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A NZ Herald front page headline on 22 February screamed out to anyone who  cared to read – or perhaps even just happened to glance at the paper;

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Written by veteran Herald political reporter, Audrey Young – the on-line version’s headline was considerably more restrained;

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Regardless of headlines, the content confirmed years of media reports and countless blogposts  on The Daily Blog, The Standard, and elsewhere, that New Zealand’s public healthcare system was critically under-funded; over-stretched; and staff were burning out from over-work. The story confirmed nine years of National’s gross under-funding and mis-management of the health system as successive ministers demanded that DHB managers and health-workers “do more with less”;

The Government said total health spending would be a record $16.77 billion in 2017/18 – an increase of $879 million, with an overall increase of $3.9b over the next four years.

However, the record claim does not take inflation into account, and sidesteps the fact that almost half the spending will go toward mandated wage increases as part of the pay equity settlement.

[…]

Meanwhile, mental health workers and union representatives said the funding was only a fraction of what was needed to adequately respond to demand.

Social worker Andy Colwell said he expected to see the gap between demand and funding get even worse as a result of Budget 2017.

“As a mental health worker, seeing families struggling with life-threatening situations not being seen as urgent is incredibly frustrating, and knowing it will get worse is incredibly distressing,” Colwell said.

Healthcare workers made their cries of frustration heard clearly and unequivocally;

A survey of almost 6000 paramedics, nurses, mental health workers and support staff earlier in 2017 found 90 per cent felt the healthcare system was understaffed and under-resourced.

Some said they feared burnout could be jeopardising patient safety, and 72 per cent said their workload was not reasonable.

Gordon Campbell wrote on 3 April;

Week by week, the sheer scale of the neglect to crucial social infrastructure by the Key/English government becomes apparent – and with it the size (and expense) of the problems they’ve left behind, for the Ardern government to somehow address. The mouldering walls and the decaying electricity and sewage systems at Middlemore Hospital serve as a perfect symbol of the dilapidation that’s been fostered by pressure to meet the political goals of budgetary constraint. All of it done so that John Key and Bill English could brag about being capable managers, who kept expenditure under control – as if balancing the books was an end in itself.

Meanwhile at Middlemore, the necessary investments in maintenance were being deferred – as they have has been in DHBs all around the country, in order to prop up the illusion of competence by a government always far more interested in delivering another round of tax cuts, if it possibly could. It didn’t want to hear bad news. Its managers in public health heard that, and obeyed orders.

Since National changed leaders, the same illusion has been perpetuated by Simon Bridges, who cited National’s claim to be “good economic managers” in his first statements as leader.

Over the last two years, Radio NZ  featured a series of hard-hitting, critical stories examining growing waiting lists and worsening under-funding at the various DHBs around the country. The reports were damning;

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This year,  DHB Boards mustered the courage to disclose the full extent of under-funding.  Our dilapidated hospital buildings were literally rotting from within;

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On top of stretched services; lengthening waiting lists; and stressed medical staff, the full extent of  the public health nightmare became apparent, as revelation after revelation was made public;

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Noticeably, it was this country’s non-commercial broadcaster, Radio New Zealand, that led the steady expose on the crisis in our public health system. Other media outlets picked up on the issue, belatedly, albeit based on Radio NZ’s sound investigative reporting;

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A subsequent Fairfax editorial was damning of the previous National government;

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The un-named editorial writer sheeted home responsibility for this mess firmly where it belonged;

The new Government has inherited these problems from a National Government that prided itself on running a tight financial ship. Even as recently as this week, when worsening news about Middlemore appeared in the media, new National leader Simon Bridges stuck to a script about prudent financial management and passed the buck back to Prime Minister Jacinda Ardern and Health Minister David Clark. 

But the responsibility for this and other problems of underfunding and general neglect in the health system really need to be sheeted home to former Health Minister Jonathan Coleman, who has already signalled his departure from politics for the private health system. Many National MPs are said to quietly blame Coleman for their 2017 election result as both health and mental health became political quagmires. 

The editorial echoed Gordon Campbell’s earlier blogpost, and those of  other bloggers over the last nine years. This blogger has consistently pointed out that the 2009 and 2010 tax cuts implemented by National created a fiscal hole; forced increased borrowing; and corresponding under-funding/cuts to public services;

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As this blogger reported in January last year (2017);

A decade late, National’s ongoing cuts, or under-funding, of state services such as the Health budget have resulted in wholly predictable – and preventable – negative outcomes;

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In response, National’s current, caretaker Leader, Simon Bridges attempted to mitigate his Party’s shocking record of incompetance by repeating the oft-parrotted, mythical mantra of National’s “good economic management“;

“But remember we didn’t have all the choices that this government’s blessed with from a very strong legacy from good economic management.

We had to get through a [global financial crisis,] we had to get through earthquakes.

Now we are in actually a relatively blessed period with strong surpluses, it’s for this government to look at how they do this”

Bridges seemed utterly oblivious as to why “we are in actually a relatively blessed period with strong surpluses“. Those so-called “surpluses” were at the expense of  rotting hospital buildings and under-funded services and medical staff.  He seemed wholly blind to the social costs incurred in National’s single-minded mania to create “surpluses”.

Bridges’ attempt to deflect to the GFC  ignores the critical fact that National stubbornly proceeded with it’s reckless promises of tax cuts that – as predicted – eventually proved to be unaffordable.

Even right-wing commentator, Matthew Hooton panned Bridges’ comments on Radio NZ’s Nine To Noon political panel, saying;

“That was his worst Morning Report interview so far…”

Hooten  also dismissed former Health Minister Coleman’s claims not to have been informed of Middlemore Hospital’s dire building crisis as “hopeless”.

Hooton suggested that rather than National’s 2017 election year bribe for more tax cuts, that the focus should have been on writing off DHB debts and more social spending. He believed that offering tax cuts was the reason National was no longer in government;

“That was the wrong call.”

He has a point – a point that many commentators on the Left have been banging on for nearly a decade.

It should be abundantly clear to all by now that National’s strategy of tax-cuts was simply to win votes at election time. It was a successful tactic during the 2008 election;

National will fast track a second round of tax cuts and is likely to increase borrowing to pay for some of its spending promises, the party’s leader John Key says.

But Mr Key said the borrowing would be for new infrastructure projects rather than National’s quicker and larger tax cuts which would be “hermetically sealed” from the debt programme.

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National is yet to explain how it will pay for the promised larger cuts.

And they tried it on again last year;

Prime Minister Bill English is talking tax cuts – saying “something will be covered” in the upcoming Budget and any changes would take effect from April 1 next year.

“There will certainly be something covered in [May’s] Budget. Look, there’s not going to be some big sugar shock with tax cuts. We have a range of tools, we want to be able to help and support low and middle income families,” Mr English told Newstalk ZB.

Had it not been for NZ First coalescing with Labour and thew Greens, National’s planned tax cuts might well have proceeded. And the rotting buildings at Middlemore would have continued to decay; waiting lists throughout the country continued to lengthen; and increasing numbers of front-line staff burning out.

However, there is an aspect far worse than the opportunistic use of tax-cuts as electoral bribes by a National Party hell-bent on re-election at any cost.

That is that District Health boards have not made these problems public earlier.

Waiting for incoming Labour-led governments to finally ring alarm bells by announcing;

“We have been facing this for years and every year make savings or defer capital or struggle to get permission to get capital through the [Ministry of Health] capital investment committee.

– appears to be an act of cowardice.

Auckland District Health Board states that it’s  “strategic priorities” are;

• People, patients and whānau at the centre.
• Values and equity underpin everything we do.
• Guarantee quality and safety.
• Get the best outcomes from our resources.
• Hold people, systems and structures to account.

Fine words. But have they been followed through?

When District Health Boards fail to make clear to central government that funding for public healthcare is inadequate; that there is a crisis in offering services in a timely fashion; that buildings and equipment cannot be kept to a high standard; that staff are over-worked and leaving in droves – then they have abrogated their duties to their communities; their employees; and to those vulnerable people who desperately seek medical assistance.

Waiting for a change in government is not a viable option.

Appropriate funding for DHB services must be the the number one duty of every Board member and Chairperson, irrespective of which hue the government-of-the-day is.

Acquiescence in the face of a Minister expecting (and demanding) a surplus from DHBs is not a viable option.

We, the public, expect our DHB Boards to look after our interests – not those of  Ministers with their eye on re-election.

If DHB Boards cannot find the inner courage to speak out on our behalf, to demand appropriate funding, then they should resign. Step aside and let others do the job. After all that is said and done, people’s lives are at stake.

Silence should never be a viable option.

 

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Acknowledgement

I acknowledge and thank the hard-work of Radio New Zealand staff who have brought to our attention the current abysmal state of our public health system. This is indeed the role – the raison d’être of the  existence of public broadcasting. Your dedication to bring us the truth may have saved lives.

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References

NZ Herald:  Huge demand for services in Auckland stretches health system to the limit say bosses

Fairfax media:  Counties Manukau district health board in financial crisis

Fairfax media:  Frustration, disappointment over health funding in Budget 2017

Fairfax media:  Nine in 10 healthcare workers feel understaffed and under-resourced

Radio NZ:  Eye patient delays a nationwide problem – specialists

Radio NZ:  Eye check-up delays: ‘Within that time, I went blind’

Radio NZ:  Damning report on delayed eye appointments released

Radio NZ:  Eye patients forced to sit on floor at overcrowded clinic

Radio NZ:  Health Minister defends number of ICU beds

Radio NZ:  Man waits five months for urgent cancer surgery

Radio NZ:  ‘People will die waiting for the attention they need’

Radio NZ:  Southern DHB in a ‘slow motion train crash’

Radio NZ:  Dunedin Hospital surgeons operate only twice a month, surgeon says

Radio NZ:  Minister refuses to apologise for ‘toxic’ DHB comment

Radio NZ:  Southern DHB to implement all recommendations in scathing review

Radio NZ:  ‘I had a death sentence hanging over my head’

Radio NZ:   Prostate cancer patients face wildly varying wait times

Radio NZ:  Southern DHB commits to clearing patient backlog

Radio NZ:  Health Minister responds to ‘unacceptable’ delays at Dunedin Hospital

Radio NZ:  ‘Megaclinics’ planned for Dunedin urology patients

Radio NZ:  Akl DHB defends work culture, ‘rubs salt in wound’

Radio NZ:  DHBs warn funding crisis may worsen

Radio NZ:  Doctors push to reduce wait time for mental health patients

NZ Herald:  Rot, mould and sewage at Middlemore: Health minister ‘disappointed’ he wasn’t told

RNZ:  Hospital rot was ‘fully disclosed’ to board, ministry – former boss

RNZ:  Hospital rot – Sewage leaks linked to 2014 outbreak

RNZ: Middlemore maintainance a ‘bloody nightmare’ – ex-manager

TVNZ:  ‘We have rot, we have mould, we have sewage’ – Health Minister asks Middlemore Hospital for explanation over faulty buildings

RNZ:  Middlemore building woes worse than first thought

Fairfax:  Health system underfunding worse than PM expected, as more problems uncovered at Middlemore Hospital

Fairfax media:  Middlemore is a bleak symbol of health failure

Radio NZ: Patients have ‘severe loss of vision’ in long wait for treatment

Fairfax media: Researchers claim NZ health budget declining, publicly-funded surgery on way out

Radio NZ: Patients suffering because of surgery waits – surgeon

Fairfax media: 174,000 kiwis left of surgery waiting lists with Cantabrians and Aucklanders faring the worst

Radio NZ:  New govt ‘blessed’ with National’s surpluses – Simon Bridges (alt.link)

Radio NZ:  Political commentators Matthew Hooton and Stephen Mills (alt. link)

NZ Herald:  Nats to borrow for other spending – but not tax cuts

Otago Daily Times:  Tax cuts would take effect from April 2018 – PM

Auckland DHB: Who We Are

Radio NZ: DHB vacancies likely even higher than 400

Additional

NZ Medical Journal:  Funding New Zealand’s public healthcare system – time for an honest appraisal and public debate

World Health Organisation:  New Zealand cuts health spending to control costs

Infonews: Government’s 2010 tax cuts costing $2 billion and counting

Fairfax media:  Government to urgently establish new health advisory group

Other Blogs

The Jackal:  National has failed our health system

Werewolf:  Gordon Campbell on Middlemore Hospital as a symptom of neglect

Previous related blogposts

12 June – Issues of Interest – User pays healthcare?

The Mendacities of Mr Key # 19: Tax Cuts Galore! Money Scramble!

Cutting taxes toward more user-pays – the Great Kiwi Con

The cupboard is bare, says Dear Leader

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