Hague Kevin: Financial Review Debate — In Committee 
Hague Kevin: Financial Review Debate — In Committee 
[Volume:653;Page:2433] 
KEVIN HAGUE (Green) 
: 
 I want to take this opportunity to take up a line of questioning and thinking that I first pursued with the Health Committee’s review of the Ministry of Health. The Minister of Health Mr Ryall when in Opposition had a particular focus on waiting times for elective surgery. Even though elective surgery represents perhaps 5 percent of what the publicly funded health sector actually does and even though it is a topic that is beset by complications because it lies across the boundary between the public system and the private system the waiting times for elective surgery make for an easy target because of the emotional charge associated with waiting for needed surgery. It did not matter to him that the often-criticised system for prioritising and booking elective surgery was in fact developed under the National Government of the 1990s. 
The health sector has watched with interest to see how a politician with such an expedient political focus while in Opposition would make the transition to ministerial responsibility for the sector. The answer is in and it is “not very well”. The politically easy targets for an Opposition politician—waiting times for elective surgery emergency departments and radiotherapy and railing against bureaucracy—have unfortunately continued to be that Minister’s focus. To compound his failure to adapt to his new role he has adopted a public style from the Joan Collins school of management: “Do it my way or you’re all fired.” 
What is at stake here is not just the Minister’s misplaced enthusiasms. There has been a bipartisan consensus around the need to greatly strengthen our programmes to keep people well in the first place through public health and to treat illness as early as possible and in the patient’s own community through primary care. This necessarily requires a relative deprioritisation of hospital-based care particularly at the most specialised high-tech and expensive end. This is not just some idea of New Zealand’s but rather reflects the common global understanding of what is required to combat in particular the rapidly rising tide of long-term conditions that will otherwise swamp health services. 
I had the greatest of difficulty in obtaining a copy of Minister Ryall’s letter of expectations for district health boards and to date I have not yet received a copy from his office. It is no wonder that is the case. Rather than continuing the practice of his predecessors of emphasising the broad strategic direction primary care merits only a cursory mention in that document. This at least is one mention more than the other issues get such as keeping people well equipping New Zealand to deal with chronic conditions and reducing health inequalities including taking action to address the national emergency in Maori health. This is important because district health boards will take their steer from the Minister’s priorities—if they do not improve radiotherapy waiting times boards will get the sack. So will the district health boards focus on that or on improving access to primary care for Maori for example? 
Nobody is arguing that improving waiting times and moving patients faster through emergency departments in order to maximise productivity and minimise waiting times are not important things to do. The fact is that district health boards have over the past year or so been placing a very great emphasis on quality improvements and workforce development to achieve precisely that. Edicts and threats may convey an action man image but they simply do not help. At some point in the not too distant future the Minister will begin to understand the complexity of the health sector. Let us hope that in the meantime the progress that has been made towards meeting the real challenges does not sustain too much damage from his desire for simplistic and politically expedient solutions.