This might hurt a little bit: policy check-up

Tony Ryall
Tony Ryall
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 portfolio.

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 clarification.

Long and potentially embarrassing surgery waiting lists are a thing of the past - but that does not mean fewer people waiting.

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 compliant.

At the same time as encouraging collegial competition, Mr Ryall reduced unnecessary market-based competition and duplication.

An example was the fact the 20 boards had used 18 suppliers of non-sterile gloves, when there were only two manufacturers.

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 initiatives.

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 years.

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 hospital.

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 realised.

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 National government.

Green Party health spokesman Kevin Hague, a former health board chief executive, is expected to be health minister in a Green-Labour Government.

Dunedin-based National Cabinet minister Michael Woodhouse is tipped as a possible health minister, should National win a third term.

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.


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