Grey Power New Zealand General Health Policy

In 1998 we, Grey Power New Zealand Federation Inc as an organization, presented An Accord on Health.

This had the following mission statement and this we still promote and endorse.

Mission

To protect and promote the health of New Zealanders through the public health system.

Introduction

In our introduction to that policy we stated that there must be no further disruption of an already severely traumatised service.

We had hoped that any change of ideology direction would be under a consideration freed from narrow partisan political ideological objectives.

Regrettably, this in our assessment has not happened and we are once again in the throes of a major change that has created 21 different health systems throughout New Zealand purely for the political purpose that this will enable better public participation which could have been done by elected members to the Boards of existing HHSs.

Such evidence as follows

  1. The Minister's own particular advisers, the National Health Committee, detailed a specific arrangement for the elderly health to be a continuum of care which although being the tenth time this has been recommended, still remains unimplemented.
  2. The inclusion of rural hospitals under the auspices of the District Health Boards may seem insignificant but many of these have previously been threatened with closure and there is no guarantee that as the District Health Boards are centred on emergency hospitals, that the position has changed.
  3. The National Health Service Report in Britain showed that the centralisation policy they have been following (which we had adopted under the previous government), is not producing hoped for results in terms of economy of scale and quality of service - rather the contrary. We have doubts that the establishment of 21 different health systems is the right answer especially since administrative costs have escalated so much that a very substantial portion of the health dollar is absorbed in administration.

The overall impression is still one of confusion.

The public perception still remains as one of anxiety over access to care. There is also widespread anxiety over the pressure exerted upon quality of care by under-funding and resultant under-staffing.

We are told that modern technology has produced an insatiable demand for new expensive treatments that the State cannot fully fund and that therefore rationing is inevitable. Such belief continues to pervade all present Government health policy. It is not however, supported by the experience of countries such as Germany and Holland where there has not been any overwhelming increase in demand even though both countries fund virtually free services and have very short waiting lists.

On the other side of the argument, no estimate exists of the negative costs - financial or social - incurred by delay or non-provision of treatment when health care is rationed. Surely community health status should be based on the degree to which we eliminate poor health not the degree to which we propagate it by the imposition of poorly conceived economic restrictions upon clinical necessities.

We need a Parliamentary Accord on Health.

All members of the Grey Power Federation have common belief in the safeguards of a Parliamentary democratic process that is not limited to their election of the House of Representatives but allows them further, during the term of the Government, to participate in the continuing democratic process.

In Grey Power we believe in a shared responsibility for vulnerable people of all ages and for any who have no voice of their own. Citizens of a true participatory democracy in fact, not just as part of political rhetoric, should be able to see that same belief reflected in the policies and actions of any Government we elect.

Recent events have severely damaged this belief to the extent that to safeguard the most precious of our social services, that of health, we believe the time has come for all politicians to put aside party politicking and embrace a Health Accord.

The current political health agenda places over-riding emphasis on cost rather than value or health benefit. Sick or injured people in urgent need rarely have time or opportunity to exercise any choice - they must accept the service as and where it is available, not choose the one that suits them best.

The only recourse management appears to favour still lies in reduction in health staff and health services - but not in management where it seems that it takes more managerial staff to close hospitals or reduce services than to maintain them. This still remains in the current system as each District Health Board has to duplicate what were central provisioning services.

Waiting lists continued to grow, public confidence still falls, many smaller hospitals lose specialists. Now small and many not so small towns are being forced towards consideration of Community Trusts as they look for any means to save the specialist services at local hospitals.

Trusts are at best a short term expedient answer - a first step to privatisation and a recipe for long term disaster undertaken by communities in desperation as they face the threat of hospital closures.

Once responsibility for management and delivery of health services is accepted by the community it becomes totally vulnerable to future political funding decisions.

We own the health system, the education system, the police and justice system. We pay the taxes that support all these things. We have reasonably thought that we elected and paid Politicians as our servants to administer the departments of state according to our wishes. We have said repeatedly and clearly that we preferred maintained social services to tax reductions.

Isn't it past time for us all to stop for a moment and ask ourselves the unashamedly emotional rhetorical question "Who are we - what are we?" Are we truly citizens of a participatory democracy or are we content to accept a deteriorated system of corporate self interest government whereby the wealth based power of the few controls decisions that effect us all?

We desperately need a commitment from all political parties, all health professionals and a large majority of the population for an end to partisan political treatment of the health of the country.

In these areas of social concern of which health is a prime and perhaps the most immediate example we are talking about the very elements of basic democracy that made New Zealand the one time envy of the world. We have allowed them to be subverted by an alien philosophy of material greed to which we did not subscribe and of which a great majority still do not approve.

We must work with all people of goodwill to relieve the poverty illnesses of rheumatic fever, hepatitis, tuberculosis and meningitis so often associated with poor housing.

We must have a Parliamentary Accord on health that interprets the declared will of the majority of the citizens of New Zealand.

Our General Objectives still remain the same.

  1. To remove basic health structures from the adverse effects of repetitive, ideologically driven, politically instituted change following almost inevitably upon change of the party in power.
  2. To introduce an over-riding authority capable of bringing co-ordination to artificial divisions within the health sector and between the many social elements ( e.g. housing ) which influence health outcomes

Specific objectives

  1. To preserve a fully funded public health service as a clearly requested priority before tax cuts or even with accepted specific targeted tax increase.
  2. To establish true dialogue with the public - based on full information to establish basic funding principles and resource allocations and to allow consultation on an equal footing about matters of vital future importance such as General Practitioner bulk funding, capitation and budget holding. We deplore the current trend in the establishment of advisory committees with a majority of Board members - this does not further public input but just pays token respect to the principle of public input while ignoring it.
  3. To recognise the continued public demand for elected representatives on health bodies when considering basic structures for management and control of health institutions and agencies - leading to openness, transparency and accountability. The inevitable politicising of the voting for the Board members because the election is at the same time as the local body elections is not acceptable.
  4. To assure citizens of certainty of access to necessary and appropriate health services - community based, hospital based, including Maternity Childcare, Eldercare, Ethnic special needs, Rural, Pharmaceutical etc.
  5. To ensure that existing social policy and all proposed changes give full consideration to effects on the underlying causes of poor health in New Zealand - such as poverty, poor housing, unemployment and poor educational attainment.
  6. To recognise the effects on health of increasing costs of basic utilities such as electricity, water, car registration etc. for people on fixed or low income.
  7. To recognise in private health insurance
  8. To ensure that there should be no privatisation of existing services without unanimous agreement of the Accord Committee or agreement by the community affected .To also ensure that any treatment of private patients in public facilities is strictly in accordance with the protocols now in force and that these protocols are effectively policed by the MoH.
  9. To consider specifics within the health system such as independence of the Public Health Commission and the need for both the Commissioner for Children and the Mental Health Commissioner to be Officers of Parliament and appropriately independent. These three distinct areas within the Ministry of Health exhibit clear evidence of bureaucratic centralisation that does not serve the purposes for which the Commissions were established.
  10. To establish an overall plan to co-ordinate the activities, curriculums and financial responsibilities of those providing the education of the medical/nursing professions in the universities , medical schools, teaching hospitals , training organisations and general practice so that there is an identifiable aim and purpose in the various activities that provides a pathway to patient care and continuing research to improve that care.
  11. To have adequate legislation to ensure that residents of retirement villages are adequately protected by legislation on entry, during occupation and on exit from an arrangement to reside in a retirement village.
  12. To have the present regime of asset and income testing for long term geriatric care in Rest Homes and Hospitals repealed so that those requiring care in the 50 single and 65 married age brackets are not financially penalised by virtue of their age.
  13. To re-establish the A T & R units in all District Health Boards' areas so that the elderly can be properly assessed, treated and rehabilitated.

We consider the proliferation of Rest homes is not in the interests of the elderly as the economics are based on occupancy. We consider that there should be only a limited number of Rest Homes registered to take subsidised and other patients so that occupancy figures are high before the registered number is increased. We also are concerned with staffing levels and quality of staff.

We must have a Parliamentary Accord on health that interprets the declared will of the majority of the citizens of New Zealand and not a system that reflects the aspirations of any current government.

Dennis R Paget
Health Spokesperson
Health Committee
Grey Power New Zealand Federation Inc.