That was the i97os-3. Health

Press, 4 January 1980, Page 11

That was the i97os-3. Health

By

JOHN BROWN

New Zealanders are no ' healthier now than they were 10 years ago; and the health system which should- meet- their- needs ; faces a bleak future.’-’ ! : Weighed down by huge cost increases; poor planning, and a stop-go policy of reform,, the health system has made only piecemeal advances in the last decade. Diagnostic services have mushroomed, but the demand for modern technology can no longer be met 'from existing resources and long delays are commonplace in introducing new . ideas. These are not introduced as a result of forward-looking policy decisions made in this country but as a response to pressure of overseas medical experience.

The message as we enter the 1980 s is clear — New Zealand can no longer afford the cost of modern health services in all parts of the country. The decade started with S2OOM being spent on health. It will end with a health vote near SIOOOM. Most of this money is

spent on hospitals for which the Government has given clear direction — to make more “efficient and effective” use of them.; :• This 'call, an urgent one if the rate of Government expense of health is to be levelled off, was not matched at any time in the 1970 s by a comprehensive health policy acceptable to health administrators. The one attempt in a White Paper of Health in 1974 to set out a modern health plan was dropped when the Labour Party was defeated in 1975. This proposal is now slowly creeping in by the back door, with regional health schemes similar to the 1974 suggestion, running in Northland and Wellington. Central Government, however, maintain as strong a control as ever on the purse strings, and hospital boards, the last bastion of medical parochialism, are forced to be little more than rubber stamps for decisions vetted bv the Health Department in Wellington. Decentralisation first hinted strongly in the

early 1970 s is now little more than a dream, and it will take a strong political decision to change this. Hospital boards, many of which have annual budgets ■ exceeding S4OM —■ larger than most commercial companies — are forced in the main to make do with inadequately qualified executive staff as the Health Department does not allow boards to pay salaries of a level which would attract more highly qualified executives. Patients entering major hospitals in 1970 could confidentially expect that a full range of technology would be available there to help them. Now the cost of this technology has ruled out such hopes. The clamour of the large hospital boards for their right to every piece of new equipment has not been met by Government, and in the future it will be a matter of taking people to where the equipment is rather than having it available in all large hospitals. Predictions that there will soon be a surplus of

doctors in New Zealand are cold comfort to parts of the country that cannot get a doctor. A view that the country could have saved '-large -amounts by not setting up clinical schools in Christchurch and Wellington is not shared by professionals who point out that the 1970 s had seen a surge forward in medical education as a result of the setting up of these units.

The new sense of medi-

cal scholarship engendered by these clinical schools has not, however, managed to attract back to this country some of the most talented medical personnel who, for better salaries and conditions, have been lured overseas. Without highly competent leaders the health system cannot avoid a dangerous period of recession. Nursing education grasped almost without proper consultation from hospital board control by the technical institute sys-

tern progressively since 1973, is not producing as many trained people'as the hospital-based schemes. A shortage of nurses is likely in the early 1980 s. No long-range policy on ■nursing education, has been given to the boards, and even though 43 per cent of nurses are now trained by technical institutes the boards consider that much more consultation with them must be made before the system

is totally run by the technical institutes.

A flurry of activity through the country’s 29 hospital boards in the last three years of community health schemes funded from the Government’s “beer and baccy” tax, has not met the needs of large numbers of disadvantaged groups and ethnic minorities. No national plan exists for this new health care programme and little research has been done to justify some of the schemes already getting

grants.. At the same time many of the. programmes which have proven their worth have suffered financial cuts along with community programmes as yet unproven. ■ • The new community-, based schemes • are not always welcomed by hospital board’s which see the traditional role of hospital care under threat, yet the boards are expected to administer the community programmes.

The most controversial health meashre of the 19705, the change in the country's abortion law, has now settled into the health system, with earnest attempts being made by- State hospitals to cope with the demands -of the law.

Legislation in 1972 which made accident compensation available to all has brought widespread benefits to thousands of people but has also unwittingly created a “class” of less privileged disabled people — those whose disability is not caused by an accident and who do not qualify for help- from the

Accident Compensation Commission. Disabled people generally are still forced to cope with an institutional approach to their status and the impetus gained by .the passing of the Disabled Persons’ Community Welfare Act of 1975 lias not been matched with a concerted effort to integrate disabled people into the community. Because of the slowness in implementing the Home Help Service, many disabled and elderly people will be forced into institutions instead of staying in their own homes. Disabled people comprise about 10 per cent of the population and their care is a substantial cost on the health system, yet no effective co-ordination of services exists to meet their needs. Voluntary groups dissipate their efforts in a frustrating and costly amount of duplication within a system without a national plan, without any modern philosophy, and almost totally bereft of adequately trained professional staff.

One of the brightest hopes for a more positive approach to health care in the last decade had come in the field of preventive health care, such as the concerted attack on alcohol abuse and educational programmes to discourage smoking. People are now being told plainly that they must take more responsibility for their own health. To do this effectively, however, will demand a greater input of finance and personnel, as well as new methods.

Effective programmes of preventive health care will also demand a healthy system less dominated from the centre through largely powerless hospital boards, and more attuned to the needs of each community.

Few hospital boards can say with any accuracy that they know the health needs of their districts. Finding what these real needs are and marrying them to an effective system of regional control is the health challenge for the 1980 s.