Trust me, I know what I’m doing

A befuddled crowd surrounds someone who has collapsed in a heap. “What do we do?” they cry, “we need someone to tell us how best to provide care for this person. But who?”

A figure strides forward, brushing people aside with the swagger of someone with all the answers: “Make way…make way, I say. I’m a politician…”

And why not? For reasons that will never make sense, we quite literally put one of our most fundamental needs in the hands of people whose careers, incomes and egos are based on convincing us that everyone else is talking complete nonsense, and only they know the truth and the way.

And the result? Overhaul after reinvention after transformational once-in-a-lifetime opportunity to get healthcare done right.

And every time it’s, this time, yes, this time, it’s going to work. It really, really is, you just wait and see. Look, here I am supporting your favourite sports team. See? If we like the same thing, we think the same. It’s just common sense.

Has anyone ever totted up the cost of this endless cycle of review, rebuild, centralise, decentralise?

I was talking to former National politician Bill English a few years back and he told me how Labour only ever wants to centralise control, which was to say National will always look to decentralise things again. It’s like the last to leave home moves all the furniture around, then the next to return puts it all back again.

Has anyone ever totted up the cost of this endless cycle of review, rebuild, centralise, decentralise?

It’s an endless game of pickleball. I was made redundant from Auckland Area Health Board in the mid-1990s to make way for Helen Clark’s reforms, and that feels like a whole bunch of “re-acronymed” systems ago.

And, if we know anything, it is that the clock is already ticking for when Te Whatu Ora and Te Aka Whai Ora (should it survive the election) will be chopped up.

Yet, as far as I know, practitioners have pretty much practised as per usual throughout. All the ancillary messing around made damn sure job titles changed to suit the times, while the hard stuff never got done.

In an unstable system, the only stability is that people keep getting sick and they all want to be fixed now. We really should do something about that…oh, never mind.

Because New Zealand is trapped in the three-year election cycle. When it comes to healthcare, the policy pitch is reduced to hospitals and waiting lists, waiting lists and hospitals, and the occasional wad of cash for new cancer drugs to show they really do care.

Easy, low-hanging promises make easier attention-grabbing, front-page stories too, for that matter.

But there may be an unintended consequence to all this hardware and buildings “porn”. Secondary care becomes understood as where proper healthcare happens, what with all the whiz-bang machines, people on trolleys being pushed head first through swinging doors, and the inevitable romantic entanglements (my television never lies).

On the other hand, selling a macrosystem, where the concept of health is expanded to include the social determinants, is complex and pointy-headed, especially when the ministries responsible for those determinants are mired in the usual inertia you get in long-embedded institutions.

You can’t point to some child and say, “What I am doing means the (insert preventable disease here) you’re going to get won’t happen.” Even if it’s true.

Instead, our current political environment makes it controversial to point at decades of evidence proving healthcare inequity and say: “While we’re at it, we should do something about that too.”

Is it even possible to get politics out of healthcare?

Tāmaki Health chief executive Lloyd McCann thinks so. He reckons we should look at countries such as Denmark, where the role of government in health is ring-fenced. If policy priorities ebb and flow, the urge to destroy the village to save the village is mediated.

And a system that achieves and maintains equity is something that would benefit all, even if you never have a sick day in your life.

Children who grow up healthy do better at school, get better jobs, pay more tax, contribute more to their communities and so on and so forth. Maybe they’d even become doctors? Ka-ching.

We wouldn’t need hospitals groaning under the weight of stupendously expensive life-support systems. In fact, as is the ambition in Denmark, we may not even need as many hospitals.

We’d have so much money we could hold a flag referendum every year if we wanted...okay, a step too far. The rose-tinted glasses were steaming up.

But, fair dinkum, we are a small country beyond the black stump. Why do we keep messing around with the big stuff?

Alan Perrott is a staff journalist with New Zealand Doctor Rata Aotearoa. Editor Barbara Fountain returns next issue