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It is often said the human body is the most complex machine in existence, but the system designed to keep that body healthy must come a close second.
The multiple layers of New Zealand’s health care system have been probed, tested and diagnosed for the past two years by former Prime Ministerial staffer Heather Simpson and a team of experienced health professionals.
The first part of their labours was revealed in September last year, a stocktake of the New Zealand health system.
The eagerly-awaited and much more complicated sequel, how to cure this ailing patient, was released last week.
No half-hearted document, the Simpson report calls for major transformation in the governance and administration of the health system, and greater focus and resources deployed to improve the well-being of those whose health outcomes are statistically poor.
All well and good, but there are few specifics offered as to the mechanics of how all this will be achieved.
With an election less than 100 days away and the Covid-19 pandemic consuming the attention of the Health Minister and his officials, it seems unfathomable that any substantial changes could — or indeed even should — be initiated in the short term. As to the long term, that very much depends on the outcome of the September 19 election.
Current health minister David Clark has already committed to appointing a ministerial committee to provide ongoing expert advice on health reform. Decisions on individual recommendations will be considered by Cabinet, which is as good as saying this will be a matter for Labour’s next term, should it achieve one.
Dr Clark was careful to avoid committing to specifics, saying the Prime Minister would lead a group of ministers to "drive the changes".
On the other side of the House National health spokesman Michael Woodhouse criticised the delay in releasing the report, said he expected nothing would happen any time soon, but was also careful not to tip his hand as to what he thought of the report’s contents.
This inevitable delay might be a bad thing: it is quite possible that its carefully thought out 274 pages could linger, forgotten in the post-election aftermath, especially if a party other than the one which commissioned the report forms the next Government. Alternatively, the fact the election campaign is looming might be a good thing.
Despite the generally favourable response to the report from the health sector, there is much in the Simpson report which is contestable rather than agreed with unanimity, and a decent nation-wide debate on a health system everyone uses should be held.
As it stands, the report recommends a substantial decrease in the number of district health boards, and the scrapping of elected representation. The Southern District Health Board — an arranged marriage between the Otago and Southland hospital boards — has had plenty of experience of regional voices claiming they have been disenfranchised, a peril which will face any future merged health boards.
There must also be concerns about how connected locals will be with health boards appointed from Wellington, how responsive those boards will be local issues, and how communicative they will be with those communities.
The report’s call for greater emphasis on primary health mirrors current health administration thinking, but there remains the question — already brought into focus by Covid-19 — of how to make the sector financially viable.
Resource allocation will also be a headache for the next Government, given there has already been a substantial commitment to the national cancer control agency and tackling an illness which is expensive to treat and with case numbers which will continue to increase for years to come.
The report’s call for greater emphasis on Maori and Pacific Island health will seem inarguable to some but contentious to others.
Those are but a few of the many issues raised. The work highlights important concerns and it deserves a considered, effective response.