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Vision
The Labour policy for health will provide a public health system which meets the reasonable needs of the people, regardless of their ability to pay.
It will refocus on personal health and well-being along with public health, the central focus of health policy, to deliver care in the context of the social and physical environment.
The Ottawa Charter will underpin many of the principles for Labour support.
The importance of intersectoral links, to address the impact on health of such issues as low income, will be highlighted, but requires leadership and the use of protocols before change will come about. Public sector ’turfism’ needs to be removed through incentives. The Public Finance Act will be reviewed to assist this process.
The policy aims to increase accountability, by identifying a lead agency acting at the individual level through a key worker. Funding of services will be attached to needs assessment, eg the Good Start Policy.
Strategy
The policy will be implemented through a number of strategies:
- Addressing inequalities in health status
- Achieving improvements in child health
- Improving co-ordination of mental health services
- Tackling waiting times
- Developing a patients’ rights charter.
Key Issues
The key issues to be addressed mirror the key strategies:
- Changing the structure - a transition task force will be established to address this
- Mental health - the Labour Party would wish to engage in direct discussion with the Mason Committee, but identify priorities as the development of rehabilitation beds and security for individuals and the community
- Children’s health - removal of general practitioner (GP) and prescription charges for children under five years
- Equity - ensure a more equitable distribution of resource and access to care to remove inequalities in health status
- Waiting times - develop and ensure access within acceptable time frames
- Travel and accommodation - improve support for those requiring it.
Structure
Labour proposes to make significant revisions to the current health care delivery structure.
Significantly the Regional Health Authorities (RHAs) will go, which in principle will allow redirection of the overhead involved in the purchase of services. They will be replaced by District Health Services, based on the current Crown Health Enterprise (CHE) boundaries charged with providing services for their area.
The District Health Services will be managed by boards largely comprising elected members, including Maori, and will be measured on their ability to provide the services required against the principles of safety, equity, efficiency, effectiveness, risk management and appropriateness.
Key activities will include:
- Cost containment through reducing hand-outs
- Standard setting
- Service planning and provision - eg hospital and old people’s homes.
Initially responsibility for services provided will include CHE, community care and public health. Primary care will not be included, although it is hoped to integrate this at an early stage.
Health policy and planning will be managed at the national level through a Department of Health.
Some form of regional office will remain, to undertake a facilitative role to co-ordinate the activities of a number of District Health Services. The exact details of the role remain to be developed.
Disability support will remain delivered through a separate but parallel structure.
People
The Labour Party identifies a lack of accountability as one of the weaknesses in the current system. This would be addressed through introducing an approach involving more leadership and less management, a process starting right at the top of the system.
Specific management skills for health are required. Current standards are variable. There is a need to increase the involvement of health professionals in the planning process. One particular area for focus is that of rural health. The required skills will be attracted and developed through the establishment of a chair in rural medicine, and providing rural incentives for both GPs and nurses.
Management
The focus of management will be on longer term five year strategic planning, supported by an annual funding round based on health service plans for the coming year, where the ability to meet national targets and objectives will be required, but include consultation to develop local priorities.
The amount of funding made available will be determined centrally, with explicit assumptions on the level of acute demand. District Health Service boards will be required to fund or provide the range of services necessary to meet the health needs of the community on the medium and long term.
There is a specific concern over the current deinstitutionalisation programme. Funding is provided on an interim basis, leading to uncertainty over sustainability. This needs to be addressed.
Waiting list management will be improved through the definition of maximum waiting times, and the availability of extra money when acute demand increases so access can be maintained.
Funding
Labour is committed to the delivery of a health system largely supported from public funds, to a level of 80% of the total requirement.
A population funding approach will be used to allocate resources to District Health Services, along with a rural premium recognising that care may cost more when the economies of scale are limited.
The priorities are to deliver quality of access, not quantity of expenditure. At a time of change it is recognised there will be a need to fund both the old and new systems. This will require an increase in funding. The budget projection predicts an increase from the current level in excess of $5 billion to around $7 billion per year.
The incremental funding requirement will be provided by delaying tax cuts currently proposed, the running of a small budget surplus, and reduced repayments of overseas debt.
The policy acknowledges the role of insurance to provide the majority of additional funding requirements.
Specific additional funding will include:
- District Health Services - up to $500 million additional funding in the first term for services
- Removal of hospital charges and scrapping asset testing - an additional $600 million
- Waiting lists - $150 million over three years for elective surgery
- Mental health - $100 million over three years to improve services
- Primary care - $340 million towards reducing costs
- Prescription charges - $270 million to assist removing these.
The policy on private investment is still undecided, however, it is an area which is being looked at, recognising it may assist in the development of leading edge care. The key principles are to ensure both safety and quality.
Change
Significant change is proposed which will require collaboration from many groups to achieve success. This cannot be achieved overnight and it is essential that all the implications are fully worked through, and proper planning to minimise the disruption takes place.
The change process will be delegated to a transition task force, involving health professionals, union, community and government representatives to make recommendations on the approach and time lines.
Labour is willing to work with any group prepared to address the key health issues. The process used is seen as important. It needs to be open and honest.
Specific Issues
Pharmaceuticals
The process of purchasing pharmaceuticals needs to be reviewed. Currently there appears to be some element of ’buck passing’ where new products are recommended but not made available.
Pharmac would continue to perform its current function, but be accountable directly to the Department of Health. Key principles for the provision of pharmaceuticals would include:
- Equiy of access to medicines
- Purchasing on the basis of demonstrated cost-effectiveness.
Managed Care
Labour recognises that the interface between primary and secondary care requires improved management.
The policy would manage demand through a community approach with education to set reasonable expectations, starting in schools, and being continued by nurses and others.
There is concern that managed care leads to profiteering, reducing the level of resources available to a community, and differential access to care. Nonetheless there will be further evaluation of the options and benefits. In the meantime existing contracts will be honoured.
Maori Health
The current low health status of Maori is a major cause for concern; infant mortality equates to rates seen in less developed countries. Low health status is directly linked to low socio-economic status and needs to be addressed.
Approaches proposed include:
- Health promotion - seen as vital
- Support for a cultural approach - whanau, whole being, spiritual/physical/mental well-being
- Establishment of a Maori Development Commission
- Funding for Maori health being in the mainstream, but identified and evaluated separately
- Maori representation on the District Health Services.
Child Health
Also requires a specific focus to address the unacceptable child health statistics. Improving the status of child health is the utmost priority.
The "National Strategy for Child Health" is accepted as a starting point. Further action will be taken through the Good Start Policy, made up of three integrated programmes:
- Healht beginnings
- Parent support services
- Family / Whanau care services.
Other activities to receive focus will include:
- Primary care
- Nutrition
- Reducing hospital admissions
- Youth health.
Mental Health
A caring approach to mental health is seen as vital to the health of the nation.
Specific action will include:
- Taking a leadership role in mental health - further discussions with the Mason Commission
- Extra funding to improve mental health services
- Improved discharge planning based around an agreed care plan.
Information
Improved information systems are seen to be required to assist in the management of the health system. In particular they need better integration. Information should be collected for a specific purpose and in a streamlined manner.
Key information will be gathered and collated in the National Health Archive.
Important aspects within this are to respect patient confidentiality and commercial sensitivity.
Summary
Labour plans to restore a public health system based on the principles of equity and accountability, delivered through a philosophy of partnership between government, communities, consumers, individuals and health professionals, to provide a system people can rely on.
The public health system will meet all reasonable needs of the people, regardless of their ability to pay. The system will be funded to a large extent (80%) from public funds, and no longer be run ’as a business’. The competitive market model is seen as inappropriate.
It will refocus on personal health and well-being along with public health, the central focus of health policy, to deliver care in the context of the social and physical environment. The importance of intersectoral links, to address the impact on health of such issues as low income, will be highlighted.
The policy will be implemented through key strategies:
- Addressing inequalities in health status
- Achieving improvements in child health
- Improving co-ordination of mental health services
- Tackling waiting times
- Developing a patients’ rights charter.
There will be major changes to structure. The RHAs will be replaced by District Health Services, based on the current CHE boundaries, and charged with providing services for their area.
They will be managed by boards largely comprising elected members, including Maori, and will be measured on their ability to provide the services required against the principles of safety, equity, efficiency, effectiveness, risk management and appropriateness.
The budget projection predicts an increase from the current level in excess of $5 billion to around $7 billion per year. The incremental funding requirement will be provided by delaying tax cuts currently proposed, the running of a small budget surplus, and reduced repayments of overseas debt.
The change process will be delegated to a transition task force involving health professionals, union, community and government representatives to make recommendations on the approach and time lines.
