Not in rude health – just rude

Health announcements this week...I don’t know where to start.

Twice this week we saw Hon. Simeon Brown – the holder of a Ministerial Warrant and the person making decisions on the nation’s $30bn health service – decide that the best way to make progress in the permacrisis that is health was to look at a 2023 election result in Rongotai. Not just once, but twice. Regular readers will know that I usually hyperlink the points I make so you can find the original source. This is so beneath contempt I won’t.

Normally I don’t mind a bit of knockaround politics and don’t complain when people have a go at me. It comes with the territory. But what we have seen in health this week is a government that has completely lost control. When asked questions about why 81% of frontline health workers say cuts have damaged health service – they have responded with personal attacks. As Nassim Nicholas Taleb wrote in The Black Swan “An ad hominem attack against an intellectual, not against an idea, is highly flattering. It indicates that the person does not have anything intelligent to say about your message”.

This smear was the latest attempt to paper over the cracks in a health system they have chosen to deliberately underfund. CTU analysis of Vote Health in Budget 2024 shows that health funding per person fell 4.5% in real terms from last year.

Table 1: Health Operational Expenditure Per Capita

The government likes to talk about “record $16.68bn” investment in health. Every year is a record – adding just $1 makes it a record amount. That $16.68bn is the funding increase over 6 years. Kathy Spencer wrote a great article about this nonsense with a diagram that makes it clear how that money has to cover many, many, many years.

Diagram 1: New Health Funding across the next 6 Fiscal Years

Source

This number also represents the money going in – it’s not counting the money going out. If we look at Budget 24 Vote Health, we can see that total available operational spending rose by just $93m in the last Budget – or 0.35%. Analysis from ASMS and NZNO was written up by the CTU below:

Table 2 Health Operational Expenditure

The additional operational funding being allocated to meet cost pressures in 2024/25 amounts to $1,430 million. Te Whatu Ora officials indicated in March that this was likely to fall short of what is needed. This is due to higher-than-anticipated inflation between the calculation date and the Budget. That underfunding has helped lead to the health service needing to find $2bn in savings this year.

So, what has been put on the table this week? The government is desperate to make the problems in health go away – the last Ipsos Mori Issues Poll on this showed that health was now the second most important issue for voters after the cost of living. They have fired one Minister, senior management are departing, and still nothing works. So clearly the government decided that this week was the chance for a reset.

There are promises of up to 100 placements for overseas doctors. Great – only we need to find them, register them, get them on a programme (with no new money), get them trained, and then we might have them. Right now, we are 485 GP’s short – and that number is continuing to grow. This is a promise to maybe have more GPs in the future.

The package promised a new digital telehealth service. First question – by when? Also, digital providers probably won’t have access to your medical records – unlike your GP. You will however have to pay to be seen – and we don’t know how much. But this is one of these ‘public private partnership’ opportunities – where the private sector will provide the new doctors. Only there aren’t spare doctors in NZ – so the new telehealth will be competing for existing doctors. Finally - these services already exist in New Zealand i.e. https://practiceplus.nz/ & https://www.bettr.co.nz/ . So it’s difficult to know what is genuinely new here.

The Minister promised an extra $285m for GPs over 3 years - $95m a year – or $17 per person a year. That is - if they hit their performance targets – the nature of which is currently unclear. From where is that money coming? Because the press release doesn’t say – nor has the Minister. They have both just said it comes from our existing investment in health. So, is it a cut from somewhere else in health? Is it money from a future Budget? We simply don’t know. In short – all we do know is that it’s not new money.

$30m is provided to practices to recruit graduate nurses over 5 years – or $6m a year. That’s $1.29 per person annually – so…tiny whoop? That would be equivalent to 0.4 nurses per practice in NZ – so two days a week. Great! But the money goes nowhere near the training and development costs associated with a graduate nurse. And again – where is this money coming from? No idea – likely the same place as the GP money.

Funding was found for more graduate doctors. At the election – the National Party promised 50 new doctors a year. It promised to have “New Zealand graduating 759 doctors a year by 2030”. We are still nowhere near this…the government's PR on Wednesday has a target of 639. Also, at the risk of repetition - where is the money for these places coming from? Again - we have no idea.

At least we know where the money for the bowel screening changes announced on Thursday is coming from – existing Māori and Pasifika bowel screening. Shifting the funding so that everyone gets funding from 58 rather than 60 sounds equitable. But experts disagreed. We are nowhere nearer getting bowel screening for everyone at aged 45 – the promise made by the now Prime Minister at the election.

Which brings us to Friday, and another announcement. Five new priorities for health – only one of which had any meaning. That was “Clearing the elective surgery backlog by partnering with the private sector to deliver more planned care”. Just like telehealth, this is yet more privatisation. The Minister claims that we will be “investing $50m” on this. From where is a mystery. At this point the accounting team at Te Whatu Ora should just go to the pub. It’s less financial management and more freestyle jazz.

Also, the surgery part is only one bit. Let’s assume that you have a knee operation – delivered by a new private provider. Nice! But then who looks after the wound management? The physiotherapy? The medical devices (crutches, wheelchair)? Your pharmaceutical needs (painkillers, antibiotics)? Who does the paperwork? Who does the follow-up? If the surgery goes wrong who pays? Who has liability? This costs money, time, and resources – and requires coordination. It doesn’t appear if any of it has been thought through. It's just an excuse to bring in the private sector to skim a bit more profit.

So at the end of this week, we know probably a bit less than when we started. We do know:

• Health funding is not matching inflation and population challenges – never mind demographic challenges

• Funding is about to be stretched even further with a range of new initiatives that have no new funding

• The new initiatives go absolutely nowhere near need.

• At no point since the Budget have we tackled any of the of the real drivers of poor health – child poverty, obesity, poor housing, stress, overworked families.

• The government is happy to resort to insults rather than answer questions on this.

Instead, we have chosen to loosen tobacco regulations – generating more than $1bn in new tobacco taxation. That was used to deliver the tax cuts last year – so it didn’t even go into the health service. Smoking kills 5,000 Kiwis every year. We have chosen to loosen the target for the number of children living in poverty by 17,000. Government targets for faster cancer treatment, immunisation, and wait times for specialist assessment gone backwards in the past year. Do you feel back on track yet?

In his speech on Friday the Minister said “There’s often too much focus on what the unions, the colleges, or professional lobby groups say, and not enough focus on what the patient says”. Minister – if you actually listen carefully all those groups are saying the same thing. You aren’t putting the money in. You are cutting elements like IT projects that can make it work better. You are blaming anyone but yourself for your choices. You have no plan – save for more privatisation of a service that Kiwis don’t want to see privatised.

The great people who staff our health service, and New Zealanders who use the service deserve better. They deserve a Minister who will actually get to grips with the challenge – not one who thinks throwing insults is the same as a solution.