Repeating comments about our ailing health system begin to sound like a cracked record. Many wonder whether anyone is listening or cares.
Severely strained healthcare resources are dictated by limited government funding. Hospital budgets determine availability of resources for patient care.
Vastly experienced clinicians, after years working at the coal face, have complained for decades about resources lagging increasingly further behind identified needs. Meeting patients’ needs presents increasingly difficult challenges.
In contrast, managers are primarily focused on meeting budgets set by their political masters to meet their KPIs.
Private medical care is available for those who can pay; this should not become part of a secret strategy of creeping privatisation, undermining the principle that everybody should have access to quality healthcare.
Clinicians’ inability to meet patient needs draws frequent attention in the media.
Primary care is currently underfunded, despite being shown to circumvent more costly hospital care. General practitioners are significantly overworked; 60% of them wish to retire within the next six years.
Support previously provided by specialists is severely restricted or absent owing to tertiary staff shortages. A growing population increases demand.
Medical costs are ballooned by inflation. Pharmacists now complain of over-strained resources. The ambulances can no longer reach all those at the bottom of the proverbial cliff, even in wealthy areas like Waiheke Island.
A recent editorial in the NZ Medical Journal confirms the sad decades-long saga of New Zealand trailing other comparable OECD countries in healthcare funding. Needs are not being met, and the situation is deteriorating each year.
Puzzlingly, those currently in charge of our health system pretend that funding is sufficient and that poor productivity is at fault. They maintain that often fancifully derived hospital budgets validate staff requirements for any task.
Practical experience at the work front paints a drastically different picture.
Restructuring of our health system is producing further turmoil. A commissioner becomes Mr Fixit, who has designated inefficiency, and not inadequate funding, as the problem. Maybe he needs to work shifts in some rural hospitals to be able to comment objectively?
Many of us currently experience excellent care during hospital treatment. Well-trained staff render dedicated service. It is difficult to imagine how they could make significant efficiency gains.
The effect of delayed, and sometimes denied, care carries a heavy toll. Each dollar spent now on healthcare saves more than $4 in future costs, even without considering unnecessary suffering of patients and their families.
Health funding provided is still widening the gap between what is provided and urgent necessary needs. If we do not invest and build for the future, our situation deteriorates steadily.
Preventive medicine programmes, including screening, have become an important part of medical care. Those already in existence survive on shoestring budgets.
For example, the national bowel screening programme has saved many lives, but is restricted to a limited age cohort excluding a significant number of important potential beneficiaries. Resource restrictions have resulted in reduction of screening test sensitivity by 16% from those of the pilot programme, lower than recommended by most countries.
Colo-rectal cancer investigations are currently not available in the public sector to those under age 50. Suggestions to augment the service (e.g. flexible sigmoidoscopy, training nurse endoscopists) have not gained traction. Many are dying prematurely after delayed diagnoses.
Hospital maintenance has been neglected for years, with many hospitals being hardly fit for purpose. Building of new hospitals throughout the country seems to be generating plans to match budgets rather than needs.
Recent threats to reduce surgical theatre capacity and abolish emergency care beds in the Dunedin hospital rebuild is penny-pinching budgetary vandalism. These expensive structures need foresight and investment in the future so that present and future standards can be protected.
The standard of medical practice in our country is strongly influenced by the quality of our teaching institutions. At present, rectifying doctor, nurse and ancillary staff deficiencies is well short of current plans offered by our politicians.
A third medical school is not the answer, especially when funding required for such an institution is far beyond that required by strengthening the two existing medical schools.
However, expanding graduating numbers of all healthcare personnel dictates adequate funding and facilities at all levels; this is currently increasingly inadequate.
Funding for the future has, to date, eluded our politicians’ mindset. This should extend beyond party politics; people of all political persuasions would applaud satisfactory care.
Potential funding models for more equitable healthcare support include some shared with those funding ACC. These issues affecting life and death decisions amongst our population require urgent investigation and corrective action.
More deaths while waiting in A&E are an unacceptable alternative consequence.
— Gil Barbezat is an Emeritus Professor of Medicine at the University of Otago.
