Top Scoops

Book Reviews | Gordon Campbell | Scoop News | Wellington Scoop | Community Scoop | Search


Health Minister Talking Bonkers On Postcode Lottery And Simpson Review

Minister of Health Chris Hipkins is trying to justify the restructuring of DHBs proposed by the Heather Simpson review of New Zealand’s health and disability system with the argument that it will solve the problem of what he labels as the postcode lottery of access to health services.

By postcode lottery he meant that access to funded health services was an inequitable lottery depending on where one lived. The term was popularised by Tony Ryall when he was National’s opposition health spokesperson in 2005-08. His response was the slogan ‘better, sooner, more convenient’ although little of substance changed during his six subsequent years as health minister.

The Simpson review doesn’t give the same emphasis to postcode lotteries as the Minister is now giving. Its final report doesn’t use the term. The closest it gets is three brief references to geographic location. One of these references briefly lists it as one of five factors (along with ethnicity, socio-economic deprivation, age and disability) whose interactions “exacerbate inequitable outcomes and access to healthcare” (p.26).

The Simpson review identifies inequities and lack of national cohesion as the major problems facing the health and disability system. Rather than focus on process improvement, capability and capacity, it proposes a massive restructuring of the system’s bureaucratic structures without outlining how this will address these problems.

Simpson’s ‘mega DHBs’

District health boards are statutory creations responsible for the totality of community and hospital healthcare for their defined geographic populations. The Simpson review proposes replacing the current 20 DHBs with somewhere between 8 and 12 ‘mega DHBs’ controlled by a new additional national bureaucracy. Most likely these new ‘mega DHBs’ will be based in Auckland, Hamilton, Hastings or Palmerston North, Wellington, Christchurch and Dunedin. In other words, our bureaucratic structures running the health system will be both much bigger and more distant from their communities than now.

There is no logical link between this restructuring (or, for that matter, the current DHB structure) and postcode lottery access. To appreciate this it helps to understand what a DHB actually is. A DHB is responsible for a defined population in a geographic area containing at least one base hospital (providing a varying range of emergency, acute, chronic illness, diagnostic and elective services) and community health providers such as general practices (who can refer patients to the base hospital) and rest homes.

Let’s assume

More often than not postcode lottery refers to access to hospitals. Let’s assume, rightly or wrongly, that the residents of Wairarapa DHB have less access to their base hospital in Masterton than residents of Capital & Coast DHB have to Wellington Hospital.

Let’s then assume, in accordance with the Simpson review, that both DHBs disappear and we have a new bigger ‘mega DHB’ covering the lower (perhaps also mid) North Island. How is this going to help remove postcode lottery for those seeking access to health services in Wairarapa especially when decision-makers are now distant and the Wairarapa voice no longer exists? And who, apart from the marginalised, is going to advocate for the continued provision of health services in Wairarapa. This scenario can be applied to the rest of the country.

The only way the postcode lottery could be removed under this restructuring was if access data were to be aggregated for each of the ‘mega DHBs’ so that the situation of the geographically disadvantaged hospitals is fudged. In other words, data cleansing.

What the health minister should do

If Minister Hipkins wants to remove postcode lottery for access to health services he should not look to restructuring as the solution. Instead he should focus on reducing (preferably removing) the effects of the social determinants of health (which are external to the health system), addressing our debilitating health professional shortages, strengthening the role of services responsible for the healthcare of populations (differentiating from individual patient diagnosis and treatment), requiring workforce empowerment through active engagement between health professionals and decision-makers at all levels of the system, and upgrading our rundown public hospital facilities.

To cut to the chase, using restructuring DHBs to address postcode lottery is sheer bonkers Minister. You are smart enough to be better than this.

© Scoop Media

Top Scoops Headlines


Binoy Kampmark: Biden’s Victory: A Eunuch Presidency Beckons

Whatever was set to happen on November 3, President Donald J. Trump would not lose. Falling in that establishment firebreak against democracy known as the Electoral College would not erase, let alone repudiate him. His now victorious opponent, far ... More>>

Reese Ehrlich: Foreign Correspondent: The Challenge For Joe Biden

If he’s smart, the likely President-elect will stop the unpopular endless wars and use the money to help our domestic economy. By Reese Erlich I’m pissed. I’m pissed at Donald Trump for trying to shut down the vote count early and at Republicans More>>

Boris Johnson At Sea: Coronavirus Confusion In The UK

The tide has been turning against UK Prime Minister Boris Johnson. Oafishly, he has managed to convert that tide into a deluge of dissatisfaction assisted by the gravitational pull of singular incompetence. Much of this is due to such errors of ... More>>

The Conversation: Biodiversity: Where The World Is Making Progress – And Where It’s Not

The future of biodiversity hangs in the balance. World leaders are gathering to review international targets and make new pledges for action to stem wildlife declines. Depending on whether you are a glass half-full or half-empty person, you’re likely ... More>>

The Conversation: The Numbers Suggest The Campaign For Cannabis Reform In NZ Will Outlive The Generations That Voted Against It

Like Brexit in the UK, cannabis reform in New Zealand fell into an age gap — given time, a second referendum would probably succeed. More>>

Gordon Campbell: 22 Short Takes On The US Election

Finally, the long night of Donald Trump’s presidency is over. To date, the courts have been given no cause to conclude that the exhaustively lengthy counts of those mountains of mail ballots was anything other than legal. Stacking the US Supreme ... More>>

Gordon Campbell: On How The US Supreme Court Is Undermining American Democracy

If Joe Biden is elected President next week, here comes the bad news. If Biden tries to defend Obamacare, combat climate change (via say, a variant of the Green New Deal) or tries to improve the access of US women to abortion services , he will run afoul ... More>>

The Coronavirus Republic: Three Million Infections And Rising

The United States is famed for doing things, not to scale, but off it. Size is the be-all and end-all, and the coronavirus is now doing its bit to assure that the country remains unrivalled in the charts of infection . In time, other unfortunates may well ... More>>

  • PublicAddress
  • Pundit
  • Kiwiblog