The focus should be on the frontline of our health service. Photo / 123RF
OPINION
You may have noticed that the election campaign is under way. The woefully lame slogans have been rolled out, the TV news features politicians walking the streets shaking hands, and our leaders are asking us to forget about their past and instead consider how wonderful they are.
The Prime Minister is continuing the mantra that we should overlook everything about the performance he and his team have delivered over the past six years, and instead have confidence in the fact that he is there for us. Really?
But we can’t overlook the past six years, Prime Minister. In fact, we must remember those years and their impact forever more. Our wallets will certainly be feeling the pain caused by those six years for a long, long time.
A year ago this week, I wrote a piece entitled “10 vital ingredients of a better nation”. At the top of that list was “law and order”. At numbers two and three respectively, I placed “quality healthcare” and “education”. The order was deliberate. While it is true that people with a better education are less likely to commit crime or suffer poor health, I figure that the number one obligation of any government is to ensure the health and safety of the population.
In my view, we are performing worse now in all three areas than we were a year ago. Crime is up. Health and education are in various states of chaos. The feedback to this column suggests that our citizens are deeply worried about all three. But I recently received a letter that made me dig a bit deeper into one area in particular.
Dr Hylton Le Grice is one of New Zealand’s most eminent physicians, a highly respected New Zealander and one of our most decorated medical practitioners. He was awarded the OBE, then made a Companion of the New Zealand Order of Merit for his services to the country as a surgeon, university teacher and company director. He was also chairman of the nation’s largest health insurer, Southern Cross, for seven of his 17 years on its board.
When people like Dr Le Grice write to you outlining the shameful state of our health service, you should take notice.
As much as our recent health ministers — namely Chris Hipkins, Andrew Little and now Ayesha Verrall ― have refused to use the word “crisis”, there is no doubt that it is the right description for the current status of our health service.
Note the word “service”. Our politicians are prone to calling it a “health system”. It is, and should always be intended as a “health service”. Pedantic? Perhaps. But to me, a system represents flowcharts and diagrams. A service is about looking after people. Perhaps that would be a good place to start.
As we know, this Government has introduced a new plan for health. The core of that plan has been to centralise the entire health service with everything being run by an even larger bureaucracy, driven out of Wellington.
The problem with that plan is that it is the absolute opposite of what we could have done and, in my opinion, should have done.
During my executive career, I developed a specialty for what I called “fixing broken businesses”. One of the things I learned was that nothing improved because you complicated it. But things can improve a lot if you simplify them.
Centralisation means complication. Too many people end up doing business with each other, while that person at the coalface, the patient, gets lost and forgotten.
If you think that bulging, centralised Wellington-based bureaucracies create better outcomes, consider this. Why do we have warehouses full of rapid antigen test kits, about 60 million of them, many of which are rapidly approaching or past their use-by date, which were purchased for a pandemic that is now behind us? The cost? Depending on whether you believe Te Whatu Ora or the Act Party, somewhere between $400 million and $500m.
Either way, it’s a disgraceful waste of money. If we meet them in the middle and call it $450m, that’s a lot of taxpayer dollars down the drain. At an average salary of $90,000 per year, that will pay for 500 additional nurses, every year, for 10 years.
Or how about the recent case of the 81-year-old woman, just down the road from Parliament, who upon fronting for the hernia operation for which she had been waiting for more than a year, was told it had been cancelled because the hospital was too busy.
She’s one of 6000 people approved for surgery who have waited more than a year for their operations. And then there’s the very sad case of the mental health patient made to wait for 94 hours at Auckland Hospital’s emergency department before a bed was made available.
Let’s not forget the 67,000 individuals who have been waiting more than four months for specialist appointments and treatment.
Incidentally, this health service has more than 8000 vacancies. And we need another 13,000 nurses and 5000 doctors within a decade.
Crisis? What crisis?
All this is occurring in a government department, the former Ministry of Health, that is now receiving 71 per cent more taxpayer dollars than it was just six years ago. That includes an additional $1.9 billion commitment to mental health in the 2019 Wellbeing Budget of which just over half was for health-related initiatives.
So here’s a question: where is all this money going? We’re spending almost 10 per cent of our total GDP on healthcare services. That’s almost double the rate that Singapore spends on its world-class health service.
As if the list above is not bad enough, while all this is going on, our health masters have made a decision to prioritise access to medical treatment based partly on race. How can a country like ours even consider such an approach?
Frontline medical professionals regularly make decisions to prioritise one patient over another. It’s a judgment that has been, and always should be, based on the needs of the patient and the urgency attached to their condition.
To ask those medical specialists to change the basis of that decision to one where patients are prioritised partly based on ethnicity is wrong. As Dr Le Grice told me last week, “it goes against everything I have ever understood about medicine”.
There is no doubt that we need change. But the problem with the centralisation experiment is that you take decision-making away from the coalface. I’d like to see us reverse the experiment and empower local regions to resolve their own and often unique challenges.
Auckland will have different health challenges to Taranaki. As will Invercargill, Christchurch and the West Coast. Lumping them all into one overburdened bureaucratic machine makes no sense. It’s like putting all of your small, difficult-to-solve problems into a big bucket and creating one big, impossible-to-solve problem.
The first challenge is that our health service needs to ensure that the frontline people (nurses, doctors etc) are present and available to treat the patient. To do that, they will need facilities, equipment and supplies.
All that happens at a local level. At a hospital or a clinic. Usually, that’s close to where the patient lives. The health service therefore needs some local management to ensure timetables and schedules are in place and the right people are in the right places at the right times.
To be effective, we will also need a supply line to purchase and deliver bedding, food, drinks, medicines, dressings and so on. That means we need non-patient-facing people to ensure the business end of managing healthcare is being looked after. The best place for those managers is close to the location of need.
At any hospital or clinic, that team of frontline and business people will need some leadership, perhaps a local medical superintendent who leads the response to the changing needs of the facility and the community it serves.
So far, nothing that is happening on behalf of that patient needs to be dealt with by a public servant in Wellington. However, between that superintendent and the Minister of Health, we currently have a bureaucracy employing thousands of people.
According to the Ministry of Health website, there are just 86 hospitals in the country. So let’s accept that there is scope for a centralised bureaucracy to ensure we’re delivering educated professionals, either through education or immigration, fit-for-purpose facilities, a supply chain for provisions to ensure economies of scale, and a workable process to acquire and deliver medicines and treatments. We’ll need to make sure the budget works too.
Everything else is local — nurses, doctors and specialists.
But how many people do we really need? Certainly not the thousands currently in the system. Maybe 1000 maximum.
If every medical superintendent had the authority to run their operation in the best interests of the local community they serve, three things will happen. First, you get better health outcomes at a local level. Second, you don’t need the mammoth bureaucracy. Third, you save non-productive money that can be distributed into the productive end of the service.
There’s a rider to all of this. At every level, we need to make sure we attract people of a suitable calibre. People who understand healthcare and know how to run a medical facility. We don’t need a return to publicly elected health boards — just a proper commercial footing with appropriate funding, the right people and the ability to get on with the job.
The Te Whatu Ora website displays the values the organisation has decided to live by. They talk about being welcoming, nurturing and caring. And they say, “We are a high performing team. We aspire to excellence and the safest care.”
My experience suggests that our frontline medical professionals abide by these aspirations every day. But beyond those dealing with the patients, from the minister to the bureaucrats, we are far from it.
It’s time to give control to the frontline. We just have to treat our people better than this.
- Bruce Cotterill is a company director and adviser to business leaders. He is the author of the book, The Best Leaders Don’t Shout. www.brucecotterill.com
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