Health reporter Eileen Goodwin looks at some of the
health promises in this election, and issues facing the sector.
Health Minister Tony Ryall has set the bar high for
successful political management of a traditionally vexed
Mr Ryall pushed competition between health boards, and is
acknowledged for upping productivity in some areas.
Critics say his intense focus on targets and treatment
volumes is too simplistic and has caused neglect of things
that fall outside the official measures.
Health information is regularly published in league tables
and press releases, and the Government's strategy has been an
endless cycle of numbers and statistical improvements.
In a sector where few are allowed to make public comment, the
deluge of information sometimes lacks necessary context and
Long and potentially embarrassing surgery waiting lists are a
thing of the past - but that does not mean fewer people
Elective surgery wait times are five months at most, and if
patients do not qualify for the consequent threshold, they
are not on the list.
Some doctors have expressed frustration about the plight of
patients who do not qualify, but mostly the sector has been
At the same time as encouraging collegial competition, Mr
Ryall reduced unnecessary market-based competition and
An example was the fact the 20 boards had used 18 suppliers
of non-sterile gloves, when there were only two
Mr Ryall adopted two methods for shaking up the sector: one a
gentle move towards co-operation on a regional level, the
second the much more aggressive Health Benefits Ltd.
Established to centralise and organise bulk purchasing, HBL
has met huge resistance, its programmes beset by delays.
A plan to centralise hospital meals has echoes of 1990s-style
overly exuberant rationalisation.
Critics argue its cost accounting approach is too narrow, and
it rides roughshod over boards, wiping out regional
One DHB manager in a leaked memo labelled it a Ponzi scheme
whose costs had blown out, while its pay-back period was more
than 60 years.
''The New Zealand health sector is, through Health Benefits
Ltd, pursuing a path of centralisation which is creating the
single biggest risk to the delivery of public health services
in New Zealand in a generation, and at a time when the system
is under extraordinary cost and service delivery pressures,''
the memo said.
Claims in the explosive memo were denied by senior government
figures, including Prime Minister John Key and Mr Ryall.
Because the programmes mostly involve back-office services,
there has been little public impact, although there was
concern over the hospital meal plan.
Many health board workers in kitchens and other services face
long periods of uncertainty over jobs and say they are told
little about what is happening.
Not only have boards had to contend with the new dynamic
created by the Auckland-based HBL, they have had more active
management of their affairs from Wellington. Poorly
performing health boards have been under intense pressure
from the Ministry of Health and the National Health Board.
Combined health board deficits have reduced from about
$200million to $25million, while elective surgery procedures
increased from 118,000 to 162,000 a year, over the past six
To reduce deficits, some boards embarked on urgent
cost-cutting, which might prove costly in the long term.
A joke early in Mr Ryall's tenure reworked the health sector
mantra of Better, Sooner, More Convenient to read Better
Succumb to the Minister's Command, reflecting a reputation
for behind-the-scenes hands-on management.
While it has had less publicity, progress was made on
improving surgical safety and hospital acquired infection
rates, again using collegial competition to encourage
practices such as doctors washing their hands.
Whether Green-Labour or National, the next government is
likely to continue to focus on volumes and collegial
competition to cope with increasing demands.
The $15.6 billion health budget is pulled in different
directions: more older people, diseases of poverty and poor
lifestyle, new technology and medicines.
The parties have engaged in a mini bidding war over health
ahead of the election.
Labour seemed to be taken by surprise in May by the
Government's Budget announcement of free GP visits for
children under 13, starting next July.
In response, Labour promised free GP visits and prescriptions
to everyone over 65, making it the centrepiece of its
campaign launch last month. It also matched National's
promise for the under-13 age group.
The Green Party would give free visits to everyone under 18,
but does not favour free doctor's visits for those over 65.
Labour's policy for the over-65 group has not been
particularly well received in the health sector and has not
given it much lift in the polls.
Labour argues the policy will keep older people out of
Arguably, its 2011 promise to remove GST from fruit and
vegetables - which it abandoned in favour of its new policies
- was more in keeping with its desire to move the health
sector towards prevention, rather than treating symptoms.
Labour and the Green Party talk up the importance of
prevention in their respective health policies, including the
role of decent housing and diet.
However, the parties will face the same operational realities
in health until the benefits of longer-term change are
Labour and Green MPs struggled to land hits on Mr Ryall,
Labour making no impact at all until former health minister
Annette King was assigned the shadow portfolio last year.
Mr Ryall tended to dismiss criticism by repeatedly pointing
to shortcomings of the previous Labour government's
performance in health.
He also had an excellent grasp of the detail in his
portfolio. Attempts to blame Mr Ryall for lack of action to
address the obesity epidemic failed.
Mr Ryall will retire at this month's election, his six years
as Health Minister rounding off a 24-year career in which he
was also a Cabinet minister in the latter years of the 1990s
Green Party health spokesman Kevin Hague, a former health
board chief executive, is expected to be health minister in a
Dunedin-based National Cabinet minister Michael Woodhouse is
tipped as a possible health minister, should National win a
Tucked in Labour's health policy is an item that will get
little attention before the election, but would have a big
impact if implemented.
The policy would force health boards to deliberate on budgets
in public, rather than behind closed doors.
It is unlikely to be implemented, at least in any meaningful
way, but if it was, it would start the public debate on
health that has been lacking in New Zealand.