Don’t look over

All it takes is one locality to look over the fence and say: They have one, we want one too

Australian politics never fail to surprise.

It was revealed recently that former prime minister Scott Morrison had at various times during 2020 and 2021 “secretly” appointed himself not only to the finance and treasury portfolios but also health, home affairs and resources.

I say “secretly” because only Australia’s governor-general and six fellow Cabinet members knew Mr Morrison had taken on the five “ghost” ministries. The rest of Cabinet, Parliament and the electorate knew not a whisper of what was afoot.

Ostensibly the move was to safeguard decision-making in the face of the pandemic. The health minister, in particular, wields sweeping powers in Australia once a “human biosecurity emergency” is declared, as happened in March 2020. If that minister were incapacitated, say with COVID, Mr Morrison was poised to step up.

I find myself imagining Morrison contemplating his choices. Maybe even “internalising a really complicated situation in his head”, to borrow a line from the popular “ghost chips” anti-drink driving ad, before he reached for those ghost ministries.

But the question now on the minds of many Australians, is why the need for such secrecy?

Because few politicians in their right mind willingly step into the quag that is the health portfolio.

In many portfolios, the public tend to take political promises with a grain of salt. But in health, essentially all about life and death, voter expectations often grow and flourish alongside the political rhetoric that breeds them.

One piece of rhetoric common to politicians on both sides of the ditch is the evils of the postcode lottery in health.

The lottery that sees some people wait too long for surgery, others miss out on access to pharmaceuticals and others face huge travel costs to access healthcare.

“It all depends on where you live”; “it’s a postcode lottery” are perennial news headlines.

Health minister Andrew Little has been clear in his desire to see an end to this inequity in healthcare.

To quote from his health-reforms announcement: “Removing the postcode lottery to put patients and com­munities at the heart of our health system is what the reforms are about. We need a system that works for all New Zealanders, and that is what we are building.”

It is a recurring theme. Back in 2019, then health minister David Clark acknowledged postcode cancer care was embarrassing.

At the 2019 General Election, the National Party promised a crackdown on the DHB postcode lottery were it to win.

Again, in 2015, Labour health spokesperson Annette King was calling out postcode healthcare: “We will see more of this unless sufficient funding goes into health for district health boards to meet cost pressures.”

And before that, in 2010, National health minister Tony Ryall took a stab at tackling the problem with his “Better, Sooner, More Convenient” manifesto.

So you get the picture. I suspect postcode healthcare has been around as long as someone has been able to look over the fence at a neighbouring new hospital and say “I want one.”

The aim of the latest reforms, I think, is to switch that to “I need one.”

To drive the change, services need to get far better at measuring outcomes. The public also need to understand that new buildings do not necessarily equal better outcomes.

The creation of locality plans may help, as the idea is for communities to be actively involved in identifying priorities for their locality services and outcomes.

But that begs the curly question; if you have two localities side-by-side with different priorities, doesn’t that lead to postcode health?

All it takes is for one of them to look over the fence and say: “They have one, we want one too.”

And the politicians are back to square one.

The ideal is that everyone is satisfied with their local services because they deliver outcomes equivalent to those in other regions.

Politicians and health leaders would be wise to focus on the nirvana of achieving equity in health outcomes irrespective of a person's postcode or ethnicity, rather than the elusive ending of postcode health with its confusion of "want" versus "need".

And maybe Scott Morrison should be grateful to have never become a ghostly health minister haunted by these perennial problems.