Roy: The Health Of A Nation
The Health Of A Nation
Heather Roy Saturday, 16 September 2006 Speeches - Health
Speech to ACT Wellington Regional Conference, Museum Hotel, Saturday 16 September 2006.
Shortly after New Year 2005 I drew attention to the numbers of people dying on waiting lists for our public hospitals. I had been asking for information about waiting list numbers for some time - the numbers waiting to see a specialist for the first time, those told they needed surgery but having to wait, and the numbers taken off waiting lists for a variety of reasons - some opting to 'go private', a few who decided they no longer wanted or needed treatment, others who were sent back to their GP and those who died before they could be treated.
I was concerned about this last group because over a 2-year period the numbers had jumped by an alarming 40%. I had the figures for each District Health Board and regional papers right around the country printed the stories of the 'deaths' in their region. This is the first and only time I've had 100 percent success on any story I've done. I knew I had touched a raw nerve - the then Minister of Health Annette King launched a personal attack of me via press release, in speeches and Letters to the Editor. It is always good to have confirmation that you are on the right track.
We have yet to hear a plausible explanation for why the death rate of those waiting for further treatment increased by 40% over two years. But as a result of the public outroar these figures caused the Ministry of Health to change the way in which it collects statistics from DHBs. Previously there had been 10 exit categories from waiting lists so that it was relatively easy to determine where and why people had been taken off. Now, exits are combined so that there are only 4 categories, and deaths are now merged with those who have been treated privately and have left the region.
Today the statistics are pretty much worthless and my expose', in the long term anyway, has achieved little. I have stopped asking for the figures because they meaningless and tell nothing of the real picture of the health status of New Zealanders. This process has been repeated as spin takes over reality to such an extent that any observation that could be embarrassing simply isn't made.
The DHBs are still required to report on a number of activities, and they employ staff and expensive computer systems to do just that, but what statistics are used is at the discretion of the Ministry. There comes a point when the Minister himself does not know what is happening - and that is where Pete Hodgson now finds himself, trying to peer through the smoke screen created by his own party. And he has to do battle with obfuscation created by his own Ministry.
The situation at the front line can be illustrated by an anecdote I heard recently:
At one New Zealand hospital a few weeks ago there was a deadlock as the number of admissions exceeded the hospital's ability to absorb new cases as winter took its usual toll of respiratory infections and flus. The short stay A&E had turned into a medium stay facility and five new cases lay in the Casualty department waiting for a spare bed in a medical ward. Some of the medical patients were housed in surgical wards to help ease the strain but more admissions kept coming in. Reluctantly management decided to stop elective (non-urgent) surgery.
News reached a surgeon as he was about to enter the operating theatre that there was no bed for his patient to return to, therefore he couldn't operate. The patient was prepped and the anaesthetist was standing by.
"What do you mean there are no beds" he demanded. "The patient had a bed this morning and came to theatre on a bed. Why can't he go back to the same bed?"
He was told the ward was full of patients with a medical patient in this man's bed.
"I can't cancel this man, he has been put off twice already".
While the manager went to see if there wasn't a bed somewhere, the surgeon started operating in defiance of instructions.
A number of hospitals over the winter period have been on "red alert" - an indicator that they are overfull - and many have cancelled all elective surgery requiring an overnight stay, for periods. The junior doctors strike a couple of months ago and the radiographers strike this week have also caused the delay of elective surgery further for many patients in desperate need of treatment.
I recently read a press release that aptly described the struggle to cope with acute admissions in the face of winter flus and illnesses.
"Winter should not be a crisis. It happens every year and its associated ailments can be life threatening, especially for the elderly and very young. These crises could be avoided if we had a health policy flexible enough to allow for a surge in demand in the winter. It is unacceptable that people are missing out on planned surgery because of bad planning."
This release was dated 11 August 1997 and was the work of Labour's then health spokeswoman, Annette King. She was - of course - criticising the policy of a National government, but nothing has changed.
To be fair, Ministers from both Labour and National have delivered budget increases in most financial years, over the past two decades. For their efforts they have been constantly pilloried as uncaring and mean spirited and have started accusing those at the front line - the doctors, nurses and other health professionals - of letting them down. Many become convinced that hospital staff are incompetent, but that is very far from the truth. I can tell you from personal experience that New Zealand-trained health professionals are exceptionally well trained and sought after around the world.
In the health arena it is possible to be excessively pessimistic. The true story is actually very optimistic. Life expectancy is rising rapidly, by 8 years since 1970 - that's nearly 3 months per year. It is true that it's best if you are white and female but life expectancy is rising for all groups surprisingly rapidly. That is why everyone wants to sell you life insurance - with a falling death rate it is very profitable.
So should we be celebrating our health system or condemning it? I've already said that those at the front line do a great job. A significant number work too hard and it is a major indictment of our health boards that they made our junior doctors work excessive hours for so long in the face of abundant evidence that sleep deprivation impairs decision- making ability.
The suggestion that there could be an erosion of junior doctors' working conditions recently put me in the unusual situation of agreeing with industrial action. The junior doctors went on strike, but as the employees of a monopoly, what alternative had they but to strike or leave the country?
Constant calls from the public for injections of cash will do nothing to solve the problem. This is what's been happening for years, yet per head of population, less surgery was done in 2004/05 than the two previous years. There is talk of Minister Hodgson injecting $60 million into the Health Budget for elective surgery - an elaborate band aid with the real problems continuing to be ignored and is no long-term solution.
The injection our health system needs is a large dose of honesty. At the moment there is a lot of dishonesty in the analysis of health, and I've talked of this many times. There is the issue of price. Anyone with a rudimentary knowledge of economics knows the price of a service is the point at which supply equals demand. If the price is held low then demand will exceed supply. If it is free then demand will dramatically exceed supply. The only way to deal with that is to ration the care provided - this sums up New Zealand's public health system in a nutshell. Public healthcare is rationed, but the pretence by the policymakers is that if you need treatment, the state will provide. Because rationing isn't acknowledged officially it is implemented by those who have no choice. Doctors' receptionists have to ration access to the doctor. Junior doctors have to decide who gets admitted and who doesn't.
So what can be done about the state of healthcare in New Zealand? Everyone knows there is a big problem - but few think that there is a solution.
First, there must be an acceptance that every health need or want cannot and will not be met by the state. ACT ran two focus groups this week - a men's group and a women's group. Health came up as an issue - unprompted - that people thought was most important for them and for the country. They saw health insurance as a large part of the answer, with comments such as "Kiwis need to start taking some responsibility for their own healthcare".
One possible solution is to separate acute care - heart attacks and injuries caused by car accidents for example - from elective surgery. Turn the tables. Private hospitals rarely cancel surgery because acutes don't come in and bump electives down the list. While the two are scheduled together, the uncertainties of acute workloads make it impossible for elective surgery to be scheduled with certainty.
We should encourage DHBs to contract with private hospitals to provide this certainty. At the moment, they are told by the Ministry and Labour that everything must be done in-house where possible.
We can also encourage innovation - for example, Southern Cross offer their Activa programme, a savings plan that you use to buy your health insurance. In other countries, this has been very successful in recruiting young people to buy health insurance, and this is where our attitudinal change is most important for the future.
I want to finish by reading to you from another press release. This one is from The Australian, yesterday. I could have written this release myself - it says everything I've been proposing for the last four years. It shows that historical political blinkers can be thrown off where there is courage and political will.
"Private hospital beds will be bought to slash waiting lists for public hospitals under a new ALP policy designed to shake up the health sector"
"Cost-shifting and duplication are crippling the health system at a time of massive increases in demand for services"
"We need to tap into the full potential of the private hospital sector [...] Private hospitals are an invaluable national health resource and more needs to be done to integrate them with the public system".
This is from Kim Beazley, leader of the Australian Labor Party - a modern Labour Party - one that cares about people in pain in suffering, one that is prepared to look at options for the health of a nation. We don't have that sort of Labour Party in our country.