Gordon Campbell On The Mindset Driving The Crisis In Public Health

02 Sept, 2024

As far as the rest of the country is concerned,Wellington rarely has a Goldilocks moment. Central government is either too involved in telling people what to do, or not involved enough in responding to public needs. Talking of which, the chronic under-funding of the public health system by successive governments finally seems to be coming home to roost.

Nationwide, some 80% of GP practices have had to close their books on occasions since 2019 in order to maintain an adequate level of patient care, and to reduce staff burnout. True, there has been a small 8% recent uptick of GP practices taking on new patients, but even so, less than 40% are doing so. Incredibly, the most recent offer of government funding assistance to struggling GP practices was below the annual rate of inflation, and would do nothing to help keep GP practices solvent. In other signs of a system in terminal decline, after hours care is disappearing altogether on both affluent Waiheke Island and among the dispersed communities of the West Coast.

As RNZ reported yesterday, a survey last month of 244 practices – a quarter of the total number in New Zealand – found that:

• 89 percent had recently increased or were about to increase fees
• 70 percent were in a worse financial position than a year ago
• 83 percent were worried about their long-term viability.

That outlook is grim, given that on average, the New Zealand population is ageing, and increasingly in need of treatment for more complex, interacting health ailments. Over one third of GPs (37%) expect to retire in the next five years, and over half (55% ) expect to do so within the next ten years, up from only 36% in 2014. Largely because of the financial crisis in GP practice, fewer medical students are choosing GP primary care as a career option.

These problems have been decades in the making, but the response by the coalition government has been particularly abysmal. The 4% offer in government funding support to GP practices made in May was not just below the annual inflation rate, but marked the lowest such offer in 20 years. At the same time, Health Minister Shane Reti has given the greenlight for GPs to raise their fees in order to help make up the funding shortfall.

Last week, Reti was also citing the government plan to spend hundreds of millions on building a new medical school, even though current medical schools have said they could manage the extra intake. In the meantime, Reti also said that the government is funding 25 additional medical student places. Fine. But this is only half the 50 extra places that National promised 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 tinkering in the face of 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 deteriorating access to community-based care, the ASMS noted

that an estimated one third of the adult population in this country is already being forced to live with unmet medical needs. In a sign of its brutally myopic thinking, the coalition government budgeted that it will “save” $14.3 million by reintroducing prescription charges, thanks to the numbers of people unable to afford to pick up their medicines. In all likelihood, this will drive more sick people to turn up in our overflowing ED departments, within a hospital system that has been subjected to a hiring freeze.

Finally, 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.”

Spinning out

The cutbacks in public health staff and conditions have become so indefensible that even the spin doctors appear to have given up trying to offer credible reasons for them. In a classic case of exhausted spin, this week saw a narrowly averted attempt by Wellington hospital to impose a ban on giving a slice of toast (a) to mothers who have just given birth, or (b) to their support whanau, or (c) to the midwives and nurses who assisted with the birth, sometimes in the dead of night.

Shane King, the manager of Capital Coast and Health’s hospital services, didn’t seem to have his heart in it. Apparently, the food budget for patients has incurred a cost overrun of $1.5 million because (according to King) staff and whanau had been eating it! (Hmm. Have they really been caught on surveillance video having midnight feasts in the maternity wing?) Having brought up the cost factor, King then tried to deny its relevance. The bread and spreads commonly given to women after labour were being cut for “nutritional reasons.”

Heaven forbid that after giving birth, a new mother should be offered the comfort of a cup of tea and a slice of toast with jam. (Rather than say, a carrot.) Good to be vigilant with public money… but that aside, excessive post-natal toast munching cannot really be a prime contributor to the cost over-run. A loaf of Molenberg currently costs $3.99. Even if voracious mothers, whanau and staff were motoring through 80 extra loaves each week all year at Wellington hospital , this would still only comprise .005333% of the annual cost over-run. More sensible people would say the original patient food budget was inadequate in the first place. Sensible managers would never have risked damaging public and staff good will in this fashion.

Mean without meaning

Pretty typical, though. What we are seeing right across the public service are the mutant outcomes of budget cuts being pursued not to achieve rational goals, but as ends in themselves. Along the way, some Cabinet Ministers appear to be seeing wasteful over-runs where none actually exist.

For example: last week it transpired that Disability Issues Minister Louise Upston had quietly imposed an arbitrary freeze on funding for disabled people receiving residential care. Funding for the disabled, and for those who care for them, is to be subjected to a review, likely to reduce access to support.

Dr Rebekah Graham from Parents of Vision Impaired NZ has encountered some of the widespread shock at the funding freeze

“The restrictions are so severe that there is significant risk of harm to disabled people and their families, particularly for aging parents who are finding care work increasingly difficult.

“Disabled people will now have to compete for residential care, with priority being given to disabled people in court ordered care (forensics – those who have committed a crime), those in the care of Oranga Tamariki (often severe, with no family support), those exiting Mental Health care (including secure care), those needing to exit hospital care and have nowhere to go, and people whose health is deteriorating and need hospital-level care (usually aged care).”

Or, as Bernard Hickey put it on his excellent Kaka website… This “effectively means disabled people currently living with carers will only have a chance of getting into residential care if they’ve committed a crime, are leaving mental health care or hospital and have no appropriate place to go, or have escalating needs that can only be meet by hospital-level care.” It seems that everyone else – and their families – will be required to fend for themselves.

What on earth could be the rationale for such a step ? Dr. Graham, again, reported on the online meeting that she – and others in the disability sector – had with Upston:

She was pretty short with disability community representatives/stakeholders at an online meeting last night, stating that she was ‘cleaning up the mess’ and “ripping off the scab to deal with the mess underneath”, and “there are areas of waste at the moment”. She also said that she “objects to disabled people being used as bullets towards me”. The Minister was absolutely certain that she was doing the best thing by disabled people, had the support of disabled people, and that any disagreement was purely politically motivated.”

The evidence for that alleged “mess” and “waste”? Well, a briefing paper from Whaikaha, the Ministry for Disabled People, cited a cost increase of 29%… since 2015/16!

While the number of people in residential care has been relatively constant for several years, the cost of delivering the service has increased by 29% between 2015/16 and 2022/231.

Right. Yet by some estimates, inflation has been running at 24% and wage inflation of 29% over the period in question. Is a 29% increase quite as “significant” then, as Upston is claiming? Or in fact, is this evidence of a residential care service that has actually been treading water in the number of people it assists, with funding that has barely kept pace with inflation, let alone with being able to deliver an improved service to more disabled people.

That’s the real problem, right across the public service. More often than not, there is an underfunding crisis, not an overstaffing crisis. The Minister in charge of the care of the disabled seems to have a shaky grasp of economics, is treating any increase in spending over the past decade as wasteful, and is regarding any criticism of her performance as being a politically inspired attempt to make her look bad. That’s a toxic brew.

Public Service Broadcasting

The British band Public Service Broadcasting made their breakthrough over a decade ago, with their homage to the Spitfire aircraft. Since then, they’ve made ingenious use of corporate videos, old films, news clips, and public service messages to celebrate the moon landing, the climbing of Everest, the evolution of stereophonic sound etc. etc.

Their new album is devoted to the pioneer aviator Amelia Earhart. Here’s the new single “The Fun Of It”

And here’s their tribute to Earhart’s plane, the twin engine, all metal Lockheed Electra 10. Fun fact for plane nerds : the distinctive Lockheed double tail on this plane was suggested by a young student assistant called Clarence “ Kelly” Johnson. Johnson went on to lead the legendary “Skunk Works” design team at Lockheed, later responsible for what is – IMO- the world’s greatest aircraft, the SR-71 Blackbird. Here’s the PSB track about Earhart’s Electra 10:

© Scoop Media