Lifting productivity

Written By: - Date published: 9:45 am, June 17th, 2011 - 14 comments
Categories: health - Tags:

So, the statement of intent from the Ministry of Health  has just been released. This document outlines how our health service will operate during the next three years; so what does it actually say? Is health truly safe under National?

Let me first start by doing a DPF disclosure type statement; I work in public health, I have a strong social science background and I truly believe that the social determinants of health are an area that most of NZ neglects to consider (if you are unsure what I am on about have a look here)

Anyway, back to the document; after a quick read it is very easy to do a quick, very simplistic discourse analysis of the content. Arguably one of the biggest issues facing New Zealand are the raft of illnesses and disabilities that, by virtue of cause and effect, are preventable – examples type 11 Diabetes, cardiovascular disease, bowel cancer, etc. These cost the country a small fortune to treat, but it would be more cost effective to prevent.

Right at the outset Tony Ryall points out the agenda of ‘lifting productivity’ – straight out of his capitalist doctrine (remember though we are talking about that ‘unproductive’ sector that doesn’t actually make money for the country, therefore are hated by the right). At least they identify how much time is lost from work by ill health, but little is offered to provide solutions for this. Again it is all down to dollars and cents.

Prevention – a simple word, it means to stop something happening – appears just three times in the whole  document; if you use ‘prevent’ then you get six instances, with three around preventable sentinel events, e.g. medical mistakes.

Targets – now there’s a business word – 33 times, targets for this, targets for that. Cost-effectiveness comes in around nine times; not that that is a bad thing. But this then begs a further question; why have we moved away from a health system that wanted to maintain the fiscal integrity of the service by reducing demand for expensive treatments by preventing disease (the recognised cost-effective way of working), to a system that only wants to have targets for fixing the already broken? (an expensive solution that is unsustainable)

Lastly, how can you lift productivity without investment; doctors, nurses, radiographers, beds, wards, etc. are all finite. Yes you can tinker with processes, but medicine and health are two very different things; fixing physical ailments does not necessarily make the population healthier! Arguably health should be one area where performance measures are most harmful, or could we be seeing the start of privatisation by stealth, as the only available extra resources are in that sector.

– ianupnorth

14 comments on “Lifting productivity ”

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  1. queenstfarmer 1
    17 June 2011 at 10:28 am

    All good points. But has the system ever really focussed on prevention? And where should the line be drawn on what “prevention” includes?

    • Blighty 1.1
      17 June 2011 at 10:38 am

      the line should be drawn where it makes economic sense.

      We need to get beyond saying that controls on the healthiness of food, for example, are nanny state and consider the issue rationally – can investing in healthy food save higher costs down the track in healthcare costs? If so, the state, on behalf of society, should spend money at save more.

      Junk food out of school canteens, for example. Just plain good economics.

      • Tigger 1.1.1
        17 June 2011 at 10:45 am

        Good economics for the taxpayer but not for corporates. And we all know whose tune this government dances to.

    • ianupnorth 1.2
      17 June 2011 at 11:36 am

      That is a very good point -another way of putting it is do we have a health service or an illness service?
      Prevention can fall into three main areas

      Health protection – that is preventing the spread of communicable disease by having good drinking water supplies, good sewage systems, preventing airborne pollution, exposure to harmful substances etc.
      Health promotion – that is the process of empowering individuals to select health behaviours which sustain and prolong healthy lifestyles; thiffers from ‘health education’, as health promotion works on building community capabilities, involves having healthy public policy and changing service delivery (as per the Ottawa Charter)
      Screening for the possible indicators that disease processes are occurring.

      Arguably New Zealand has been good at number one, has at times done well in number two and has some good practices in number three.
      The problem is this though; under Labour we were developing number two very effectively; there were a range of policies that came through that sought to improve the health and well-being – the example that Blighty gave is perfect; get rid of junk food from schools and you should see a change in the general health of the student population (and there is strong anecdotal evidence to support this)
      Whilst Tony Ryall’s statement is big on ‘screening’, the focus has moved to a focus on a repair service.
      A good analogy is this; you buy a new car – if you follow the recommended guidelines, use the right oil, have services done, drive it as per the manual,etc, it should last a long time. if, however, you use the wrong parts and oil, don’t service and abuse it, it will need expensive repairs.
      People are exactly the same; regrettably Tony Ryall wants a fleet of quick response garages and not a fleet of well maintained, smooth running people!

  2. Penny Bright 2
    17 June 2011 at 5:40 pm

    How about a health system based upon ‘wellness’ – not ‘sickness’?

    Oh – yes – pharmaceutical companie$ would lose a fortune………..

    Penny Bright
    http://waterpressure.wordpress.com

    • rosy 2.1
      17 June 2011 at 7:21 pm

      Not necessarily so Penny. If our health service was based on wellness a significant number of people would be eligible for some very expensive drugs that allowed them to get their lives back, rather than cheaper drugs that simply stave off future health system expenses but do not reduce restrictions on physical function and life choices/chances.

      Pharmaceutical companies may also find it worthwhile to invest in research that may lead to prevention of some diseases rather than relying on cures to enhance their bottom-line.

  3. Adele 3
    17 June 2011 at 7:58 pm

    Teenaa koe,

    If our health system was based on wellness, it would be integrated with the other determinants of health – socio-economic, education, justice, and housing. Whare Tapa Wha is a Māori model of wellness that was introduced to the medical model over 20 years ago. It sought to broaden the focus of the medical beyond the alleviation of physical ailment to incorporate other aspects that would ensure longevity in health.

    Having read the statement of intent I agree that it appears to emphasize the “business” rather than the “purpose” of health care and that “more for less” is the actual intent.

    • ianupnorth 3.1
      17 June 2011 at 11:11 pm

      Agree totally.

    • rosy 3.2
      18 June 2011 at 1:00 am

      +2 It is also interesting to read the latest statement of intent with earlier ones for instance the 2007 statement of intent and compare the focus…
      from 2007

      A whole-of-government approach is critical to ensuring whanau and communities are better able to take control of the circumstances affecting them and to improving the health and wellbeing of whanau. For Maori whanau to participate fully in New Zealand society, co-ordinated and effective service development across all sectors must be in place to ensure equitable access to resources and services

      The later statement, as well as being focussed on the ‘business of health’ also isolates health from the social and economic determinants of health.

  4. ZeeBop 4
    17 June 2011 at 10:23 pm

    I know someone who is sick and unemployed and not on a benefit, welcome to the new world order, they don’t trust to fight for their just entitlements to equity since there is no culture and understanding for those rights, and equity in NZ. How do they know this?

    There are two kinds of people, the wallet people, and the people people. The wallet people have shuffled and shifted their way to the top where all the money and levers are. And the people people have let them because profit was easy to make, unforeseen consequences could easily be covered by ‘market’, so the people in positions of power didn’t need to worry about foobar.

    Oh, growth at any expense is going to back fire. In fact most engines you work over to the point of producing excessive amounts of torque are burnt out quicker, and are off the road longer. So we know in our inner auto-mechanic that economic activity justified solely for profit is detrimental to us all.

    I welcome our new foreign overlords, 6th most traded currency means the door is wide open for any opportunity to grab our economy. Of course National want to keep the door open and throw more stuff onto the asset fire sale. Burn NZ, burn.

    • Colonial Viper 4.1
      17 June 2011 at 10:35 pm

      +1 it’s looking ugly

      There are a few more things going on which are going to become obvious in the next month or two as well.

  5. Pdogge 5
    18 June 2011 at 4:15 am

    Your slip is showing…Type 2 Diabetes is of genetic origin,

    • ianupnorth 5.1
      18 June 2011 at 7:37 pm

      Evidence? Type one has a genetic component, but the actual cause is unknown; type two is heavily associated with a highly glycaemic diet.