Labour's promise to cut the cost of going to the doctor by $10 from July 1 this year will now have to be phased in over time, Health Minister David Clark has said.
He points to Labour having had to meet the cost of new priorities from agreements with the New Zealand First and Green parties, Labour's partners in Government, as the reason the full policy cannot be implemented from July 1 as promised.
Clark's admission is the first time a minister has conceded that an election promise may have to be delayed.
Labour promised that from July 1 this year, the cap on doctor's visits for very low-cost access practices would be lowered from $12 to $2 for those aged 13 to 17, and from $18 to $8 for patients age 18 and over (it is already free for 0 to 12 year olds).
For visits to other GPs it promised, from July 1, to reduce the average cost from $30 to $20 for teenagers and from $42 to $32 for adults, and to cap the maximum fee at $59 from $69.
The policy was estimated to cost $213 million a year.
Clark made it clear today the policy will now have to be phased in but has given no hint as to how - whether there will still be cheaper doctors' visit across the board but in staggered amounts, or whether the full $10 cut will apply but that some categories will have to wait longer.
"I am pursuing the principle that we get more affordable access to primary care in this country," he told the Herald. "And what happens when you form a coalition Government is that you agree priorities and we are responding to the priorities as they are outlined in the confidence and supply and coalition agreements.
"I am pursuing cheaper doctors' visit but I am signalling that that will be phased over time."
They are running big deficits right now and they should not be and I expect better financial performance.
Clark earlier today announced new chairpersons for the Auckland region district health boards, including former Labour cabinet minister Mark Gosche for the troubled Counties Manukau District Health Board, which has a budget of $1.36 billion; Pat Snedden for Auckland DHB (who has held the position before) with a budget of $1.25 billion; and Judy McGregor for Waitemata DHB with a budget of $1.46 billion.
Clark has also appointed experienced health administrator Ken Whelan as a Crown monitor on the Counties Manukau DHB, which ended its last financial year about $13 million in deficit, and with forecast deficits to come.
He said he had thought about creating a single chairperson for all three DHBs – which Lester Levy recently held - but said they were all big jobs.
However, he will be asking the DHBs to appoint a common chairperson of audit and risk across the three DHBs, so that there would be a connection at a management level.
The audit and risk committees on DHBs were the ones "that asked the challenging questions and looked at the services being provided."
Clark said Gosche had welcomed the addition of Whelan to the board – he is a former chief executive of Capital and Coast DHB – and Whelan's brief was not focused on the leaky buildings problems at Middlemore. It was broad.
Counties Manukau had a rising deficit and as one of the bigger DHBs is was expected to manage "its unders and overs" because they had more flexibility in their budget.
"It is concerning that they have those rising deficits and don't seem to have a convincing plan yet to get them under control"
Clark said he was going to be very clear with DHB chairs about the need for financial prudence and management.
"I will be wanting to see improved financial performance from those DHBs, make no question about it.
"They are running big deficits right now and they should not be and I expect better financial performance."
Clark also said he wanted better monitoring from the Ministry of Health and earlier intervention if the DHB wasn't handling things well.
"I'm expecting the Ministry of Health to be developing those functions again, where it is actually not a passive monitor but is a monitor that is actively engaged with DHBs where it becomes clear they are not doing the job themselves."
Clark also told the Herald he was considering holding a larger review of the health system – although any changes would not be implemented in this term of Government.
""But I do think it is timely to have good hard look at the way the sector operates to be confident that taxpayers are getting the best value for money that they can be getting."
National's health spokesman Michael Woodhouse said Clark's admission that cheaper doctors' visit would have to phased in show that the Government had "considerably over-promised and is now backtracking by breaking a campaign promise."
"The Prime Minister has recently stated the issues at Middlemore Hospital are emblematic," he said.
"I agree – emblematic of a Government that has manufactured a crisis that doesn't exist in order to mask its broken promises."