health & science

‘H2’ to head public health review

A wide-ranging review of the health system will encompass everything from local primary care to the funding and operations of district health boards, writes Thomas Coughlan. 

The review announced by Health Minister David Clark could mean a top-to-toe revolution for the health sector, but not before the next election.

It has been given some serious political firepower. It will be chaired by Heather Simpson, better known as “H2” in reference to her role as Helen Clark’s top advisor during the last Labour Government. Simpson moved with Clark when she took up her role at the United Nations.

Simpson was policy advisor to Clark when she was Minister of Health in 1989. 

She was working for the Labour party when the current model was implemented in 2000. This rolled the Health Funding Authority into the Ministry of Health and the DHBs. Each of the 20 (formerly 21) DHBs is responsible for independently procuring services in line with targets set by the ministry. 

The terms of reference for the review single out the devolved nature of the health system as a matter of concern.

“The current devolved health system has a complex mix of governance, ownership, business and accountability models and arrangements,”  the document says.

“This complexity can get in the way of ensuring public money is spent to invest in, and provide, healthcare to the public in a coherent and smart way”.

Currently DHBs are funded based on a complex calculation which attempts to take into account the population of their catchment with the specific needs of the area.

This can lead to inequality in services provided by the DHBs, with some providing better care than others. 

Successive governments have addressed this in a piecemeal fashion. Pharmac, the agency responsible for procuring pharmaceuticals, was given responsibility for purchasing cancer medication on behalf of all DHBs in 2011 in response to concerns some DHBs were not providing medication available to patients in other parts of the country. The Government’s first Budget rolled out this model across all pharmaceuticals, perhaps revealing an appetite for further amalgamation of DHB services.  

The terms of reference also signal concern over the distribution of tertiary services across the country, suggesting the accessibility of specialist services like mental health consultations could be set to change.

Primary care 

The terms of reference also note the health system’s incentives can get in the way of good health outcomes, with some people waiting until they are truly sick before they use the system, instead of accessing services to help them stay well. This in turn is increasing demand on secondary services such as hospitals, which then take up more funding as a result.

The Government is looking for a greater focus on primary care and preventative medicine, saying mental health and addiction services and primary care services (such as GPs and community health centres) need to be strengthened.

Change... eventually

But it will take time for any of these changes to come to fruition.

It must take into account -"take due regard of" - the results of three other inquiries, the review into mental health and addiction, the work of the Ministerial Advisory Group on health and the findings of the Waitangi Tribunal in the WAI 2575 Health Services and Outcomes Kaupapa Inquiry. 

The review panel will have its first meeting in August and issue an interim report no later than August next year with the final report due on 31 January 2020 - election year. It will have the power to recommend changes to the Government.

Health minister David Clark said: "We need to face up to the fact that our health system does not deliver equally well for all. We know our Māori and Pacific peoples have worse health outcomes and shorter lives. That is something we simply cannot accept.

“We also need to get real about the impact of a growing and aging population, and the increase in chronic diseases like cancer and diabetes. Those issues in turn create pressure on services and the health workforce that need to be addressed for the long term sustainability of our public health service."

National's health spokesman, Michael Woodhouse urged the inquiry to focus on "the best outcome for patients whilst taking an independent approach" and believed Simpson would need to reassure the public she would be free from party politics.

He wanted another major piece of work incorporated, too.

“We urge the Government to incorporate the New Zealand Health Strategy, commissioned by National and published in 2016, into its review. The strategy championed significant change in the health sector and outlined the health and disability system's direction for the next ten years – it would be a waste if this work were thrown out."

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