The centralised health system gives ministers new powers to tinker with operational decisions. Ayesha Verrall's first major target is the postcode lottery, Marc Daalder reports.
Analysis: The new health system's first birthday passed over the weekend with a bevy of criticism and hardly a whisper of defence from the Government.
National Party health spokesperson Shane Reti called it a year of health failure.
"It has been one year since Labour merged all New Zealand’s 20 DHBs into one mega entity, and the transition has not been smooth. In fact, things are much worse," he said.
READ MORE: * Te Whatu Ora 'deliberately underfunding us', industry group claims * Winter plan leads transition to new model of care
On the front line, moods ranged from depressed to cautiously optimistic. At best, health experts and workers said nothing had improved yet but they were hopeful it still would.
"We need more nurses, more beds, more techs, and all of those things. The action on those has been quite slow. It's been a year now and yes, some initiatives are starting to happen, and with the new relaxing of the immigration parameters we are seeing more nurses flow in, we are seeing a few more techs, but it's slow," Vanessa Blair of the NZ Association of General Surgeons said.
The Australasian College of Emergency Medicine said "there has been no significant change in how we deliver care to patients in EDs. The welcome focus on addressing health workforce shortages hasn’t yet translated to improvements on the ground, and EDs continue to experience a lack of skilled clinical staff, particularly in nursing."
The President of the NZ Institute of Medical Laboratory Science, Terry Taylor, said the sector had high hopes for the reforms.
"Roll on one year later and it is fair to say there is now despair and frustration resonating through the pathology sector that is no different from our other frontline colleagues," he said. "However, I do have hope – and that is because of the health leadership I have been fortunate to sit in rooms with or have correspondence with. Some have gone and new leaders have appeared but for someone like me the message that is clear is the determination and drive to get us all to a better place resonating from each and every leader."
One of those leaders is Ayesha Verrall, who is partway through a number of health announcements this week. On Sunday, the Government announced plans to train 830 more nurses over the next two years than previously expected. Monday morning, Te Whatu Ora revealed an additional $1.5 billion top-up to its pay equity offer for nurses.
It was Monday afternoon, however, that Verrall got to reveal one of the first major initiatives to leverage the new health system's centralisation. The Government has a plan to bring an end to the postcode lottery, which sees people in Invercargill or Rotorua given less access to healthcare than those in Auckland or Christchurch.
It's starting small, with cataract surgery the first procedure to be equalised across the country. But the model is scalable to every other health issue, Verrall told Newsroom on Monday.
In essence, the solution is simple. Most operations have a clinical prioritisation system, which awards each patient a number based on their need. Higher numbers mean you need the operation more badly and if you cross a certain threshold, then you're eligible for treatment.
Under the old system, district health boards each set their own thresholds for treatment for each health issue, based on resourcing and district priorities. That meant someone with a need score of 60 for cataract surgery – which corresponds to being legally blind – wasn't eligible for the operation in Invercargill, while someone with a score of 46 in Auckland was.
The easy tweak that Verrall has done is to equalise that threshold to 46 across the entire country. That's a power that ministers didn't have access to under the old system, but the new model gives them much more licence to tinker at the ground level.
"In effect, the DHBs used to be bulk-funded with government setting high-level expectations of what they did but not able to manage the granular level of how they manage each waitlist over the other," she said.
The cataracts rollout shows some of the pitfalls in equalising healthcare across the country, too. Once you adjust the numbers, you have a sudden influx of patients who are now eligible for treatment everywhere. That figure is estimated at 3500, including people who aren't known to the health system because they weren't eligible under the old threshold.
The surge will be handled through outsourcing to private ophthalmologists and so-called in-sourcing, in which doctors who wish to can work extra operations (and get paid for it). This year's Budget included $118 million for slashing waitlists and some of that cash will cover this added cost.
Ophthalmologists have been calling for this move for a long time and they're ready to roll it out. That isn't necessarily the case for every health issue, each of which will have its own complex and unique barriers to overcome.
So while the solution is in theory simple – just even out all of those clinical need thresholds across the country – it isn't as easy as flicking a switch.
"Officials are working on advice on what we can do next," Verrall said. "In general it would depend on the logistics of that. The number of operations we would need to do, what the picture is across the country. That sort of process just takes some time to make sure that we can, once committing to do it, get through it."
Eventually, Verrall says, these reduced thresholds will apply to every health issue, everywhere in New Zealand.
It's an example of the brute force imposition of ministers' demands on the entire health system that is only possible with the centralisation reforms.
Alongside the winter plan, which saw a similar level of ministerial meddling in operational matters, this postcode lottery plan is one of the first major initiatives to take advantage of the new powers.
Come July 1, 2024, Verrall will be hoping for a whole new narrative when Te Whatu Ora blows out the two candles on its birthday cake.
