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Health reform: Is NZ up for the long haul?

Transforming the health system will demand a mindshift away from an adversarial style of politics, otherwise we are doomed to watch the Simpson Review sink like a stone into the political mire, writes Sarah Dalton

After the political turmoil of the past few days and weeks, it is tempting to reach for a cup of tea and a lie down, but it is worth reflecting on some of the big issues we face. Covid has the world by the neck. We need to think differently about travel, about work, about our population health.

In the health space we have both a new Health Minister and a new opposition health spokesperson – changes that happened within just a few short weeks of each other.

Importantly they have come at a time when we are still digesting the Health and Disability System Review, aka the Simpson Review. It lays out a vision for our health system that is measured in decades, not in days, weeks, months, or even the handful of years that make up an electoral cycle.

The review panel warns early in the report that for its recommendations to make a meaningful and positive difference to health outcomes we need to adopt the whole thing, not just bits and pieces. For this to happen we need long-term political commitment, careful stewardship, and oversight, not to mention planning, resourcing, review, and quite a lot of joined up work.

The question is - are we up for it? If we judge the present according to evidence from our fairly recent past, the answer might somewhat worryingly be, not really.

The review, as Professor Des Gorman noted, bears a striking resemblance to several of its predecessors. It has a strong focus on public health, more services in the community, stronger primary care systems addressing health inequities, better service networks and integration, along with improved mental health service responsiveness. It recommends we build positive, collaborative cultures, improved IT systems, stronger leadership, stronger accountability, etc.

All of which you will find in the New Zealand Health Strategy 2000. In other words – been there, haven’t done that.

The recent Mental Health and Addiction Inquiry made a similar finding when pondering why, over the past couple of decades, the mental health and addiction system "has not shifted", despite stated intentions to do so in earlier strategies. A key conclusion was that “a fundamental disconnect exists between stated strategic direction, funding and operational policy and ultimately service delivery”.

A similar disconnect is clearly evident in our health system as a whole.

We need to tackle this with strong public accountability. Not just on the performance of service providers, but on the implementation of policy and progress towards intended goals. The key barrier to progress is not so much about the ‘what’ we want to do, but the ‘how’ we go about it. Our lack of direction on the ‘how’ is where things fall down.

We welcome the long overdue focus on Te Tiriti. There is an urgent need for better health outcomes for Māori. That said, the review panel itself could not agree on the ‘how’ around that, failing to reach consensus on the powers and functions of a specific Māori Health Authority.

Many past health ‘reforms’ both here and overseas have largely relied on formal organisational restructuring and top-down policy directives based on financial imperatives like budgets, throughputs and targets.

Many frontline health workers tell us these policies bear little resemblance to the lived reality of their working lives. This disconnect has contributed to an ‘us and them’ divide between our clinical workforce and the management charged with overseeing them, as well as with government. When you add workforce shortages, high burn-out rates, increasing acute demand, and long waiting lists, it is little wonder we see a frontline workforce in poor shape. The review confirmed it had found a health and disability workforce under considerable stress.

The Simpson Review calls for the development of a more positive culture, better working conditions, improved collaboration and integration, and clinically-led service development, all of which are laudable. But history shows us that these things don’t happen just because you really, really, want them to. They require deliberate strategies, hard work, a steely focus, and recognition that change can be gnarly, and takes time.

If we can pull that rabbit out of this rather large hat, the benefits could be significant.

Transforming the health system in practice requires long-term timeframes, unified values among policymakers, and constancy of policy approaches. This demands a mindshift away from an adversarial style of politics, to one that is more constructive.

Such important decisions that will affect the future healthcare of New Zealanders should not be tied to party political processes and electoral cycles. Health issues will always need healthy debate, but we need to see some political consensus around what happens next. Are our political parties ready to agree on the fundamentals of New Zealand’s health system? Can they commit to a shared vision?

If not, we will be doomed to watch the Simpson Review sink like a stone into the political mire.

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