WEBVTT - Warwick Bagg: Let doctors do what they need to do 0:00:05.761 --> 0:00:09.401 You're listening to the Weekend Collective podcast from News Talks. 0:00:09.401 --> 0:00:13.041 I'd be the government is legislating health targets to lock 0:00:13.201 --> 0:00:16.281 in accountability, to use quotes around those three words. It's 0:00:16.321 --> 0:00:18.961 part of the slew of changes to the health system 0:00:19.241 --> 0:00:22.841 with the aim of refocusing on outcomes rather than bureaucracy. 0:00:23.281 --> 0:00:25.321 The Health Minister hopes it will ensure all patients have 0:00:25.401 --> 0:00:30.641 access to timely, quality healthcare. Professor Warwick bag is the 0:00:30.681 --> 0:00:34.241 dean at the University of Auckland's Faculty of Medical and 0:00:34.321 --> 0:00:36.561 Health Sciences and works with me. 0:00:36.641 --> 0:00:39.841 Now, good afternoon, Oh, good afternoon, sim How are you good? 0:00:39.881 --> 0:00:40.201 Thanks? 0:00:40.801 --> 0:00:43.441 In practical terms, I saw the headline for Simon Brown's 0:00:43.441 --> 0:00:48.361 press release talked about putting patients at the center. That 0:00:48.521 --> 0:00:51.121 sounds like sort of medicine one oh one, isn't it? 0:00:51.801 --> 0:00:55.081 Or is there more to this than a sort of slogan. 0:00:56.601 --> 0:00:59.081 It is medicine one on me. You're absolutely right, and 0:00:59.161 --> 0:01:01.881 putting patients at the center of healthcare is what every 0:01:01.961 --> 0:01:05.681 healthcare professional and person in New Zealand one right now. 0:01:05.721 --> 0:01:09.281 So I think that that is healthcare one on one, 0:01:09.361 --> 0:01:12.001 and I think what the Minister's trying to do is 0:01:12.001 --> 0:01:15.481 to ensure that there's not a whole lot of bureaucracy 0:01:15.521 --> 0:01:20.161 that's blocking that from happening. So I think that what 0:01:20.201 --> 0:01:22.641 he's trying to do is to make it more efficient 0:01:23.401 --> 0:01:27.241 to address need and those are admirable and good things 0:01:27.241 --> 0:01:27.481 to do. 0:01:28.081 --> 0:01:31.441 I guess obviously when we talk about focusing on patients, 0:01:31.441 --> 0:01:34.281 that's every medical professional. But the system, I guess he's 0:01:34.321 --> 0:01:37.601 focusing on has the system or had it? Has it 0:01:37.841 --> 0:01:40.601 lost its way? 0:01:41.281 --> 0:01:43.121 I think the first thing to say, Tim is if 0:01:43.321 --> 0:01:45.801 today you were unfortunate enough to end up with a 0:01:45.801 --> 0:01:48.881 heart attack and you present it to a hospital for 0:01:48.921 --> 0:01:51.321 the vast majority of people in New Zealand, you would 0:01:51.361 --> 0:01:55.321 get outstanding care today. Right now, if you were in 0:01:55.321 --> 0:01:58.401 a nasty car crash, for the vast majority of people 0:01:58.401 --> 0:02:02.801 in New Zealand, you'd get outstanding care today. But has 0:02:02.801 --> 0:02:05.441 the system lost its way? There are problems in the system. 0:02:05.561 --> 0:02:08.681 We could do better, and I think that that's what 0:02:08.761 --> 0:02:13.481 the minister is trying to address. So you know, for example, 0:02:13.521 --> 0:02:15.201 the targets, sorry, is. 0:02:15.161 --> 0:02:17.041 It a signal? Sorry you ker, I'm sorry you're the 0:02:17.081 --> 0:02:18.041 targets for example? 0:02:19.121 --> 0:02:21.241 Yes, So the targets, for example, I think you know 0:02:21.281 --> 0:02:23.441 that is part of the answer, But we just need 0:02:23.481 --> 0:02:28.921 to be clear that not everything that's healthcare is easy 0:02:28.961 --> 0:02:33.881 to count, and so sometimes with targets, you count lots 0:02:33.921 --> 0:02:36.441 of things that are important, but you're not counting the 0:02:36.481 --> 0:02:38.641 whole system. So that's one of the tricks in all 0:02:38.681 --> 0:02:40.281 of this is to ensure that we have a whole 0:02:40.321 --> 0:02:41.121 system approach. 0:02:42.481 --> 0:02:45.081 When you heard of the announcement, was it is it 0:02:45.201 --> 0:02:47.721 a signal of things moving in a direction that you 0:02:47.761 --> 0:02:48.441 would approve of? 0:02:49.841 --> 0:02:52.241 Well, I think we need to see the implementation. We 0:02:52.281 --> 0:02:54.041 don't have a lot of the details. But one of 0:02:54.121 --> 0:02:57.481 the things that's fantastic is around the infrastructure. You know, 0:02:57.561 --> 0:03:01.121 we have seen the challenges around infrastructure across the country, 0:03:01.681 --> 0:03:05.481 and to prioritize infrastructure is very very important. So I 0:03:05.481 --> 0:03:09.241 think that's definitely getting in the right direction. I think 0:03:10.161 --> 0:03:14.281 ensuring that the adequate frontline staff is important. That we 0:03:14.281 --> 0:03:17.001 should also remember that those front line staff needs folks 0:03:17.081 --> 0:03:19.841 behind them to ensure that the system is operating well. 0:03:20.001 --> 0:03:24.641 So it is a minister who is trying to improve 0:03:24.681 --> 0:03:28.041 a system that in many respects is already delivering very 0:03:28.161 --> 0:03:29.121 high qualities. 0:03:30.001 --> 0:03:33.401 I guess prioritizing infrastructure it sounds it's easy to say 0:03:33.561 --> 0:03:36.681 and sees to also talk about prioritizing putting patients first. 0:03:37.681 --> 0:03:40.521 But in reality, what actually needs to change. For instance, 0:03:40.801 --> 0:03:42.521 we know the delays with the need and hospital and 0:03:42.841 --> 0:03:45.361 the budget blowouts and all sorts of things. What could 0:03:45.361 --> 0:03:47.961 have been, what could have prevented something like that? 0:03:49.761 --> 0:03:52.521 Well, I think that we need to have careful governance 0:03:52.521 --> 0:03:57.041 and oversight and careful fiscal oversight over all of these aspects. 0:03:57.161 --> 0:03:59.321 And I think that's what the Minister's trying to achieve 0:03:59.361 --> 0:04:03.401 in some of what he's announcing. I think what we 0:04:03.521 --> 0:04:06.401 need to have buy hard as an agreement on these 0:04:06.401 --> 0:04:10.161 big infrastructure spends. If we don't have that by part 0:04:10.161 --> 0:04:12.201 as an agreement, then we go on this merry go 0:04:12.361 --> 0:04:14.761 round of the three year electoral cycle, and that's not 0:04:14.881 --> 0:04:17.161 helpful to getting the big projects done. 0:04:17.721 --> 0:04:20.841 Of course, it's early days. What sort of cooperation you're 0:04:20.841 --> 0:04:22.961 expecting from the opposition, I know that gets a little 0:04:22.961 --> 0:04:25.321 bit political from your point of view, But would you 0:04:25.361 --> 0:04:28.201 hope that these changes are obvious enough that they would 0:04:28.201 --> 0:04:29.161 support them? 0:04:29.721 --> 0:04:31.521 Well, I think you know some of these, Like if 0:04:31.561 --> 0:04:34.801 we're talking about infrastructure, everyone agrees that we need adequate 0:04:34.801 --> 0:04:38.081 infrastructure in both primary and secondary care, So not just 0:04:38.161 --> 0:04:40.721 in hospitals, but also in our primary care sector. And 0:04:40.761 --> 0:04:42.881 I would have thought that getting behind primary care, which 0:04:42.961 --> 0:04:47.521 the Minister is really prioritizing, would be something that the 0:04:47.601 --> 0:04:50.641 major parties could certainly both support. You know, if we 0:04:50.721 --> 0:04:55.721 have a healthy population, then we will have a prosperous nation. 0:04:55.881 --> 0:04:59.521 It's one of the core foundations to having a prosperous nation. 0:05:01.041 --> 0:05:03.081 I guess one of the other things that you mentioned 0:05:03.161 --> 0:05:07.521 earlier on is about in your comments about alcohol that 0:05:07.561 --> 0:05:11.721 you're talking about later, this is the importance of prevention. 0:05:12.081 --> 0:05:16.641 So we shouldn't only think about just at the bottom 0:05:16.641 --> 0:05:18.721 of the cliff. We should think about what we're investing 0:05:18.841 --> 0:05:21.921 to prevent many of the conditions that we're treating occurring. 0:05:22.681 --> 0:05:25.601 So what would you like to see next in terms 0:05:25.601 --> 0:05:28.281 of how the government rolls out the changes they want 0:05:28.281 --> 0:05:31.441 to implement in pursuing this refocus. 0:05:32.161 --> 0:05:34.201 Well, I think we need to have good engagement around 0:05:34.281 --> 0:05:37.721 what those targets are to ensure we don't have perverse outcomes, 0:05:37.721 --> 0:05:39.641 because one of the risks with targets is you only 0:05:39.681 --> 0:05:42.521 measure the things that are easy to count and not 0:05:42.601 --> 0:05:46.041 the much more complex aspects of healthcare delivery. So that's 0:05:46.401 --> 0:05:50.401 the key clinical engagement is really important. We need to 0:05:50.721 --> 0:05:55.441 agree what is the unmet health need, which we don't 0:05:55.481 --> 0:05:58.121 have agreement across the country on that, and that would 0:05:58.161 --> 0:05:59.721 be something that I would have thought was right for 0:05:59.761 --> 0:06:04.201 a bipartisan agreement. And I think that we need to 0:06:04.401 --> 0:06:08.521 ensure that we are focusing not only on the bottom 0:06:08.561 --> 0:06:11.481 of the cliff treatment but also on prevention, which is 0:06:11.561 --> 0:06:12.801 so very important. 0:06:13.481 --> 0:06:17.361 Looking at the just the overall the announcement, would you 0:06:17.441 --> 0:06:19.601 say that it is a sign of the government heading 0:06:19.641 --> 0:06:19.801 in the. 0:06:19.801 --> 0:06:22.121 Right direction with its approach to our health challenges. 0:06:24.361 --> 0:06:27.001 What I say the government doing is being really focused 0:06:27.081 --> 0:06:30.281 on improving our system, and I think that we have 0:06:30.401 --> 0:06:33.361 to see what the implementation will look like. That is 0:06:33.401 --> 0:06:36.961 where the challenge is. I haven't heard any Minister of 0:06:36.961 --> 0:06:39.521 Health over a long period of time who is not 0:06:39.601 --> 0:06:43.121 interested in improving the system where it comes and stuck 0:06:43.201 --> 0:06:45.921 is in the implementation. And so this is where we 0:06:45.961 --> 0:06:51.961 need to have everyone on board, working together, agreeing about 0:06:52.241 --> 0:06:55.561 what are the priorities for the system and then implementing 0:06:55.601 --> 0:06:58.841 them according to those agreements. That's what we need. 0:06:58.721 --> 0:07:00.601 To so really, I mean, it gets back to my 0:07:00.641 --> 0:07:04.001 first question. It says putting patients first, it's all great 0:07:04.001 --> 0:07:06.121 to have this talk and to talk about refocusing, but 0:07:06.201 --> 0:07:08.561 really this is really just the first step on a 0:07:08.641 --> 0:07:13.601 very long in a very long ladder, isn't it. 0:07:13.601 --> 0:07:16.241 It is the first step in a long ladder. But 0:07:16.281 --> 0:07:18.681 we are building on a system that already is a 0:07:19.161 --> 0:07:20.961 you know, it's got its problems to them, but it 0:07:21.041 --> 0:07:23.961 is a high functioning system. And as I said earlier, 0:07:24.001 --> 0:07:26.401 if you are very sick today and you need help, 0:07:26.441 --> 0:07:30.281 for the vast majority of people, that help will be provided. 0:07:30.801 --> 0:07:32.441 We just need to be really clear to him that 0:07:32.481 --> 0:07:36.121 we are not wasting money. So you know, I see 0:07:36.121 --> 0:07:38.961 the Minister's keen to train more people. We welcome that. 0:07:39.201 --> 0:07:41.601 We be open to doing that, but then we need 0:07:41.641 --> 0:07:43.801 to be thinking about where we invest in their training. 0:07:43.961 --> 0:07:48.601 So for example, let's invest in our existing institutions. Let's 0:07:48.641 --> 0:07:51.481 not waste money on new institutions. We have no track 0:07:51.521 --> 0:07:52.881 record in training. 0:07:54.441 --> 0:07:58.441 Oh so that would be is that basically, let's give 0:07:58.441 --> 0:08:00.481 more money to a Tigo in Auckland and forget about 0:08:00.481 --> 0:08:01.201 new medical schools. 0:08:01.201 --> 0:08:02.641 So I'm not sure if I'm just something there. 0:08:03.801 --> 0:08:05.761 I mean, that may be one example. Well, I mean 0:08:05.761 --> 0:08:08.521 I think you know, if we're talking about medical schools, 0:08:08.561 --> 0:08:12.841 we've said to the government as a tiger, we'll train 0:08:12.921 --> 0:08:14.601 the students you want us to train. We already have 0:08:14.641 --> 0:08:18.361 one hundred and seventy training and cut out this right now, 0:08:20.041 --> 0:08:23.281 so we don't see the sense in doing something else. Yeah, 0:08:24.041 --> 0:08:27.321 for example, but I think there's a whole range of 0:08:27.361 --> 0:08:30.721 initiatives of being efficient with our dollars, whether it's in 0:08:31.001 --> 0:08:34.801 healthcare treatment or whether it's in training. Let's make sure 0:08:34.801 --> 0:08:37.721 that we have enough momentum to do it really well 0:08:38.161 --> 0:08:40.281 and not simply try and reinvent the wheels and we 0:08:40.321 --> 0:08:41.481 don't have enough money to do then. 0:08:41.561 --> 0:08:41.761 Yeah. 0:08:41.841 --> 0:08:43.961 Actually, justin that was my last question for you. Really, 0:08:44.081 --> 0:08:46.401 how are things going at the Auckland Faculty of Medical 0:08:46.441 --> 0:08:48.721 and Health Sciences in terms of budgets and have you 0:08:48.721 --> 0:08:52.121 got what you need to be turning out the professionals 0:08:52.161 --> 0:08:52.881 that we rely on. 0:08:54.681 --> 0:08:57.441 We have what we need to. We are we have 0:08:57.641 --> 0:09:00.681 very strong growth in enrolments across all of our health professions. 0:09:01.121 --> 0:09:03.281 And what we're really focusing on is trying to make 0:09:03.281 --> 0:09:05.641 sure that we are having our health profession has operate 0:09:05.681 --> 0:09:07.521 at the top of scope. So what that means is 0:09:07.521 --> 0:09:10.961 that we're making our pharmacuts and our nurses or we're 0:09:11.041 --> 0:09:13.401 enabling them to operate at the top of their scope. 0:09:13.481 --> 0:09:15.561 You know, we saw this in the pandemic where pharmacuts 0:09:15.561 --> 0:09:18.081 were able to just spend vaccinate for the first time. 0:09:18.921 --> 0:09:20.841 That's the sort of thing that we're really focusing on, 0:09:20.921 --> 0:09:23.281 so that we're operating across the whole system, not just 0:09:23.321 --> 0:09:24.961 focusing on doctors for example. 0:09:25.121 --> 0:09:27.521 Yeah, well Warwick, I really appreciate your time this afternoon. 0:09:27.761 --> 0:09:28.441 Thanks very much. 0:09:29.481 --> 0:09:29.721 Thank you. 0:09:30.081 --> 0:09:31.601 That's Professor Rot Warwick back. 0:09:31.681 --> 0:09:35.881 He's he's a dean of the Universe of Auckland Faculty 0:09:35.921 --> 0:09:37.641 of Medical and Health Sciences. 0:09:38.281 --> 0:09:41.041 For more from the Weekend Collective, listen live to News 0:09:41.081 --> 0:09:44.201 Talk z'd be weekends from three pm, or follow the 0:09:44.201 --> 0:09:45.761 podcast on iHeartRadio.