Rethinking health service provision in this country could start with removing the health board layer from between the public and our taxpayer-funded health services.
The benefits would be great.
For starters the government could take direct responsibility for the management of our hospitals. If the management at a local level is deficient in any way, we would know the government was directly responsible, rather than it being able to hide behind health boards, some of which are clearly more able than others.
Local managers would be accountable not to boards, who are chosen by local people who can’t be expected to know whether the candidates chosen are any good at leading local health provision, but to a national structure which could see what is happening all around New Zealand. In our situation in Dunedin we already have government-appointed commissioners, so the difference would only be that there is no-one paid to take the heat off the government.
The local management team would be accountable directly to the government for delivering what the government has required of them. They would not need to make a local board look good and able to operate within their budgetary requirements, or to defend anything outside their local management issues.
For another thing, whatever health services New Zealanders receive could be expected to be delivered equitably across New Zealand. If 50 points gives you a heart bypass in Manakau 50 points should give you a heart bypass in Oamaru and Dunedin. If local areas share service provision, then wherever you live you should receive the same level of service, rather than if say Christchurch provides some health services to Otago people our people have to wait in the queue behind Christchurch locals.
We would not have the position where one health board is prioritising orthopaedic services for some budgetary advantage to the local board, whereas another has decided eye services are more important this year. Where priorities are made by the government of the day the situation would be much more transparent, and any lobbying of the government to change priorities would be directly with the government. This would not need to get in the way of services being provided in a different way in different parts of the country.
Those who are at a distance from a base hospital may have different requirements as to how and where services can efficiently and fairly be provided. In some areas services may be provided through private providers or, say, using marae-based services. The important issue here is that however services are provided it is the responsibility of government to make the provision fair and accessible across New Zealand.
We would also use our energies to demand better health provision for taxpayer funds, or an increase in funding, instead of a focus on a hospital site. We would be demanding of central government that the hospital should be efficient, equitable and accessible, and leave it to them to work out how to make sure we don’t lose services while a new hospital is built.
And we know instinctively that direct provision by the government is likely to be a fairer system. We take taxes from people evenly across the country, without any suggestion that somehow those living in some areas can pay a different amount in the same circumstances. We have a police force which is expected to enforce national laws in a nationwide consistent fashion, and a benefit system which applies across the board.
We expect those who work for the government in other departments to provide consistent service throughout New Zealand.
In the health area, we have a national purchasing authority buying drugs for all of us on the basis that it is more fair and efficient to have such purchases made by one authority on behalf of all of us.
We have the previous leader of the Labour Party announcing a policy of a national approach to cancer treatment throughout New Zealand, describing cancer care as a post code lottery. The same rationale applies to all health treatments.
It would be hugely difficult to bolt a national cancer initiative on to local health board funding models, and likely to have a negative effect on other health provision which was not similarly under national scrutiny. All of our health services should rightly be under scrutiny of all of us.
And we should not allow successive governments to hide behind health boards when we all know it is taxpayers’ money and the government that takes that money should be directly responsible to us.
- Hilary Calvert is a businesswoman and former Dunedin city councillor.
