Rob Campbell is a professional director and investor. He is chancellor at AUT, chair of Ara Ake, chair of NZ Rural Land and former chair of Te Whatu Ora.
OPINION:
Government spending on health services is a large part of political debate, not least at Budget time. That is becauseit involves big numbers and because it is such a personal matter of interest for so many of us who use or work in the health services.
It often seems that the Government (whichever party is in power) is spending more but either on the wrong things, or in the wrong way, or inefficiently. Probably all three are wrong most of the time.
Certainly they are again this time around. I would guess that pretty much every interest in the health services which rely on Government spending will be dissatisfied to one extent or another.
Gumboot Friday founder Mike King (right) with Deputy Prime Minister Winston Peters and Mental Health Minister Matt Doocey.
Much attention has been given to the payments made to Gumboot Friday. In my view this support for youth counselling services is useful. But no one would pretend that it will shift the dial on the factors actually causing mental distress, let alone solve ongoing mental illness itself and its treatment. Something can be good without being enough or complete.
Politicians oversell their deeds habitually and there is no known treatment for that disease.
Whānau Ora has been one of the success stories of health and social services in recent years. There are not many of those, far from enough of them. They have maintained past funding levels and that is welcome, as they recognised in statements, even while they were actively and rightfully engaged in activations against the myriad inequities being imposed on Māori.
The shame is that they could efficiently and effectively deploy so much more through kaupapa Māori health services if funded and able to avoid the Te Whatu Ora bureaucracy into which Te Aka Whai Ora has been largely absorbed.
Dr Lester Levy is the new/old chair of Health NZ.
The manner in which Budget health funding allocations have been made shows that very little has been learned about what works in primary health services.
There is enormous demand for health services, driven by demography and the many stresses and adverse consequences of how we live, work, eat and behave. Some people can deal with this by the way they can afford to live and access health services. Others cannot. We know who the two groups are. When the Government makes tax and spending decisions it makes important choices for us.
Those choices can help landlords earn investment returns or assist renters’ living conditions and costs.
They can help investment returns from extractive forms of industry or invest in clean air and water.
They can build prisons or homes and kura.
They can employ more police or defence personnel or fund carers.
The choices are boundless and you can tell what they value from what they do.
Rob Campbell, former chairman of Te Whatu Ora. Photo / Michael Craig
Within the public health system (funded and directly provided) the choices made in this Budget reinforce mistakes made over many preceding years:
* No real substantive effort to get pay and working conditions for carers and clinicians in training and early career at a sustainable level;
* No real shift of resource to kaupapa Māori health services, or for that matter to match the cultural health needs of other populations;
* No real shift to health care in the community from hospitals.
So we should expect to see inequity in health outcomes continue. Expect to see an increasingly “two-tier” health service based on income and wealth.
So all those people who feared separate health systems based on ethnicity will probably get what they said they did not want. But they will be safe in the privileged part.
