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.