Agenda: National's Tony Ryall IV Transcript
Agenda: National's Tony Ryall IV
©Front Page Ltd 2007 but may be used provided attribution is made to TVOne and “Agenda"
Presented by RAWDON CHRISTIE
RAWDON Is the John Key National Party more to the right than we thought. This week it unveiled a health discussion paper and it seems to follow the pattern set by their Deputy Leader Bill English on this programme last week when he revealed the party supported the privatisation of SOEs. Now it's proposing greater use of private hospitals and other non state providers, public private partnerships to provide assets from building to equipment and removing the cap on GPs fees. Tony Ryall is the party's health spokesman, he joins Guyon Espiner now.
GUYON ESPINER – TV One News
Ryall let's start there, your health discussion document
talks about making greater use of the private sector in the
health system, how much and in what areas?
TONY RYALL – Health Spokesman, National
Well we think there's a real role for the private sector to supplement the work that our public hospitals are doing particularly in providing elective surgery. What we know is that in the last seven years of the Labour government they’ve put five billion dollars extra into the health system and fewer New Zealanders are getting elective surgery on a population basis and we think that there's spare capacity in private hospitals and we should be able to tap into that, have those publicly funded operations performed there, we'd also like to see more minor surgery and assessments done in GP's surgeries much closer to home.
GUYON Okay let's talk about elective surgery because the Ministry of Health says at the moment the private sector does about 2% of elective surgery, what would you like to see that rise to?
TONY Well I don’t think we've got a specific number in mind but we very much see the private sector as being supplemental to the work that’s going on in the public sector.
GUYON But have you got an idea of roughly how much you'd like to see that private sector being involved?
TONY Well I think there's a much greater use that could be made than what's being made at the moment, it's because we want more service for patients. Right now despite the five billion dollars a year extra fewer New Zealanders are getting elective surgery, that’s hips and cataracts and things like that, than there were seven years ago, and that’s just not good enough when you look at the level of investment so we've gotta use all our resources in health smartly.
GUYON Okay, and that’s one of the themes of your discussion document, you talk about bureaucracy going out of control in the health system. How many jobs will go in the health sector and from where?
TONY Well we're not saying in this discussion paper the specific number of bureaucrats that will go, what we're…
GUYON Why not though, because if your going to identify that and say there are too many and they're out of control, you must be able to give us some idea of where those jobs will go from?
TONY Look I tell you you will see a lot less reliance on managers and administrators and DHBs in the Ministry of Health.
GUYON Let's talk about the Ministry of Health with some numbers for a minute here, 2% of the health budget, you're not gonna save much by cutting that are you? It's 2% of the health budget that is spent on those people.
TONY Yes but so much of the bureaucracy emanates from Wellington that is actually causing so much of the troubles. Don’t forget in the last seven years you’ve got 2000 extra DHB managers and administrators. Now frankly when you look at the fact that services have flatlined, no more New Zealanders are getting elective surgery, surgery of any kind, even specialists appointments with that five billion dollars we think there's quite a lot of room to manoeuvre.
GUYON But there's not is there because it's 2% of the total budget.
TONY But that’s just the Ministry of Health, but don’t forget those people in the Ministry of Health while many of them are doing good work many of them are creating the paperwork and the red tape that is restricting our doctors and nurses, physios, midwives, from getting on with the job of delivering good care for New Zealanders.
GUYON Would you cut those people out of the DHBs as well?
TONY I think you'll see a significant reduction in DHB managers and administrators, because we've got a plan to re-involve and re-engage doctors, nurses, midwives, in the running of the health service.
GUYON Who will do the administration then? Doesn’t that just mean that the people who are providing healthcare now will end up having to do the administration?
TONY Well it's not a fixed sum Guyon, in fact if you have a health system that actually is much more trusting of the health professionals and engages them more in the health system, you’ve got much less need for the bureaucracy, and that’s in many ways what this document is about. It is about trusting our health professionals in the hospitals, re-engaging them, involving them more in the planning and the delivery and the future of our health services, such that we don’t need to rely on this constant new vision strategy whoever everything, which seems to be the government's approach in heath.
GUYON Okay, can I talk about health spending overall? We spend something like 12 billion dollars on health now, those costs have been rising 9% a year roughly under Labour. Can you today commit to National keeping spending at the same level as this Labour government has done?
TONY Well we don’t know exactly what Labour's spending in the future is going to be so we can't do that now, but what I can tell you and it's clear in the document, is whether any government likes it or not they will always be spending more in health, but we can't give you a firm view on whether what Labour's spending will be, we've gotta wait until their spending track is announced and Bill English the Finance Spokesman will do that.
GUYON It's a pretty simple question though isn't it? I mean for the viewing public will you spend as much as Labour is on health?
TONY Well we can't say that yet but what I can tell you is there'll be no reduction in what's being spent, and we fully expect and we know that we will be spending more as a government because every government spends more on health, and the wealthier New Zealand gets the more money we will have to spend on health. New Zealand will be a wealthier country under a National led government and that will give us more opportunity to invest in health.
GUYON One of the big discussion points wasn’t in your policy at all, that is removing the cap on GPs' fees, now will you do that.
TONY Look this is a hoax that there's a cap on GPs' fees, there's no such thing, this document here is all about reducing bureaucracy in health and the government's socalled fees review on GPs' fees is a hoax. Virtually every GP who applied to the Fees Review Committee for a fee increase go it. Now we think that that’s a huge bureaucratic cost that has no impact on patients. What we're saying is that fees review process should go because it simply doesn’t work, and I do want to say this, the government has been quite deceitful in the way that they’ve responded to this issue. The Prime Minister was on television saying that poor New Zealanders will face hikes in their GP costs, that’s absolutely ridiculous, because a quarter of New Zealanders well over a million are in what they call very low cost access general practice, that’s where their doctor has agreed to have low capped fees, or low fees as part of a deal for getting more subsidies, now that’s mainly for lower income New Zealanders, that’s well outside of the fees review process, so the government has been quite deceitful in trying to indicate that there is a cap when there is not and secondly that lower income people who are getting the very low cost GP visits would have those change.
GUYON But weren't you deceitful in not putting it in that discussion document?
TONY There's no deceit here, we've been talking about this for …
GUYON Well John Key was quoted yesterday as saying that it wasn’t transparent to not put it in the document.
TONY Oh well well, what I was going to say is, we'd been talking about this for six months before the discussion paper was being released.
GUYON So why didn’t you put it in your paper?
TONY Look I accept responsibility that in light of all that’s happened that was a point that we should have put in the discussion paper, but we had been talking about it for six months, we've been quite clear with people, it's a system that does not work, would not be felt in any way, so I haven’t included it in there because it didn’t fit with the nature of the proposals in here but look I do accept and take full responsibility, we should have had it in there, because it's overshadowed many of the very good proposals we've got in here to get faster elective surgery, fix the Emergency Department crisis.
GUYON Have you been surprised about the backlash because the connection has been made at the top of this programme as well with Bill English's more market approach to state assets, your own more market approach to the health system, have you been surprised by this backlash against privatisation which we've seen over the last week?
TONY Well there's no privatisation proposed in this document.
GUYON Your leader said it was a market approach to GPs' fees, that if the charge was too high you just walked down the road, do you agree with that?
TONY Well GPs are the cornerstone of family health relationships, there's no doubt about that and John Key is absolutely right when he says that there's a very good relationship between GPs and their patients, and GPs aren’t intent on ripping off their patients, but look I accept that we should have included that in this paper as a result of the public disclosure and the public concern about it.
GUYON Let's broaden this out more….
TONY Can I be quite clear on that we'd been talking about it for six months beforehand…
GUYON Just hang on – okay, but let's broaden this out into that more market approach because that’s obviously what the National Party wants to do, that’s part of its agenda for state asset sales. I mean presumably the state asset sale programme this partial privatisation doesn’t go far enough for you?
TONY Well I'm not responsible in that area, I'm the spokesman on health.
GUYON But you're a former Minister of State Owned Enterprises and as we sit here today on your website it talks about how wildly successful that programme was, and you're a senior member of the National Party surely you can talk about that.
TONY Well what I can convey to you is that at the last election we had a very cautious policy on state asset sales, Bill English has floated an idea for discussion, there's actually been quite a lot of discussion over the last week about it on both sides of the argument, and I would fully expect that we'd have a very cautious and open policy on wherever that goes before the election.
GUYON Have you been surprised about the backlash to it, Grey Power said forget about it.
TONY Well New Zealanders have a view and it's different depending on who you talk to, I think the debate's being had, what I can say is we had a very cautious policy and I expect that we'll have a cautious policy on that again, the debate's being had and frankly that’s part of what this health discussion paper is about. We've set out here a number of quite detailed proposals on how we can provide a faster more convenient healthcare for New Zealanders, that discussion process is ongoing and there's quite a lot of interest.
GUYON Just before we come back to the panel, you’re seen as to the right of the National Party your were at the vanguard of the whole idea of selling off more state assets, I just wonder if whether you are the right person to be the health spokesperson when you see this fear that is around about privatisation and health.
TONY Well I would disagree with your characterisation there when I was the Minister of SOEs there was this wild sell off of assets, in fact what we did was we brought in Kiwi mums and dads into participating in the ownership of those public assets, but look time has moved on, the National Party had a very cautious policy last election and I expect that we'll have a very cautious policy in that this time.
GUYON Do you want the portfolio, it's a very different thing isn't it being opposition spokesman, do you want to be the health minister?
TONY Absolutely, I think it will be a real opportunity to make a difference to improve the level of service that New Zealanders are getting. I think with the National Party's plan and we've got it in our discussion paper here, we can deliver much more service for New Zealanders, much closer to home with a lot less bureaucracy, that’s what this plan is about, and New Zealanders are now having the opportunity to discuss these ideas.
GUYON Alright thanks very much, I'm sure there are other issues that the panel will want to pick up.
RAWDON Richard Long who's being deceitful?
RICHARD LONG – Former National Press Secretary
Well I think it was bound to happen that National has been Labour Lite for some time and the wheels have been falling off the government and the government's been getting a hard time so as soon as National goes slightly wrong in one week the media quite rightly focus on it.
But Tony going back to health, the thing I'm puzzled about is that why not the emphasis on waiting lists. Now we know that waiting lists are shuffled all the time and people are dropped off so they're kept down. Every New Zealanders probably knows people, I know people, who can't get access to a specialist because every time they go the appointment's cancelled. Why no sort of put the emphasis on that area and how much more money will it take to fix both the waiting lists and the access to specialists area?
TONY Well there's a very strong emphasis in our discussion paper on dealing with this endless waiting that we've got in the health system and it's the total indication of the failure of the Labour government's policy that after five billion dollars extra fewer New Zealanders are getting elective surgery today on a per head of population basis than when the DHBs started, and actually it's even worse Richard, we can tell you today that the number of New Zealanders getting a hospital specialist appointment is the lowest it has ever been under the Labour government, it's a total failure of what Labour has done in health.
Now on the issue of waiting lists further evidence of the failure is this callous culling of patients from waiting lists, 25,000 New Zealanders who a hospital specialist said the best thing for you is an operation were culled from waiting lists for no other reason than the government wants to say they've got waiting lists under control, so what the National Party is saying how can we improve the level of service in the health system for the huge investment that’s being put in to get more services for patients, and we're talking about a much smarter use of private hospital capacity to supplement public hospitals and we're talking about getting more minor surgery done in GPs' surgeries so that New Zealanders have fast access closer to home.
RICHARD And the overall budget, does it affect the overall budget?
TONY Look the budget has doubled in the last six or seven years, we've got scope to do this.
RAWDON Can I bring in Chris here, waiting list culling is that the secret to re-election?
CHRIS TROTTER – Political Commentator
Well I'm not sure that it is, I mean Tony would know because a lot of work has gone into this paper. Now there are really only two options for handling the vast number of people that want access to sophisticated medical care, the one is by price and the other is by establishment of a waiting list system. Now there is always a greater demand for healthcare than there is a supply of it and that is the difficulty that all governments face and you will face if you are the Minister of Health in 18 months time.
I mean how do we maintain this balance? Now the problem it seems to me that you'll also have is that over the last six or seven years there's been a catch up in terms of the wages and salaries of nurses and the doctors and specialists. I'm just wondering how he's gonna cope with this because it seems to me that the primary healthcare service is where you in a sense reduce as much as possible the demand for those tertiary services, and it seems that the removal of the cap was a rather strange way of improving the primary healthcare available to New Zealanders.
TONY Well Chris, there is not cap, the government's fee review process does not work, the vast majority of GPs who apply to get a fee increase get it and there's going to be no change for those people who are on very low cost access because their GPs have a contract with the government to provide those cheaper visits in return for subsidies.
CHRIS But Tony you know as well as I do that if you have a system like the current one, yes doctors who have had changes in their circumstances can apply to the review committee and can have an increase, it's good that’s the way the system should work. If you remove that review committee altogether you're gonna get what's always happened in the past, the effective value of the subsidy will shrink and the bit that the doctor takes off the top will increase.
TONY This is an important point, National is not proposing to change the universal subsidies that are being provided at the moment, that’s really what drives the cost of visiting a GP, and in this document we have a very clear proposal that the universal subsidies that people are receiving at the moment should be maintained. Now that’s the biggest driver of changes in your GP fee. Now we think, picking up on the point that you made about the important role that primary care can play in reducing hospitalisations is that there are improvements in primary care that we would like to see, for example we'd like to work with general practice to try and consolidate GPs into larger groups providing services with other health professionals and trying to devolve some hospital level services into what we're calling integrated family health centres. Now there are some of these around the country and the opportunity here is for people to get care closer to home through cooperating general practice, midwives, physios…
RAWDON Mr Ryall can I just broaden this away specifically from health, I just want to ask you what the mood's been like behind closed doors of the National Party this week. It's not been a good week has it?
TONY Oh you have good an bad weeks in politics don’t you…
RAWDON But we've also had prediction that there's gonna be a points drop in the latest opinion polls and lo and behold there was quite a significant one yesterday.
TONY Well polls go up and down don’t they?
RAWDON What's being said behind closed doors?
TONY Well if I was saying it on this programme it wouldn’t be behind closed doors would it? What's important is that these polls do go up and down but we're absolutely focused on providing New Zealanders with an opportunity to engage with us on our policy proposals for the future. In this document here, 50 pages, we've outlined some very good ideas to improve the level of service for New Zealanders. Now my real frustration about what happened this week, and I take total responsibility for it, despite the fact we talked about it for six months beforehand it has diverted attention away from ….
RAWDON We've talked enough about the document itself. Guyon
GUYON Well I'm just wondering what John Key's reaction was to the way that you handled that GPs' fees issue?
TONY Well I think we just have to say that no one's more disappointed in the way it was handled than I was, but look I'm determined to make sure that we get on to the message here that Labour's failure in health is total. Five billion dollars a year extra and fewer New Zealanders are getting service it's unbelievable.
RAWDON Yet despite those statements Labour's popularity seems to have grown.
TONY Well frankly, if you go and talk to New Zealanders today and say are you happy that fewer people are getting elective surgery, that fewer people are getting to see a hospital specialist, all the incredible waits in Emergency Departments you'll have New Zealanders talking about the failure of the Labour Party.
CHRIS Once again you’ve got a problem, one of the reasons that people are waiting so long, one of the reasons for that culling is that the number of specialists have gone down because they get more money elsewhere.
RAWDON We've got to move on now. Thank you very much Tony Ryall.