Does The Government Have Any Major Health Policy At All?

Labour is campaigning to be re-elected in a few weeks, and has ruffled a lot of feathers by declining to issue any policy manifestos, saying they are “too busy” with the Covid-19 crisis. The real question, however, is whether Labour has any major policy in a number of areas, including health. During the 2017 election, Labour’s policy manifesto for health included a number of promises, but the only policies significant to the hospitals and DHBs were to improve cancer care through a National Cancer Agency, rebuild Dunedin Hospital, and increase overall health expenditure by $8 billion. The latter amounts to allocated funding increases of $21 million in the 2017/18 year, $846 million in 2018/19, $1.535 billion in 2019/20, $2.361 billion in 2020/21 and $3.157 billion in 2021/22. It could therefore be said that the current funding crisis at CDHB is not breaking any election promises, because Labour didn’t actually commit to making any major changes to the public health system. However, it could also be the case that Labour did not product any significant policies because they did not wish to make any real change to the way that the Government interacted with the public health system or DHBs, including any commitment to addressing growing public concerns over waiting lists and diminishing availability and provision of services.

In a post at his blog Otaihanga Second Opinion, Dr Ian Powell, who recently retired from the directorship of the Senior Doctor’s union, the Association of Salaried Medical Specialists (ASMS), which he had served for 30 years, questioned the funding commitments the Labour-led government had made, particularly in relevance to the 2020/21 financial year. To quote, “total funding for the 20 DHBs for community and hospital care increased to $15.274 billion from $13.980 billion in the 2019/20 financial year. In other words, a 9.2% increase. This is massive by any stretch of the imagination”. He points out that a real increase of these terms would wipe out DHB operating cost deficits by the end of that financial year. However, this optimistic note is soon dashed by noting that the actual operating costs in 2019/20 amounted to $14.359 billion owing to deficits incurred, and this made the real increase in funding only 5.1%.

The question that we feel is important, regardless, is whether this funding increase would have been sufficient to allow Canterbury DHB to proceed with its original proposals to shrink its deficit over several years rather than halving it within a year as the Ministry is said to have demanded recently. We feel there is nothing further we can add to the debate over the DHB’s funding issues without repeating what we have written in previous posts. We don’t have a specific knowledge of or insight into the DHB system, we just have a significant level of concern over the way the issue has been handled by the Labour-led government to date that is similar to that held by clinicians and other professionals employed in the public health system in Canterbury.

The issue of Labour’s policy is quite significant because the current administration has gained, with some justification, a reputation for being extremely slow to develop or implement major policy, even some campaign promises, since being elected in 2017. Take as an example social welfare. The Government commissioned a major review of the welfare system on election and the panel which was convened and received public submissions, and then produced a report with about 55 recommendations for change. In 2020, very few of its proposed actions have been implemented and there has been very little public comment about the report from the Ministers concerned. This pattern is similar to growing concerns from agencies involved in public health. The obvious conclusion is that the Government has either made very little effort to upskill its own limited knowledge of the best way to implement a public health system, or has deliberately concealed from the public its preference for almost no significant changes in the way the public health system is run. Either way, it seems to be willing in this and other major policy areas to concede significant power to existing bureaucracies, which provide a convenient smokescreen for its lack of action. As we mentioned previously, the Government during its first term has commissioned what has become known as the Simpson Report. One of the key premises of this document is an expectation that significantly greater funding will be needed in coming years. Former minister Dr David Clark committed in principle to the implementation of the report in a press release on 16 June 2020, but his statement carefully omitted the report’s fiscal conclusions or any reference to funding whatsoever.

We have said previously that the major issue we wish to have addressed is the Government’s obvious wish to avoid having public conversations about the kind of health system it is shaping for New Zealanders, specifically how it will be influenced by funding decisions. Whilst the public at large has become increasingly concerned by shrinking service provision over many years, the system now lacks the capacity to be able to deal with major emergencies such as the present Covid-19 pandemic. Despite this being flagged on numerous occasions this year, the Government is yet to produce any meaningful response to the capacity concerns apart from its existing nationwide capital works programme. But increasing the size of hospital facilities is irrelevant if the operational funding to provision them is insufficient. It has been highlighted in CDHB’s case that even if they get another new building that they have sought in their current investment case, it will not be able to be used to capacity in the shorter term because of operational fiscal constraints.

In effect, the lack of commitment by Labour to produce policy manifestos for the imminent election, and their unwillingness to have a public debate on the type of public health system that will be provided by Government in future, are clearly two sides of the same coin. The Government, having fudged its way through its first term with relative silence within many major policy areas of which health is just one, is hoping that its recent performance in the Covid-19 crisis will get it over the electoral success line. It may well succeed due to poor performance by ineffective Opposition parties and the personal charisma of the Prime Minister, but there are alarming echos of the Fourth Labour Government of the 1980s, whose electoral platform was similarly funded on popular appeal rather than substantive policy considerations. Unless by some extraordinary circumstances Labour is in a similar position in 2023 to capitalise on exceptional handing of a national crisis, the electorate is likely to be far more critical of Ardern’s administration, just as it appeared to be earlier in 2020 when some opinion polls suggest National had a much greater prospect of bringing the Government down. Ultimately, whilst the Government may be willing to sweep these issues under the carpet and hope that sufficient of its MPs and key supporters will look the other way, the very independence of DHBs from the Crown provides them with important leverage with the public at large that can easily blow up in the Government’s face, as is happening now.

On Tuesday 25 August 2020, the following articles were published in the news media in relation to the Canterbury DHB crisis: