Health Estimates

Once a year, following the budget, Health Minister Annette King comes before the health select committee to explain the spending estimates for the forthcoming financial year.

The overall spending for this year is $192 million over budget, after an initial prediction of $79 million over.

The Minister was very clear that that District Health Boards would be made to keep within spending plans. She has been true to her word, and several boards have had their plans for next year sent back for revision.

The Minister is insistent that no services will be cut, and has issued directives to this effect - all of which would be very amusing if it weren't such an important issue as health.

The circle is going to be squared by "efficiency savings", and the Minister's comment that there are efficiencies to be gained yet at our hospitals will come as a surprise to many Boards.

Annette King's authoritarian approach may look good from a political point of view, but authoritarianism isn't efficient.

The truth is that services will be cut, but it will be done in ways that are hard to measure. Issuing orders from the Health Ministry may decrease efficiency and new responsibilities are being devolved to health boards all the time.

The Minister has gagged DHB members - but Canterbury board member Erin Baker defied the gag in March, to make say it was difficult to know who to miss out when services, such as surgery, are not available to every patient.

This very good point resulted in a condemnation by the Minister.

Unfortunately, Ms Baker also made some unfavourable comments on the weight of some other local body members and the very valid point, on who to decline for surgery, was lost.

The point is that health services are rationed, but the fact of ration The issue of how to get efficiency in health deserves careful consideration, and it has been a major issue in Britain recently.

Tony Blair's government has decided to increase its health spending to the average for Europe. This may sound an unremarkable proposition, but (like New Zealand) Britain has a nationalised health system and its spending is decided by government.

This has tended to keep spending low, as Treasury often confuses cost containment with efficiency. In any event, the Blair government has spent billions of pounds on health and intends to spend more.

The move has been very popular with the British public - although it has made recruiting staff from Britain very difficult for New Zealand.

The problem is that increased spending does not automatically mean increased productivity. In New Zealand, recent Treasury papers have shown that our hospitals recently saw a

One think tank, "Reform Britain", has been set up to create imaginative solutions to the chronic problem of poor productivity in the public sector.

This Think Tank is known to have the ear of Tony Blair, and has set up a three-person group to develop solutions.

The surprising thing is that two of them are New Zealanders: Ruth Richardson and Sir Roger Douglas. They have written a comprehensive report entitled "A Better Way", which is well worth a read.

It can be found at http://www.reformbritain.com/index.asp .

The Mad, the Bad and the Sad

When I first came to Parliament I thought about writing my Maiden speech on the mad, the bad and the sad.

There is a lot of confusion surrounding categories of people that society doesn't really want to deal with.

The bad are easily defined - those who have committed terrible crimes and who everyone (with the possible exception of ex Alliance, now PCP MP Matt Robson) agrees should be locked away.

The Palmerston North paedophile recently released from prison comes into this category. The mad, who sometimes commit terrible crimes, like the Raurimu massacre's Stephen Anderson, are often confused with the bad, and are plainly insane at the time of committing their crime and can frequently be treated easily.

Problems usually only arise when they go off their medication. Then there are the sad, who are rarely of any danger to anyone except themselves.

I heard a story this week. An Auckland man, in desperate need of psychiatric care was taken to the local police cells to be "accommodated" overnight while a psychiatric bed was found for him.

In the morning, his mother came to visit him with some chocolates. The policeman on duty very nicely, but firmly, explained that while he was in police cells the patient had to be treated as a prisoner.

Unfortunately, this is yet another instance of a fragmented system failing the truly vulnerable. The police do an exceptional job, but they are crimebusters, not psychiatric nurses, and their patience is wearing thin.

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