by Kevin Hague
Yesterday the Health Select Committee heard a briefing from the Ministry of Health in response to the petition of Jacinda Ardern and others seeking to safeguard youth one stop shops.
These Youth One Stop Shops have mostly grown up in the health sector from the ground up, where needs have been expressed from young people and, usually, the health professionals who work with them for a centre that:
- is a youth friendly place to go
- is not the same place that their parents or other family members get health services
- have a range of health services (and preferably other services, like legal advice and housing) under one roof so that young people don’t have to navigate complex and fragmented systems to get the help they need.
I worked a lot in the past in youth health, sexual health and mental health, and was involved in this establishment of these one stop shops. For me the prime motivation was that for sexual health, family planning, mental health and alcohol and drug issues, in particular, young people would often be too embarrassed to access mainstream services, especially if these were the same health professionals they had seen as children, or too worried about whether the services that they went to would tell their parents about the issues they had. The result was all too frequently that young people went without much-needed health services. So our aim was to increase access to services by giving young people choices, enabling them to choose the mix of services that they felt comfortable with. Very often, for example, they would choose to continue to go to their traditional family general practice for less embarrassing health issues (sore shoulder, flu vaccination, upset stomach) but to the one stop shops for genital rashes, contraception, depression, addiction etc.
Because these services grew out of particular communities, they tend to be extremely varied, with different ranges of services, structures and funding arrangements. Now a new zeal for minimising costs is putting some excellent services at risk. The pioneer and flagship one stop shop, 198 in Christchurch, has already closed, as have several others, and more are under threat. The precise nature of the threats in each case vary, but fundamentally the problem is that if we want to maximise access by increasing the options available to more at-risk populations (and the Greens certainly do) then it will cost more.
For example, Primary Health Organisations are paid a fixed amount for each person who enrols with them, and are expected to provide a full range of services with this (plus limited patient ‘co-payments’ when they visit). District Health Boards would say they have already paid the PHO for all the health services the young person needs, so why should they also pay the one stop shop for some ? Some argue that the solution is simple: we just get the PHOs to pay the one stop shops for the services they provide. Theoretically this could work, but in practice most PHOs are still largely associations of privately-owned small businesses who want to see as much income flow through to practices as possible, and it also would create a very uncertain funding situation for the one stop shops, which are unlikely to be manageable.
So there is a trade-off here: youth one stop shops set out to increase access by providing choice. This inevitably involves some duplication of funding. Eliminating the duplication will see most or all of these youth one stop shops close, with the result of decreased access by young people to important health services. It seems obvious to me that we need to retain these services, and therefore important that the Minister should signal this at a national level, rather than simply leaving it to DHBs to decide – his current approach.
Published in Featured | Health & Wellbeing by Kevin Hague on Thu, August 19th, 2010
Tags: health, health cuts, Kevin Hague, Youth
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on the trolls and those who are unable to keep on topic
Excellent post, Kevin. Youth services like these one stop shops are vital for supporting our youth through what can be a difficult time in their lives. Invercargill’s Number Ten was a very well supported centre for our youth and was well regarded by health professionals, but it too was threatened with closure based on financial concerns only. Strong protests from many sectors of our community, who knew its real value, have saved it for the time being, but if our DHB suffers even greater financial constraints it appears that both our elderly or young people are the first to have service cuts. I have included some links that tell our Number 10 story:
http://www.stuff.co.nz/southland-times/opinion/letters-to-the-editor/3381245/Your-view-Education-Number-10-Waihopai-Track
http://www.mentalhealth.org.nz/newsletters/view/article/14/165/spring-2008/
http://www.bebo.com/Profile.jsp?MemberId=10151894296
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Kevin – it sounds like the same sort of services that are delivered through schools.
It would be interesting to know which method delivers more health care for the money – health care being taken to where young people are – schools, or them individually travelling to where the health care is, which may be only one location in a town or city.
As a country were currently spending more than we earn. We have to make cuts somewhere. Finding new ways of doing the same job for less money is a good way of making cuts.
Otherwise we need suggestions of other places to make cuts.
And on this website in particular there seems to be hundreds of suggestions of where to spend more money, but not a single suggestion on where to make cuts needed to make the extra money available.
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How about the billions planned for more motorways for a starter, photonz? And how much more might have been available if National hadn’t gone ahead with its tax cuts? And once again they avoided a Capital Gains tax.
But why wait for other people’s suggestions? How about coming up with some of your own – apart from cutting benefits, which appears to be your favourite.
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philip – I’m not the one chanting spend spend spend.
Our road infrastructure is at third world standards with decades of under-investment. We have main roads where people die on a regular basis. So we’ve got years of catch up there.
I’d be quite happy with a capital gains tax, but I think it’s probably political suicide, so that’s unlikely.
Better than that, is actually correcting the housing market where kwiis have a blinkered mentality about making money on houses. There’s been good moves from this govt towards that. We now have 1 in 7 people wanting to invsst in property down from 1 in 4 a short time ago.
Currently the whole country spends far more than it should in servicing mortgages and paying rent. If the housing market can be fixed there will be massive gains for NZ.
- Less money from everyone going to foreign banks in interest.
- More money going into the productive sector that grows businesses and jobs.
- More money to spend in teh local economy.
- More affordable houses for people.
- Lower rents
- Lower accomodation supplements
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Where the money is to come from.
45% tax on incomes over $150k.
Capital gains tax.
APT tax. Tax on NZ currency speculation.
Broader tax base as more money into wages etc in NZ means more money stays here.
More people in work with real wages = more money for local business = more taxes paid.
Fix up financial rules so the share market and finance companies cannot rip people off. So we can feel safe about investment in NZ.
Protect and finance emergent industry like Singapore does.
Compulsory savings. Government bonds to build up equity.
Build up Kiwibank until we control all banking in NZ. Stop the capital hemorrhage. Those who control the money have the say. If NZ’rs want to have real control in their own country we have to control the money.
Allow small business to borrow at reasonable rates, maybe from a Sovereign fund.
Get away from FTA’s, globalization, which only works to the big corporates advantage.
Build trains here! and many other things.
Residents only to own land?
Even Garth George and Paul Holmes have realised neo-liberalism does not work
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Sure some of the users of the youth health centres are at school and may be able to access the same services at school (although, again, school health services have some of the same issues as general practices – some schools will have fantastic nurses and counselors and others won’t; some people may be reluctant to talk about sexual or mental health issues with someone at school; some people may be reluctant to see the nurse when they have to go past the receptionist who knows mum etc) But also, many of the young people served by these youth health centres are not in school.
I agree that it’s important to be disciplined about the cost of policies, although I sometimes struggle with comparisons with the Government because our approach would be so different. Obviously we would put much less priority than this Government (or the last) on new roads, and obviously we would have a very differently structured revenue. We believe more money can and should be made available for Health services. Within health our priorities would also be different, placing a very high emphasis (in fact as Gareth Morgan also suggests) on services to improve health and keep people well in the first place and on primary care services. This inevitably involves less emphasis at the other end of the spectrum: I wouldn’t have committed to a major programme of building new operating theatres; I wouldn’t have funded herceptin for 12 months; I would be looking closely at services that cost a lot and produce littele (quantity or quality) in end of life care etc.
But the main point about cost is that these costs are ones that we already pay – this wouldn’t be new expenditure.
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This so-called caring government attacking first the olds with axing at home services (may have been only an hour house care a week)for goodness sake! Then the young losing particular services very important to them at a vulnerable time.
Another loser idea from this cut-throat government just to pay out tax-cut money to those who don’t need it.
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Very thoughtful posts, Kevin. I am a health professional, but don’t have the sort of experience in young people’s sevices as you describe, however I have worked in Union and Maori health services and initiatives.
I think the proof of the need and the failure of our present system is not hard to find, take a step back, see the disgracefully high rates of teenage pregnancies, sexually transmitted diseases, drug abuse, depression and suicide and the high levels of family violence in some communities. I don’t know how much better these facilities help young people, but for goodness sake, we need to be looking after them one hell of a lot better than we presently are.
Not dealing with these issues adequately is akin to not dealing with global warming, we are heading for trouble, and money spent now will save ten times as much expense in the future.
And for a country that spends annually $6 billion on oil imports, much of it fuelling grossly inefficient SUVs and unnecessary commuter trips, $300 million on flat screen TVs, $2 billion on gambling and $4 billion on alcohol, the question of “how can we afford it” seems at the best just a bit ingenuous, and at worst,a cynical denial of the needs of a substantial section of New Zealand’s large and increasing disadvantaged population.
Like many other societies, we collectively have a very distorted sense of priorities. It will bring nothing but trouble in the years to come if we continue to ignore these social needs.
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I am glad such a program exists. It also brings to memory a lot of cut back Canada made with some of the programs it offered to the public. Those cut backs were a huge mistake and if they were around now would have helped tremendously.
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As a follow up, Kevin, you article also illustrates very well the piece-meal, ad hoc and fragmented approach to health care provision, especially primary health provision, in New Zealand. I still find it really strange, and I have lived here now for twenty five years, how a country of less than five million people, rather smaller than the population of Yorkshire, can have so many disparate provider organisations, local and national policies and significant differences in accessibility for the patient as New Zealand has. The cost of this must be enormous, not just financially, but in the provably poor measures of health outcomes that this ever-changing jumble and disorganisation provides, exacerbated by the deep philosophical and political divisions in New Zealand politics and the public at large. As a society, we are nothing like as cohesive as we imagine ourselves to be. The same problem is even better exampled in the continuing fiasco of retirement and pension arrangements.
I hate to suggest this, but with neither major party having got to grips with this issue, and recognising that the last thing that the health system needs is a major reorganisation, there still has to be a push to simplifying the system, providing more direction from the top, and improving access to primary health services for all groups in society, regardless of age, gender or geography. This difficulty of access to primary health services was highlighted, I believe, in a recent international examination of various health systems? It is something that has concerned me, as a primary health provider, for a long time. And I am also sorry to have to admit that the New Zealand medical profession has provided very poor leadership in this matter, being divided as they are, just like the public in the wider community.
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