The most important lesson from the Covid pandemic is the failure of the current health structure to deliver the national public health campaign demanded by the crisis.
There was a time when the country could have delivered such a campaign through a high quality, dedicated public service. We can do it again – in fact it’s the only possible way forward to deal with any national health crisis such as the Covid pandemic or our mental health emergency.
When the Department of Health was abolished in favour of a slimmed down Ministry of Health dealing with a devolved health structure of hospitals and primary healthcare providers, the main driver was to create “competition” and improve “efficiency”. This would be provided by bringing in “private sector disciplines” through contracting of services to the public and private sectors.
The Ministry of Health was deliberately populated with non-health sector lawyers and administrators whose main job was to develop and monitor contracts for health services.
Politicians since then have tinkered to create more “efficiencies” with smaller hospitals closing and local health services diminished. As part of this push Aotearoa New Zealand’s first woman Prime Minister, Jenny Shipley, wanting a bigger role for the private sector, brought in “hospital part charges” and fought hard to ration health services. For the most part she failed on these initiatives through grassroots public fightback campaigns.
When the Clark Labour government came to power in 1999 it retained the contracting model because they said it was important for Māori healthcare providers to obtain funding for devolved delivery of primary healthcare. Māori providers often argued the contracting model was a liberating model from a stifling “one size fits all” bureaucracy.
Māori should have been delivered services based on the Treaty of Waitangi rather than Māori desire to provide primary health services being used as an excuse for allowing fat private sector profits to be made from privatising public services. The contracting model was NEVER developed to provide for Māori alternatives – it was developed to provide government health contracts to the private sector. Māori were a convenient excuse for the attempted wholesale privatisation of public services in health.
Despite supposed benefits for Māori health, the opposite happened and the eyewatering cost to Māori has been revealed just this week. Peter Crampon from Otago University has costed the “making of policies to address service failures and then failing to properly implement them”. He has calculated the underfunding and under-provision of primary health care for Māori and says “The dollar equivalent cost of poor health and deaths for Māori over an 18 year period that may be attributable to failed policy implementation is in excess of $5 billion a year”.
Meanwhile our Ministry of Health is dominated by bureaucrats who are expert at writing contracts but far below par when they have to respond to a national health emergency such as the pandemic. They are making it up as they go along.
Among the myriad of failures was the Ministry’s assertion they would replace private security guards at MIQ facilities with directly employed guards. As far as I’m aware that idea has been quietly dropped in favour of continuing with private security guards because key Ministry bureaucrats prefer contracting – it’s in their blood – irrespective of the health issues involved.
National have been right to point to the numerous failures as our “not fit for purpose” health system has tried to deal with a national health emergency. The health system has also been an utter failure to deal with our other national health emergency – mental health care.
The holes in the pandemic response are obvious but National and Act proposals to hand over more of the response to the more “efficient” private sector, such as allowing employer groups to run MIQ for their areas of the economy and a dedicated, purpose-built, privately-run MIQ facility, would make things worse. (“Efficiency” was one of the weasel words of the 1990s – it sounds sensible but simply means the private sector will pay people less to do the same job and will pocket the profit for doing so – in general Māori health providers have been as poor employers as any other private health provider)
Private provision of health care can never result in a high-quality primary or secondary healthcare system for everyone. The US is the example National and Act would like us to follow – the pinup example of healthcare failure – the worst health outcomes for the greatest expenditure.
As Minister of Health, Andrew Little has the ball in his hands and he is punting it in the right direction.
Covid has shown us that we need a single national health structure to deliver health services as announced by the government in the 2021 budget.
For a small country with the same population as Sydney our ongoing insecurity has led us to mimic the failed health structures of other countries.
The Ministry of Health – more a “contractocracy” than a health delivery system – has to go and the neoliberal zealots who have run it and our various DHBs must follow.
Rebuilding a quality healthcare system, for primary and secondary care, needs dedicated public servants and billions in extra funding to make up for the underfunding over the recent decades of decline. (The sort of billions the Reserve Bank has printed this year and given to the private sector banks who have used it to make the housing crisis worse – like pouring jet fuel on a fire and hoping it won’t explode)
We have all suffered one way or another from healthcare failure. The holes are being plugged in an ad hoc way now as we face this national pandemic – and it shows.
A single national health service alongside a dedicated Māori national health provider is the best direction to head.
Don’t let the buggers steal your ball Andrew Little.