Provision of adequate healthcare should be above party politics, Gil Barbezat writes.
Most New Zealanders acknowledge that our health service is in crisis.
Our once impressive and well-performing system has been reduced to being short-staffed and deficient in resources, and can no longer meet some basic demands of our communities. Access to adequate care has become difficult for some, and impossible for far too many. Those in greatest need are affected most.
Healthcare is a basic human right that should be beyond party-political bickering. Our current crisis results from decades of underfunding and under-resourcing of the health services by both major political parties. Funding is essential for recovery to meet today’s needs and into the future. Smarter, more efficient delivery of services is an additional component.
Te Whatu Ora gives us a chance to effect meaningful change.
Improvement depends on healthcare staff from all professional sectors (medical, nursing, pharmacy, etc). These staff need to work as a team with excellent IT communication systems.
The current lack of patient care continuity between primary and secondary care requires urgent attention. Good management systems are essential, but need to be well informed and work collaboratively with those who provide the clinical care. Services in both urban and rural areas should be integrated into overall healthcare planning.
I can affirm the opinion of many that good care is received once access is gained to the services required. These experiences indicate that it is not primarily the staff that is at fault in the system, but the environment in which they must work.
Too few people are required to meet unrealistic demands in an impoverished environment. Service restrictions become a current method of evading demand.
At present, New Zealand tops the OECD country ratings relying on foreign trained medical staff. World markets are competitive in all healthcare sectors. Caution is required to ensure we rely on people of good standing trained in recognised institutions.
Appealing working conditions and better remuneration will attract overseas trained professionals. Most urgently, we need to support better training facilities for more health professionals in our medical schools and polytechnics.
Those who choose to spend their discretionary funds on healthcare can choose to access that in the private sector. That is limited in choice (no emergency care) and is expensive. This would help by taking some demands off the public system.
The American system, based mainly on private user- pays care, records the highest expenditure per person as a percentage of GDP compared to all other OECD countries (United States 17.6% v New Zealand 9.7% in 2019). In contrast, it ranks very poorly in most outcomes.
Having this as a dominant or sole alternative to public services is unacceptable, particularly in circumstances where those who cannot afford the cost or medical insurance must do without the care.
A vital question remains. Who will pay for the better funding and resources for our healthcare?
Surely this should be beyond party politics. Two recent letters to the ODT suggest that multi-party agreement should be reached on raising specific healthcare funds.
Ultimately, funds would have to come from the public in some form of taxation, but vitally, ring-fenced for health spending. Surely politicians should look beyond limited horizons and appreciate that we must all contribute to the welfare of our country and its citizens. This would be money well spent as there are excellent data showing every dollar invested in healthcare saves more than two dollars later demanded for expenditure.
Our national sports teams can rely on strong backing from the New Zealand public. Why should the equivalent enthusiasm not be expressed towards providing and funding modern healthcare?
How the new funding is spent will be contentious, but the current situation is in stalemate; funding is insufficient to support the clearly demonstrated needs. Consensus decisions would make it possible to progress healthcare in a positive direction.
Experience in Costa Rica has shown that such an approach is not only possible, but highly successful in raising community healthcare standards. (Dr Atul Gawande, "The Costa Rica Model", New Yorker, August 30, 2021).
The status quo is unacceptable. It is currently on a slippery slope which could easily disadvantage everyone by tilting further in the wrong direction. Close follow-up of vital data is important and necessary to monitor progress. Input would be known and the desired outcomes have already been defined in New Zealand. The success or otherwise of introduced measures could then be measured. Maybe the Ministry of Health could then become accountable for what it has or has not achieved in providing equitable services for all sections of our community.
As one ODT correspondent has suggested, the same multi-party approach could be suggested for education and social welfare.
Both require an injection of dedicated funds, common sense and goodwill to be viewed as vitally interrelated entities beyond party politics.
But that is a question for another day.
- Gil Barbezat is an Emeritus Professor of Medicine. Public health medicine specialist Brian Cox, GP and palliative care specialist Dave McKay and retired specialist surgeon Murray Pfeiffer contributed to the article.
