Checking the health system for fat

The Government has released figures revealing the public health payroll has grown by 6827 in the past five years - but rejects the Opposition's claims there is too much fat in the system.

The greatest proportional increases are in nursing and then doctor numbers, but management and administration staff have also increased by 1500 at district health board level.

They account for 19.8 per cent of all staff - compared with 19.4 per cent of all Crown Health Enterprise staff (their counterpart) in 2000.

It is these staff National, New Zealand First and Act have in their sights and want culled from the boards which now have a payroll of 48,150 people.

National leader Don Brash, who has signalled National will spend less than Labour on health, wants money stripped from the bureaucracy and invested in frontline services.

NZ First leader Winston Peters said yesterday that he wanted greater health spending, but less on the bureaucracy.

The Government has increased health spending by 50 per cent since 1999 and the health vote accounts for 20 per cent of all state spending.

Health Minister Annette King says the Government won't continue to increase spending on the current trajectory, but needs a significant cash injection to tackle key health problems: including increasing access to GPs, bolstering public health initiatives and reducing disparities.

She reformed the system, scrapping the Health Funding Authority and replacing the 22 Crown Health Enterprises with 21 district health boards and sub-committees.

Opposition parties claim the change has created new layers of unnecessary bureaucracy, but their attempts to get actual figures have been thwarted.

Those provided by Mrs King reveal the Ministry of Health has grown from 482 staff in 2000 to 1090 in June this year, an increase of 608.

However, the 2000 figures do not include the HFA and HealthPac staffing numbers which totalled 531 in 2000, before being disbanded. If staffing numbers for all three in 2000 are compared with Ministry figures now - the increase is only 77 staff.

But critics point out Mrs King said in 1999 she expected significant numbers of HFA staff to move to district health boards, as they gained greater control over funding.

Board staffing numbers have significantly increased and the number of "bureaucrats" is up 0.4 per cent.

National, Act and NZ First say that's too many for too few operations and are talking about potentially fewer boards and committees and probably ministry staff.

In addition to the debate over which positions can be called bureaucrats (see alongside) there have been wage-round increases, which aside from pay equity issues, are required to prevent people heading overseas.

Those increases have to be calculated into the spending versus productivity argument, she points out.

And of course it is medical professionals' wages - not those of booking clerks - which cost the money.

"I'd like them to tell me exactly where the waste is, because I haven't found any waste."

She says the extra bureaucrats are needed at the ministry to service new health initiatives, including screening programmes.

National is promising a baseline review of health spending and has yet to specify exactly where cuts will be made.

Mr Peters says he would start with the "21 different DHBs which are duplicating or triplicating 21 times over the service of health in a small country of 4 million people."

Hunting the health bureaucrats

One of the key issues in the health spending debate is also one of the hardest to pin down - what exactly is a bureaucrat?

The Government says many people listed as administrators or managers in district health boards are hard-working staff, who answer phones, fill in forms, update records and make sure everyone gets paid.

If they lost their jobs, doctors and nurses would have to do much of this work instead, giving them less time to spend on patients.

Opposition parties suspect the Government deliberately confuses the issue by producing figures which combine these staff with middle managers and policy analysts - the sorts of jobs they believe can be trimmed.

National health spokesman Paul Hutchison says the bureaucracy should make up about 6 per cent of DHB staff. But he's not sure he and Mrs King are comparing apples with apples, suspecting her count includes staff he wouldn't.