Have a heart

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UCAN’s advice to political parties on forming a Coalition agreement on Health.

The NZ Health system is in serious need of attention to its heart – the current ticker has been badly neglected, with severe restrictions to its love supply.  Signs of ischemia abound but are being ignored.  We urgently need to support a compassionate workforce supported by compassionate organisations. 

 Signs of Health System Ischemia:

Patient centred?

Mental Health Patient: “You need to be really fucked up to get help… I guess the budget doesn’t stretch to hope.”[1]

Fair?

1 million NZers are reporting access barriers to primary care, and the number is increasing each year.  

Effective?

The population’s self reported health status is declining in the most recent health survey, despite increasing life expectancy – we are living longer in poorer health. 

 Actions:

Building compassionate health organisations:

Leadership – Senior health leaders need to lead the way. 

Critical DHB leadership positions in the Auckland region need separating.  Counties Manukau has been merged with the two other Auckland Boards by having a common chair, putting at risk decades of work to ensure effective resourcing of the largest high need population in the country. We need to stop the  DHB money flowing from the poor to the rich in Auckland immediately. 

DHBs needs to be stopped from sucking community services dry. Currently they are taking money from  the community sector ;millions of dollars, away from where where care is most effective and efficient.[2] 

On the other hand, small DHBs have been left to wither – they need stronger DHB pairing with larger DHBs on the basis of the patient’s referral pathways. Such pairings need to be structured so that the large does not consume the small unless it really is better for patients, especially patent access.  

Free primary medical care available in every community.   One million people have an unmet need for primary medical care. The cost of care for these patients is the biggest barrier, including the cost of drugs. There is low availability of primary medical care services, particularly in deprived areas. Barriers are bigger for those with chronic conditions, especially mental illness. A primary health care approach with a focus on equity and social justice is required across the health system.

It needs a more sophisticated response than National’s current plan to up the VLCA scheme for CSC holders. History yells us that only some GPs pass these subsidies on to patients, the rest goes to increasing GP incomes as they maintain their ‘right to charge”. Only some general practices have the passion, the rest will just clip the ticket, and this is becoming more common as family practices are increasingly being replaced by corporate entities.  Funding should target practices with a social purpose who do make care accessible to those with most need and who do effectively manage chronic conditions in the community. Where no suitable organisations with a social purpose exist and the needs are high, the government should establish accessible primary care services itself.

To Start:

Free primary care should be extended to people with mental illness (who currently die 20 years earlier than the rest of the population not from their mental illness but from chronic diseases).

Free primary care for the frail elderly. We must guarantee universal access to care for our elders group in their final years. Often that care is best provided in the community and this is where the support is required.   

A specific rural health investment fund is required for remote rural areas to support community based services, starting with Northland, Rotorua and East Cape, based on their high health need and geographic isolation.

References:

[2] NZ Treasury 2016.

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