As I write this I am preparing to go into Parliament to hear the Budget, and no doubt to see Government Ministers crowing about “more money than ever before” spent on Health, and ‘brave new’ programmes for this and that. I only get the Budget documents once I’m actually in Parliament, and have to frantically start digging through to see what’s actually been increased and – more likely – what’s been cut. Government changes the expenditure lines, the names of the funding, from year to year making this as difficult as possible and trying to guarantee positive media coverage that’s more or less unopposed.
So before that unseemly scramble and the inevitable focus on detail here are some big picture observations on what I expect to be in the budget and what I would do differently. By the time you read this you will be able to tell how accurate I was!
- There will indeed be more money spent on Health than ever before – in dollar terms. The reality though is that in each of its budgets so far, this Government has put significantly less into Health than is necessary to “tread water” or retain the system’s capacity to respond to need. Each year we have an older population with greater needs, where costs have risen at the rate of “medical inflation” (significantly higher than the CPI, the normal measure of inflation). Government budgets have not kept pace, meaning erosion of capacity. I believe services must at least maintain parity, and that Health should be a higher funding priority than, say, Roads of National Significance.
- There has been genuinely new money for only a very small number of services, most notably elective surgery, which Health Minister Tony Ryall uses as more or less the sole indicator of system performance, even though it comprises only about 5% of what the system does. In the context of a sinking lid on funding this means that these increases occur at the expense of everything else. If I were facing a sinking lid – or even just constrained resources – I would ensure that the prioritised services were those that reduced the need for other services in the long run. This is not what the Minister is doingat all.
- There has been a decades-long consensus that the best value for money and most important priority for Health spending has been in Public (preventive) health services and primary care. Over time these areas were being gradually increased at the relative cost of more highly specialised services. Minister Ryall has reversed this direction and I expect to see more of that today. The most important services are being cut to fund Minister Ryall’s pet projects. I would prioritise long-term and durable health gain over short-term political priorities.
- The National Government has shown some glimmering of understanding that collaboration between different sectors might be helpful in achieving health (and other) gains. Just maybe we might see some funding and impetus given to that ‘whole of Government’ work. I certainly hope so. This would be a high priority for me. People do not live their lives as isolated individuals or in sector-based compartments. Damp overcrowded houses for example have terrible and expensive health consequences.
- One of the consequences of the National Government getting its spending balance wrong in Health has been that inequalities have increased – both in the outcomes themselves, and the factors that drive the outcomes. Those with the worst health – Māori, Pasifika, people with disabilities, people with low incomes and other marginalised groups have had increasingly worse health. Despite the small gains the Māori party have succeeded in negotiating, I expect this adverse trend to continue today. A fundamental priority for me would be to ensure that those with the greatest need receive the most help. This is a human and citizenship right.
- The National Government’s real terms cut to funding primary health care has meant that people pay more to visit their practice nurse or doctor and to get prescriptions filled. I expect to see this increasing privatisation of health services to continue. I think access to primary care is fundamental and that Government should be working to ensure cost is NEVER a barrier to care. And it is cheaper and better for everyone to deal with problems at the level rather than adding to burdens of already stretched hospitals.
And of course now I’ve started a list I can’t stop. I expect more ineffective flailing in health workforce, more inaction in Health IT and continued inadequate response to our aging population and the urgent and unprecedented challenge to health services from obesity-related diseases. Mark my words.