Health Minister Ayesha Verrall. Photo / Jed Bradley
OPINION:
There might be plenty to niggle about over how the rebooted health system is functioning, but it’s difficult to find fault with the devoted frontline staff in hospitals who do the mahi, day in, day out.
As someone who from time to time has received inpatient and outpatient treatment at Wellington Regional Hospital, I speak from experience. This month I was there again and found, inevitably, that the service remains gold standard.
Whether it be the doctors, nurses, therapists, technologists or the help desk volunteers, all are professional and unfailingly polite in their dealings with patients, and visitors too. I can’t speak for other hospitals, but my expectation is that this sort of experience is probably the norm around the country.
To channel a Fred Dagg classic, we don’t know how lucky we are.
Health Minister Ayesha Verrall, during her maiden speech in Parliament in December 2020, spoke of her time as a junior doctor in Wellington. In a message pitched to her former patients, Verrall said: “I want you to know what a privilege it was to care for you.”
You get the sense her words are an axiomatic truth for all who work in hospitals. They are people who feel honoured to be doing their daily jobs.
So a plea to those who whinge about the system’s problems: never bag the workers. The ship isn’t sinking, as Shane Reti laments, because the dedicated professionals crewing the ship will simply never allow that to happen.
But clearly, things are far from rosy. Long emergency department wait times, funding shortfalls, staff shortages and burnout, a growing demand for acute services, plus the lingering effects of the pandemic — all are contributing to a testing time for the sector.
Add to that the new structures that are still being bedded down, and the kerfuffle over data issues, and it’s no wonder there’s an impression that things are going awry.
The health administrators clearly have to lift their game.
Former Te Whatu Ora chair Rob Campbell, who went from one of the most powerful figures in the health hierarchy to a victim of his own candour, had a point with his “freeing minds” call, which saw him urging hospital managers to see opportunities, not obstacles, and to serve their communities, not their bosses.
I imagine that Verrall, who was Campbell’s executioner, wouldn’t disagree with those sentiments. She has made it clear she expects Te Whatu Ora to do a better job and do it faster, so that staff pressures are eased and New Zealanders begin to see the gains that the new order promised.
The predicament for public healthcare is that it’s so large and complex that improvements don’t happen quickly. No matter how much money is thrown at it — and this Government has thrown plenty — or what the framework looks like, the challenges remain daunting. It seems that has always been the way.
For that reason, the health system has long been something of a playground for reforming politicians. Successive governments have tried their hand at restructuring in the name of efficiency, effectiveness and spending taxpayers’ money wisely.
Anyone remember hospital boards? In the 40 years since they disappeared and were replaced by area health boards, with a mix of locally-elected and appointed members, different versions have come and gone.
The early 1990s saw the Bolger Government’s quasi-market reforms. Four regional health authorities were established and the 14 area boards reconfigured into 23 Crown health enterprises, structured as for-profit organisations and subject to ordinary company law.
The funding, purchasing and provision of healthcare were separated, and the government’s drug-buying agency, Pharmac, was created, amid skyrocketing prices for medicines. User charges were introduced in public hospitals — ouch! — then quickly dumped.
Soon afterwards, the reform juggernaut stirred again, with the four RHAs being rolled into a single national purchasing agency, the Health Funding Authority. That lasted just four years.
In 2000 Helen Clark’s Government further streamlined the system. The HFA was folded into the Ministry of Health and district health boards, funded through a population-based formula, became the providers of health and disability services. Primary health organisations also joined the mix of services.
DHBs lasted 21 years, during which time there were further innovations, including Whānau Ora, launched in 2010 by the Key Government in recognition of poor health outcomes for Māori.
Most recently we’ve had the Heather Simpson review, most of which the Government has adopted. It centralises the system, giving Wellington far greater influence. Te Whatu Ora has taken over hospitals, a new Māori Health Authority, Te Aka Whai Ora, has emerged and debt-laden DHBs have been consigned to the scrapheap.
Of course, the healthcare system will continue to be politically vulnerable, as it always has.
Listen to the drumbeat from National. If elected this year, they’re promising to save health dollars by slashing the bureaucracy and consultants, and by torpedoing the new Māori Health Authority, even before it has had the opportunity to demonstrate what it can offer.
But irrespective of how the system is configured, there are two unshakeable facts.
First, health spending will inexorably climb, driven by a combination of factors such as an ageing population, greater acute demand and the rising cost of new buildings, technologies and drugs.
And healthcare workers’ professionalism and compassion will continue to shine — which ultimately is what really matters.
- Mike Munro is a former chief of staff for Jacinda Ardern and was chief press secretary for Helen Clark.
Economists expect the recovery continued during the first quarter of the year.