Peter Davis: Health crisis? What health crisis?

Our health system is being judged on a series of irruptions of concern - often based on single cases, anecdotes, questionable data, and special interests. Photo / 123rf, File

OPINION

Barely a day goes by without concerns loudly and forcefully expressed by advocates, health unions, lobby groups, and members of the public about the functioning of the health system.

In turn, these concerns are amplified by the media, such that we now apparently have a “health crisis” on our hands and the Minister of Health is then reviled for being loath to admit it.

Yet, health funding has increased 40 per cent over the last five years, an increase I have never seen even close to being matched before in my near-half century academic career in health policy and health services research.

So, is there a health crisis?

We simply don’t know – and we should. We should have objective, independent information available that would allow us to draw that judgment. But we don’t.

The public is done a great disservice by the lack of availability of such information.

During my just-completed three-year term on the Auckland District Health Board, we had a complete dashboard of key information about the functioning of health services in the region, mainly hospital-focused but also relevant to primary and community services.

That has all disappeared. We now have a series of irruptions of concern often based on single cases, anecdotes, questionable data, and special interests. This is not to deny there may be fire where there is smoke and that these are all real experiences with real consequences. But, without a larger picture of information, we cannot easily pass judgment on the scale of the problem and how to address it.

My tenure on the Auckland DHB ended in mid-2022. That’s just a few months ago. In the previous three years, Auckland was in the eye of the storm, including the onset of Covid. Not once were we as a board tempted to call our circumstances a health crisis. Critical in some areas, yes, and under severe stress, but not a continuing crisis.

Our management team were generally able – just – to deal with “the slings and arrows of outrageous fortune” that were hurled at us as almost every conceivable adversity and setback came our way.

Yes, management had to do things differently. For example, they had to get senior doctors to be present on the wards at weekends to make judgment calls on whether or not patients could be discharged, thus freeing up beds for new admissions, including those coming from ED.

Can we get to a position where information on the functioning of the health system can be publicly available and form the basis for informed debate, rather than just relying on claim and counter-claim?

An example of what can be done is the establishment of the Cancer Control Agency (CCA) in 2019. This is an area of great debate and public concern, well-populated by advocacy and lobby groups. The CCA publishes a series of informative reports on the sector, including on cancer drugs. As a result, much of the heat has gone out of the debate in this area. Debate is better informed, and, as a consequence, more productive.

The public would be better served by the availability of timely, searching, and comprehensive data on the functioning of the system, including key elements of infrastructure such as equipment, facilities, and IT. This is not just a matter of health. Recently we learned of unexpectedly high failure rates from a trial run of NCEA numeracy and literacy tests. Is this the way to find out these things?

Peter Davis. Photo / Supplied

In Australia, there is a comprehensive, longitudinal analysis of basic educational attainment information called NAPLAN. The results from that work are available for debate and, indeed, they show that Australia is suffering a decline in some key educational standards. But that is a far more comprehensive and continuing assessment of the sector than what we have available in New Zealand.

Water infrastructure would be another example. How did we get to a situation where depreciation was rarely properly set aside for future investment and we only got to know about shortcomings in such infrastructure when it started to break down? Again, we have been operating for decades without publicly-available information on essential infrastructure with enforceable requirements to show prudence in providing for future generations.

What is startling is that, in many instances, the data required to underpin such publicly available information dashboards on key services is already being collected as part of the management of these services. Thus, on the Auckland DHB, we were often just collating information that was already being collected for clinical and administrative services. The same could be said of education, water infrastructure, and other essential services.

Is there a health crisis? Maybe. A water infrastructure crisis? Probably. A decline in educational attainment? Perhaps. But let’s have the information on which to make those judgments.

Peter Davis is an Emeritus Professor in Population Health and Social Science at University of Auckland, and a former elected member of the Auckland District Health Board.