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.