Kathy Spencer: Has Andrew Little been sold a pup on health reforms?


Andrew Little appears convinced the announced restructuring of the health system will achieve major improvements in equity, consistency, and health outcomes.

However, there is absolutely no explanation of how this will happen. The steps to get from the structure to the resolution of longstanding problems are completely missing.

Melissa Vining, who has campaigned for faster access to care, pointed out: “There’s no immediate plan to address long delays for cancer care, pressure in EDs and … pressure in
people being delayed or going without surgeries.”

Bringing DHBs into one organisation (Health NZ) won’t make these problems go away. It will still be hard to attract GPs and specialists to certain parts of the country, to galvanise the hospitals to deliver services in a much more timely and consistent way, and improve services for people with disabilities.

In his announcement, Little said the reform was “about doing better with what we have”. However, it is not realistic to think significant improvement will happen without additional funding.

Kathryn Ryan has interviewed several commentators on her Nine to Noon programme. But she put her finger on it when she asked her IT expert why we didn’t already have a national IT system for health: “Why haven’t we just dealt with that issue? Why are we now thinking that a massive massive restructuring, with all the distractions and pressures that come with it, is suddenly going to resolve that we’re short of specialists, that we’re short of GPs, or that our IT systems are out of date?”

A major restructure won’t resolve these issues. The main impact will be a long delay in progress on any front while the deckchairs are rearranged.

While DHBs are being brought together into Health NZ, the Ministry of Health is being pulled apart, with its functions split between a new Ministry, Health NZ, and a Māori Health Authority.

The ministry has been restructured five times in 10 years, most recently by Ashley Bloomfield in 2018.

The structure he put in place has a directorate for Māori Health and another focussed on public health, which is leading the response to Covid-19, as well as managing programmes to prevent disease.

We are told the new Māori Health Authority will “…work alongside the ministry on strategy and policy, and partner with Health NZ to craft care…”

It is hard to see how this can work because the functions of the three organisations are too closely related. For example, the investment in prevention, the overall funding of the system, and the service delivery objectives for Māori and for the wider population, are inextricably linked.

When organisations have to co-design and partner, where does the accountability actually sit and what happens when they can’t agree?

Disparities in access and outcomes for Māori, long waits, and people missing out on medicines or services, are problems that have persisted under many different health structures. Blaming the structure is a mistake, and looking for the perfect structure is a waste of time.

All the strategy, plans, and accountability levers to achieve the Government’s aims are already there.

Significant progress has been made in the past through incremental change, eg to the way primary care is organised and funded, and more recently through the investment into mental health. The review of Pharmac will be another positive example if it gives us better and more timely access to medicines.

Problems can be addressed if there is a willingness to use the levers to make the system work, and to invest adequate funding.

Instead of being diverted into legislative change, organisational charts, and shuffling people from one organisation into another, the effort and energy should be focussed on solving the most important problems.

Identify the highest priorities for improving access and outcomes for Māori; set a target of removing the disparities within two years; commit to everyone being able to see a GP within seven days for a routine appointment.

Recruit GPs to parts of the country with poor access. Bring them in now, through the quarantine system, while NZ is a particularly desirable place to live.

Develop a unified IT system across the health sector so health records are readily available wherever people are treated.

Get visibility back by reinstating regular public reporting on the system’s performance, including access to GPs, timeliness of specialist appointments and planned surgeries, satisfaction with disability support services, and reports on how the large injection of funding into mental health is being used.

These are the areas that need actioning, not a major restructure that will take everyone’s focus off the end game.

Kathy Spencer was a deputy director general in the Ministry of Health, a general manager in ACC, and a manager in the Treasury. She has also worked as a senior adviser to a Minister of Health and a Minister of Revenue.

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