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.