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Vision
There has been a tidal wave of ill health, in particular child and mental health, with a need to improve access to services.
There is a need to drive a return to service orientation, with a focus on the provision of locally based integrated services, delivering an improvement in clinical outcomes, outputs and utilisation of resources. New Zealand First would build in incentives to achieve this.
New Zealand First aims to turn the situation around through an integrated approach to health using the following:
- Health protection
- Prevention
- Promotion
- Treatment.
Strategy
New Zealand First would address the situation through a number of strategies:
- Refocus the health sector on delivering service and achieving good clinical outcomes at a population level
- Removing the profit focus - health centres run in a business like way, but not seeking profits (current business focus is to maximise profit and minimise risks)
- Remove distortions in the process of services provision inherent in the current market model which discriminates against those with the greatest need
- Move away from the current direction of an insurance based approach which will inevitably lead to failure at the margins of health care delivery.
Key Issues
Three key areas are identified.
Child Health
Introduce multi-disciplinary family health teams to work closely with families in difficult circumstances and apply an intense range of State interventions
Double the commitment to well child programmes over the next three years.
Mental Health
The basis of policy in this area is founded in the Mason Report. In particular the following issues would be tackled:
- Remove mental health from ’Cinderella status’
- Insist on the Mental Health Commission having independence from the Ministry of Health
- Improve the competence of the community to deal with mental health.
To ensure appropriate, adequate and readily available acute services.
Treatment and management of chronic mental health.
Major thrust into community supports, child relationships, elderly minorities:
- Build teams, which include primary practitioners, which are based in the community and are surrounded by community supports and psychiatric nursing care
- Ensure care takes into account the individual disposition of clients, the needs of chronic long term management, and use of medication.
Waiting Lists
There are a wide range of efficiency issues. Waiting list management in New Zealand is seen as a very imprecise science, largely because there has been inadequate research of the necessary systems.
In managing waiting lists most attention is given to surgery, however, focus is also required on medicine and medical specialities. There is a potential conflict of interest between clinicians’ activities in private and public sectors.
Health promotion leading to prevention through improved treatment also has a role to play in the longer term, reducing the requirement for specialist input.
A number of solutions are proposed:
- Increased funding - to purchase increased or additional throughput
- Better management - leading to increased efficiencies
- Investigate and implement new efficiency strategies.
Structure
New Zealand First proposes quite marked changes to the current health system structure.
A summary of the structural changes includes:
- Shake up the Ministry of Health
- Dismantle the purchaser/provider approach
- Remove the Regional Health Authorities (RHAs)
- Develop a contracting/provider model similar to the arrangement the State Services committee has with chief executives of government departments
- Locally based contracting
- Ensure clear accountabilities
- Contract on the basis of results delivered
- Restore community involvement and democracy through a community based health care system.
The approach used would be to generate Regional Health Boards which replace the current Crown Health Enterprise (CHE) structure. These would serve a given population based on size, probably using territorial local authorities which would cover a larger area than the CHE equivalent.
There would be a move from 23 CHEs down to 14 CHEs, each of which would consult with its community around the exact configuration (eg involvement by Health Waikato, Western Bay, Lakes and Eastern Bay). Hospitals would be stand alone, run as separate entities and not by the Regional Health Boards.
Regional Hospital Boards are seen as a form of ’not-for-profit’ Independent Practitioner Association (IPA). Efficiencies would generate savings which would be reinvested as services. Health analysis would be an important discipline within these organisations.
Community members would be elected democratically. Competition would be intense but needs to be in order to ensure skills and quality; an appointing system would operate to bring in the required expertise.
People
New Zealand First does not believe there is a sufficient supply of good skills or visionary people within the workforce to address issues of contracting or policy development. This needs to be addressed.
It is recognised that there is a shortfall of good quality clinicians with the talent to manage clients, particularly in the less popular areas, eg mental health. It is proposed to recruit from experienced New Zealand general practitioners (GPs), to address these issues, providing significant training resources and good remuneration ($150,000 - $175,000)
Management
New Zealand First does not believe there is overspending in health management. The $120 million costs spent on the RHAs and Ministry of Health is well within an industry norm. An increase is probably needed to improve the quality of contracting.
It is believed that value can be added by bringing people into the system from outside, although it is useful if they have a health background.
A number of requirements to improve management have been identified, in particular, this includes better information systems.
Funding
The health policy requires increased funding. Some specific areas are costed:
- To reduce public hospital waiting lists -add $450 million to surgical/specialist budgets
- Provide $140 million for long overdue mental health reforms.
The exact level of funding for the full policy, or its source, is identified, though in general this will be from a reduction in the rate of debt repayments and stimulation in growth in the domestic economy.
Change
Few details are yet available on the process to be used to restructure the health system, nor the time scale required.
Specific Issues
Managed Care
There are major concerns about moving further down a road to managed care. Notably it is seen as a cynical way of privatising health care and placing State resources into the hands of large conglomerates.
Issues and particular concerns include:
- Risk management - insurers will move to manage risks by delivering lower levels of service
- Restrictions on practice by clinical staff leading to diminish quality of health care
- Cost - would need to achieve efficiencies of 20% for profitability.
Maori Health
New Zealand First is insistent there should not be a separate Maori health system, an approach supported by Maori. The aim is ’By Maori, for everyone’.
Empowerment under the Ottawa Charter, which is what Maori want. Maori providers have been rebuked for offering ’for Maori services’ only.
There is a need to move quickly to eliminate State sponsored separatism introduce by politically correct individuals with one particular view of how empowerment should be interpreted.
Summary
New Zealand First wants a health service where New Zealanders are put first before economic ideology.
The drive will be for a return to service orientation, with a focus on the provision of locally based integrated services delivering an improvement in clinical outcomes, outputs and utilisation of resources.
Emphasis is to be placed on prevention and health promotion and the move from ’for-profit’ driven health care provision.
Three key areas are identified: child health, mental health and waiting times.
New Zealand First proposes quite marked changes to the current health system structure.
The approach used would be to generate Regional Health Boards to replace the current CHE structure. There would be a move from 23 down to 14 CHEs, each of which would consult with its community around the exact configuration to be developed. Hospitals would be stand alone, run as separate entities and not by the Regional Health Boards.
Regional Hospital Boards are seen as a form of ’not-for-profit’ IPA. Efficiencies would generate savings which would be reinvested as services. Health analysis would be an important discipline within these organisations.
Community members would be elected democratically, competition would be intense, but needs to be in order to ensure skills and quality; an appointing system would operate to bring in the required expertise.
Some workforce development is required to ensure the skills for management, contracting planning and policy development, as well as in the less popular clinical areas, eg mental health.
Maori health continues to be a priority, and would be developed in the main stream. The principle followed is, ’By Maori, for everyone’.
Managed care is not supported, with particular concerns that the profit motivation will generate restrictions on services of lower quality and ultimately result in privatisation.
