As changes in the new public health system unfold, the Government may be able to deflect the noise from the professions, but convincing a wary, long-suffering public will be a very different matter
Opinion: Last week, in an act of supreme irony, the man who stood down as leader of the Labour Party just before the 2017 election because he did not believe he could lead it to government, took steps that will decide whether his party remains in government after next year’s election.
Andrew Little’s changes to the public health system are the most dramatic in more than two decades. In a further irony, his recentralisation of the health system and abolition of elected district health boards reverts to the system National put in place in the 1990s, which the last Labour government had abolished.
This game of musical chairs should not detract from the fact major changes were required. District health boards had become cumbersome bureaucracies; waiting times for elective surgery and specialist services had grown to unacceptable levels, fuelled by the disruption caused by Covid-19; critical staffing shortages among nursing and medical staff were increasing; and, public confidence in the system was waning. A strong case for change existed.
However, the question now is less whether the minister’s back-to-the-future approach is the right way to go, but much more whether it will achieve the public expectations he and his colleagues have built up around the changes. Time is not on his side. Health professional groups are already saying last week’s changes could take up to a decade to achieve their potential and deliver improved services to the public.
While some of that will almost certainly be an element of patch-protection and natural resistance to change among health professionals and administrators, there is nevertheless a strong measure of truth in what they say. Major change of this type always takes a long time to implement fully.
The jostling for position within the new structure – which has apparently already seen all the previous district health board chief executives accommodated in new senior positions – will not of itself lead to immediate improvement in service delivery. Neither is who sits in which chair of any great interest to the public.
Amid all the change going on – the new agencies, the new names and logos, and the bureaucracies involved in establishing them – the public is focused simply on how it will affect them. Will they be able to get the operations or treatment they need more quickly? Will services be more responsive to their needs? Will critical services, such as mental health, be resourced and supported in the way they expect? The public’s assessment of the impact of the new system will be based on the extent to which it satisfactorily answers those basic questions.
All this creates a significant political problem for the Government. It cannot afford to wait anything like the possibly 10 years some predict it will take to bring about meaningful changes. The time-frame is dramatically shorter than that – with an election next year the Government has but a few months to achieve significant delivery improvements and to demonstrate these to the public. While this may appear unreasonably unrealistic, the reality is the intensely personal nature of health problems has always meant that public expectations and demand for better services are insatiable.
This is not new – every government making major changes to the health system has been beset by this reality. And, in the end, health systems survive not because of the rationality and efficacy of their structures, but on the extent to which the public sees their needs are being met.
The Government has taken on a massive risk in gambling that it can show substantial improvements to the public in just a few months, especially when so many essential details of the new system remain unresolved. For example, the Government’s working party considering how surgery waiting times can be reduced is not even due to report its recommendations for another three months, meaning decisions on what to do, let alone any perceptible, significant reduction in waiting times, are still many months away, at the earliest.
There have also been ministerial promises of more staff in critical shortage areas, such as nursing and clinical services. But these gaps cannot be filled overnight – it takes years to train more nurses and doctors, and there is no evidence of large numbers of health professionals just waiting around to quickly fill the gaps. For at least the short-term, until sufficient additional numbers can be trained locally, the Government will need to look to immigration, but that will not be easy in the post-Covid19 environment.
Leaving aside the vexed question of the recognition of overseas qualifications, current immigration procedures will be challenged to respond quickly enough. Even if restrictive immigration policy is loosened to facilitate overseas recruitment, there is the question of the remuneration packages needed to attract sufficient suitable staff. In turn, those conditions will need to be applied to existing local staff to ensure they are retained, and not lost overseas. And all this will have to be funded, at a time when the Government is saying there is going to be less emphasis on administration and bureaucracy, and more focus on frontline services.
The politics of all this are sharp and brutal. Labour has invested a huge amount of political capital in the success of these reforms, courageous enough when its failure to implement successfully other major reforms (eg KiwiBuild, Three Waters, and Auckland light rail) is so glaring. The health reforms not only cannot be allowed to fail, but more importantly they have to be seen to deliver benefits the public will see as significant, tangible and real improvements by the end of the first quarter of 2023.
As the changes unfold, the Government may well be able to resist and deflect the noise from the professions and their interest groups, but convincing a wary, long-suffering public will be a very different matter.
The public will have the last say on the latest health reforms at the ballot box next year.
