As you know, I was a fan of Andrew Little’s justice reforms in the last term of parliament. Unfortunately, it was more a case of believing in the reforms than living them, as key structural elements were never introduced.
But “Pooffff”, like a clap of thunder, a flash of lightning, today he announced the dramatic reform of the health system. Oh if only Chris Hipkins had had the courage to do this in education! Oops, getting off topic a bit.
In the 1980s we had hospital boards, which literally provided hospital services. There was an elected board that determined things at the margins (some of you will have read the dramatic tale of us trying – and failing – to get abortion services in Palmerston North), while the community health system was left out in the cold, and often unfunded.
Labour (yes, THAT Labour government) reformed to increase the power and reach of health services within regions, with Area Health Boards. It wasn’t so bad, made sense to bring primary and other services together. Then the 1990s came with CHEs and Regional Health authorities – pure neo-liberalism and a very nasty competitive model that absolutely failed.
That model was replaced with Area Health Boards and there we have been for 20 years or so. Elected, yes. Powerless, yes! Short of funding? Yes. Inequitable? Always. Politicised? Of course.
I love the abolition of elected people. Scrutiny will take place, yes, but not in little battles within areas but in terms of the ability of the health system as a whole to meet our nation’s needs. When measured up against services in the UK and Australia, we fail abysmally. And don’t expect that to be resolved overnight.
But now we have the possibility that a government owned, government-run system tasked with providing health care for all might work. Gosh. For health, first time for a long time. As long as no-one suggests the four regional boards compete with one another. Been there, done that, brought home the bad memories.
It is not just that twenty separate organisations have reinvented health policy and practice for so long now. It is also about the Ministry of Health, a truly ineffective organisation that had no over-riding vision for the health system. You’ve heard the old saying ’good people, bad system’? It is also about Pharmac, which will continue to exist and to attempt to maximise the drug-funding dollar by cutting out excellent drug treatments at the margins.
Because there is not enough money in the health system and, as it were, there’s the rub. The per public spend in the UK is something near double our spend, or more. In the US, same as UK plus huge private costs.
There is a bit to be saved by streamlining decision making, cutting out boards, reducing senior executive. Even if that is $100 million, this is not enough. There is a long way to go.
I think the Māori health service is brilliant. Māori have been demanding by Māori, for Māori, for a long time, In the community, whanau ora has been incredibly successful. Maori deliver health really well – much better than us all.
Have Labour now begun to deliver the real goods – the long term change that this blogsite, and others, have been waiting for? Time will tell. In the meantime, all power to you Andrew, and excellent Cabinet Minister, and harbinger or a fairer society for all.
Yay. I voted Labour for the first time since 1987 (yes, I know, mea culpa in 1987) and it looks like change has arrived. No doubt my loyal readers will ridicule eme for this, btu I feel a real sense of hope.
Dr Liz Gordon is a researcher and a barrister, with interests in destroying neo-liberalism in all its forms and moving towards a socially just society. She usually blogs on justice, social welfare and education topics.
Why didnt justice minister ‘superman’ little do something about our out of date drug laws?
Sack the PSA and half of all the problems within the Health system will disappear!
Or sack the multiple levels of management instead
They’re already gone burger if this change to the Health system gets off the ground.
We need an Andrew Little in all our Ministries.
“Because there is not enough money in the health system and, as it were, there’s the rub.”
You’re right – a country that subsists largely on hill farming sheep and selling milk powder probably cannot afford a first world medical system, regardless of the organizational structure chosen. Our industry underpins our spend on services and some people need reminding of that.
“I think the Māori health service is brilliant. Māori have been demanding by Māori, for Māori, for a long time…”
OK, so show me one of the many ethnically based services that have delivered anything to anybody.
More like a country that subsists largely on massive immigration will always be under funded in health.
Whanau ora is going great guns, certainly down here in the South Island! Transformative. The question is, why don’t we know about all that great work being done?
Andrew do you mean we are not collecting enough taxes to run Health and education. Cuba which has little exports has free health at a high standard and free education at all levels.
Many other nation do both systems free.
Who is not paying enough tax.
( Shhhhhh….. I’m writing in a whisper font. Shhhhhhh…. There’s a very well kept AO/NZ secret. Shhhhhhh… That secret is… now wait for it…. Here it comes….. Here it is….. There’s plenty of money to go around and around and around. For health, for education, for transport, for housing, for fun and development. It was, I thought, rather sarcastically pointed out here that our farmers produce enough world class food to feed forty million people. Shhhhhh…. Not so loud. That’s 52 thousand primary agrarian types feeding forty million people. Not just once, but all the time. Shhhhhhhhh……
Where then, is the foreign exchange that must be pouring in? And that doesn’t even include the wools of the sheep. Shhhhhhhh…..
Where’s that money gone? Because as sure as fuck the farmer isn’t getting much of it. Shhhhhhhhhhh……. The adoption of neoliberalism was to effectively hide then launder farmer earned foreign exchange. All our AO/NZ was left with was the crumbs that’d fallen of the banksters desks. Shhhhhhhhhh……. The reason why we’re now witnessing the mighty Little bwavely flaunt his chin whiskers is because the Kiwi criminal elite are A old and dying so nothing to lose and B they already have billions so they can step back a little and chill with a Gin and a South East Asian working boy, girl or child or several. The U$A dollar must go a long way in Thailand aye ronny brierly? Shhhhhhhhhhhhhhhhh…….
“….pure neo-liberalism and a very nasty competitive model that absolutely failed…..”
There’s nothing about neoliberalism that’s failed. It did it’s job brilliantly. [It] made a few crooks many, many billions from the 52 thousand farmers who earn our sole income from their agrarian enterprises once the crooks pain-trained city people in to loathing the hands that fed them. That was a master stroke of criminal genius. Shhhhhhhhhhhhhhhhhhhh……..
That picture tho… jesus… haha
“Because there is not enough money in the health system and, as it were, there’s the rub.” ..its not just ‘the rub ‘..its the number one issue….number 2 being….good luck on Health outcomes with failing housing policy and the growth of inequality
I’m not sure that there is any virtue in using completely separate issues to the one being written about above as a method to be criticise … The amount of unintelligible, or pointless comment on here today is a little bit telling, so to speak…
NZ has the third most fiscally efficient health system in the world – what the issue is, is that per capita our health spending is declining – this is due to our immigration policy which is one of the highest per capita in the world.
A restructure of the health system without looking at the demand situation, is likely to make our third most fiscally efficient health system worse, not better. Do we want to go to the US/China/India system of health where people fear going to the public hospital? The answer is, neoliberals want this to happen so they can go to the US model.
What NZ needs is to increase the amount of doctors and nurses and medicine and hospitals per capita and have a set amount paid paid to the health system each time a NZ visa or visitor is granted entry into NZ for their share of health care.
Government has a pathetic fee for tourism ($35) which the neoliberals hated and now they need to do this to each person coming to NZ for their estimated health care costs based on private health premiums to gage their share by their age/condition.
White Island, car accidents and so forth, people’s relatives visiting are all ways that more and more people may need very high levels of NZ health care.
Visitors to NZ all need to start paying their share of the health costs.
Government need to stop building roads and start building more hospitals and having more places at medical school.
Want more Doctors Nurses and health professionals the educate them FREE.
Before the Neolib user pay on tertiary we had Doctors graduating and staying here instead of going over seas for more money to pay off their student debt. Once they are gone our investment in them since childhood is gone.
Countries with high number of Doctor per thousand capita have free education right through.
Dump the neoliberal imposition and return to good sense and train doctors free with bonding to work here for a number of years.
Is that the same Andrew Little that promised to get the men out of Pike River right up until the moment he reneged?
No, you mistake him for John Key
I suspect you’re making Andrew Little blush @ Liz.
I’m glad you’re pleased with the changes, because after talking to medical professionals today (I mean people actually delivering health services – nurses, doctors et al), and watching media over the past 24 hours or so since the announcement, I am too.
IMHO, the only people who seem to be a little worried are those that worship at the altar of the Neoliberal Cult Temple – or at least those that benefit from it in some way. They’d include members of the political class, people that are dedicated members of the commentariat and others, often used as rent-a-voices on media. They’re all worried about becoming irrelevant.
So……… Ultimately……. a little less ego and a bit more humility wouldn’t go amiss if you’re genuinely concerned about what’s been going on …… in this space going forward.
And as for the anti-democracy and anti-local-community arguments.
This is (as Ian Powell says), a transfer of bureaucracy from the local to the central, and so just as costly. NOT QUITE. Pull my other tit Ian. 20 DHBs complete with their CEOs and boards and overpaid celeries complete with a tasty onion dip.
Rationalising that alone would be worth it – let alone health professionals’ need to access a patient’s file, no matter where the fuck they are. (I’m disappointed btw @ Ian).
Yes, there is a transfer. But thank Christ we have MMP where we elect electorate MPs based on whether they’re up to it, and we elect parties on the basis of their policies.
If they fail, or do not reflect our selfish interests – vote for a fucking alternative! OR stand yourself!
There is no lessening of democracy. Merely a calling to account of those that have failed us.
You know, probably as well as I do, that local gummint and its bullshittery is worse than central.
It is the training wheels for budding central gummint politicians (Darran Ponter springs to mind if only because I worked alongside him in another life and who I suspect has ambitions. Nice bloke – really nice bloke, shame about Wellington public transport tho’ – OR for that matter a load of other shit while he was at TPK).
It’s ALSO the retirement plan for the failed. Just look at Queenstown. Fuk ’em! There’s already a pension and you can always indulge in that gig economy you’ve masterminded and expect others should aspire to.
Before the doom and gloom, let’s take a breath. It’s been 24 hours
Probably my worst fear is that the marketers and PR spin merchants desperately and unnecessarily try and put their filthy mitts all over this at a cost of millions.
I agree with you. Government at all levels is now unused to running things and not prepared to be properly accountable. Another thing that needs to change. Getting rid of the neo-libs is complex stuff!
It is complex yes and apt to drive someone to use really bad language.
After 30 or so years, I’m wondering when it will be that politicians and the bureaucracy wake up and realise that they’re not doing themselves any favours. And when they start to understand why the electorate is losing faith in democracy.
Again, well done Andrew Little
My lad, done,Mahie,and the boss,done my lad, all his abuse by his employer done it. Compulsory unionism,is needed .
Compulsory Unionism,my words what fear.
Compulsory Unionism- what is there to fear.
Its not new.
Liz you have allowed yourself to be hoodwinked again.
” As you know, I was a fan of Andrew Little’s justice reforms in the last term of parliament. Unfortunately, it was more a case of believing in the reforms than living them, as key structural elements were never introduced ”
I hope i am wrong but i am a creature of the long neo liberal night lol.
Wait and see who gets the lucrative appointments like the Levy’s from South Africa who have pocketed a lot of coin by denying New Zealanders and i include vulnerable sick children who should have the right to access healthcare in their own country and not because making a profit by slashing budgets has always been the priority not saving lives or treating the many who have always paid tax to provide the services they need when the unthinkable happens.
The rich have always got their private provision because its only function is to provide the best by those who would never think twice that their health must come first and when they need it and in total comfort of course.
The wealthy get a second chance but the rest of the unfortunates will take their chances with the Markets health providers who will despite every human misery imaginable will make a profit !!!!
Our hospitals are STILL Shipley’s CHE’s in many ways like their invention in the 1990’s and to the horror of a born again Keynesian Mr Jim Bolger who thought it was a wonderful idea at the time.
How many National and Social Democrats go public ? or opt for the private sector to avoid the horrors of the health service they denied so many of their fellow New Zealander’s.
Horrors of the private health system when due to under-funding of the public system, some are forced to go private or risk dying to find when the private operation goes wrong no responsibility is accepted without more money being found to repair the mess.
Comments are closed.