The irony is, if the Government did follow the evidence and invested in primary care, then it would have a better chance of truly meeting those targets
Driven as I am by deadlines, I can understand the value of targets. But as a sole focus they make for a pretty dreary life and produce dubious outcomes.
A good publication needs a lot of love as well as that dedication to deadlines. The same can be said for a health system.
Simeon Brown seems a bit short on love in his determination that the Government’s five health targets are his core priorities as health minister. In a nutshell, those targets, handed down last year, are childhood immunisation, elective surgery waiting times, first specialist assessment waiting times, emergency department waiting times and cancer treatment access.
At the same time, we have another target – finding savings of $1.4 billion. Or was that $1.7 billion? It’s hard to keep track. The target was set by Health New Zealand Te Whatu Ora commissioner Lester Levy last year, cheered on by finance minister Nicola Willis. It requires the disappearance of anywhere up to 4000 roles at Te Whatu Ora. Those staff currently wandering the corridors wear their own personal targets – a bullseye. This has to be one of the most torturous, lacking in compassion, restructuring campaigns this country has seen since Rogernomics cut a swathe through the public service.
But I digress. Setting targets is one thing. Meeting them is another.
If each of these targets is a core priority, then resources must be assigned to ensure they are met.
The biggest resource injection needed in at least four of these targets is greater access to general practice. In fact, prime minister Christopher Luxon was so concerned about access to GPs, following a summer holiday revelation that people were very worried about accessing general practice, he cited it as a reason behind ditching specialist GP Shane Reti as health minister and replacing him with health novice Mr Brown.
But Mr Luxon was not worried enough that GP access should make it to target status. There is a good reason for that. It would require the Government to act in good faith and deal to the funding crisis in primary care. Is that likely to happen when Mr Brown dismisses underfunding as “fake news”? Even if that was mere political grandstanding, and he is seriously getting advice on what needs to be done “to support primary care to be able to do more”, as he told reporter Stephen Forbes, where is the money going to come from with the current targets for spending cuts in place?
Mr Brown is right to ask why the Labour Government ditched targets back in 2017 when the sector had been achieving strong results under the last National Government. But the targets were focused so narrowly they took resource from elsewhere. They also led to “gaming”. When the country last went hard out on targets, research by Tim Tenbensel and colleagues found at least four hospital emergency departments made use of short-stay units to ensure patients were shunted out of ED in a timely fashion to meet target times.
Chances are “gaming” will happen again because it is just not possible to deliver on targets with less funding and fewer staff. The irony is, if the Government did follow the evidence and invested in primary care, then it would have a better chance of truly meeting those targets and also obviating the need for folk to jiggle their target figures.
Meanwhile, there are whispers afoot that with the dispatching of Dr Reti, departure of Te Whatu Ora chief executive Margie Apa and resignation of director-general of health Diana Sarfati, Professor Levy’s tenure is in doubt. Mr Brown has declined to express confidence in the commissioner, possibly one of the more astute political moves in his first weeks in the portfolio. Ultimately, only a few weeks into the job and with Mr Luxon close at his back, the handling of the health portfolio feels more like political game playing – steps being made to appease the voter, not support the next patient through the door.
To be honest, working in a health-media newsroom feels somewhat supercharged with every day bringing yet another puzzling twist. I can only imagine what it is like working in the sector.
