Speaker 1: Kiota.
Speaker 2: I'm Chelsea Daniels and this is the Front Page, a
Speaker 2: daily podcast presented by The New Zealand Herald. Chaos, overstretched,
Speaker 2: and a blood bath. These are just a few of
Speaker 2: the descriptions of New Zealand's health sector in recent days.
Speaker 1: It's as the sector faces its third.
Speaker 2: Resignation of its top brass Director General of Health Diana Sarfati,
Speaker 2: will finish up this Friday, ending her term two years
Speaker 2: earlier than expected. Her resignation came soon after Health New
Speaker 2: Zealand Chief Executive Marjie Arper, followed by Public Health Director
Speaker 2: Nicholas Jones, who quit just a few days later. We're
Speaker 2: constantly being told the system is in crisis, on the
Speaker 2: brink of failure, spending beyond its budget, waiting times are
Speaker 2: getting longer and suffering from widespread staff shortages. But the
Speaker 2: decades old question is how do we actually fix it?
Speaker 2: Today on the front Page, University of Otago Professor of
Speaker 2: Public Health Peter Crampton joins us to give us a
Speaker 2: rundown on our health system. So, Peter, it's no surprise
Speaker 2: that the health system is in crisis. In fact, it
Speaker 2: feels like we're constantly being told this what kind of
Speaker 2: challenges is it facing right now.
Speaker 3: Well, the word crisis has been used quite a lot
Speaker 3: over the last twelve months. It's a word I would
Speaker 3: use with a great deal of caution. In my professional life.
Speaker 3: I've been observing this closely for at least thirty years.
Speaker 3: I don't think I've seen so much pressure and uncertainty
Speaker 3: in the health system as I see now that there
Speaker 3: are new factors led upon old factors. In terms of
Speaker 3: the stress is being brought to bear in the new
Speaker 3: zin and health system and also all around the world,
Speaker 3: I'd say number one as the fact that healthcare gets
Speaker 3: more complex and more expensive by the day. And in
Speaker 3: a country such as New Zealand, it's driven by the
Speaker 3: aging population. We get sicker and we get older, and
Speaker 3: we're living longer, and we drive the costs of healthcare delivery.
Speaker 3: And that means that well, for example, increasingly individuals as
Speaker 3: they get older have multiple conditions that would need treatment.
Speaker 3: At the same time, that complexity brings with it increase
Speaker 3: need for healthcare, professional time, more medicines, more expenditure on
Speaker 3: expensive medicines, and so on. And that is a real driver.
Speaker 3: It's a driver of complexity. It's a driver of difficulty,
Speaker 3: it's a driver of expenditure, and that's no one's fault.
Speaker 3: It's not a bad thing. It is a fact. Nevertheless,
Speaker 3: what it does mean is that there is pressure on
Speaker 3: a government, on all governments, to deliver in those circumstances
Speaker 3: where there's a great deal of pressure driving upward expenditure. However,
Speaker 3: hard governments try that pressure on and it can only
Speaker 3: be partly addressed through increasing product to video or increasing efficiency.
Speaker 3: It does, in the end need more expenditure per capita
Speaker 3: per person. I would say that in our system we
Speaker 3: have over the long term, we've underinvested in primary care,
Speaker 3: by which I mean nurses, doctors, and all those people
Speaker 3: in the community who look after us when we get
Speaker 3: on will and that's where the bulk of healthcare is provided,
Speaker 3: and we've underinvested in that, and that is at the
Speaker 3: point of extreme stress right now. And what that means,
Speaker 3: amongst other things, is that we get sicker, we're not
Speaker 3: treated early enough, and then we end up in the
Speaker 3: hospital system, costing the system more and also driving up pressures, stresses,
Speaker 3: and waiting times in hospitals. So that's in there as
Speaker 3: an underlying reason. Look, I think there's two more immediate
Speaker 3: aspects of the health system which need to be commented on.
Speaker 3: The first is COVID and post COVID politics. There has
Speaker 3: been a rapid shift to political populism and that brings
Speaker 3: with it less trust in so called elites, less trust
Speaker 3: in science, less trust and experts. And because the health
Speaker 3: system so reliant on experts and science, and while groups
Speaker 3: of people who are regarded as being elite has a
Speaker 3: destabilizing effect in the health system. And not just in
Speaker 3: New Zealand but all around the world. That this is
Speaker 3: a new phenomenon. And of course COVID. Coming back to COVID,
Speaker 3: it brings with it all the stress is on the
Speaker 3: country's finances that we know are very very difficult. Again,
Speaker 3: this isn't about this government or the previous government or
Speaker 3: any government. It's just countries around the world are experiencing
Speaker 3: huge stress post COVID. In addition to that, the previous government,
Speaker 3: the Labor government with Andrew Little as the Minister of Health,
Speaker 3: initiated a set of major reforms of the health system.
Speaker 3: This kicked off under Minister David Clark who initiated a
Speaker 3: review of the health system. I was on that review panel.
Speaker 3: We made a number of recommendations to the then government.
Speaker 3: Some of those recommendations were taken up, others were not.
Speaker 3: In the event, Minister Little made his own decision to
Speaker 3: centralize the health system under one organization, to Fatal Order
Speaker 3: Health New Zealand, and that of course represents what is
Speaker 3: undoubtedly the largest merger ever in New Zealand's history, bringing
Speaker 3: together the twenty district health boards into one organization. And
Speaker 3: another of other changes were initiated at that point, and
Speaker 3: then there was a change in government, so the new
Speaker 3: government inherited this rather complex and difficult set of circumstances.
Speaker 3: This would have been very difficult for any government. There's
Speaker 3: no doubt this was a very challenging set of circumstances.
Speaker 3: And what they've done since then is introduced their own changes.
Speaker 3: For example, they scrapped order the Maori Health Authority, which
Speaker 3: brought expertise into the center of the system. Last year
Speaker 3: the Board of Health New Zealand to Fatal Order was
Speaker 3: sacked and replaced with a commissioner, along with several co commissioners,
Speaker 3: and since then there have been a number of resignations,
Speaker 3: thinking particularly back to last week where we had three
Speaker 3: important resignations in the health system, but the government was
Speaker 3: not responsible for the challenging circumstances it inherited. But it
Speaker 3: is of course now in charge and has been for
Speaker 3: well over a year, and is making its own decisions
Speaker 3: about how to lead the system.
Speaker 4: I mean, it might be scary to have to respond
Speaker 4: to the Prime Minister, the Minister of Finance and the
Speaker 4: Minister of Health, but nothing is more scary than my
Speaker 4: own wife holding me to account for the health system.
Speaker 4: And I love her and respect her, and I'm going
Speaker 4: to make sure I'll keep it that way because she's
Speaker 4: holding me to account, which is a different time but
Speaker 4: type of accountability.
Speaker 2: You mentioned Health end Z Commissioner Lester Levy. He was
Speaker 2: broad on board last July. He was tasked with solving
Speaker 2: an estimated one point four billion dollar overspend and then
Speaker 2: he and then chief executive Marjie Arper have been in
Speaker 2: charge of a reset, so to speak, so to ensure
Speaker 2: it's spending within its budget after it was found in
Speaker 2: July to be spending one hundred and thirty million dollars
Speaker 2: more than its budget each month.
Speaker 1: How do you think all of this is.
Speaker 2: Going the cutting, the cost cutting, I suppose, I.
Speaker 3: For one, feel unclear about the actual state of healthcare expenditure.
Speaker 3: Generally there is a single source of authority d data
Speaker 3: about how much we're spending on health per capita and
Speaker 3: how that fits into the long term trends. I would
Speaker 3: say at the moment, I, for one, don't have that clarity.
Speaker 3: You know, the government says repeatedly that it's spending more
Speaker 3: on health now than has ever been spent before. There
Speaker 3: is the expenditure above budget that you've just talked about
Speaker 3: with in Fascil order. But as I said, I'm unclear
Speaker 3: on this point. There was one analysis I read last
Speaker 3: year from a well respected health economist which looked at
Speaker 3: the twenty year healthcare expenditure and it went up per
Speaker 3: capita around four to five percent during the first more
Speaker 3: or less during the first decade of the century. That
Speaker 3: was with the Labor government. That per capita annual increase
Speaker 3: in expenditure went down to I'm remembering three or four
Speaker 3: percent under the nine years of the subsequent national government,
Speaker 3: and then it went back up again slightly to or
Speaker 3: four plus percent annual per capita increase in expenditure during
Speaker 3: the last Labor government. And according to that analysis, the
Speaker 3: twenty twenty four year was the first time in that
Speaker 3: twenty four year period that the health systems faced an
Speaker 3: actual decrease in per capita healthcare expenditure. Now, that was
Speaker 3: just one analysis. It received some publicity at the time,
Speaker 3: but incredibly important that we actually know whether or not
Speaker 3: that's true, because if it is true, it explains so
Speaker 3: much of the intense stress and pressure within the health system.
Speaker 3: Because basically the health system which is facing real per
Speaker 3: capita decrease in expenditure is sort of an unprecedented thing.
Speaker 3: Not many countries would ever attempt to do that. Now,
Speaker 3: government's making claims that that's not the case. Some economists
Speaker 3: or this one in particular, is making a claim that
Speaker 3: is the case. I think we need authoritative analysis around that.
Speaker 3: Coming back to your question about how is it going
Speaker 3: into fatal Aura, Well, look, I would say three things. Firstly,
Speaker 3: that fat AURA is a highly stressed, highly disrupted organization
Speaker 3: at this point in time, there is a great deal
Speaker 3: of change and uncertainty and that affects probably the vast
Speaker 3: majority of people who work within the organization. And remember
Speaker 3: this is a huge organization. This is a single employer
Speaker 3: of When I last heard the numbers, it was between
Speaker 3: eighty and ninety thousand people doing all lots of jobs
Speaker 3: all the way from the frontline clinical roles through to
Speaker 3: IT systems and procurement and supply and all the things
Speaker 3: that are a huge organization like that is responsible for
Speaker 3: doing so a great deal of disruption in that organization.
Speaker 3: How it's going financially, I don't know. Again. I think
Speaker 3: that we need authoritative financial data being produced at regular
Speaker 3: intervals so that we can we the public can make
Speaker 3: judgments on that point. And certainly I've no doubt at
Speaker 3: all that Commissioner Lester Levy is working extremely hard on this,
Speaker 3: as are the other co commissioners. That that's I think
Speaker 3: as much as I can say on how it's going,
Speaker 3: because this is the story is unfolding in front of us.
Speaker 3: Maybe one can take a little bit of a steer
Speaker 3: from the fact that there are senior resignations in the system,
Speaker 3: some of which might have been anticipated, others not. The
Speaker 3: resignation of the Chief Executive of Health New Zealand faceral
Speaker 3: At Margie Upper, which was two Fridays ago, may have
Speaker 3: been anticipated. I certainly wasn't expecting it to happen on
Speaker 3: that day and that week her term came up for
Speaker 3: a renewal later on this year, and I was expecting
Speaker 3: her to step down perhaps at that point, because that
Speaker 3: had been signaled.
Speaker 1: And what about Diana Saferti's resignation.
Speaker 2: I don't know about you, but where I work, i'd
Speaker 2: need to give at least four weeks notice, and she
Speaker 2: finishes up this Friday.
Speaker 3: I think that is unusual, Chelsea. I think that is
Speaker 3: a very unusual thing. It was an unexpected announcement. She
Speaker 3: is leaving very abruptly within a week, so no notice
Speaker 3: bit with those sorts of senior roles. Now we're talking
Speaker 3: about Professor Diana Safati, who was the Director General of Healthcare.
Speaker 3: Resignation was announced on Friday, taking effect this sometime this week.
Speaker 3: That's very unusual with those senior roles. We expect that
Speaker 3: a resignation to be announced well well in advance of
Speaker 3: it taking effect, and their time for the system to
Speaker 3: respond and an interim person or an acting person to
Speaker 3: be put in place, and ideally a recruitment process to
Speaker 3: be god underway. None of that has happened this time,
Speaker 3: of course, so we don't know what lies behind that,
Speaker 3: except this is an unusual circumstance. What we do know,
Speaker 3: of course, is that we have a new Minister of
Speaker 3: Health who's come in. The Honorable Sandertti has moved on
Speaker 3: to other portfolios and we now have the Honorable Simeon
Speaker 3: Brown in the role of Health Minister. He's brand new
Speaker 3: to health. Not only is he brand new to the
Speaker 3: portfolio as Minister of Health, he's also brand new to health.
Speaker 3: Nothing wrong with that, per se, It's just that we
Speaker 3: all need to recognize it will take him some time
Speaker 3: to get his FETA under the desk properly and understand
Speaker 3: this extremely complex system that he's now responsible for. And
Speaker 3: I don't hold him. I don't think he's the author
Speaker 3: of these resignations necessarily at all. But following his taking
Speaker 3: on the portfolio of Health, there have been, as I said,
Speaker 3: a number of very senior people resigning, and maybe with
Speaker 3: the fullness of time, we'll understand more about the nine
Speaker 3: amics there.
Speaker 2: Well, if we go back to the system itself, I
Speaker 2: know that staff shortages have plagued the sector for years now,
Speaker 2: and this is right across the workforce, from GPS closing
Speaker 2: their books with nearly forty percent of them actually not
Speaker 2: taking new patients last year to of course nurses being
Speaker 2: tempted across the ditch by better pay, packets, added extras,
Speaker 2: et cetera. Health New Zealand has released its workforce Plan
Speaker 2: in December and that outlined how gaps will be filled
Speaker 2: over the next three years, and the government's already made
Speaker 2: moves to fund more homegrown doctors and midwives for example.
Speaker 1: Do you think it's doing enough?
Speaker 3: Health workforce probably is the number one or number two,
Speaker 3: or at least one of the top issues in the
Speaker 3: health system. And this is again not unique in New Zealand.
Speaker 3: Health systems all around the world experiencing the same sorts
Speaker 3: of health workforce pressures that we're experiencing. Is the government
Speaker 3: doing enough well? I mean, the answer has to be known.
Speaker 3: I say that was some sympathy for the government, but
Speaker 3: the problems are mounting in the health workforce space. I
Speaker 3: think the government wants to get on top of this.
Speaker 3: A great deal of good work is being done. Certainly,
Speaker 3: we don't have solutions to all the problems at the
Speaker 3: moment at all, by any stretch of the imagination. And
Speaker 3: I'll come back to point I made earlier about the
Speaker 3: point you mentioned about general practices and general practitioners and
Speaker 3: practice nurses in the community. That is an area of neglect,
Speaker 3: which is one of the most urgent pressure points in
Speaker 3: the health system, I would say, and it's not receiving
Speaker 3: a huge amount of public air time. Is receiving some
Speaker 3: but not a huge amount. The whole system is reliant
Speaker 3: on that layer in the health system with GPS practice
Speaker 3: nurses and or all the others who work in the
Speaker 3: community keeping people well and out of hospital. The financing
Speaker 3: situation for GPS is complex and has been neglected for
Speaker 3: a long time. Work is underway by to Facial Order
Speaker 3: Health New Zealand and by the Ministry of Health to
Speaker 3: fix that, but it's a long time coming, and it's
Speaker 3: it's an area of really considerable pressure and stress within
Speaker 3: the system. I fear that these really important strategic or
Speaker 3: long term issues like health workforce are probably being somewhat
Speaker 3: neglected right now as the system goes through its own
Speaker 3: processes of change.
Speaker 5: Official information reveals that in the first six months of
Speaker 5: last year, more than three hundred thousand patients around New
Speaker 5: Zealand who turned up in an imminently or potentially life
Speaker 5: threatening condition were not seen in a clinically appropriate time.
Speaker 6: Is that a concern it's really concerning data and as
Speaker 6: we have to do better. It is showing a system
Speaker 6: under intense pressure, and it's showing a whole system under pressure.
Speaker 5: Is it showing a system failing by.
Speaker 6: The numbers you're telling me, it is showing a system
Speaker 6: that is failing.
Speaker 4: Well.
Speaker 2: Something that does get a lot of airtime is ed
Speaker 2: waight times. Right, we haven't even gotten to that yet.
Speaker 2: We're constantly hearing horror stories about people waiting upwards of
Speaker 2: eight ten hours for care. More than three hundred thousand
Speaker 2: patients with time critical conditions were not seen within the
Speaker 2: recommended time frames during the first six months of last year.
Speaker 2: And this is where there's a bottleneck, isn't it. It's
Speaker 2: like all the other areas of the health system when
Speaker 2: they underperform.
Speaker 1: This is what we see. This is what we get.
Speaker 2: The fact that all of the country's eds are failing
Speaker 2: to assess patients with eminently or potentially life threatening conditions
Speaker 2: on time. That's a massive problem, isn't it.
Speaker 3: It is a problem, and it speaks to failure elsewhere
Speaker 3: in the system. GP's books are full in many parts
Speaker 3: of the country. Waiting time for CGP are unacceptably long
Speaker 3: in many many places, the failure of primary healthcare to
Speaker 3: meet the basic needs of people is one of the,
Speaker 3: if not the most important factors leading to pressure on eds.
Speaker 3: Because what do you or I do when we can't
Speaker 3: get to see our doctrine, we're worried about our health.
Speaker 3: We go to the ED. That is all we can do.
Speaker 3: That's the only option available to us, So we go,
Speaker 3: you know, And that's what people do. They're going to
Speaker 3: ED departments and wait to be seen there rather than
Speaker 3: having issues dealt with in primary care. And it's not
Speaker 3: just the issue of closed books and pressure on primary
Speaker 3: care services, so also the issue of cost for many people.
Speaker 3: A lot of people can't afford even sometimes quite basic
Speaker 3: elements of care. So there's constellation of factors there which
Speaker 3: leads to pressure on ED departments. But yes, it's a
Speaker 3: big issue.
Speaker 2: Finally, Peter, I feel like speaking about the health sector
Speaker 2: and the health sector in crisis is just a broken record, right.
Speaker 2: Is the health sector a prime example for the need
Speaker 2: for long term bipartisan agreements, because surely we can't go
Speaker 2: on like this.
Speaker 3: I think that is just so on the money, long
Speaker 3: term bipartisan agreement around the direction of the health system.
Speaker 3: I think one of the things that we're experiencing right now,
Speaker 3: at least I am, and I think many people working
Speaker 3: in the health system is a sense of not really
Speaker 3: knowing what the direction is right now. Because it's a
Speaker 3: system which is so reliant on good will, trust, people
Speaker 3: working over beyond the call of duty, et cetera, et cetera.
Speaker 3: There needs to be confidence that the systems lead in
Speaker 3: a way that is consistent with the values that people
Speaker 3: work in the system have, and that we have stability
Speaker 3: in leadership and leaders who are capable of forming long
Speaker 3: term relationships all around them to give confidence that we're,
Speaker 3: even through tough times, that we're all pulling in the
Speaker 3: same direction. And I think that having some sense of
Speaker 3: direction for the public health system right now would be
Speaker 3: immensely helpful because to my mind, there are mixed signals
Speaker 3: at the moment around them. Role of I mean, the
Speaker 3: natural default I think for many in the current government
Speaker 3: would be private provision, a privatization of services, not just
Speaker 3: healthcare but in many domains. And I think people working
Speaker 3: in the public system, which so many people in New
Speaker 3: Zealand are totally reliant on, they need confidence that there
Speaker 3: is a long term commitment and a bipartisan approach I
Speaker 3: think would be extremely helpful.
Speaker 1: Thanks for joining us, Peter pleasure to talk.
Speaker 2: That's it for this episode of the Front Page. You
Speaker 2: can read more about today's stories and extensive news coverage
Speaker 2: at enzdhrald dot co dot nz. The Front Page is
Speaker 2: produced by Ethan Sills and Richard Martin, who is also
Speaker 2: our sound engineer.
Speaker 1: I'm Chelsea Daniels.
Speaker 2: Subscribe to the Front Page on iHeartRadio or wherever you
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Speaker 2: behind the headlines.