Time For A Change in How We Think About Health

Time For A Change in How We Think About Health

Kei nga kaiwhakahaere e noho mai ra huri rauna i a Taranaki maunga, tena koutou katoa.

I want to use this occasion to change the dialogue on health reform. We have become mired in a morass of despondency, criticism, blaming and finger-pointing which comes from frustrations widely felt within and outside of health services. It is understandable but not productive. What we need is action and support to strengthen our public health services. Much current discussion only further undermines and weakens them.

I could spend this time giving you a summary litany of the many faults of the current system. I could allocate blame and try to create a base from which any positive outcomes no matter how minimal from Te Whatu Ora and Te Aka Whai Ora might look good. But what use would that be to patients, their whanau or to staff? None at all.

It may be that there are people who do not much care about the state of our public health services. They may be wealthy or insured enough to feel they have no exposure to the faults and gaps. I feel sorry for them. In part because they may well find one day they do have emergency or critical needs which rely on public health response. But more because in their sought isolation they deny a vital part of their humanity which is being part of a community with which they can contribute and share.

I’m assuming that as business leaders you do have a community view and a shared humanity.
In my fairly lengthy working life with people from vastly different economic and social positions I have reached the conclusion that being a ratbag is a phenomenon of roughly even and fortunately minority distribution across classes. And one which is often capable of rehabilitation.

So I’m asking you to reflect, along with me, not on what is wrong but what we can do about well being in our communities and in our shared health system. Very few, if any, of our health system crises are new. They are not accidents. In healthcare terms they are almost all long term conditions with serious co-morbidities. Nor are the answers to them mysteries.

Obviously there are some where leading edge technologies or medicines or treatments are not available in this country due to cost or other reasons. These absences are all terrible to face for those affected. Some may be avoidable and should be avoided, others will be simply too hard. We regret that but cannot hollow-promise our way past them.

But that is not the day to day, month to month, experience of healthcare for most. The frustrations and bad experiences too many in our communities have are about how many of us develop serious illness, how many face obstacles to early and effective treatment. This is what drives most concerns. It is important, I think, that in my role I (along with my board colleagues and executives) acknowledge the reality and legitimacy of these concerns. Te Whatu Ora does this, we do not deflect or evade them. They are real and they are our calls to action.

Yes we work as we must within national policies, planning and guidance documents and monitoring. There is enough of that to cure insomnia forever . But the real call to action is the pain and suffering which are the lived reality for too many.

That is pretty much the way it is for health system staff. Few are really driven by monetary incentives or “key performance” indicators. The drive comes from serving the needs of the patients and whanau in front of them. I worry that too often our internal systems and processes not only treat patients and whanau as numbers but treat our people the same way. We work with nurses and doctors and orderlies and care workers - people not “EFTs”.

Changing that approach takes time, and trust builds through actions not words. But let me come back to us, you and me, the owners, users and guardians of our health system. Never mind the Ministry or, with respect of course, the Minister. They have their roles but it is us, I repeat the owners, users and guardians of our health system, who really make a difference. What can we do in that capacity to make things better?

This is a group of CEOs. Is your business doing all it can to ensure that public health measures like vaccinations, healthy working conditions, and well-being support, healthy food and water are available to your workforce and their whanau? Some are, but many are not.

Are you doing anything about the plagues of sugar and fat fast food pushers targeting low income areas, or the liquor pushers on the same mission in your district . What about the proliferation of vape pushers whose premises certainly do not look like they are a service to mature adult smoking cessation policies. Maybe you look to support Green MP Chloe Swarbrick’s private members bill to assist limiting proliferation of liquor outlets and promotions.

Are you actively promoting warm, dry, ventilated housing for all? Are you concerned about working families struggling on low wages? About gender and ethnic pay gaps? Do you shudder or cheer when business organisations oppose actions to fix these on the basis of cost. Do you need reminding of the elite mantra of “there is no such thing as a free lunch” applies here too and that you will find the cost either in the misery of others or in your tax bill? Maybe you have made that choice and opted for others paying the bill with their distress . I hope not. When it comes to the health of our communities we must all work together.

What positive, healthy activities do you support in your business and communities. We know that many people struggle to meet the costs of participating – you can support those who are providing readily accessible healthy activity in your community. Or you can do nothing and watch the results queuing up in ER, and bemoan the failure of “them” to act never acknowledging that you are part of the problem.

To me this highlights the critical fact what what we call our health system is predominantly a system to treat ill health not to create pae ora or healthy futures. This is more than just words. We need more and better services and facilities to treat ill health and that objective is very much what our communities and the Government expect us at Te Whatu Ora and Te Aka Whai Ora to fulfil. But the lever and the fulcrum for pae ora lie not so much there as in “population health” initiatives which promote and support healthy, active lives. More holistic services I expect will be often lead by Te Aka Whai Ora given the nature of a Te Ao Maori kaupapa on health. But it can not be exclusively that source and over time I expect that more and more of our allocation of resources must go, along with that of other agencies in housing, welfare, social development and education, to supporting the work in good healthy activities.

There are some facts that we all must face. Not as excuses or judgements. Just facts which are stubborn things. Our health system has been broken down and hollowed out by many years of underinvestment but also with poorly structured and confused and confusing process. This has encouraged the development of private options which do work for those who can participate but also divert resources from the public system.

It has lead to primary health organisations which have both positive and adverse impacts. It has lead to a wide range of community based services many of which are vital to connection and culturally appropriate forms and practices but many of which struggle for sustainability. It has lead to duplication and waste and inefficiency but equally to some very fine hospital services. It has lead to a stressed and often frustrated professional and support workforce with major gaps in recruitment and slow innovation in shifting roles and careers to more suitable and modern processes. It has lead to some aged care services flourishing while others go out of business and the needs of the working class aged languish. It has lead to people in rural and remote communities being cut off from access to health care services others take for granted. It has lead to a messy and inadequate digital base for future innovation.

We all bear responsibility for this. We were bystanders to the crime. As adults we saw it happening, it was not a secret and we can only reverse it together. There are solutions. Most of them are working somewhere in our system already. Te Whatu Ora is about identifying those, removing barriers, and making them nationally available. Our leadership team is working on that right now.

We hear talk about unequal outcomes. These are not new. They have been researched and widely publicised for many years. We all bear responsibility for this. We heard and saw but we walked on by. It was easier to leave it to “the system”, to make “the system” and its operators wrong. But it was and is we who are wrong.

For Te Whatu Ora it is vital that we establish better relationships across the board. Externally we need to make sure that our contracting and funding processes actually support our principles and priorities. A lot of what is currently in place is a jumble of historical arrangements which have been added to over time. Some of this change will be jarring. We cannot just continue with the same contracts and terms, they need to be rationalised and restructured. Otherwise we just repeat the past. That work of change is underway. But let me be clear. We want to and must work with suppliers of the materials and services our system needs. We want longer term, more relationship-based than narrow transaction based contracts. But only with people who can show that they are genuinely committed to the equity, efficiency, effectiveness, inclusive and accessible principles on which we are based. Expect equal rigour on finance, function and performance across all aspects. Adapt to it and flourish, fight it and fail.

For staff and their unions and professional organisations the call is the same. Please lay aside your past frustrations and work with us on solutions. I am really encouraged by what I have seen on this – some of the best proposals I have seen come from these sources, far more realistic than the glossy and over complex and expensive offers from the consultant industry. We want to work with these union and professional organisations as partners. Te Whatu Ora can be your ally in the workforce future you rightly advocate for. I cannot promise to meet all wage demands – that is not our role or in our power – but we will work with you on the best allocation of what resources we do have. On the best job structures and working conditions and career progress we can build together.

For people like GPs, urban or rural, we do recognise the stresses and difficulties your structure faces in this world. We know that how you are funded and how you relate to other funded and to the services we deliver needs to change. That is a shared need, let us work on it together as partners not adversaries.

These same principles apply across the board, this is “our” health service. It is not a commodity business with services for sale. It has been bastardised by poorly conceived neo-liberal aspirations and actions over decades and Te Whatu Ora offers the platform for changing this. Not a certainty but a platform. We have much to do to activate and deliver the change.

I think that as CEOs you will recognise this. The best executives in any private or public organisation typically learn to leave their ideologies and pre-conceived attitudes at the door. The exigencies of changing markets, consumer demands, financing and technology and the rest dominate and demand pragmatism and adaptability. You deal with what you have to when you have to. It is no different for us at Te Whatu Ora. We cannot run deficits. We have to complete years worth of capital projects already committed. We have to keep operating our existing services. On top of that we have to change the inequity of outcomes with which we are all too familiar. I think that once frustration and cynicism are put aside this is a great opportunity for us all to express our individual and collective humanity. An exciting exercise for all of our communities to participate in and support in our mutual interest. I implore you to look past the frustrations and recriminations and to join us.

So when you see critics suggesting we are building a big bureaucracy in Wellington, gently point out that we are reducing overhead bureaucracy and we are basing ourselves in Manukau to be amongst an area of real need not the cloistered corridors of the capital.

When you hear the local community health service, hospice or clinic calling out for help, don’t walk on by. Ring them, offer practical help. It is our system.

When you hear critics say that we are building a separatist health system politely point out that Te Whatu Ora and Te Aka Whai Ora are working together on one system, integrating kaupapa Maori services for everyone’s benefit and to overcome clear, longstanding inequity in access to and outcomes from our health services.

When you hear that funding is short for critical services or infrastructure in Taranaki you can grumble into your beer about the Government, or write to the editor to whinge about how bad it all is, or you could contact the Taranaki Health Foundation and make a regular or one-off donation. Be a supporter. Be a better person for it. Be part of the solution. Join Brian Ropitini and his fellow directors and staff in their vital work.

After all it is our health service.