Health system concerns in spotlight after high turnover of senior leaders

getting longer and suffering from widespread staff shortages. But the decades old question is how do we actually fix it? Today on the front Page, University of Otago Professor of Public Health Peter Crampton joins us to give us a rundown on our health system. So, Peter, it's no surprise that the health system is in crisis. In fact, it feels like we're constantly being told this what kind of challenges is it facing right now.

are new factors led upon old factors. In terms of the stress is being brought to bear in the new zin and health system and also all around the world, I'd say number one as the fact that healthcare gets more complex and more expensive by the day. And in a country such as New Zealand, it's driven by the aging population. We get sicker and we get older, and we're living longer, and we drive the costs of healthcare delivery.

And that means that well, for example, increasingly individuals as they get older have multiple conditions that would need treatment. At the same time, that complexity brings with it increase need for healthcare, professional time, more medicines, more expenditure on expensive medicines, and so on. And that is a real driver. It's a driver of complexity. It's a driver of difficulty, it's a driver of expenditure, and that's no one's fault.

It's not a bad thing. It is a fact. Nevertheless, what it does mean is that there is pressure on a government, on all governments, to deliver in those circumstances where there's a great deal of pressure driving upward expenditure. However, hard governments try that pressure on and it can only be partly addressed through increasing product to video or increasing efficiency. It does, in the end need more expenditure per capita

per person. I would say that in our system we have over the long term, we've underinvested in primary care, by which I mean nurses, doctors, and all those people in the community who look after us when we get on will and that's where the bulk of healthcare is provided, and we've underinvested in that, and that is at the

point of extreme stress right now. And what that means, amongst other things, is that we get sicker, we're not treated early enough, and then we end up in the hospital system, costing the system more and also driving up pressures, stresses, and waiting times in hospitals. So that's in there as an underlying reason. Look, I think there's two more immediate aspects of the health system which need to be commented on.

The first is COVID and post COVID politics. There has been a rapid shift to political populism and that brings with it less trust in so called elites, less trust in science, less trust and experts. And because the health system so reliant on experts and science, and while groups of people who are regarded as being elite has a destabilizing effect in the health system. And not just in New Zealand but all around the world. That this is

a new phenomenon. And of course COVID. Coming back to COVID, it brings with it all the stress is on the country's finances that we know are very very difficult. Again, this isn't about this government or the previous government or any government. It's just countries around the world are experiencing huge stress post COVID. In addition to that, the previous government, the Labor government with Andrew Little as the Minister of Health, initiated a set of major reforms of the health system.

This kicked off under Minister David Clark who initiated a review of the health system. I was on that review panel. We made a number of recommendations to the then government. Some of those recommendations were taken up, others were not. In the event, Minister Little made his own decision to centralize the health system under one organization, to Fatal Order Health New Zealand, and that of course represents what is undoubtedly the largest merger ever in New Zealand's history, bringing

together the twenty district health boards into one organization. And another of other changes were initiated at that point, and then there was a change in government, so the new government inherited this rather complex and difficult set of circumstances. This would have been very difficult for any government. There's no doubt this was a very challenging set of circumstances. And what they've done since then is introduced their own changes.

For example, they scrapped order the Maori Health Authority, which brought expertise into the center of the system. Last year the Board of Health New Zealand to Fatal Order was sacked and replaced with a commissioner, along with several co commissioners, and since then there have been a number of resignations, thinking particularly back to last week where we had three important resignations in the health system, but the government was

not responsible for the challenging circumstances it inherited. But it is of course now in charge and has been for well over a year, and is making its own decisions about how to lead the system.

with in Fascil order. But as I said, I'm unclear on this point. There was one analysis I read last year from a well respected health economist which looked at the twenty year healthcare expenditure and it went up per capita around four to five percent during the first more or less during the first decade of the century. That

was with the Labor government. That per capita annual increase in expenditure went down to I'm remembering three or four percent under the nine years of the subsequent national government, and then it went back up again slightly to or four plus percent annual per capita increase in expenditure during the last Labor government. And according to that analysis, the twenty twenty four year was the first time in that twenty four year period that the health systems faced an

actual decrease in per capita healthcare expenditure. Now, that was just one analysis. It received some publicity at the time, but incredibly important that we actually know whether or not that's true, because if it is true, it explains so much of the intense stress and pressure within the health system. Because basically the health system which is facing real per capita decrease in expenditure is sort of an unprecedented thing. Not many countries would ever attempt to do that. Now,

government's making claims that that's not the case. Some economists or this one in particular, is making a claim that is the case. I think we need authoritative analysis around that. Coming back to your question about how is it going into fatal Aura, Well, look, I would say three things. Firstly, that fat AURA is a highly stressed, highly disrupted organization at this point in time, there is a great deal of change and uncertainty and that affects probably the vast

majority of people who work within the organization. And remember this is a huge organization. This is a single employer of When I last heard the numbers, it was between eighty and ninety thousand people doing all lots of jobs all the way from the frontline clinical roles through to IT systems and procurement and supply and all the things that are a huge organization like that is responsible for doing so a great deal of disruption in that organization.

How it's going financially, I don't know. Again. I think that we need authoritative financial data being produced at regular intervals so that we can we the public can make judgments on that point. And certainly I've no doubt at all that Commissioner Lester Levy is working extremely hard on this, as are the other co commissioners. That that's I think as much as I can say on how it's going, because this is the story is unfolding in front of us.

Maybe one can take a little bit of a steer from the fact that there are senior resignations in the system, some of which might have been anticipated, others not. The resignation of the Chief Executive of Health New Zealand faceral At Margie Upper, which was two Fridays ago, may have

been anticipated. I certainly wasn't expecting it to happen on that day and that week her term came up for a renewal later on this year, and I was expecting her to step down perhaps at that point, because that had been signaled.

That's very unusual with those senior roles. We expect that a resignation to be announced well well in advance of it taking effect, and their time for the system to respond and an interim person or an acting person to be put in place, and ideally a recruitment process to be god underway. None of that has happened this time, of course, so we don't know what lies behind that, except this is an unusual circumstance. What we do know, of course, is that we have a new Minister of

Health who's come in. The Honorable Sandertti has moved on to other portfolios and we now have the Honorable Simeon Brown in the role of Health Minister. He's brand new to health. Not only is he brand new to the portfolio as Minister of Health, he's also brand new to health. Nothing wrong with that, per se, It's just that we all need to recognize it will take him some time to get his FETA under the desk properly and understand this extremely complex system that he's now responsible for. And

I don't hold him. I don't think he's the author of these resignations necessarily at all. But following his taking on the portfolio of Health, there have been, as I said, a number of very senior people resigning, and maybe with the fullness of time, we'll understand more about the nine amics there.

et cetera. Health New Zealand has released its workforce Plan in December and that outlined how gaps will be filled over the next three years, and the government's already made moves to fund more homegrown doctors and midwives for example.

the problems are mounting in the health workforce space. I think the government wants to get on top of this. A great deal of good work is being done. Certainly, we don't have solutions to all the problems at the moment at all, by any stretch of the imagination. And I'll come back to point I made earlier about the point you mentioned about general practices and general practitioners and

practice nurses in the community. That is an area of neglect, which is one of the most urgent pressure points in the health system, I would say, and it's not receiving a huge amount of public air time. Is receiving some but not a huge amount. The whole system is reliant on that layer in the health system with GPS practice nurses and or all the others who work in the community keeping people well and out of hospital. The financing situation for GPS is complex and has been neglected for

a long time. Work is underway by to Facial Order Health New Zealand and by the Ministry of Health to fix that, but it's a long time coming, and it's it's an area of really considerable pressure and stress within the system. I fear that these really important strategic or long term issues like health workforce are probably being somewhat neglected right now as the system goes through its own processes of change.

That's the only option available to us, So we go, you know, And that's what people do. They're going to ED departments and wait to be seen there rather than having issues dealt with in primary care. And it's not just the issue of closed books and pressure on primary care services, so also the issue of cost for many people. A lot of people can't afford even sometimes quite basic elements of care. So there's constellation of factors there which

leads to pressure on ED departments. But yes, it's a big issue.

There needs to be confidence that the systems lead in a way that is consistent with the values that people work in the system have, and that we have stability in leadership and leaders who are capable of forming long term relationships all around them to give confidence that we're, even through tough times, that we're all pulling in the

same direction. And I think that having some sense of direction for the public health system right now would be immensely helpful because to my mind, there are mixed signals at the moment around them. Role of I mean, the natural default I think for many in the current government would be private provision, a privatization of services, not just

healthcare but in many domains. And I think people working in the public system, which so many people in New Zealand are totally reliant on, they need confidence that there is a long term commitment and a bipartisan approach I think would be extremely helpful.