The healthcare system fails us every day; can it be repaired?
Sarah Dalton is Executive Director of the Association of Salaried Medical Specialists Toi Mata Hauora
Opinion: Hardly a day goes by without the media reporting that someone, somewhere in New Zealand, has been let down by the public health system.
He seems to have come to state the obvious. The health system is in a hole, but not because of the Covid pandemic. Before Covid, public hospital bed occupancy rates were at record highs and wards were operating at levels exceeding clinical safety standards.
Services were struggling with long-standing staff shortages, burnouts, dilapidated buildings and equipment that in many cases were well past their expiration date. An estimated 450,000 people requiring hospital treatment were either on waiting lists or excluded altogether by being considered ‘non-priority’.
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In addition to this, an estimated 1.2 million adults have one or more types of unmet primary care needs. There is no doubt that some of them end up being hospitalized. We have relatively limited access to publicly funded drugs and relatively low cancer survival rates compared to other comparable countries, and the cancer survival gap is widening.
Before Covid, there was a palpable sense of dread among doctors of what awaited them as winter set in, when hospitals are at their busiest. Now, with winter approaching, they and their healthcare team colleagues must prepare for flu and measles viruses, ongoing Covid cases, a huge backlog of surgeries and… appointments with specialists canceled due to the pandemic.
So, Covid aside, how did we get to be in such a hole, and is this year’s budget going to dig us in or dig us in deeper?
Years of underfunding of the health system have been acknowledged by the current government, but while there are real improvements over recent budgets, overall there have been few signs of meaningful progress for see most health services go beyond simple day-to-day survival. .
As Finance Minister Grant Robertson announced a budget operating allocation of $6 billion for 2022/23 – the largest since the 2008 global financial crisis – and funding the health system is a priority, big numbers can be expected for Vote Health. Current indicators suggest it could see more than $2 billion in new funding for the next fiscal year. But we’ve seen in previous budgets that big numbers can very easily evaporate when thrown into the spotlight, as it costs a lot just to maintain the current level of services – more so than ever this year. Additional funding is needed to cover costs such as inflation, wage growth, pay equity agreements, demographic shifts, lockdown service arrears, budget pre-commitments and addressing funding shortfalls baseline indicated by a decade of DHB deficiencies.
It will certainly affect more than 2 billion dollars. Launching an urgently needed multi-year strategy to address New Zealand’s shameful unmet health needs, which is a key part of achieving the government’s health equity target, as well as addressing the long-standing staff shortages in all areas, requires much more. For this to happen, rather than being unique, as Grant Robertson has indicated, the government will need to repeat this year’s budget operating allocation for at least another year.
The current policy debate about whether this year’s operating allocation amount is justifiable must take a much broader social and economic perspective that acknowledges the overwhelming evidence that spending on health and other social services is an investment resulting in substantial social and economic gains.
The apparent obsession with running government budget surpluses – a trait our finance ministers seem to share with those in Australia – is also in dire need of this broader social perspective. As one financial commentator put it, we’ve been hearing it for so long now that it’s become ingrained in the collective psyche. Surplus good, deficit bad. Both sides of politics have embraced it, almost like a mantra. But a lasting surplus can be just as debilitating to an economy as persistent deficits.
The hole we find ourselves in today, and the enormous price we must pay to get out of it, is largely due to decades of underinvestment. A simple example is today’s $14 billion bill to restore our dilapidated hospital buildings due to the penny-pinching of previous governments. In fact, New Zealand’s recently released infrastructure strategy report contains some hard lessons for health and social investment and the consequences of neglecting it.
The report reveals that the country’s infrastructure – water and electricity networks, roads, railways and buildings, etc. – have deteriorated to the point that more than $31 billion per year would have to be spent over the next 30 years to fix it.
As Grant Robertson said, “As a country, over the decades, we simply haven’t invested enough, planned ahead enough, or coordinated or efficiently enough to meet our needs in infrastructure.”
Replace “infrastructure” with “health” and you’ll have a good summary of why our health services are in such a precarious state.
Much is expected from the restructuring of the health system this year, which is necessary to advance health equity and, in the long term, reduce health costs.
But restructuring alone will not be enough to meet our long-standing health and social needs. As the Health and Disability System Review states, “No system can function effectively without adequate funding.
Whether or not the government has learned of the irreparable damage that can be caused by underinvestment is about to be tested.