Ryall: headlines over healthcare?

I’m worried that Health Minister, Tony Ryall, doesn’t seem to have made the transition yet from Opposition to the responsibilities of government. In opposition he was able to take pot shots at the Government based on populism and what he thought would be most effective in attracting headlines – an essentially political framework.

Now as Minister he is responsible for the system, and yet most of his announcements to date still smack of an overly simplistic understanding. He has continued the rhetoric around stripping out wasted spending to put more money in frontline services, despite the warning from the NZ Nurses Organisation that he has another think coming if he has some kind of mental picture that involves rooms full of bureaucrats not doing anything useful.

He seems still to think that the success of the health system should be judged on how many people are waiting for elective surgery. Elective surgery represents perhaps 5% of the output of the system, maybe less. It’s not a great indicator, and is infamously hard to manage (in all health systems) in part because its sits just to one side of the interface between publicly and privately funded health services – a change in the supply of one alters demand for the other, and many of the surgeons who provide the services work in both systems (with potentially conflicting incentives).

Of course it’s important for people to have good access to elective services, but is this 5% really more important than the 95%? His latest announcement of a new elective services super-clinic to be based in Auckland exemplifies the problem: New Zealand already has plenty of unused operating theatre time. Access to theatres, then, requires not more theatres but more intelligent use of the ones we have. But that’s all a bit subtle and complex, lacking the drama of a new building.

As the Association of Salaried Medical Specialists (effectively the surgeons’ union) says, it is far from clear where the specialised staff will come from to use these new theatres. “Don’t worry”, says Mr. Ryall, “we’ll get more”. Well why didn’t anyone think of that before? Huge effort has gone in to trying to do this, without a lot to show for it so far. It’s a difficult, slow and complex process. Again the existing staff could be deployed better, but maybe the resource planning approach required to line up people who need surgery, with others who can provide it and surgical facilities, just isn’t as headline grabbing.

Unfortunately, as Ruth Dyson has pointed out today, nothing comes without a price tag. The new theatres will be paid for with money that would otherwise have been used for something else. So what will be cut? Will it be rural health services (already severely under threat), important public health and primary care initiatives (harder to see), quality improvement activities (to cut down on adverse events and improve health outcomes) or perhaps workforce development?

It’s early days to pass judgement on the Minister, and perhaps unfair to do so, but if he is not to be a disaster for health services, then a change of approach is needed, and fast.

About Kevin Hague 163 Articles

Green Party Member of Parliament

10 Comments Posted

  1. Katie: Many thanks for your insightful comment – it makes a difference. I wrote the Post expecting (if anything) more denial from some kind of stalking horse.
    Yep: Tried in fact to retire altogether in August, but found there are people (such as this guy) who deserve better, and will get better if I can help them.
    Restrict my little brood to under six people these days.
    I didn’t want to intervene in our Health Care yesterday – just the (proposed) patient wouldn’t sit there another minute – and I don’t blame him – frankly I was not thrilled to have someone that ill bounced back onto me – but had Hobson’s Choice.
    Chinese Gunpowder Green Tea will wash out stale Meds. Haven’t used Arnica or Hypericum but will check them out – basically his spine had seized in pain from a fall – I used anti-inflamm. cream, glucosamine, and a few hours gentle massage so he was able to rest – I might add that had the Hospital done their job, he probably wouldn’t have got this kind of care anyway.
    The ground in New Plymouth where they made Agent Orange (and this boy had a shower or two) has imploded, collapsed on itself, along with the houses they built on it – meanwhile our Vets are left to die, mostly alone.

  2. Mark –
    couldn’t read that without commenting.

    Good on you for using commonsense, and choosing the option of alternatives to the allopathic drug regime we’re all brainwashed to prioritise.

    Second good-on-you for being an advocate for someone who has probably got more souvenirs from his service in ‘Nam than he expected – when I lived in PN some two decades ago, Agent Orange was still being identified as a causative factor for many illnesses for which Vet’s were being treated.
    Many of the guys I met (friends of my mum) didn’t live long enough to see their symptoms taken seriously; or get any compensation or viable treatment.

    Homeopathy has a lot to offer those who have been failed by the pharmaceutical industry, especially those who have had toxic poisoning from petrochemical-based compounds.
    The general public usually have no idea how many pharmaceuticals are created from petrochemical by-products – these end up being the drugs to which those with toxic overload react first adversely.

    Yes, I know something about pain, and pain relief, and with my Dr’s complicity, use a combination of steroid and homeopathic remedies – arnica preparations are good, hypericum massage oil or cream can be good for specific muscle pain.

    Last thought – don’t forget to support yourself, as well as others; voluntary work is valuable and rewarding, but some self-nurturing is also necessary to recharge the batteries so that one can continue to be effective and capable of helping.
    I choose my battles, and my ways of entering the fray, much more carefully now, to use best the energy that remains to me.

  3. The Health score today is Health Volunteer-1: Palmerston Nth Hospital-0.
    I took my friend out of Emergency as they were passing over him as he turned a nasty grey colour.
    He is better off at home with naturopathic remedies and resting, than waiting for hours in a desperately ill condition at said Emergency, whose officers showed not a glimmer of common sense in Prioritizing their Caseload.
    You (or I) are not allowed to leave a dog in the sort of pain my friend was left in today – a lawsuit may well give them cause to pause, and reconsider – or better still, hire competent staff.
    Public Servants Parading as Little Lords are alway worth reminding who serves who in our society – the guy waiting has paid his dues in Vietnam and beyond, and it was a disgrace to see him endangered by uncaring and ignorant public servants (i pay their wages too!).

  4. Bliss: Same Planet, different hospitals I’d guess. Because the local one refused to do anything about a broken rib sticking thru my kidney – I drove to the next town and got the treatment you speak of.
    Unfortunately – I need a fair amount of Healthcare and speak not about one incident but many.
    Also I started supporting other Disabled People and my experiences became cross referenced over and over.
    Congratulations on your good fortune – there are good people everywhere.

  5. He [Ryall] seems still to think that the success of the health system should be judged on how many people are waiting for elective surgery.

    As I have recently blogged, Health delayed is health denied. The long waiting lists are at the heart of the dysfunctional nature of our health system. As Bliss points out, the system functions perfectly well when you finally get access to it. Ryall is right to be focussing on this – it is by far and away the most urgent thing to fix.

    Katie: We need to look harder at why young doctors prefer to complete their specialisations overseas, and then stay there

    Not really. I can tell you in a word. Money.

  6. Well, as a Wellingtonian who has been watching the re-build of a significant proportion of the Wellington Hospital campus with great interest, I’m concerned that CCH now has a bright, shiny, fresh over-supply of capacity.
    At least they may have solved the ‘h-bug’ problems …

    The Women’s Hospital was under-staffed, despite record inpatient numbers in the maternity throughput, right through spring & summer, the peak time for births in our region.
    Lovely that neo-natal and SCBU have up-to-date premises at last, and ditto the oncology department, having visited there when a friend was receiving treatment, it was definitely due for some help.

    But where are our surgeons, midwives, oncologists, ob/gyn specialists, coronary care specialists, etc – the list goes on.
    Private practice does not suck up available specialists – it often enables them to keep a practice going, despite the erratic funding and staffing of DHBs around the country. [looking at the long-term funding paradigms, rather than annual budgeting]

    We need to look harder at why young doctors prefer to complete their specialisations overseas, and then stay there, rather than returning here to work within an often staff-punitive system, overwhelmed by an unnecessarily complex bureaucratic layering of non-medical staff.

  7. Some of the best advice you can get when running an enterprise is “KEEP IT SIMPLE & STUPID” Sometimes referred to as the KISS principle.

    It is easy to see the health system as a complicated, unwieldy, difficult to change enterprise of government, and it is equally easy to turn it into that. What is not so easy is to see it as a process that starts with healthy people, identifies when the cease to be healthy, provides appropriate treatment to return them to health as quickly as possible, and goes back to the beginning again.

    Since the advent of the Welfare State in 1948, our Health System has been subjected to complicating moves to suit a myriad of political beliefs, and, in the main, has lost sight of its true simplicity. Perhaps the Minister has the wisdom to see it as it should be seen and the will and determination to return it to that simple state.

  8. Good to hear from Kevin!

    Will the Minister even comprehend the scope of our failed Health System?
    Have you used it lately? I have, and it was fantastic! I god service that would have cost >$30,000 in the private sector, professionally and on time.

    Do we even live on the same planet?


  9. None of the new Minister’s have lost that ‘rabbit in the headlights’ look. They didn’t expect to be Govt., weren’t prepared for it, and are obviously winging it – fair enough for a while.
    Will the Minister even comprehend the scope of our failed Health System? (all Services are run down (or running amok) – this one causes direct death.)
    I wouldn’t want his job – as a Health Care Volunteer for some years I could write a book of horror stories from the NZ Medical System.
    Had to spend 4 days in our provincial Hospital after being mistakenly given the Wrong Medicine – a frightening and educating experience.
    We have exported all our talent and experience – for four days I was told there were no Doctors to assess things. Well; Beauty Guys….my advice to Kiwi’s is to stay away from hospital – you could die in there and no one would give a hoot (the old national forelock-tugging syndrome).

  10. Yes there has to be a time and I think that it is rapidly approaching that Ryall, Brownlee et al,will have to stop the headline grabbing populist moves and actually get on with the job of Governance.

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