Health system creaks on

PHOTO: ODT FILES
Another day, another negative news story about the staff shortages and other failings of our creaking public health system.

If we find it wearing and wearying, those sentiments must be overwhelming for many struggling on within the system or seeking treatment from it.

There seems to be no corner of the system which is not short-staffed and stretched to breaking point.

Last week’s list of concerns included the lack of radiation oncologists in the Southern district, meaning some patients with brain and gynaecological cancers or benign brain tumours could not have treatment close to home, and access to specialist first assessments was delayed.

There were also reports of almost 5000 nurses having registered to work in Australia since last August.

It is too early to tell whether their enthusiasm for the move will have been tempered by their recent pay rise here.

While they may still be able to earn more money across the Ditch, the grass might not necessarily be as green as they hope.

A 2021 report suggested by 2025 there could be between 20,000 and 40,000 nurse vacancies unfilled there.

Nor is it hard to find Australian stories of nurses complaining about short-staffing, their working conditions, and lack of recognition.

The Government has been criticised for pushing ahead with the health reforms despite the fallout from the Covid-19 pandemic, but if we still had the district health boards the system-wide issues now thrown into national focus would not have miraculously disappeared.

The results of a Te Whatu Ora staff survey held at the end of last year, completed by less than a third of the total staff, included concerns about persistent bullying in some areas which was poorly dealt with, lack of confidence in those in decision-making roles, and inadequate resourcing.

None of these would be new, but they may have been heightened by the uncertainty surrounding the new system.

Some of the major unions are speaking out about the level of clinical leadership in the reform process, a criticism they also had about the previous system. It has been concerning to hear instances of clinicians still being chastised by management for speaking out.

Whether the new system will be any better at addressing these issues than the old one is not yet clear.

More questions about the pace and direction of change arose last week in a speech from sacked Te Whatu Ora chairman Rob Campbell.

Colourfully describing the reforms as something which might have looked OK on a whiteboard but in practice resembling a half-baked cake, he considers there was much which was poorly defined.

It is hard to disagree with this.

He says this led to excessive centralisation, or at least the perception of that, at the expense of local and regional involvement.

To stretch his cake simile further, it has been like trying to bake a cake where the ingredients list misses things or contains something you have never heard of.

One area which is poorly understood, and not surprisingly because so few of them exist, is that of the localities.

There are to be 60 to 80 of these where communities will decide on their needs and how all organisations can work together to improve health.

There are still only 12 of them — and just two in the South Island — although these localities are supposed to be in place by July next year.

Among his many criticisms is the failure to define a new funding model and support of primary services in conjunction with those services ahead of the new structure.

In his view, effecting substantial social change requires a clear and shared view of the purpose for change, leadership and strategies consistent with that purpose, a realistic appraisal of the environment involved, sound understanding of the issues for those affected and ways to involve them, and effective and comprehensive communication.

The jury is still out on whether the health reform programme, although it is still in its early stages, comes close to meeting any of those.