Roy: Changing Direction In Health
Changing Direction In Health
Heather Roy MP
Wednesday, October 29 2008
Speech to ACT Health Policy Launch; Cnr Hobson & Davis streets, Wellington; Wednesday, October 29 2008
Welcome to ACT's Health policy launch. We're releasing our policy outside an Ambulance Station to signify Labours' 'Ambulance at the bottom of the cliff' approach to public healthcare. Ambulance services do a fantastic job dealing with emergency situations, but our health system needs to be much more comprehensive than that.
When I launched ACT's Health policy at the last election, we released 1,152 yellow balloons - one for each person who died while on a waiting list that year. We can't do that today because the figures are not available.
The Health Ministry cannot say how many people have died because it has re-categorised its exit categories from waiting lists, and deaths are now bundled in with those who have gone privately and those sent back to their GP - not exactly the actions of a caring government that wants to fix problems but, rather, a government that is ashamed of its record and wants to hide the truth from the public.
We also don't know how many people are really waiting for First Specialist Assessments or for surgery because - in order to make the numbers look better - they're taken off waiting lists after six months and are sent back to their GPs.
Well, the numbers aren't flash. Today a report was released - 'Productivity Performance of New Zealand Public Hospitals' - showing that hospital efficiencies (productivity) from the end of the 2001 financial year to the end of the 2006 financial year have dropped eight percent. This is a trend that has continued from a 2005 Treasury report showing a similar drop in productivity.
This decrease in outcomes is despite the fact that since 1999 the Labour Government has increased the Health Budget from $6.8 billion per year to $12 billion per year - Vote: Health has almost doubled. One dollar in five of government spending goes on health, but less is produced - eight percent less in fact.
We would have been better off spending that $6 billion on a basic health insurance policy for every Kiwi - each man, woman and child - so they could choose whether to stick with the public system or to go private.
That's my goal in health: for every Kiwi to have choice through health insurance - not be destined to wait and wait for treatment they might never get. The public system caters very well for emergency care: if you have a heart attack or a car accident, the care Kiwis receive is second to none.
But we have a two-tier system for those requiring non-urgent healthcare: those who can afford to can go privately and jump the queues; those who can't afford it get to wait or be dropped off waiting lists. Making people wait is false economy - as is making people pay for their healthcare twice, as those who have health insurance do.
Part of the problem is that politicians and bureaucrats are making decisions that our health professionals should be making. Our doctors, nurses and other health professionals are the ones with the medical training after all. ACT wants to see clinical leadership in health - departments handed over to doctors and nurses to run.
The public perception is that no one can fix Health. The common misconception being that pouring more money in is the only solution. When we accept that there is only so much taxpayers' money - and, therefore, rationing using public funds is inevitable - we can begin making some sensible decisions. Looking more broadly at how health services are funded and provided is the key to better access to more healthcare.
I've described the problems; what are the solutions?
In many respects, the most simple solutions have the greatest effect. Florence Nightingale delivered the greatest gains ever to health services with her campaign to improve hygiene - basically clinicians washing their hands. Infection rates and resulting deaths plummeted.
This traditional medical bag symbolises a more effective approach to Health.
First, a diagnosis must be made - poor governance and mis-management.
Once the problems have been established, a prescription [prescription pad] is written. Services must focus around patients. ACT's prescription is simply this: the best quality services, in the best time, at the best cost.
And then the prescription is dispensed. [Bottle of Pills]. Wherever possible, the treatment should be choice.
With these principles in mind, ACT's Health Policy includes the following:
The Health Ministry must be streamlined and separated from the day-to-day delivery of healthcare. It's function must be determined - it isn't to protect the Health Minister from embarrassing situations.
District Health Boards should be disbanded and replaced with small appointed committees to run local operations. DHBs are elected under a phoney democratic processes. People put their names forward to stand and are voted for under the misapprehension that they are to represent the health needs of their local populations. In reality, their job is to implement the government of the day's health policies. Everything must be rubber stamped by the Health Ministry and government interference is rife with Ministerial instructions - such as so many hip and knee replacements, so many cataract operations with no flexibility and 'use it or lose it' funding. This farce of 21 DHBs replicating services nationwide needs to end.
Primary Healthcare: Primary Health Organisations have added a further layer of governance to the Health sector. We should return to the General Medical Subsidy, where doctors were paid a fee for service. Community Services Cards should be used to determine the level of subsidy, which must be graduated depending on the cardholder's socio-economic status. Co-payments should be charged to cover appropriate costs. After-hours care is in crisis and has become, by default, the responsibility of already overcrowded hospital A&E departments. A return to a fee for service system would see the re-establishment of After Hours Clinics because doctors would be properly paid for providing care and fees significantly lower than at present.
Hospitals: clinical leadership and fund holding of departments should be established where possible. Contracting to the provider who best supplies quality, timely and cost effective services should be aim using public funding. ACT will inject a one-off payment of $500 million to clear the current waiting lists. Co-operation between public and private providers must be established for efficiency gains. With certainty of contracting, private providers will increase their capacity to accommodate the growing demand for health services.
Public Health (vaccination etc) and disease prevention programmes play an important part in improving quality of life and good health. As with any public spending, these programmes must be evaluated and outcomes assessed to ensure taxpayers are receiving value for health dollar spent.
PHARMAC, with its monopoly and sole-supply philosophy, limits choice for both patients and clinicians when prescribing. The limited budget means New Zealanders miss out on quality medications that people in Australian, and other countries we like to compare ourselves to, receive. One solution would be to have a base price for each family of drugs and allow people to pay a top-up fee for the medication of their and their prescriber's choice. Strengthening our economy so that we can afford to subsidise more medications is the obvious solution under the current situation.
Workforce issues are the single greatest problem facing the public health sector. We train our health professionals for export, with many leaving New Zealand soon after graduation, and rely heavily on overseas graduates to staff our health services. Pay and working conditions - combined with hefty student debt - all contribute to this growing trend. Strengthening our economy is again a key solution - as are incentive schemes to encourage graduates to stay in New Zealand. ACT wants a voluntary National Service Scheme established allowing graduates to draw down their student debt in return for length of stay and service given. Lower taxation rates will also allow graduates to repay student loans more quickly.
A disturbing and significant inequity exists between those who suffer an illness and those who are injured in New Zealand. We need to establish a level playing field so that cause of a condition does not favour one Kiwi over another. ACT favours a Risk Insurance Scheme to establish fair access to healthcare for all, but will consider options put forward by other Parties to deal with this favouritism established by ACC.
Choice for patients, utilising all health services available - whether they be private or public - and strengthening New Zealand's economy are all key to providing health services that are accessible, available and affordable.
A change of government alone is not sufficient to improve our health services and provider efficiencies. A government of change is needed. Only a Party vote for ACT will bring about a change of direction in Health.