Richard Prebble: Andrew Little’s radical health policy


Every election, health is a major issue. The gap between what the politicians promise and what they deliver is enormous.

Last election, the Labour Party’s manifesto pledged that “everyone should be able to access the healthcare they need, when and where they need it”.

Doctor Phil Bagshaw’s 2017 research revealed that one in 11 New Zealanders needed elective surgery. Since then it has got worse.

Health Minister Andrew Little has launched a “high-powered taskforce” to produce – by September – a plan to merge hospital waiting lists into a single national list. This, the minister claims, will end “postcode” healthcare, combat bureaucracy and provide quality health care when it’s needed.

It will do none of these things.

How long patients wait does depend on where they live. Women in Taranaki on the waiting list wait 789 days for elective gynaecological surgery. But women in Gisborne have their surgery in no more than 120 days.

A national waiting list does not mean more elective surgery. If women in New Plymouth are to wait for less time, then women in Gisborne will wait for longer. It will need a high-powered taskforce to sell this to Gisborne women.

The local health boards’ waiting times reflect local conditions. My DHB prioritises children with rheumatic fever, prevalent in the Bay of Plenty. It is a preventable disease that can cause lifetime disability.

Replacing local priorities with national priorities just creates new anomalies.

Every health system has “postcode” health. For the best heart treatment, you need to live within an hour’s drive of Greenlane Hospital. I live outside the golden hour from any hospital. A national waiting list cannot change my postcode health.

Bureaucracy is the tool successive governments use to manage waiting lists. New Zealand’s booking system allocates patients points to get a specialist appointment in order just to get on a waiting list. Numbers on the waiting list are managed by changing the points needed to see a specialist. Bureaucracy will continue to manage the numbers on the new national waiting list.

The aim of the reforms is not to provide quality healthcare when it’s needed, but the goal of all socialists: to make it fair. When 440,000 people need elective surgery, but only 27,000 make it to a waiting list, no system will be fair.

The goal should be performing more elective surgery. I have lost two family members in the past 12 months. Both would be alive today if they had had early surgery.

Health is very challenging. The demand for a free service is infinite and there is a finite amount of money.

In most of the economy, most of the time, rising productivity is making everything cheaper and more abundant, allowing real wages to increase. Health, in contrast, is more expensive.

My grandmother, when she was nursing 100 years ago, was just as productive as a modern nurse. Today’s scans and tests produce better outcomes, not better productivity. No one would nurse today for 1922 wages. To pay health professionals today’s wages, the cost of health has to increase. Health costs will only fall when we have robots and AI.

Sir Roger Douglas’ and Professor Robert McCulloch’s solution to rationing health care is that everyone has compulsory individual health savings accounts, topped up where necessary. We would then make our own health choices. It is an idea so radical that no party will consider it.

Instead, DHBs today ration healthcare. Neither the new Health New Zealand nor the new Māori Health Authority will make the final rationing decisions. The final decision will rest with the minister. The system will last until Andrew Little realises he must defend in Parliament his decision that denied Mum her operation.

The waiting lists have blown out. The minister blames Covid, but there have been relatively few hospitalisations. A fifth of all surgical positions are vacant. There is a shortage of nurses and radiologists. The shortage could have been avoided if hospitals had been allowed to manage their own quarantine.

Another “taskforce” investigated the health sector nearly 40 years ago. What the Gibbs Report found will still be true. The most inefficient private hospital is more efficient than the most efficient public hospital. If all hospitals were as efficient as the average private hospital, there would be no waiting list.

Buried in Little’s press release is this statement: “I also expect the taskforce to make full use of all health resources, including those in the private sector”.

Little may not realise it. He has announced a very significant reform that will provide more quality care and reduce hospital waiting lists: the privatising of the delivery of elective surgery.

Richard Prebble is a former leader of the Act Party and former member of the Labour Party.

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