- Date published:
9:30 am, February 16th, 2016 - 101 comments
Categories: health, john key, Privatisation, privatisation, Public Private Partnerships - Tags: don mackie, Jonathon Coleman, ministry of health, neoliberalism, suicide, Tony Ryall
In between slurping simpers during his most recent session of MediaWorks virtual fellatio, John ‘The Liar’ Key managed to express concern for the emotional well being of Cantabrians after yet another earthquake rattled their region.
Whether John Key is actually concerned is moot, but he is certainly in a position to know there is real cause for concern. His own chief science adviser told him. Yet, despite that advice, his government has been deliberately ignoring the increasing need for mental health services in the region. Now, National Ltd™ is going to further reduce what little funding is available.
The root cause of the under-funding is National Ltd™’s privatisation-by-stealth of the our public health system. In typical neoliberal fashion, National Ltd™ is quietly moving towards a voucher system while simultaneously diverting public funds towards an increasing number of for-profit private providers. Coupled with deliberate cuts to funding, privateer stalking horses such as “Whanau Ora” and “NASCs“, along with a bunch of overtly profiteering outfits, are soaking up so much money that public health is beginning to fall apart at the seams. When it finally does – hey presto – TINA, because the “public system is not as efficient as the private sector, yadda yadda yadda.” Now, that privatisation agenda is largely fixed. Thanks to the TPPA, any significant changes to National Ltd™’s ideologically-driven framework for the privatisation of health (and other social) services are open to challenge in secret courts where international corporations sit in judgement.
The effects of such neoliberal ideology are bad enough when applied to general government services. In that case, the effects are mainly economic and result in a gradual transfer of wealth and concomitant rise in inequality. But the psychopathological nature of neoliberalism becomes stark and has more immediate effects when its cult-thinking impacts directly on the provision of social services such as income support, housing, education, and health.
Those suffering from mental health issues are, for a wide variety of reasons, particularly vulnerable to neoliberal reform. Already, the number of New Zealanders committing suicide has reached record levels and the numbers for Christchurch are disproportionately higher than for the rest of the country. The DHB’s mental health figures show child and youth cases are up 67 per cent, and adult psychiatric assessments at Emergency Departments have risen by 102 per cent since 2012. Also, Police are dealing with a higher number of suicide call outs than ever before.
This neoliberal economic slaughter of innocents in Christchurch is being facilitated by a contrived impasse. In essence, the Ministry of Health is acting on instructions from its Minister, Jonathon “Biffo” Coleman, to deny that there is problem while also squabbling over various definitions. Fronting for Coleman is the ministry’s deliberately ignorant chief medical officer, Don Mackie. According to Mackie, the increase in demand for mental health services has got nothing to do with people dealing with the stress of coping in the aftermath of the earthquakes. Rather, Mackie says, the increase in demand is because access to the services has been made easier. He’s also petulantly dismissed the use of the Health of the National Outcomes Scale, a measure his own ministry promotes!
The situation is ridiculous. So ridiculous, in fact, that senior doctor and Canterbury Hospital’s Medical Staff Association chair, Ruth Spearing, wrote to Coleman explaining that there were negative relationships with ministry officials who were denying reality and, instead, engaging in “dysfunctional interactions … at many levels”. That was back in August last year. And what’s Coleman got to say about it? Nothing. If he can’t dismiss it as an “operational matter”, any other time he is questioned about his portfolio Coleman spouts the compulsory mantra “but, but, but Labour . . . .” and then reels off claims of how much more money National Ltd™ is pouring into health. No mention is made of “unmet need”, or funding in relation to inflation, or funding per head of population, or how much of the money is actually going to his privateer mates, or disappearing into the hole left by the Health Benefits Ltd pyramid scheme, or in facilitating the on-going privatisation agenda, or keeping the public in the dark about that agenda.
While Biffo Coleman, and his predecessor, Tony ‘Dandy’ Ryall, both have blood on their hands, and are quite happy to engage in typical National Ltd™ number juggling, they are the small fry. Full responsibility for the agonies being deliberately visited upon the people of Canterbury and, indeed, all of New Zealand, by National Ltd™ sheets home directly to John Key and his unfailing devotion to, and worship of, the market’s Invisible Hand.
But wait . . . there’s more: http://www.radionz.co.nz/news/regional/296627/chch-mental-health-funding-slashed
What the Brits call swingeing. But that underlines what is unbelievable but nonetheless true – that Gnats don’t care a fig about ordinary citizens. Like examples of cruelty to animals show a decayed moral sense that will likely be carried forward to people, pollies that show such disdain for ordinary people in distress of any type are capable of worse.
Be afraid, really afraid, and do all you can to get rid of the mob that seems to be thriving on taking these steps.. The apathetic and self-interested will stand by and endorse more of this stuff, and when it becomes the norm, a whole people can lose their integrity. Germany is a standout example, but each nation has its densely black historic periods.
Really no idea how to respond to this Blip.
The need for good mental health provision in Christchurch is just so bloody obvious and going to be increasing as peoples reservoirs of resilience empty out. But if you can’t advocate the case; if you can’t bring reality into the picture because there’s a bloody minded ideological agenda at play.
If this sort of thing doesn’t speak directly to a need for large scale civil disobedience, then I don’t know what will.
Its been 5 years! Get over it for goodness sake.
I lived in North Beach. I was in the Centennials gym when the quake hit (not good at all a good place to be). My partners best friend was killed in Kings College when CTV collapsed.
We had no power or water for 2 weeks (and trust me, you can do without power but water – no). My house was damaged. My street devastated.
With the exception of a tiny few, the vast majority of people have no grounds for mental help now. Those who now think they need mental help due to the quakes are the ‘worried well’. The perpetually neurotic. No amount of money in the world will ever be enough for these people, Get over it and start thinking of others would be the best prescription that can be given them.
And civil disobedience? Well that really says it all Bill. How about doing some good old fashioned civil care?
But I guess many of the regulars on here are just hypocrites, with little interest in helping others, just abusing them.
That all you got? A “Pull your socks up dear!”? Misanthropic arse-hole is a term that comes to mind.
Nothing wrong with ‘good old fashioned civic care’ (not a term I’d use, but I get the point). But when a government is rolling out shit with no regard to reality and simply not fucking listening, then civil disobedience is the tried and tested way to make them change tack. Sometimes (within the context of non-violence) it’s the only way.
It was a quake. 5 years ago. A small number of people were killed. It was a tough time for sure. But here we are now.
Do we dine out on war stories fr the rest of out lives, or actually start focusing on others, the future, and so on?
I honestly have never met anyone that, after the first 12 months, thinks much about the quake. Even Saturdays jolt (which was one hell of a jolt), everyone I know or met pretty much just took it as background noise one day later.
Were you here during the quake? Do you actually talk from person experience or is this just another pathetic attempt to join a cause and have some fun at the expense of others?
I have seen first hand far far worse than this when i lived in Sri Lanka. Many of those Tamils are now in NZ and are extremely successful citizens here after coming in as refugees. Same with Somalians.
An example of the heartless neoliberal attitude that ordinary citizens are up against. I’m OK so you should be too (and what’s more I don’t even care about your experience).
What you seem unaware of is resiliency. That’s an individual’s internal ability to cope with stress. It’s partly genetic, partly established by responses to previous life experiences, and partly learned. You can’t really just buck yourself up if you don’t have good resiliency and your body and brain have already established biological pathways that are entrenched. That’s why you can have two people in the same location during a quake and have very different experiences. One person is fine the other is panicked.
Attitude can play a part, but for most people resiliency was already set by the time they experienced the quake. And if they didn’t fare well after the quake that can undermine their resiliency further. This is why it’s probably not the quake that is the biggest issue (except for people that were involved in collapsing buildings etc), it’s the fact that the stress didn’t end with the quake or in the days/weeks afterwards. Many people never got to recover like you did and for some the stress was compounded by ongoing issues around security and insurance etc. For the people that were already stressed before the quakes, that’s even worse.
No. Of course not. Those servicemen suffered ptsd, just as I am sure I time you number suffered this in 2011 also. And I certainly exclude from NY comments those with real mental illnesses, such as bipolar or schizophrenia
Weka that is an extremely good reply, and I totally agree with all your points.
It’s just the solution i would disagree with. We are all neurotic in some way, to a greater or lesser extent. Start throwing money at the ‘worried well’ and it will never end. More to the point, those truly in need of help, such as the bipolar and schizophrenic community will be starved of the resources they need (not just funding, but skilled professionals who are always in short supply). And it’s these people that most need the help and dollar for dollar, respond best.
Can you give some examples of where people who are the ‘worried well’ are being offered services or funding? (because I don’t know what you might be referring to).
Progressive modern definitons of mental health/illness acknowledge that everyone has mental health and at times has problems with that in the same way that most people get sick physically from time to time. If you try and define valid mental health as only those people with severe problems like bipolar, you misse a big chunk of the people needing help and you completely undermine preventative care i.e. you create worse mental health problems across the population. Where someone might pull themselves out of their depression with a bit of support and so never need psych services, that some person might end up in hospital if they never get support and get told there is nothing wrong with them and then some other shit hits the fan in their life and tips them over the edge. That stuff is just as important as more serious mental illness.
Again weka, an informative reply and one in which I find myself in agreement with you, in general at least.
First, I don’t have a problem so much if true professionals like registered psychologists are involved. They have the training, accountability, professionalism to pretty much do an objective job. Success for them is when the therapy ends, as there is no longer a need.
My problem is more the legions of the semi trained counselors that inevitably get drafted into these things. They lack all of the above, in most cases.
An example? Well (not quake) first one that springs to mind is that sad case of Peter Ellis, civic creche. One of my in laws was intimately involved in that case. Bulk of problems were the circling sharks of counsellors feeding the frenzy, dragging out minor and unrelated neuroses and feeding their personal agendas onto vulnerable people. The result in many cases were vulnerable people becoming dependant on frankly sick counselors, turning normal life issues into problems, with no plan much less a solution. They caused way more damage to the lifes of many vulnerable people than any good they might have done.
I fear this will again be the resilt if we give licenxe to these people to fix probkems that in many cases are just normal reactiins and will pass.
I am sorry, I probably have not expressed this very well, but I hope that you can see my general logic.
Pete -my what a clever clogs you are – obviously you haven’t personal knowledge of people suffering from mental health issues. Just because its not wrapped up in a bandage, ignorant people like you should not mouth of – everyone of us is a heart beat away from suffering a brain injury through accident on a work side or wherever and thereby suffering mental health issues. People like you should shut your mouth before you offend the many sufferers who through no fault of their own suffer from brain unwellness. Jesus people like you need to get a life and be thankful you have managed so bloody well and thank God for small mercies. . How about our service men who come home with post traumatic disorder – are you going to tell them they are neurotic as well you stupid man. Not so next time for you, just remember that, you may suffer from dementia one day and your long suffering family (and that’s what they are) will have to cope with your mental health issues – poor sods..
No. Of course not. Those servicemen suffered ptsd, just as I am sure I time you number suffered this in 2011 also. And I certainly exclude from NY comments those with real mental illnesses, such as bipolar or schizophrenia
fortunately for humanity you don’t get to determine what is a real mental health issue.
As someone who works in the mental health sector in Christchurch, I can tell you that you are talking utter bollocks. The cases that come in are heartbreaking and the numbers are certainly not declining.
It was spelled out very clearly at the time of the earthquakes that the mental health impacts would not truly be seen until 5 – 10 years later, we are now entering that time-frame.
There is a whole generation of young people who have disrupted lives, shattered emotions, unstable home life.
You might be OK ‘Pete’, well bully for you. But please don’t stick your head in the liquefaction and ignore the facts that there are many, many who aren’t.
+ 1 Very true comment – I work in mental health in another area and my heart goes out to the people trying to help the young, middle and old struggling with all sorts of stuff.
“Its been 5 years! Get over it for goodness sake.”
what a c#*t….
how about all the stress and anxiety of being f#*ked about by the EQC/Insurance firms for the last 5 years ?
“Get over it for goodness sake”
f*#king liberty if you ask me ….
You think I did not suffer similar things? Yes, dealing with insurance and so on is very stressful, but it is part of life. Deal with it. Having the taxpayer fund counseling is not going to help. Time alone will fix that.
“You think I did not suffer similar things?”
and look at what its done to you
turned you into a right f*#ker……
I guess some would say that i was a right f*#ker before then, but what would they know?
But seriously, taxpayer counselling will not help the situation. it will just take resources away from those in need.
And this article I take great exception to. It makes a real issue into a hate rant against nasty old National. Thats just being juvenile.
The real problem is about balancing a limited budget with near unlimited need in health. Labour, Greens. Whoever. They all face the same problem.
And neurotic complaints tend to be nebulous and most are solved by time. Better to steer the funding away from the counselling sharks and into the sharp end of mental health: dealing with the psychotic. Their need is greater.
Because presently talk therapy is the core tool for helping with depression/anxiety simply because it is effective and if medications also work, becomes even more effective, per current up to date review studies in the literature.
But hey, what does evidence based psychology know when pete so totes has all the fucking answers?
Oh and kindly go fuck yourself, you don’t get over depression, let alone chronic suicidal and self-harm ideation by “toughing up” and advice like yours just leads to things not improving, or getting worse with each new stressor.
Well if you ‘don’t get over it’, then not a lot of point in taxpayers money being used to fund counseling then is there?
But anyway, what you are talking about is an illness. What this article was talking about is stress resulting from a life event. Two completely different things that demand two completely different approaches.
I never said, and never would, that help should not be provided to those suffering real or serious mental health issues. In fact, if you actually bothered to read my posts above, you would see if fully support this. Just not for normal life stresses like an earthquake 5 years ago.
Personally , I believe talking about an issue endlessly is the worse thing you can do, all you’re doing is creating a neuron super highway to that part of the brain which contains all the bad memories and trauma.
The brain does have the ability to compartmentalise these stressful incidents.
Constant rehashing or talking through situations in my mind can be counter intuitive.
At last, some sanity!
I understand that part of the problem alcoholics face in recovery is that the brain effectively becomes hard wired to drink.
Logic says that endless talking about problems would do the same, with the same self defeating behaviors.
At last, some sanity!
I understand that part of the problem alcoholics face in recovery is that the brain effectively becomes hard wired to drink.
Logic says that endless talking about problems would do the same, with the same self defeating behaviors.
Oh fuck the ever loving hell off you ignorant fuckwit.
Except oh ignorant one, talking about problems can be used to defuse the emotional triggers with the right techniques, I should fucking know since I use it on the upswing to sort out head space fun from depressive episodes. Along with shorting out any triggers as I notice them.
It’s one of the reasons talk therapy can be highly effective when done rigorously per the literature, and combined with anti-depressant medication where need be is even more effective. But of course, research is so totes not needed by the likes of fuckwits such as yourself, since you totes know more than any of us who actually bother with learning and research 🙄
Which doesn’t work that well per all the fun research on PTSD management.
Oh dear, pete really is deeply stupid.
Translation – you’re better off dead.
That could just be the depression talking, but lets face it, your attitude towards those of us who are struggling with mental health issues is pretty shit, amounting to little more than “toughen up” so frankly it’s perfectly fair.
On top of being a fuckwit, you also suck at critically reading. How utterly unsurprising.
If you’d bother reading you’d have noticed theat Blip mentions mental health heavily in the above article.
Yeap, because the effects of chronic stress from the quakes so totes isn’t a mental health issue, nor has it seen a significant increase in anti-depressant prescriptions etc. But hey, why deal with the truth on the ground when you can shit all over those in difficulty?
Pete Post Traumatic Stress Syndrome can happen through any situation which triggers trauma. Car crash victims often suffer from it, if seriously damaged by injury any further minor accident such as being rear ended or side swiped just makes the condition worse until it can be almost impossible to drive in traffic. Returned Servicemen have the same problem, sudden loud noises or similar situations which sound like war zone noises can have them cowering like wrecks. There is such a lot of ignorance about mental unwellness – always there has been a stigma attached as well, which hasn’t helped. The brain can be damaged just as easily as the rest of the body its just not physically seen with bandages or plaster.
Funds have been seriously drained from mental health services and it shows with people homeless, ignored by their families, the only time anyone becomes empathetic towards brain damaged people is if they have had personal experience and known loved ones or friends who have suffered and been diagnosed. A crane boom damaged a fine young man I know and he has cognitive disabilities and loses concentration – he didn’t have a clue what hit him. Be thankful Pete you are well and got over the earth quake and got your payout. Compassion cannot be bought but its a fine trait to have – try and gain it.
“You think I did not suffer similar things? Yes, dealing with insurance and so on is very stressful, but it is part of life. Deal with it.”
Met up with an elderly relative at a funeral a few months ago.
He has a late -life daughter with a young family in Christchurch.
Five years later and a million conversations with EQC, insurance, engineers, CERA, the CCCouncil and Uncle Tom Cobbly and all..and this gentle old man was in tears of rage about how his child and grandchildren have been treated.
You couldn’t ask for a more “personal responsibility” type…text book, he is….but this….this abomination that has been the government handling of the Christchurch quakes nearly finished him.
“Get over it..” my arse.
Ok so what’s your solution then? To not get over it? To spend the rest of his life feeling sorry for himself? Or years in therapy that leads no where?
No easy answer. But deal with it. Sometimes that means well placed action or anger as a way of releasing the presure at the pricks in eqc or near corrupt insurance companies. No easy answer. But bs counselling will not help, likely make things worse.
In chch we got unlucky. We suffered. Many suffered a hell of a lot less than I did. Many suffered more. But it’s 5 years ago. Life goes on. Wallowing in the past and the injustices that resulted does not help. So yeah. Get over it and look ahead, not endless hand wringing self pity.
The problem we have been facing here in Godzone for the past few years is that there has been a slow realisation that the ‘first world’ country we live in is actually not so ‘first world’ after all.
We live in a so called democracy.
We have a taxpayer funded welfare system, and likewise for healthcare.
We happily pay our taxes, (well some of us ) confident in the knowledge that there are systems, that we have funded through our taxes and compulsory levies, that we have legislated for through our democratically elected parliament, that will swing into action when the brown stuff hits the proverbial whirly thing.
This is why we pay our taxes. And vote.
Now, the brown stuff did hit the whirly thing in Christchurch nearly five years ago. And the government said….’we are in control…we’ll take care of things, we’ll make the decisions.’
Then there was betrayal after betrayal after betrayal.
Lies and exploitation and bitter in -fighting.
With those with broken homes broken bodies and broken lives caught in the middle.
And the worlds of those people who had done the right thing and paid their taxes, their insurance, their rates carried on working and going to school, trying to find a new normal….folded around their ears.
Losing trust, faith in your government…in the ‘first world’ structures that you and your forbears had carefully built up to provide support in events such as this is more psychologically and emotionally damaging than the quakes themselves.
But, pete…you’ll never get this…
You are wrong Rosemary, I do get it. I just have a different point of view as to the next step.
Firstly, the actions of some insurance companies has been nearly criminal (or would be in other avenues of life). But we knew that in advance – many insurance companies are slippery at the best of times. At a time like this, when huge sums are involved and the insurance companies have to go to what effectively are their insurers, well the result was never going to be good.
And as for EQC, don’t even get me started. Choosing my words very carefully, the bringing in of outsiders at sometimes ludicrous rates of pay, little or even no relevant experience, hiring of ones relatives and then farming out work to other relatives.Not good. The first assessor I had was a Sydney policeman on leave. Yeah, right. Thats very confidence inspiring.
‘The problem we have been facing here in Godzone for the past few years is that there has been a slow realisation that the ‘first world’ country we live in is actually not so ‘first world’ after all.’.
That about sums it up, but the other realisation is that there is a worldwide movement towards a world ruled by bureaucrats, not politicians.
Lied to by the government? I dont think so. I tend to think that they most probably had a wake up call too, as to just how little control they really have over the economy, the country. And yeah, of course they, like any human, promised things that they could not deliver on, but often as a result of frustration and impotence over what could be done.
All these things are true, what whats the answer, the next step?
Absolutely not therapy, counselling or self pity. I say again, get over it!
That’s correct: grasping wingnut spivs don’t believe in government, so they’re completely shit at governing.
Look you wanker! Many of the people you are dissing are poor little kids….and many are old and alone…these are not the complaining classes…..and suicide and attempted suicide are both at record highs in Christchurch. These are people who have struggled on for the last five years and are despairing..At which point the National Government step up and cut funding. They like you have no hearts and tiny shrivelled souls.
Pete, great you have ‘got over it’, want a medal? Now how about you tell my nephew and niece who after the quakes were so traumatised could not walk past our laundry to get to the toilet (and thus chose to soil themselves) because they were afraid of the noise the washing machine made (subsequently had to leave the shaky isles for firmer terrain). Tell that to the families who still live in quake damaged homes and due to on-going conflict and frustration caused by delays and insurance companies continue to suffer on-going stress and depression. I find it completely ignorant and condescending that you are negating people’s real experiences based on a simple and narrow personal perspective and experience. Suicide is not something people just get over, trauma is not something people just get over FFS.
Not simple or narrow experience. Just realism. Your niece and nephew clear suffered as many did. I am sure they received huge support from family. And that I am sure did wonders. Not bs counselling. And I am equally sure that, as young children (which I assume they were that they have bounced back just fine and think much less of the quake now than you do.
And no, of course no one gets over a suicide. Or a death in a car accident. In fact any tragic death. And yes, short term help at those times is absolutely justified and should be provided. But the subject of the article is not this. 5 years later, life has moved on.
pete i think you are fis back from your banning
Fis? I don’t know what that means. Banning? Not as far as I know?
Pete, actually you are wrong my niece and nephew required extensive and on-going counselling to deal with the after math of the earthquakes. Some children I am aware of suffer significant and on-going anxiety as a result of those quakes. I think suicides are relevant to this topic, with increasing rates of depression and stress as direct and indirect consequences of the earthquakes and that Christchurch’s rate is and has been historically disproportionately high. Added to this is the increase of meth use in the city (an indirect consequence of the quakes), as well as increased homelessness (which predominately falls on women and children). Ask yourself the question are homeless people stress free, are homeless women with children stress free? Long term stress leads both physical and mental health issues. Five years on, people having lived a good portion of that time under stress, there are bound to be a number of people still affected by the after-math of the earthquakes.
Regardless of what I say, or it appears anyone else says, Pete you say you are okay so in your opinion everyone else should be too, which shows a level of insular thinking that cannot empathise or understand other people’s feelings – I am sure there are any number of mental illness categories that you would fit in to with these symptoms – here I will give you a head start in your search for answers https://www.psychologytoday.com/blog/stop-walking-eggshells/201201/lack-empathy-the-most-telling-narcissistic-trait
Pete @ 2.1 Your opinions are showing your complete ignorance of mental health disorders.
There will be many in Chch suffering from PTSD. This is a complex problem that needs high quality treatment. The onset of PTSD can be immediately after the trauma or it can be delayed on-set PTSD, which may occur months/years after the trauma.
The disorder can become chronic if not treated effectively and produces high levels of disability.
You are lucky you didn’t develop PTSD. This will likely be to do with genetics and coping mechanisms.
“The need for good mental health provision in Christchurch is just so bloody obvious and going to be increasing as peoples reservoirs of resilience empty out.”
One of the things that concerned me when I read on this yesterday was a statement from one of the health authorities along the lines of how adult mental health had stablised but child mental health was getting worse. But this was being measured by amount of use of ambulance at the bottom of the cliff mental health services, which we know are inadequate. So there’s an issue of people not using those services because the services are too dysfunctional or overloaded and thus those people aren’t counted in the stats. And there is the issue of ‘sub-acute’ mental health, which is the strain that people are feeling without needing to go to the hospital. That second one will be huge and largely underreported and under-accounted for.
one would hope that extra funds will flow into CHCH for those that are suffering again, or even more so then before in the aftermath of the last quake.
Gosh, when will this country wake up to the fact that they are being systematically fleeced and robbed of everything that made this country a great place to live.
Healthcare is not something anyone would want to leave to the free market to fix.
Christchurch is a fuck up it should never been rebuilt that land is far from stable
property in Christchurch is worth zero
any suggestions as what to do with the say 100,000 displaced persons?
BLiP, what do you mean by ‘voucher system’ when referring to the Individualised Funding scheme set up for people with disabilities (but that afaik excludes people with mental health disabilities)?
Individualised Funding is a way of giving the person in need control over the funding instead of it being dictated to them by agencies (who have a pretty poor track record in many cases). The agencies involved have been private since well before IF was thought of (late 90s from memory), so I don’t see IF per se as being part of the privatisation agenda, although it can certainly be co-opted for that. Under a more socialist minded government IF could be a good thing.
The Individualised Funding sets a limit on the total amount of money each person may claim (based on dodgy assessments which are nearly impossible to appeal) and then sends them off to shop around approved private providers. While now appearing in the disability sector, this voucher system will eventually spread across other areas of health . . . and education, and housing, and income support / job seeking. Its the thin end of the privatisation wedge.
A voucher system for education was also advocated by ACT.
A stealth programme that dismantles public services in tiny nibbles.
what do you mean by voucher system and how does that apply to health?
A voucher is a document issued to an individual by a funder who promises to pay a provider for whatever goods and/or services the individual has been deemed entitled to receive. How they apply to health is the same way they apply in the provision of any other public service such as, for example, education. They are being used more and more widely in the UK for the provision of health services such as disabilities, eye glasses, and, more recently, nutritional needs. Once the individual has spent their voucher, that’s it – any additional costs must be met by the individual.
That’s not how IF is working in NZ, other than the cap in general terms. But as explained the cap has been there forever, and the cap is there whether the state provides services or they are contracted out.
The whole health system works under a defacto cap, it’s just that it’s not always individualised. eg surgery waiting lists are a form of capping that aren’t targetted at individuals (the budget is set to the area), but it certainly affects individuals’ access to services.
It also takes money away from the provision of services by turning part of it into profit and the pointless duplication of infrastructure.
Yes, that can be a problem. But not all non-State providers make a profit. That’s why I’m suggesting to differentiate between NGOs and private businesses.
btw, there’s also the history around the whole funder/provider split that happened in the 1990s, where it was deemd that it was better to have organisations that were providing services not also be funding them (there is a direct conflict of interest between providing enough services and managing a budget). There are pros and cons to this, but I think it’s fair to say that the issue isn’t about State/non-State so much as motivations and the directives coming out of govt.
Ok, I get your general points about privatisation and agree with much of that. However I think that are wrong on some of the details. Individualised Funding comes from the MoH via needs assessments. Those needs assessments predate IF by a long time. All IF does is give the person in need control of the funding instead of giving the funding directly to the agencies. This increases choice for the individuals, that’s the whole point.
As for caps, those have been in place since the 90s at least. Back then to get something like homehelp services a GP made a recommendation of the number hours needed and it was administered by the Dept of Social Welfare. I don’t know what the system was before that.
You seem to be implying that disabilty support services used to be funded with no needs assessment and no cap, and that the current government is trying to reverse that. I’d like to see some evidence of that.
I still don’t understand what you mean by ‘voucher system’, and your link doesn’t explain, especially in a NZ health system context. Can you please clarify?
btw, there is a cap on mental health services from a number of mechanisms, which is why there is a problem in Chch, and those same problems exist across the health system where services are still being provided directly by the state’s own organisations. (and even though people in the mental health part of the system don’t get IF they still can get a needs assessment).
A voucher system is individualised funding and promoted by that awful yet ubiquitous privatisation mantra: “This increases choice for the individuals”,
BLiP, that’s a nonsensical answer that doens’t say anything other than repeat rhetoric.
As someone with a disability and politicised around that I’m pretty uncomfortable with disability support services being misrepresented in this way to make political points especially where the details are incorrect.
If you have such a problem with private services I guess you are against organisations like the Blind Foundation. If you believe that all health and disability services should be provided directly by the government, then you are disengranchising people with disabilities from the conversation by way of the dogma.
There are huge problems with both the health system and disability services in NZ and they’re not helped by misinformation.
Yes I am against charities being used to provide health needs when they should be provided by the state. In my perfect world, everyone would be “disenfranchised” from having to rely on the private / charity sector for their essential needs. Yes, there are huge problems with the health system and disability services and the problems are not being made any better by increasing the number of private “choices” which, ultimately, cost everyone more than they need to.
Whereas I think the State is basically incompetent to run many services and that’s not a funding issue as much as a cultural one. A lot of the reason why NGOs exist is because they are where the innovation is happening that has been impossible within the hospital based system. The State puts many more constraints on services than the NGOs. Better that the State funds the NGOs with conditions as well as providing core services itself.
There is a also an important difference between NGOs and private businesses getting contracts. I have no problem with the NGOs, I have substantial problems with the private businesses (including for the waste of funding that you name). The latter are predominantly profit driven and aligned with the neoliberal take overs you are talking about. The NGOs tend to be organisations that are set up to be service orientated (not profit driven) and there is no good reason why they cannot be good providers. That is dependent on the State mandating clearly what its expectations are.
While I can appreciate the ideology behind the State providing everything, the reality is that in NZ health and disability services have had NGO involvement for most of its history (the Blind Foundation celebrated its 125th anniversay last year). I don’t see any practical way of changing that in NZ and slagging off all non-govt organisations as part of the evil empire is politically problematic.
One of the main problems we have is that our political system allows alternating govts to mess with the health system. So even were all health and disability services provided directly by the State, the State would still be quite capable of providing them badly and of fucking them up every time there was a change of govt. This is what happens already. For that reason, arguing State good, non-State bad doesn’t work.
But NGO’s have been successfully corporatised…with the resulting pulling of teeth…
“The survey results presented in this report depict widespread alarm among NGOs about their lack of
ability to speak in support of those they represent without risking revenge in the form of personal
abuse from Government representatives, public disparagement and withdrawal of funding. Nine out
of ten NGOs surveyed do not believe that individuals and organisations that dissent from current
government views are valued by the Government as part of a robust democracy. And nine out of ten
believe that dissenting organisations risk having their funding cut (Maddison, Denniss & Hamilton.,
So, Sandra Grey and Sedgewick looked at Kiwi NGOs…
Weka…I could spend the next couple of hours writing screeds about how the Misery of Health (under both Labour and National) cut its neo lib teeth by contracting out practically every level of publicly funded disability supports…and NOT to the benefit of NZ disabled.
IF and the voucher system….the PSA is getting tied up in this as the private contractors are having a collective meltdown, spreading fear and misinformation hither and thither if there is the remotest chance of disabled ppeople actually being given the CHOICE of who provides their funded supports.
“Weka…I could spend the next couple of hours writing screeds about how the Misery of Health (under both Labour and National) cut its neo lib teeth by contracting out practically every level of publicly funded disability supports…and NOT to the benefit of NZ disabled.”
Do you mean that services were better prior to that? What time period?
“IF and the voucher system….the PSA is getting tied up in this as the private contractors are having a collective meltdown, spreading fear and misinformation hither and thither if there is the remotest chance of disabled ppeople actually being given the CHOICE of who provides their funded supports.”
There’s some pretty bad shit happening from what I can tell, but I don’t think it’s universal and probably varies by geography and by disability and level of need.
I still don’t get why people are calling IF a voucher system, it doesn’t match BLiP’s description.
Weka….the Productivity Commission…bless them…
have done some work on this…in anticipation of the roll out of ‘client directed budgets’.
this is a good precis.
On their website is a ton of documents and submissions from all and sundry.
I have read every single one….I would recommend reading the NZDSN submission, the PSA submission, DPA, and a few of the other providers and NGOs to get the drift of concerns and opinions.
IF/voucher/client directed budgets won’t work for all…but…it will be life changingly liberating for many providing they have don’t place unreasonable and discriminatory conditions for eligibility and entitlement.
Which they will.
Perhaps the problem is when the government uses NGO’s to replace what should be core government services, with the only goal being to push costs off the government books. NGO’s can do marvelous work, but can also be exploited by those trying to ‘shrink the state’.
Just a general reply to a number of the pro-NGO provision of services. While NGO’s can provide effective supports (many do), some also make a good pretense at providing supports to those in need, whilst in reality their survival is more important than the needs of the ‘clients’ or real outcomes (all manner of outcomes can be manufactured if you have the right systems and tools to measure so called success). Examples of this, without getting too personal (having worked for NGO’s, contracted to Government to provide programmes for instance), I have personal experience of having to deliver an intensive parenting programme that did not exist to ‘hard to reach parents’. In fact it had to be ‘made up’ as I went along, using the free resources already provided by Govt, with no time allocated to develop an evidenced based programme, with no time to pay anything more than a tokenistic platitude to te Tiriti – despite the contract requiring a cultural component. Outcomes were evidenced using a ‘dodgy as hell’ system (which I could write a thesis on), this programme paid lip service, it did not and could never be an effective programme (based on the lack of commitment from the organisation to provide the necessary resources to develop it) – yet the outcomes measured the programme as a success (but it wasn’t). As an on the ‘coal face’ worker, what was really happening was these ‘hard to reach parents’ were simply $, the organisation did not invest time or resources in to developing an evidence based programme because they were too interested in profiting from the contract. (For the record I know what the contract was/is worth and I know how much money was invested into resourcing and staffing the programme – equals big profit for the organisation). This is not my only experience but just the most recent where I have felt that NGO’s are just as greedy as the private market, hence I choose to no longer work for NGOs because they are dishonest about what they do, while most affront me with their so-called moral superiority and good intentions!
It’s a sad endictment that this is true, and that the problems are so entrenched across the board.
The kinds of dynamics you described, I have experienced in the State-provided services as well. Probably not as blatantly obvious, but definitely a lot of bullshit going on.
A lot of this is why I argue against supplementary benefits under a UBI system being handed the Health. I think that many people are politically naive about how bad the Health system is and that it’s not just about the current govt but the whole culture that has been built up since Rogernomics.
“Perhaps the problem is when the government uses NGO’s to replace what should be core government services, with the only goal being to push costs off the government books. NGO’s can do marvelous work, but can also be exploited by those trying to ‘shrink the state’.”
Yes. I think that the idea is that the govt provides clear guidelines on how service provision should work, but because the background agenda is cost cutting and now privatisation the whole thing gets fucked up. I don’t know what the solution to that is given we have a democracy that changes govt back and forth every decade.
I hear many services complaining daily about lack of funding from Govt and the risk of private organisations coming in and vying for contracts that were once theirs guaranteed. NGOs and NFP organisations are all competing for shrinking funds. This level of competition allows Govt to further drive down funding. Most of us know this, we understand how neo-liberalism works. A pity the NGOs and NFPs don’t see this for what it is and collectivise and improve the situation by refusing contracts that are not adequately funded, that are not in the best interests of the service users and do not force the organisations into the role of gate-keeper for the state. These services are simply maintaining the increasingly unequal system for the state. (they have inadvertently become a part of the state apparatus, except the state takes no responsibility and no blame for failure).
Provision of core services should be the responsibility of the state, yet many core services have become so eroded, so underfunded, understaffed and inadequate that those services will be next in line for privatisation or partial privatisation.
CYFS will be the next. 2014 review of CYFS highlighted that significant Govt underfunding was behind many of the problems faced by the organisation. 2015/16 Paula Rebstock has been brought in to paint a different picture – her interim report is critical of CYFS practice etc etc…it will be interesting to see what the final report says. Meanwhile the Office of the Children’s Commissioner have also identified significant under-resourcing as an issue for CYFS. This Government’s agenda is very clear.
I think that the state can and should provide fundamental services and that NGO’s and NFP only provide services that they are adequately experienced/qualified to provide. Failure of the state to provide quality services is probably more likely attributed to the intentions of the incumbent Government than an assumption that the state are not good at certain tasks.
That’s a very good analysis, thanks.
Especially when the ONLY option to access any support is via one of these contracted providers…be they NGOs or companies.
Because they can, and do, simply refuse to provide any services if your disability puts you into the “very high needs” bracket.
This I know…as in between ranting here…I am performing vital cares for my disabled partner…cares that no contracted provider here in the Waikato were willing/able to provide because he needs a much higher level of care than they can/will provide for the funding.
The disability support system is broken.
Thanks…because that is all it’s worth.
(That, and Himself has 24/7 top flight care…when so many others end up in a box because the Contracted Providers have neglected them to death.)
Can you get assistance so it’s not all you for everything? Can you travel to a better DHB area that has allocated funds to help with your needs?
“Can you get assistance so it’s not all you for everything? ”
Greywarshark…it works me doing all his cares…it really does in all sorts of ways…other than me having had no income for 17 years and as a result no savings.
BUT…Himself is well, and we have a life, we did not compromise our integrity by doing a dodgey backdoor deal to get me paid…and we have our Bus so we can light out into the wild blue yonder and be free. Because we have nothing to lose, we can speak out about the gross failings in the system.
This we feel is really important, because so many disabled people and their families are too scared to speak up in case their supports are cut.
What gives me (and other family carers) the screaming shits (sorry to swear) is what will happen when we can no longer do the job.
When the threat of “he’ll have to go into residential care” has been hanging over our heads for well over a decade.
We talk about it…and today I got a call from another spousal carer who has been trying to find relief care through a large provider for over a year…no go…as the level of care her hubby needs is beyond the scope of the agency….they won’t take the contract because they can’t guarantee to be able to provide the level of care required. The same position we are in.
“..another DHB”…again, its easier to stay with the one DHB….but Peter’s supports (such as they are) come under MOH:DSS because he has had a lifelong disability, or a disability that is not age related.
We organise ourselves so we can potter off around the country for two-three months, return home for a week or two for appointments and to pick up supplies and scripts. If necessary…medical records can be emailed…https://www.managemyhealth.co.nz/
another contracted provider!!!.
That’s great you have been able to set your lives up like that!
Sorry to be ignorant, but what’s the reason you can’t get at least some of the services done by an agency even if they can’t do all of it?
@Weka…”but what’s the reason you can’t get at least some of the services done by an agency even if they can’t do all of it?”
If a carer came to do Himself’s personal cares…they would HAVE to be able to perform all required care tasks…as he could need that specialised care at any time. There are certain medical conditions, potentially fatal, that those with high spinal cord injuries can be prone to if the ‘i’s and ‘t’s are not dotted and crossed.
This is why ACC funds 24/7 care for high tetraplegics…my bloke….in a stunning example of bad timing…broke his neck and damaged his spinal cord some three years before the advent of ACC.
And on that note…it’s past time that I got Himself settled down for the night. ;-).
ah ok, that makes a lot of sense. So there are skilled carers available in another part of the system, but the provider agency available to you doesn’t employ them? And you don’t get enough funding right?
Different details but I understand the completely mind screwing nature of this kind of inflexibility and downright stupidity in the system.
It depends how (and whether) responsibility is transferred.
It’s the government’s responsibility that healthcare is available to all. Not to dictate private arrangements. Too often (as with SERCO, for an obvious example) governments of the right seek to transfer responsibility when they have a mandate to delegate it at most.
That makes sense.
“It’s the government’s responsibility that healthcare is available to all.”
This may well be…but there is no actual entitlement.
“Being eligible gives a person a right to be considered for publicly funded health or disability services (ie, free or subsidised).
It is not an entitlement to receive any particular service. Individuals need to meet certain clinical and other assessment criteria to receive many services.”
So you can argue all you like about it..if they choose to decline treatment/service….tough shit….
That link says for citizens the eligibility is pretty clear. I think what you are meaning is that the clinical and needs assessement process is failing people, and then if they do get approved or funded that there is very inadequate provision. Is that right?
There is a BIG difference between “eligibility” and “entitlement”.
“Individuals need to meet certain clinical and other assessment criteria to receive many services.”
The key words in that statement are “other” and “many”.
These words can mean anything.
Are you referring to disability support services? eg people getting needs assessments are being denied access to services or funding?
I am not sure if you fit into this category or not but are you essentially saying that your other half does not qualify because he is in the ‘too hard’ basket and service providers do not have the qualified personnel to meet his needs but he would otherwise qualify? Phew that was long winded…or have the assessors, using a ‘strengths based’ assessment process determined that all of his needs are being met by ‘natural supports’ and therefore he does not qualify…or something completely different? Sorry if you need to repeat yourself again. I am interested in this topic and how assessments are carried out to ensure that ‘client’ strengths are magnified to the disadvantage of ‘clients and the advantage of funders who in my opinion are using the ‘strengths’ perspective to dissolve responsibility for the provision of services (I have seen this in action so often).
I’m interested in this too.
I thought it was that he had been assessed but wasn’t given enough funding, and the providers weren’t willing to take him on as a client with the amount of funding he had.
Sorry for the delay in replying….been travelling!
If I were to drop down dead….the NASC would try to force him into an institution as it would be difficult to meet his ‘core needs’ (as defined in the Home And Community Support Services Specification).
The Miserly of Health still insists that family are ‘natural supports’…and should provide all care for disabled family members unpaid. There is an excellent discussion about ‘natural supports’ in the HRRT decision for Atkinson and others v Ministry of Health….http://www.nzlii.org/nz/cases/NZHRRT/2010/1.html
For anyone with a genuine interest…this is still my preferred goto document to describe the situation of those with high care needs living with and cared for by family.
Considering the Tribunal had limited experience of the issue, It took the seven weeks of hearings and translated them into a fairly accurate description of disability under MOH.
Thank you Rosemary, appreciate you taking time to educate me and others and will definitely look at that document which I am sure will be a valuable resource to show how neo-liberalism uses the strength perspective to reduce expenditure on meeting health needs in the community…could say a lot on this but won’t go on here just now 🙂
Kia kaha my friend
Don/t be hard on Blip weka for being strong on theory and short on experience. It has been the mantra for years that it was bad for government to opt out of doing its tasks and getting in contractors or whatever. That is what I learned and it has often been painfully true.
You have experience with the system and have seen the advantages that private enterprise NGOs particularly, can bring.
I think what was said by I think OAB is the crucial point, that government adequately measure the outcomes, and work in conjunction with providers.
Otherwise they withdraw to their ivory towers, or bars, and just play at doing a good civil service but only respond slightly, to errors. Or they try and micro-manage and count the inputs to see that something is happening, rather than looking at the outputs, and being open to the ‘clients’ opinions and experience.
If someone had put up a post praising NGOs I would have been able to criticise that too 😉
One of the tricky things is that the situation is so bad across the board that it’s hard to tease out where the actual problems are. I’m not convinced by the ideological argument that govt is always best. I accept the principle in general eg I don’t believe that private companies can run electricity or rail better than governments. But health is different, for good reasons and I think we should be looking at what those reasons are instead of using dogma to promote something that isn’t necessarily best.
btw, the reason I am hard on BLiP or anyone on this is that there is not a lot of good political activism happening on the left, and so when it does happen I want it to be more accurate and more nuanced and to take into account the politics of the people most affected. That’s not such an easy thing, but I do think it’s important to name it.
Thanks for this post BLiP, and the comprehensive and damning links. The demolition of public health services generally, and mental health services in particular has been one of National’s success stories – because they’ve managed it without much dissent.
That Tony Ryall was a clever chappie wasn’t he? Especially with the bit when he got out after he put the damaging changes in place, but before the impact was widely noticed.
Now that more and more people are having wtf moments about where the health system has gone, Coleman, who is is not made of the same material as Ryall, will have no problem blundering through the nasty business of denigrating those who oppose the changes as well as those who need the services.
I bet he and Paula Bennett have swapped a few notes on this one.
Why Tony Ryall isn’t in a prison cell for his HBL rip off is beyond me. Oh, and look where he’s turned up – https://www.nib.co.nz/about-us/directors
The Hon. Tony Ryall – Director
BBS (Massey University)
Independent Non-Executive Director
The Hon. Tony Ryall
Tony was appointed as a Director of nib nz limited in February 2015.
He is also a Director of nib nz holdings limited.
Tony was a member of the New Zealand parliament for 24 years. He served as a cabinet minister from November 2008 until his retirement from public life in September 2014, holding positions of Minister of Health, Minister of State Services and Minister of State Owned Enterprises. He also held ministerial positions between 1997 and 1999 as part of the Shipley Government.
Mr Ryall was appointed a Companion of the New Zealand Order of Merit for services as a Member of Parliament in the 2015 New Year Honours.
He is currently the Head of Policy with the highly-respected commercial law firm, Simpson Grierson.
That clusterf&@k is a dysfunctional nest of vipers sucking badly needed resources…..thanks nact.
One word, crony capitalist!!
Another word, lawyer. (sorry Micky Savage.) Such a handy profession for a pollie, so literate etc.
And one of my personal gripes – a company with an acronym for a name not indicating what it is, nor a person’s name indicating a personal interest in the company, and no explanation about it’s meaning, just nib (National Insurance Broker, National Invalid Broker – that would be a good one with play on words.)
Another damn good post on thestandard BLIP! One can’t help but think that the nails must be flying off the crate that houses this crock of shite government so fast that internal combustion is a very real possibility any day now.
How much longer can the public ignore the blatant lying, arrogance, hypocrisy, deceit and subterfuge that Crosby Textor and this government employ and operate on on a daily basis here in Aotearoa.
Haven’t seen a poll for a while now, must be a few due out very shortly I presume.
As a Christchurch mental Health professional I can share my experiences post earthquake.The thousands of people who went through life with mild anxiety, not treated, perhaps what has been described as worried well all of a sudden developed full on anxiety conditions, developed suicidal ideation and sought assistance. These are our friends, neighbours and collegues. They are the people flooding our mental health services.Perhaps the most perplexing has been the influx of people from other areas,who have a major mental illness who have moved into Christchurch post earthquake, the first of them within hours of the February event. They have stayed, they are the people who overwhelm Acute Services, they have no family or other supports in Canterbury, no housing and put extreme stress on stretched services.Often they are drawn by the attraction of a rebuild job but have no skills. Their own DHB,s will not accept transfers pleading overcrowding.At least we have an ethos of treating all, not like other areas who put Canterbury clients onto a bus or phone from the airport asking that patients be collected.
There is hardly a day goes by without the suicide of a mental health client,they just fall through the cracks.
Thank you for that inside info PNurse.
I was particularily horrified by this comment
It gets worse…
“Hospitals have been told to make $138 million in savings over this financial year and some have signalled they’ll cut costs through staff vacancies which have not been filled.”
We did once have a good mental health service until it was dismantled by the neoliberals, social engineering is what it is described as?