by Kevin Hague
National’s tactics in the House this week, first from Health Minister Tony Ryall, and then from his Associate-Minister Jonathan Coleman (acting in Ryall’s absence) were to attempt to divert attention away from my questions about their privatisation agenda in Health by attacking the questioner (me).
‘Shooting the messenger’ is a classic case of the kind of unhealthy politics that the Greens are trying to reform. While we believe debate can be robust, we nonetheless believe in treating others with respect and debating ideas rather than allowing an exchange of insults to substitute for grown-up behaviour. In consequence I won’t be responding to these smear tactics. We also believe that Ministers should actually have to answer questions, so for the sake of those for whom National’s tactics may have obscured the issue, here’s what we learnt this week:
- Despite Tony Ryall’s rhetoric about involving health professionals more in decision-making he did not consult the Association of Salaried Medical Specialists (essentially the NZ organisation of senior doctors) before deciding that DHBs should contract more of their surgery to the private sector. His reason for not doing so was that he had talked to them about National’s health policy before the election.
- There is a long-standing set of rules for DHBs contemplating contracting out surgery to the private sector. In amending these to facilitate more private surgery he has removed the explicit requirement previously placed on DHBs to consult their health professionals before doing so. His explanation for this was that he expected DHBs to be consulting health professionals all the time, so no special protocol was necessary.
- The Government refused to answer whether they had any information about how much public hospital operating theatres are used before Mr. Ryall made the decision to contract out more surgery to the private sector, but it appears this was not something they had considered.
- In fact analysis undertaken by the Ministry of Health comparing theatres in NZ public hospitals to a benchmark from Victoria Australia found that the theatres in 10 out of 26 hospitals were used at less than 60% capacity, while just 4 were used at full capacity. The Government is now aware of this information and argues that this under-used capacity will be insufficient in the future. This explains why more theatres may be needed in the future (although that decision looks rushed and ill-considered too) but has no relationship to the private contracting decision.
- The Government dodged questions about whether they believed more people should have private health insurance and whether they were deliberately weakening the public sector to engineer this outcome, to shift health cost away from Government.
The take-out message is that Government was determined to contract out more surgery to the private sector. This determination was not based on evidence, but either some promise made to the private health sector or simply ideology. They are entirely prepared to remove obstacles to this decision (like consultation with doctors!) should they stand in the way.
The other action sought by the private health industry from Government was encouragement of more New Zealanders to take out private health insurance (who knew?). We haven’t yet been able to confirm that this is what Government is trying to deliver – it could just be inadvertent – but their actions so far seem to fit this agenda.
Published in Health & Wellbeing by Kevin Hague on Thu, July 30th, 2009
Tags: health, Kevin Hague, private hospitals, privatisation
More posts by Kevin Hague | more about Kevin Hague
on the trolls and those who are unable to keep on topic
‘Shooting the messenger’ is a classic case of the kind of unhealthy politics that the Greens are trying to reform.
Cough, cough!
What about Paula Bennett alerting the working class of Aotearo that many beneficiaries earn more than they do!!!!
Like or Dislike:
0 
0 (0)
Great to have Kevin (with background and experience in the Health Sector) IN Parliament as Green Spokesperson for Health.
Hopefully discerning Media will pick up on the serious squirms from National Cabinet members (and, presumably, from various interested parties in the private sector) when Kevin speaks on this issue.
How many times do we Kiwis have to go down this “public”?/”private”? route before we realise that a comprehensive health system available for each according to his/her needs from all of us according to our collective means is the most efficient and equitable way to go.
Like or Dislike:
0 
0 (0)
yes kevin..but you are asking strong/logical/relevant questions..
..and to any observor with a pulse..
..they just look like obfuscating fools..with their mindless non-responses..
..and totally negligent for not fronting up to their responsibilities..
..and after each encounter..you inch up the pole..
..and they inch down..
..the longer that dance goes on..
..the higher you get..the lower them..
..you are fast presenting as one of the strongest performers in parliament..
..so hey..!
..a win’s a win..
..eh..?
phil(whoar.co.nz)
Like or Dislike:
0 
0 (0)
Cough, cough!
What about Paula Bennett alerting the working class of Aotearo that many beneficiaries earn more than they do!!!!
Are you just trolling, or are you really unable to discern the important difference between these two examples?
Like or Dislike:
0 
0 (0)
Valis,
How about comparing apples with apples?
Are you sure you are not being “used” when repeating sound bites that, it appears, have been deliberately “put out there”?
I completed an unfinished MA (one more paper and a previously uncompleted thesis) when my kids were young. I had a deadline: to complete in that year or miss out on getting that MA. As an unsupported sole parent with dependent kids, my University fees and my thesis expenses were paid by Social Welfare.
It was Social Welfare’s policy that all unsupported parents who were eligible for a benefit (including Unemployment Benefit or Student Allowance etc) were put on the DPB because it is the ONE benefit designed to be flexible with the “add ons”etc to do with the needs of dependent kids etc. Thus the statistics of the numbers on the DPB are skewed in a way that gives great glee to the all-too-frequently-uninformed “bludging Solo Mother” bashers.
Similarly, it is possible that the amount of money that Paula is quoting was to do with specially selected post graduate course fees, course costs or similar… (she is, after all, a right-of-centre politician, quite possibly with a target audience in mind!)
Also it could be that some or all of this money would be repayable later.
(Just a few thoughts outside of the black and white!)
eredwen
Like or Dislike:
0 
0 (0)
Valis,
I apologize!
Rereading what you wrote …
I had missed the point that you were writing in response to JH .
e
Like or Dislike:
0 
0 (0)
“Great to have Kevin (with background and experience in the Health Sector) IN Parliament as Green Spokesperson for Health.”
Well maybe.
Perhaps you should have a look at Grey base hospital and its many problems and blown budget before you commend Kevin as a health spokesman.
There are many people in Greymouth who seem to think it is possibly Mr Hagues fault.
Like or Dislike:
0 
0 (0)
No worries, eredwen. An informative post.
Like or Dislike:
0 
0 (0)
actually Kiwi born kids have been dropping faster than the tide of migrants waiting to dislodge them…..meaning we are losing the old ‘kiwi’ amidst a sea of migrants…..the jet age shall poison us all – seven ways til breakfast,
get out there kiwi – you aint Really tryin….
‘we’ve always shot the messenger’ –
;its what we do – you see tha’ Jesus get nail’ up?
He wiz just one of us dude….
Had a loyal terrier die this week – i’ll miss that kind of loyalty
reckon it’s snowing on the tops…..
Like or Dislike:
0 
0 (0)
“..Had a loyal terrier die this week – i’ll miss that kind of loyalty..”
sorry to hear about yr dog..mark..
they are ‘the best’..eh..?
phil(whoar.co.nz)
Like or Dislike:
0 
0 (0)
“Similarly, it is possible that the amount of money that Paula is quoting was to do with specially selected post graduate course fees, course costs or similar… (she is, after all, a right-of-centre politician, quite possibly with a target audience in mind!)”
Ah! What people make on the DPB is a nebulous thing
like looking clouds.
It’s a great unknowable
A mystery
Philosophers have pondered the question for centuries
Better not involve the [vomit] Public!
Like or Dislike:
0 
0 (0)
Target audience eredwen?
Now who on earth would National want to stir up over the issue of benefits and what on earth might they have in mind for the system?
There are jh’s clouds, right there!
Like or Dislike:
0 
0 (0)
Hey Shunda. It’s your perfect right to criticise, of course, but if you’re also interested in how fair the criticism is, then it needs to get more specific and be responded to. I’m also anxious to be clear that I don’t speak for the West Coast DHB, and haven’t done for the past year.
As a suggestion, why don’t you email me with the specific criticisms you’d like me to respond to (it’s fine for you to retain your anonymity if you wish) and we can have a dialogue about these? Then happy for you to make that public.
Everyone makes mistakes of course but I’m really proud of the overall job that West Coast DHB did during my time there to maintain and improve health services for West Coasters despite very difficult circumstances.
On the specific point you raise about living within budget, some of the key points are these:
a) The West Coast’s population is distributed over a very long (same distance as Auckland to Wellington) thin stretch of quite isolated land, and not focused on one main place with a rural hinterland. It has a population density just one tenth of the NZ average. This means that to provide health services that are reasonably accessible to everyone, you have to put them in many places where they are “uneconomic”. The cost of the services is thus driven by minimum safe capacity, rather than the number of people served. The funding package for DHBs does make an allowance for rurality, but not this extreme diseconomy of scale. This is widely acknowledged, including by the Ministry and previous Ministers of Health.
b) The second main factor is the cost of ‘locum’ (temp) staff. While the West Coast working environment suits some people, there are many others it does not suit (absence of big city amenities, absence of opportunity for private work, sometimes not enough work to maintain skills and feel fulfilled, need to work in generalist rather than specialist scope, etc). Some staff shortages can be accommodated, but others, particularly in specialist positions, cannot. DHBs have to hire locums (if they can get them), who come at very great cost. You’ll find, Shunda, that all rural DHBs have this problem. West Coast is the most rural DHB, and has this problem the worst.
c) The national wage settlements with various professional groups, especially doctors and nurses, were higher than had been budgeted for. This is a rock and a hard place situation, in that the DHBs are required to try to live within budgets but must also recruit and retain staff in, effectively, an international market where other countries offer significantly higher pay in some cases. You’ll find, Shunda, that all (or at least almost all) DHBs’ financial results deteriorated because of this.
d) I took the view that it was better for the people of the West Coast to retain health services, than for the DHB to have an improved financial result.
I could go on, but this is not the right place for it, and I hope Shunda that you’ll be prepared to take up my suggestion.
Like or Dislike:
0 
0 (0)
Well put Eredwen, we can have a comprehensive health system to serve those in need from the collective means.
That is conservative socialism!!!
Oh dear have I said somthing really dirty?
If the health system was 100% privatised it would be partly financed by
(1) fees and (2) a number of health insurance companies.
It will very likely to be cut throat competition between the insurance companies (which could seem to benifit the public temporarily) until a few are squeezed out. Then it is a monopoly situation.
If the above monopoly situation did occur and there was a public option it can hardly be described as a monopoly situation, can it?
Who was it that said “capital always concentrates itself into fewer and fewer hands”? Never mind I wouldn’t want to offend the ACTing flat earthers too much.
This is why NZ badly needs the public commons.
Public hospitals should STAY PUBLIC IN PERPETUITY!!!!!!!
And politicians of ACT/Nat hue should keep thair grubby hands
OUT!!!!!!!!
Like or Dislike:
0 
0 (0)
“The take-out message is that Government was determined to contract out more surgery to the private sector. This determination was not based on evidence, but either some promise made to the private health sector or simply ideology. They are entirely prepared to remove obstacles to this decision (like consultation with doctors!) should they stand in the way.”
Yes but we all know Kevin who National Politicians were in bed with before the 2005 election, So there should be NO surprises here.
Like or Dislike:
0 
0 (0)