What’s a billion here or there?

You have to admire Te Whatu Ora staff who valiantly soldiered on and justified to the health select committee the need for savings of $1–2 billion even when the actual figure was closer to $540 million.

Numbers are tricky blighters. That’s coming from someone whose school reports for maths typically read along the lines of “slow but thorough”.

In the case of the health authority’s balance sheet, what started as $½ billion accidentally got translated to $1-2 billion. That’s a sizeable glitch.

And brownie points to committee member and former health minister Ayesha Verrall who spotted something odd was afoot – “Does that mean you are looking to make $1 billion to $2 billion in savings in the hospital and specialist services area? And could you give an indication of how that might be feasible?” The staff member from Te Whatu Ora explained the process but Dr Verrall was far from convinced. Quite rightly we know now, but even the correct target savings figure of $540 million seems outrageous.

Numbers have been streaming into our consciousness in recent weeks. The current toll of job cuts in the public service stands at around 3500 and growing. A smaller number, but fronting a good deal of misery is 236, the number of companies placed in liquidation in March, the highest monthly figure for six years.

An additional $6.36 billion for Pharmac over four years sounds impressive so it is sobering to learn it will pretty much only fund current medicines.

An early costing for meeting targets for reduced specialist waiting times landed at $723 million, and did not go ahead.

For general practice, numbers loom large, whether it be patients on waiting lists, staff vacancies or pending GP retirement figures.

Add to those numbers the unresolved contracts that are the subject of our cover story. These contracts support primary care and its patients in many and various ways – Healthline, locum services, patient information and HealthPathways, to name a few. Not least of them is the contract that employs new GP trainees which now looks likely to land with Te Whatu Ora down the track.

From time to time, I remind myself how big those millions and billions are – that one million seconds is 12 days and one billion seconds is 31.7 years. In our small economy we don’t hear trillion too often, but one trillion seconds is 31,708 years.

The big numbers day is not far away with this year’s Budget to be announced by finance minister Nicola Willis on 30 May. Last year’s Budget predicted Crown expenditure for 2023/24 of $135 billion; Vote Health received $26.5 billion.

Primary care has been well and truly primed by health minister Shane Reti not to expect too much in this year’s Budget.

I hope you are doing okay out there in primary care. I know times are tough, winter is coming and the nature of the relationship between Te Whatu Ora and primary care continues to have all the hallmarks of a badly engineered blind date.

With the recent departure of a couple of Cabinet ministers, including the minister for disability issues Penny Simmonds, maybe take a moment to appreciate the fact we do have a health minister who understands primary care and general practice. We’re yet to see what that means on the ground or whether he has sufficient clout around the Cabinet table to achieve real change, but it has to be a bonus in the current line up.

The CDC estimates 61 million measles-containing vaccines were postponed or missed from 2020 to 2022 due to the COVID-19 pandemic. In New Zealand, immunisation rates are low – coverage at two years of age is on average around 80 per cent when the target is 95 per cent. The figures are lower for Māori and Pacific children. It was only in 2019 that Samoa was struck by a measles outbreak causing the deaths of 83 people, mostly infants and children. With so much attention on the cost constraints in the health sector it is crucial we don’t lose sight of these figures.