If anything finally convinces voters that the Luxon government is a deadly risk to life and limb, it will be the damage it is doing to the public health system. Our population is increasing and on average, it is getting older. Inevitably, the diseases related to aging require more complex, more costly and more staff-intensive forms of treatment. There is no sign that the government even recognises this reality, let alone has a response in mind.

Meanwhile, the signs of existing systemic stress are everywhere. Within our under-staffed hospitals, ED departments are buckling under the pressure, partly because patients either couldn’t get access to preventative GP care when they needed it, or because they couldn’t afford the consultation fee.

The thinly stretched GP layer of care is being set to shred. Early in July, the government offered funding support for GP practices at below the annual rate of inflation. Simultaneously, it invited GPs to raise the fees they charge patients by up to 8%, to make up any shortfall. Not surprisingly, many GPs are bailing. According to a survey by the Royal College of General Practitioners published in early 2023, 55% of GPs intend to retire within ten years, up from 36% in 2014.

Regardless of these dire trends, this year’s Budget allowed for only 25 additional medical student places, only half what was promised by National on the campaign trail last year. Given that it will take a decade to train the student intake, and given the estimated 22% shortfall of senior medical officers that already exists in New Zealand, this is a recipe for disaster.

As for the nursing situation... as the Association of Salaried Medical Specialists (ASMS) pointed out in June: “One in four hospital shifts in New Zealand [in 2023] were not adequately staffed with nurses and midwives. Further, 14 percent of hospital shifts were understaffed for more than half of all shifts in 2023. There is a nursing shortage of more than 4,800 vacancies, as reported in 2023’s Health Workforce Plan.”

Against this backdrop of workforce shortages in hospital services and the deteriorating access to community-based care, the ASMS notes that an estimated one third of the adult population in this country is being forced to live with unmet medical needs. In a further sign of brutally myopic thinking, the coalition government budgeted that it will “save” $14.3 million by reintroducing prescription charges, on the basis of the estimated numbers of people who won’t be able to afford to pay for the treatments they need. Inevitably, this will drive even more sick people to turn up in our overflowing ED departments.

Making Things Worse

Despite the crisis on all fronts in public health, the coalition government seems to be intent on making a bad situation worse. While not officially confirmed, a de facto freeze has been imposed on hiring in the public health system, and this freeze apparently extends even to specialist staff – even where it is more costly to hire the locums who are being dragged in to plug the gaps.

As the NZ Doctor magazine recently pointed out, this year’s Budget actually reduced the spending on health per capita : “Budget 2024 sees the amount of day-to-day spend per person on Health next year at current prices reduce by 3% to $4,686 per person: $143 less in real terms.”

So… despite all the evidence of (a) chronic medical staff shortages of nurses and doctors and specialists, and with (b) many GP practices experiencing a funding crisis and (c) despite the increased complexity of health conditions among a rising, ageing population… the Budget chose to cut the amount of money it spends per capita on health. In case $4,686 per person still sounds like a lot, look across the Tasman. On the 2021/2022 figures (the most recent ones I could access) Australia was/is spending on healthcare at least $NZ10,414 per person. Two and half times what we do.

True, since the Budget, the government has poured a large amount of funding into Pharmac, and earmarked it for purchase of the astronomically expensive new cancer treatments on offer from Big Pharma. However, that money will do nothing to address the staffing crisis, and could even make it worse. That’s because those powerful new cancer drugs address extreme conditions that will – if they are going to save lives - require more nursing staff and more specialists to administer the treatments and manage the serious side effects that routinely accompany them. In this area as well, the government seems culpably blind to the pressures coming down the pike.

14 Layers of Dumb

Tragedy, meet farce. Over the past week, the government has seemed intent on demonising the people trying to hold the health system together. It has sacked the remainder of the Health NZ board that hadn’t already quit in dismay. In their place, it has appointed a Commissioner who has been tasked with immediately finding (in this financial year) an extra $1.4 billion in cuts to what it claimed to be a “bloated bureaucracy” operating with 14 layers of decision-making.

As is now evident, in order to get to 14 layers, the government has to count the patient, the nurses, the doctors, the registrars etc as being separate and superfluous tiers of bureaucracy. Obviously, they’re not. Moreover, as the PSA has pointed out, even the alleged “backroom” staff that are being axed include “the people who follow up after our children’s immunisations, who ring us up to let us know that our MRI has been booked, and who work on the tech infrastructure to modernise how our health information is held.”

It takes a special set of ideological blinkers to regard “bureaucratic bloat” as the chief problem now facing the delivery of public health in this country. On the campaign trail, National promised line by line scrutiny and rigorous cost/benefit analyses in all areas of government activity. Yet since being elected, it has proceeded to sack almost all the people required to do that work.

Consistently, PM Christopher Luxon has railed against the allegedly wasteful layers of bureaucracy created by Labour’s health reforms. Yet even at its worst, Health NZ is a less wasteful model than the 19 replicated layers of bureaucracy that existed under the system that Labour chose to scrap. Surely, even Luxon would have to concede that if bureaucracy is our prime healthcare problem – and it isn’t – then having 19 separate bodies all with their own management structures in order to serve the health needs of only 5 million people was always a case of market competition gone mad.

Footnote One: Who will be the winners from the Luxon government’s vandalization of the public health system? Well, the insurance industry stands to benefit greatly from the public health system being further degraded, since more and more middle class/upper class earners will take out private health insurance for themselves and their children. Those kids will be alright.

In essence, New Zealand is being put on course to replicate the worst features of the disastrous American system of health provision. The only way to stop that from happening is ensure that this is a one term government.

Footnote Two: The Olympics is offering an interesting contrast with the government approach to public health. No one questions the fact that elite athletes need support staff in order to perform their frontline task of winning medals. That’s why they have coaches, physios, dieticians, managers etc. All of those layers of backroom bureaucracy exist, and are deemed essential. Sport is merely a game. Medical staff are making life and death decisions every day. Yet we’re actively denying, dismissing and demonising their need for similar backroom support.

Think of the All Blacks. They have a head coach, a separate deputy coach for the forwards, another deputy coach for the backs, a dietician, a comms team, a brand manager, and a sports psychologist to make sure they’re in the right headspace to execute their on-field tasks.... If the government was being consistent, it would be sacking Scott Robertson and all his minions.

Hey, they’re the All Blacks. Surely they don’t need layers of backroom support to do their job. Yet evidently, they do. Well, so do our workers in public health. They’re being expected to perform far more important tasks while their supportive scaffolding is being systematically hacked away by this government.

Three From the Heart

Arkansas country musician Willi Carlisle combines a sardonic sense of humour with his bleak commitment to truth-telling… and the combination makes him kin to Townes Van Zandt, Gary Stewart, George Jones, Webb Pierce and Hank Williams, in a tradition that goes all the way back to the Carter Family. His recently released third album Critterland is full of startling songs, and here’s a live version of one of them:

Here’s a live version of a traditional-sounding album track called “ I Want No Children” that has modern relevance, whatever the motivation for the sentiment:

To show that Critterland is no flash in the pan, here’s a heartfelt performance by Carlisle of one of his earlier songs. “The Last Magician in Tulsa” treats growing up and finding value in work as magic acts of sleight of hand, and sustained practice:

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