Brooke van Velden: Why Govt’s health remedy is a fail


You may not have heard of the Pae Ora Committee. It’s new, set up to sweep away district health boards and change healthcare from one national system to two. It’s part of the Government’s Treaty-at-the-heart-of-everything approach. I’ve been sitting on the Pae Ora committee hearing from healthcare providers concerned about these changes that will affect every hospital, clinic, and community nurse in the country.

Any other time, it would be the biggest news in Wellington. However, because the Government chose to blow up the healthcare system in the middle of a pandemic, these changes have largely flown under the radar. Here’s what I think you need to know.

Even before Covid, our health professionals were stretched to the limit, with many would-be patients on waiting lists. There’s a need for better accountability, more hospital beds, and better access to life-saving medicines so more New Zealanders can live longer, healthier lives.

There needs to be change, but the Government is focused on changing administration. It isn’t asking basic questions like will this get better treatment, faster, for more patients?

They’re getting rid of the 20 DHBs and introducing two new entities, Health New Zealand and the Māori Health Authority. Basically, we’ll have the same healthcare system, except the administration will be centralised and split in two by co-governance.

The reforms are meant to deal with the health inequalities and disparities among population groups found by the Health and Disability System Review, such as Māori, Pasifika, people with disabilities, and rural populations.

While well-intentioned, I believe it risks being divisive and ineffective. For example, the newly established health system principles say the health system should “provide opportunities for Māori to exercise decision-making authority on matters of importance to Māori” but there is no requirement for the same decision-making authority on matters of importance to anyone else.

Some of our worst health problems are in rural and remote areas far from major hospitals, such as babies being born in ambulances on the side of country roads.

We can improve the health system but I think separating New Zealanders into groups with different rights is not an exercise in health, it’s an exercise in politics. Doctors and nurses are trained to get the best result for the patient in front of them without discriminating. To me, this reform puts identity before health.

I argue that’s the strange truth of the Government’s plan. It changes everything and nothing. From the point of view of a patient nothing much will change. You’ll still turn up to a crammed emergency department or after-hours clinic needing to wait for hours only to be handed the same medicines as before. Practical things, like workforce planning to figure out what happens when ageing health workers retire, hasn’t been given priority. Access to medicines? That’s “out of scope”.

We see more people marching on Parliament protesting for access to life-saving medications than we do on any other issue.

We like to think we’re a first-world country. But every other first-world country has so many more medicines available than us.

In fairness to the Government, Pharmac is having its own review. Except, that review explicitly rules out funding of medicines. A lot of people think pharmaceuticals are important, but somehow the Government manages to ignore them.

It’s not possible to achieve improved health outcomes without having the skilled workforce to deliver it.

We desperately need more doctors, nurses, and midwives to care for our most vulnerable. Nearly half of all GPs plan to retire in the next 10 years but there aren’t enough doctors being trained to fill the gaps. The healthcare workers we do have are feeling burnt out. I’ve heard from an ICU nurse who quit this year at the age of 27 from the stress of being stretched so thin.

Yet, the bill doesn’t prioritise workforce training, development, or retention. Administrative reform, by itself, won’t provide another GP down the road, train another mental health nurse, or deliver a midwife to rural New Zealand.

In rearranging the deckchairs, I believe the Government has forgotten to put people first.

With the majority this Government has, there’s no doubt these reforms will go through before the election. At that point I hope the Government changes.

At that point, it will be time to solve the tangible problems that effect patients of every background. How do we ensure there is a health professional available, equipped with the best medicines, supported by the best information technology and management? New Zealand deserves nothing less, but I think less is what we will sadly get from the ideologically driven approach by the current Government.

Brooke van Velden, MP, is the deputy leader of the Act Party.

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