of health care, it has never been more important for New Zealanders to get value for money out of our health system.

Over the next 10 years, demand for health services in New Zealand is predicted to double. To help manage this demand we have made health a priority by investing $1.5 billion of new money over three budgets - that's half of all new government spending.

I believe that the progress we have made in turning around our health system is one of the greatest achievements of this National government. We have focussed on ensuring patients are at the centre of our health system where they belong.

I think we need to accept that New Zealand does not have the funds or ability to double the number of hospitals or medical professionals in the next 10 years. That's why we need to meet more of that demand on a lower cost platform, out in the community and closer to home. We believe that the Integrated Family Health Centre concept is pivotal to the future delivery of patient-centred care.

Integrated Family Health Centres mean people can go to one place and, for example, maybe see a GP or nurse without an appointment, have a blood test or an X-ray, see a physiotherapist, have a first specialist assessment, or visit a pharmacy for their prescription, even have minor surgery - all in the same building. In July 2010, the Alliance Health Plus PHO group began work on their two Integrated Family Health Centres in Mount Wellington in Auckland.

In the last three years we have had some huge successes with some of our most vulnerable New Zealanders. Since we set a health target of fully immunising 95 per cent of two-year olds, rates have shot up from around 70 per cent only three years ago to 90 per cent today.

One of the most upsetting things I remember when I was in London was seeing that under the last government, some New Zealanders had to fly to Australia for cancer treatment. Some patients waited up to 15 weeks for cancer radiation treatment.

Now, every single New Zealander who needs radiation treatment for cancer is getting it within four weeks of their first specialist assessment.

Next month I will be competing in Starboard's Paddle For Hope to raise funds to improve breast cancer awareness, as part of Pink October. I am proud that we now fully fund Herceptin, which has helped more than 700 New Zealand women to fight breast cancer.

We cannot deliver a greater health system without ensuring we better support our medical professionals. Earlier this year I spent the night with doctors in Auckland observing an emergency department. I was hugely impressed by the doctors and other medical staff that I met. I watched them help many people in a short period of time who were in traumatic situations - from people who had tried to take their own life, to terminally ill patients, to people who had been involved in accidents.

I watched them treat and care for a variety of people in some pretty tough situations and I admired their ability to work under pressure and be caring, compassionate and honest towards their patients.

Under National we have delivered 2000 extra nurses and 800 extra doctors to our health system. Additionally, in 2011 our voluntary bonding scheme has more than 1800 doctors, nurses, and midwives signed up to work in hard-to-staff regions and specialties around the country. Since the scheme started in 2009 (and they didn't count nurses in the first year) 313 nurses and midwives have signed up in the three Auckland DHBs

Building a better health system is also about prevention and encouraging New Zealanders to take more responsibility for their own health.

We've increased the excise on tobacco products and seen a big increase in the uptake of Government subsidised nicotine replacement therapy. Now around 85 per cent of hospitalised smokers are getting advice and support on quitting smoking. Quitline is reporting record numbers of calls and quit attempts - up 50 per cent since the first big excise tax increase.

Keeping Kiwis healthy also goes beyond the health service. We have worked with the Green Party on the Warm Up New Zealand: Heat Smart subsidy scheme to help get people into warmer, healthier and drier homes. The previous government managed 4,000 homes a year, we've helped insulate 114,000 homes in two years, including more than 21,000 across Auckland.

We're spending around $65 million on nutrition and physical activity programmes for keeping children and young people active - including KiwiSport, Green Prescription, and nutrition programmes such as the Healthy Eating Healthy Action programme. We have also put a lot of effort into the "Before School Checks" programme. This is about identifying health and sensory problems, solving them early, and helping kids become school ready. We've cranked that up to more than 100,000 checks in two years - around 83 per cent of the target population.

I believe that this Government has been a careful steward of the public money that we devote to our healthcare system. We are delivering more elective surgery, working to keep more of our doctors, nurses and midwives in hard to staff areas, and delivering on preventative measures like immunisation and home heating.

There is more to be done but I believe we're on the right track and delivering a better health system.

Nikki Kaye is on Facebook and Twitter @nikkikaye

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