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Is a whack-a-mole approach to health more likely than a cohesive and comprehensive one?
One thing National, Act New Zealand and New Zealand First all agree on is scrapping the fledgling Te Aka Whai Ora Māori Health Authority. But it is not clear if there is agreement on how best to improve woeful Māori health statistics and how much money might be allocated to that.
The most recent report card on Te Whatu Ora Health New Zealand shows it has some way to go before the health reforms are completed and working effectively. Ways to make it work will need to be found as there will be no appetite for further restructuring.
In our impatience for improvement, it is easy to forget the issues still dogging the system were there long before the reforms — short staffing, poor pay and conditions making the grass greener elsewhere, calls for more clinical leadership, a lack of cohesion between community and hospital care, and years of under-investment in people, equipment, information technology and buildings.
Questions around adequacy of health funding and how best to allocate it have not disappeared either.
Since the early 2000s the bulk of Vote Health’s billions was distributed to the country’s district health boards according to the poorly understood Population Based Funding Formula (PBFF). This assigned funding to each member of the population based on an expected average yearly cost per person. Age, gender, ethnicity, and deprivation are taken into account and three adjusters are used to allow for differences in the costs involved in serving rural areas, overseas patients, and meeting unmet needs in Māori, Pacific and deprived populations.
There is no clarity yet about the fate of the PBFF, although earlier this year HNZ said it was working on new funding models aligned with the health reforms.
In the meantime, which promises to splash the health cash will survive the coalition talks and what impact might that have on expenditure elsewhere? Among them is National’s commitment to correct pay disparity between HNZ employed nurses and those working elsewhere, something likely to cost hundreds of millions of dollars.
All three parties are about to learn it is much easier to criticise the health system than be in charge of it.
And another thing
Only in their dreams could any of them secure nearly 83% of the vote. There would be no need to put up with any preening and posturing and squawking from the also-rans (in the competition’s case the North Island brown kiwi and the kea) to sort out the pecking order.
There will be mixed views about the influence of British American-based television comedian John Oliver who’s self-described "alarmingly aggressive" campaign for the puteketeke included billboards in Paris, Tokyo and Brazil and his spectacular grebe outfit.
But what a coup it has been for Forest and Bird in its centennial year. Not only has it attracted international attention to the threatened grebe which, let’s be honest, many of us had never heard of, but it has also highlighted the plight of other endangered birds and helped to boost the organisation’s coffers to carry on its good work.
Here in Otago, we can fluff up our feathers a little and stick our chests out because of the part the Lake Wanaka Grebe Project, begun by zoologist John Darby more than 10 years ago, is playing in aiding the bird’s survival.
Not that the controversy is quite over yet. Questions are being asked about whether the puteketeke’s head plumage resembles a mullet, as Oliver suggests, or an ’80s punk rocker.
Whatever the truth of it, bad hair days will be the least of any of our struggling birds’ worries.