Kevin Hague

Government fudges Health budget cuts, has no clue on child health

by Kevin Hague

I’ve had two opportunities to question Tony Ryall today about priorities in the health sector, and his answers reveal a real mastery of evasion and obfuscation but little or no grasp of what is genuinely important in health.

First up was his appearance before the Health Select Committee to answer questions about the Budget (although in practice questions tend to be very wide-ranging). I started by asking whether his statement on Budget Day that the increase in Vote:Health would “help protect” DHBs from real terms inflation meant that he accepted that the Budget increase was insufficient to fund the drivers of health costs (inflation, population increase and aging) to enable the sector to stand still. He answered “no”. The Ministry had calculated that $509m would be necessary to stand still, and the Budget had allocated $512m. And anyway, DHBs are expected to make efficiency improvements so even if inflation was 2%, the Government wouldn’t give them 2% but would still claim that it had funded them for inflation.

I asked about the calculation by the Association of Salaried Medical Specialists and the CTU that $555m would have been necessary to stand still — what was wrong with their analysis? He couldn’t tell me but will provide detail later. Should be interesting.

I pointed out that a substantial part of the new $512m allocated was, in fact, for new initiatives, so wasn’t even available to help keep up with inflation and demographic change. He responded by talking about how Spain and Ireland were making really big cuts to their health budgets. I asked about his response to the fact that Treasury and the Reserve Bank are forecasting inflation of nearly 4% (before the GST increase is factored in) adding another $58m to the amount necessary to stand still. More about Ireland and Spain.

Then in the House I asked about his response to the recommendations of the Public Health Advisory Committee on improving child health outcomes. Well of course he hasn’t decided yet. Further questions are batted away with blithe assurances that the Government is improving child health by having an immunisation target which the sector is doing well against. Oh to have had enough questions to ask about the other child health targets he has scrapped, or to probe his belief that immunisation was an adequate response to the socioeconomic inequalities driving poor child health! He, alone amongst New Zealanders I think, doesn’t believe the Budget will worsen socioeconomic inequality.

I asked him about rheumatic fever. It’s largely a disease of poverty. The report highlights a massively disproportionate impact on poor, Maori and Pasefika kids, and an overall rate 14 times the OECD average. 14 times! Why hasn’t the Government done anything about it? He claims they have done “various things” about rheumatic fever, but when asked to be specific responds with vague generalisations. Oh to have more questions again!

Let’s be clear: this government has adopted a Budget which will increase socioeconomic inequalities, and these will make most New Zealanders, including children, sicker. At the same time they have cut health funding in real terms and, to make matters worse, have especially cut community-based health services in order to fund their flagship services at the shiny, expensive, high-tech end of the services spectrum, heedless of where value for money lies. If the Government were even slightly interested in improving child health then the PHAC report is a great starting point, which has at its heart reducing socioeconomic inequalities. Ryall does not have other advice to the contrary, and I await with great interest, but little hope, his response to the report’s recommendations.