Former Te Whatu Ora Health New Zealand chair Rob Campbell delivered this online presentation to the Health Coalition AGM today.
Whether you are working doing the job of three people in a ward or clinic, waiting too long for a procedure or other health service, wondering how you can get to the impossible number of homes on your visit list or maybe just following media stories on the health services system, you will be aware that the health services crisis continues and has not abated.
In none of those positions do you much care that this crisis of failure has taken years to build, nor care how hard and diligently people are working to patch over gaps, nor even possibly care that successive politicians and health sector leaders have denied, evaded or pretended that the tsunami of failure was not coming.
The sad news is that this situation will be with you and others for a long time. Do not believe anyone who tells you otherwise. Targets will not change it any more than evasion and denial. Only activity will.
This is true whether you believe the intent or the detail of the Pae Ora reforms is sound. My own view is that the first is true and the second partly true. But that does not much matter. You still have the same facts.
My expectation is that any changed government will not alter those facts. There may be some redecoration but the main facts will remain.
I hope that there is not much tinkering because the system and its people are just about as exhausted by efforts to paper over the gaps as they are by the gaps themselves. It will be best for all if these new structures, imperfect as they are, are allowed to develop as best they can.
So I welcome any discussion focused on how to work with and develop the structure rather than further restructure it as such. I think this is the most pragmatic approach for public health as for other aspects. I cannot let this opportunity pass without condemning as strongly as I can any suggestion that Te Aka Whai Ora be disbanded. This organisation is very new but its existence, properly sustained and directed by Maori, is critical to both equitable outcomes and to achieving healthy futures for all of us.
The context is a tough one for making public health a priority and delivering the essential and widely agreed outcomes of a great public health service. With so many holes and failures in the physical infrastructure and staffing of the “ill-health” part of the health services system it will be very hard to get attention and money for the critical part of wider Pae Ora equation which we all know is the “determinants of health” – both bad health avoidance and good health promotion.
Activism is the only answer.
I think that from ministers, to the ministry, to the health executives who pander to them, there will not be natural leadership in this direction. They will have to be pushed, harassed, and embarrassed into it. For Health Coalition and for those with similar approaches there simply has to be intense pressure based on:
* Ever-present research and education material in mainstream and social media;
* Combination to deliver this with the tertiary institutions and with the main professional bodies which are, for example, almost ignored in the health charter. Work as closely as possible with unions which are also well aligned and have cleverly got themselves far better featured in the charter than they were in earlier drafts from the “top” and can leverage this.
* But most importantly establish stronger connections with communities whose aims are well aligned. I would strongly target the Iwi-Maori partnership boards and the localities groups as they get established. These are well motivated but they will be resource short though they will be keen to be active. Health advocates must target and support them. This does not mean to ignore Te Whatu Ora and Manatu Hauora leadership but the inflexion point will be these new bodies and they will be hard to control from above. The top agencies know that the actions which bodies like Health Coalition advocate for are right – they just do not have the insight and courage to really push them or stand up to the more conventional views on health management and investment.
It is a pity that there is the artificial distinction there is between policy and operations in public health under the Act. These two can only effectively work hand in hand. The bureaucratic structure is what it is. To be effective Health Coalition must insist that both work together with those in the field seamlessly. Bluntly they must be forced to be the insistence of practitioners. There is neither time, nor energy nor money nor people to waste. You should all be roundly and openly critical of anyone who stands in the way. There are no bystanders in this fight.
Having national structures creates some opportunity for effective policies and implementation. But it would be foolish to ignore the possibility that direction and energy can be lost in such a structure, such a network. Hence my argument that only activism driven from the ground can work.
Kia kaha. We have to make it work.
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.