AGENDA Transcript – Hodgson And Ryall

AGENDA Transcript – Hodgson And Ryall

June 24

Presented by LISA OWEN

LISA The Health Ministry has given District Health Boards until the end of September to cull almost 17,000 patients from waiting lists. The idea is to make sure that patients aren’t left languishing on those lists for more than six months, but it's new like this along with the junior doctors' strike and talk of a GP shortage that suggest our health system is facing a crisis. To debate this today we have the Health Minister Pete Hodgson, he's in our Dunedin studio, and National spokesman Tony Ryall who's in Rotorua. Good morning to you both gentlemen.

Starting with you Pete Hodgson can you tell us how much you're prepared to throw at the health system to make this problem - to make the critics shut up basically.

PETE HODGSON - Minister of Health

Oh we don’t throw money at the health system we just have steady and serious increases which we seek to be spent in a cost effective way and that’s why we've had some troubles lately, for example in the case of the roll out of low cost fees for everybody it was really important that we had a contract with GPs where they didn’t have an ability to just sort of pocket the money in subsequent years, not that that’s a big problem now, I do stress that we don’t have too many recalcitrant GPs at all, but we did need to future proof that scheme so we had to have negotiations to that end, they were settled on Tuesday morning I think and we now do have a very substantial change in our primary health care system, we do have lower fees, we do have lower prescription costs and we do have a future proofed system, by we also had a while to get there.

LISA The thing is though isn't it that there is a finite amount of money to put into this issue and there is rationing, there's hard choices to be made so who in your view should miss out when we don’t have enough to keep pouring money in there?

PETE Well in the case of the primary health care system we don’t have any rationing at all, people go to the GP when they want to and we have one of the most responsive primary care systems in the world, people can get to their GP often on the day that they want to certainly within a day that they ring, but that’s unusual in other countries.

LISA But you have waiting lists for elective surgery, people on waiting lists to see specialists.

PETE Well there is always electives, electives are quite a small part of the health system but you're absolutely right, there's always prioritisation for electives so some people are taken into the system given their specialist's assessment, given their surgery, some people are asked to wait and that always causes strife, but in New Zealand again unlike most countries or many countries if you are acutely sick you will be seen, either by a GP or by your hospital, we don’t have a situation in New Zealand where we have ambulance bypasses as they sort of rush around the country looking for a hospital who will take someone, we should be pretty proud of that.

LISA But for example statistically older patients cost us more once they get past the age of 85 they cost the health system significantly what about preventable diseases like diabetes, are these the tough issues we should be looking at?

PETE They are tough issues that we should be looking at and that’s why we put all this emphasis on primary health care, you might have seen some news yesterday which showed that a third of all of the people who went into hospital at Christchurch had what they call an avoidable admission, in other words had we been able to get those people to good primary health care early enough and often enough they wouldn’t have had to go to hospital and that’s a very substantial saving for that particular hospital, it was a hundred million dollars a year or thereabouts, that’s why were placing so much emphasis on good primary health care and that’s why we now have lower fees, we also have more valued GPs, a GP is earning a great deal more than they were a few years ago their salaries are up very significantly and we celebrate that. If you're gonna value something you need to pay for it and I think what we're seeing is the development of lots of GP led primary care teams involving nurses, podiatrists, pharmacologists and psychologists and lots of other people whose job begins with P, so that we end up with a team based approach to this primary health care future.

LISA Let's bring Tony Ryall in here, Mr Ryall this is not a picture of a health system in crisis according to PETE Hodgson so what can you disagree with about what he's saying?

TONY RYALL - Health Spokesman, National

Well I think the Minister of course wouldn’t say that there was a crisis in the health service, but I think if you talk to many of the tens of thousands of New Zealanders who've been culled from hospital waiting lists who have been promised operations and dumped from hospital waiting lists, the people who are trying to get a GP but can't get on their books in various parts of the country these people would tell you there are very real problems with the public health service and they’ve got to be dealt with.

LISA Mr Hodgson what do you say to that?

PETE I think Tony has become a specialist in beating up a storm, he says that our elective surgery is going down when it's going up by 15%, he says that people are being chucked off the waiting list this year, actually the sad thing is that they’ve been returned to their GP every year since this system was being introduced and I'm trying to put a stop to it, and also to give you some context about ten or15,000 people are returned to their GP unseen but about 450,000 are seen by the specialists, so it's about 3% but for those 3% that’s failure and I don’t think it's good enough. He says we're not ready for the pandemic flu the World Health Organisation says we are you know more ready than most countries and on it goes really. It is the Opposition's job to beat up a storm and I'm not saying everything's fine in our health system, it certainly isn't, but by goodness it's a pretty good health system.

TONY Well look this is a Minister that is in denial, in fact this is a government that says that it's put billions of dollars in health over the last five years, but what we know from the government's own figures is fewer New Zealanders are getting elective surgery today than five years ago, we've got District Health Boards flinging tens of thousands of patients off waiting lists, we've now got the extraordinary situation we haven’t seen in this country for quite some years where senior surgeons are speaking out and saying the government ordered edict to dump thousands of patients from the waiting lists unsafe and dangerous. Now look we think that there is a very important priority in the health system and that’s dealing with this backlog of elective surgery and that really has to have more priority from the government. What we know from DHB after DHB is that you have to be sicker to get an operation in this country today. We can have all the flannel we like from Mr Hodgson but that’s what his own DHBs are saying, you have to be sicker to get an operation, the same number of people are getting elective surgery than five years ago, for this population growth we are falling behind.

LISA Let's bring the Minister back in here to respond to that, I mean he has a point doesn’t here, there are a hundred thousand plus people who are waiting for their first appointment with a specialist?

PETE Because 450,000 see a specialist each year you're always gonna have 100,000 waiting because you’ve gotta turn that number over about four times a year, the average waiting time's about three months so that’s just the case, it's always the case and if you're gonna have a three month average waiting time which is what we have in this country then if you're gonna see 400,000 people a year at any one time 100,000 are gonna be waiting, but let's take a look at Tony Ryall's allegation that the number of surgery operations are coming down, it's nonsense they’ve gone up by about 15.6% if you look at some detailed bits, cataracts are rising by about 50%, angioplasties have already risen by about 75%, major hip surgery, that’s major hip and knee surgery is on track to double over four years, double, one of the highest intervention rates in the world, higher than almost any country except Sweden and he says not enough people are getting surgery. This is a good system it's just not perfect.

TONY Excuse me Minister, here are your own figures that you gave in parliament, let me quote this to you. In 200/2001 that’s your first budget in government 107,881 people got elective surgery, in your last financial year 107,208, that’s fewer New Zealanders getting elective surgery. Now there are a couple of areas where the government has put additional money in to lift the level of electives but overall we're having fewer people getting elective surgery and even your own DHBs are saying to get elective surgery in a public hospital in New Zealand today you have to be sicker than you were five years ago, you put billions of dollars in and it's actually harder for people to get elective surgery. Now we've got some ideas that could make a big difference here.

LISA What ideas Tony Ryall, what ideas, specifics.

TONY Well I'm gonna tell you, we've got a four point plan. There's a lot of spare capacity within the private sector both in private hospitals and the ability of GPs to provide lower level order care surgery for some of those people on waiting lists.

LISA Who's gonna pay for it Tony Ryall, who's gonna pay for it going through the private sector?

TONY Oh well we've got a very strong – the budget's ten billion dollars in the health sector, the DHBs with their half a billion dollars of bureaucracy wages, they can afford to buy additional services in private hospitals, they buy some now but there's plenty of scope for expanding that. The second thing we need to do is have greater involvement of the GPs and the specialists in deciding how the system runs, they tell me they're frustrated with the bureaucracy and the rules associated with trying to get their waiting lists down, many of those waiting lists for example to see a specialist are GPs who've referred people to a specialist so they can get referred on to some diagnostic tests within a hospital, we've got to streamline that. The third thing is let's reward the people in our system who are trying to cut the bureaucracy, we know there is a lot of that going on in the system the paperwork, we know that the public service the bureaucracy in health has grown by almost 2000 staff in the last five years, that’s go to be dealt with and have a stronger focus on value for money, that will make a difference.

LISA Mr Ryall only 1.5% of the health budget goes on the Ministry of Health, 98.5% goes on actual health.

TONY Yes and I was talking about the DHBs, Helen Clark said she was gonna cut out a whole level of bureaucracy after the 99 election, she's created a multiplicity, in the DHBs the number of hospital managers and administrators has ballooned by 1800 that’s almost 23% increase within the DHBs you don’t have to have a manager for every two and a half nurses you employ.

LISA We've heard Tony Ryall's plan to shake up the health system, let's go to the Minister Pete Hodgson and hear his response. You heard what his plans are what do you make of it?

PETE Well first of all it's not a policy it's a four point plan with three points in it, but responding to those three points one of them was can we use the private sector more, one was can we have GPs and specialists working more closely together and taking more leadership, and one can we cut the bureaucrats. The first point, we already are, there is not a huge amount of capacity in the private sector but DHBs can and do subcontract to the private sector and from time to time that works well including involving GPs, for example in more recent times we've started educating a whole lot more GPs into doing plastic surgery, little wee bits of plastic surgery which they are really good at and some of the GPs with a specialist interest can do quite complicated stuff. Secondly the bit about GPs and specialists working closer together and specialists taking more leadership within the hospital, here we have National Party and the Labour Party agreeing so that’s great, I thank Tony for his comment, I would assert that that’s also important and that we need to do more of it. As to the third point can we please cut the bureaucrats, this is mythology, we have a reducing proportion of our workforce as bureaucrats, Tony forgets to mention an extra 4000 nurses and extra 1200 doctors since we became the government, but the other point is this who the hell's gonna answer the phone around here, who's gonna set up the outpatient clinics, who's gonna pay the staff, you have to have some people who are support staff administrators, you can call them bureaucrats if you like but frankly you can't run a hospital without them.

LISA Mr Hodgson I want to ask you I mean nobody doubts that you are spending a lot of money on health but are you getting value for money? I mean in 2004 there was a letter from Mr Cullen to Miss King saying that his officials noted that there was still overspending continued overspending, Treasury raised concerned about the health spend in this year's budget, it didn’t support some of the proposals because it thought they weren't value for money, are you getting value for money for all our tax dollars in the health area?

PETE Well we did have support from Treasury in this year's budget, the overspend is an issue, DHBs managed to overspend by about 1% of their total budget which isn't a lot but it is also an overspend and it's not okay and they have to bring it down to half a percent and they have to get rid of it altogether, so I do acknowledge that, but it is not exactly a system out of control.

LISA Alright let's bring our panel in now, first we'll got to Jenni McManus.

JENNI McMANUS – The Independent Financial Review

I've a question for both Pete and Tony, I think this is one area where the public is dissatisfied, the staff are dissatisfied and the taxpayers are dissatisfied, health, I think most people would agree on that. I'd like to ask both of you why it is that we haven’t tried to take some of the pressure off the public system by allowed tax breaks for private hospital premiums.

LISA Tony Ryall can we hear from you first on this point?

TONY Well we've considered that on a regular basis from the National Party point of view, I'd just say this, the cost of providing a tax rebate for private health insurance, say if it was 300 million dollars the question we have to ask ourselves is can we get better health outcomes for those most at need by spending that money elsewhere. I think there's a real importance to get more support for private hospitals in getting the public funding operations there but it's a matter of priorities, we've got limited resources, I want the money targeted where I can get the most for it and that may not necessarily be private health insurance.

JENNI But do you have any evidence that it wouldn’t and the one thing it would do of course is give patients some control over the health care and what's happening to them.

TONY Look I think the important thing is what can we get for that money, now we do have to have a look and see what benefits can come from further investment in private health insurance but I have to say my experience has been looking over the years that money can be better targeted to get services for those most at need.

LISA Alright let's hear from the Minister on this point.

PETE We do know the answer and we know it with some precision, if we were to spend Tony's 300 million dollars on a tax break for people who get health insurance we would end up with about 150 dollars worth of extra health care, whereas if you spend the 300 dollars directly on the health system you get 300 million dollars worth of extra health care that’s roughly a two to one loss.

LISA Alright let's bring in Colin Espiner here, you're question Colin.

COLIN ESPINER – Political Editor, The Press

Mr Hodgson I was just going to ask you mentioned that report earlier about the New Zealand Medical Journal report into the 93 million dollar spend at Canterbury Hospital which could have been avoided. Now I've been extrapolated that out nationwide that comes to some one billion dollars I believe.

PETE That sounds about right.

COLIN When you look at the fact that all these specialists around the country are dumping patients off the waiting list so they're not seeing the specialist we've got a situation here where you could argue that’s the problem that you’ve made for yourselves because you’ve got all these people that aren’t managing to get into the system and therefore aren’t being seen.

LISA How do you fix that problem?

PETE I don’t think that’s the correct analysis, if you have a look at the paper you'll see that these are people with cardiovascular disease they’ve had a propensity for stroke, they’ve had diabetes etc, these are things that can be managed much better, this is not much to do with not seeing a specialist it's a much earlier problem than that, it's a problem with getting to see your GP early enough and often enough when you are beginning to develop chronic disease and that’s what the paper shows, what's really interesting is that our avoidable hospital admissions started going up in the late 80s and they went up right through till the mid late 90s, they’ve since plateaued, but we do know that we can bring them down because 20 years ago they were lower than they are now and it's a very very important opportunity for us to reduce hospitaLISAtion and cost and the secret is the primary health care strategy.

TONY May I comment here?

LISA Tony if you can have a last word.

TONY The Minister's yet again talked about GPs and the role that they have to try and prevent these people getting to hospital that’s fine, but the government is ignoring the growing GP crisis there is in this country. I was in the Kapiti Coast last week there's almost 800 people there who can't get on a GP's books, newspapers have reported people having difficulty getting on a GP's books in Gisborne and Timaru.

LISA Alright gentlemen we could debate this for the rest of the morning, thank you both to the Minister and to Tony Ryall.

UMR INSIGHT POLL

LISA Well each week from now on thanks to the pollsters at UMR Insight we'll be bringing you an insight into political trends in the country. Now this week in the wake of the Green split over dog microchipping we thought we'd have a look at where their support is coming from. Now these figures are from UMR Insight's June nationwide political poll and they show the Green's surging on 9.8%, but when you break that down you find that they get on 8.6% of the vote in Auckland, 6.7% in provincial New Zealand, 12.8% in Christchurch and 7.4% in rural New Zealand, and an extraordinary 22.8% in Wellington, well who said the capital was going to the dogs eh.

FINAL THOUGHTS FROM GUEST COMMENTATORS

LISA Turning to our panel for their final thoughts from the day let's start with Jenni McManus, what did you take from the health debate?

JENNI Well actually I was highly unimpressed by the health debate, I mean nobody denies a lot of money is being spent on health it's where it's going. It seems to me that there's no coherence in the health system, we need to do something radical, I think the government could do something radical at this stage in the electoral cycle, they could do a quick audit of the health system and just find out what's actually going on instead of the ad hoc throwing a couple of billion here and a couple of billion there, and most unimpressed also by this business of sending people back to their GPs if they're on waiting lists I mean what the Minister is calling elective surgery some of this are people who need hip operations desperately they can't walk, what's the point of sending them back to their GPs, do they expect the GP to do the operation, and with Tony Ryall I would like to see some actual policy out of the National Party not just three or four point plans, I think by this stage he's been in the chair long enough we need to see clearly what National would do specifically to fix health.

LISA Colin your thoughts?

COLIN Well sorry to bring up the mythological taxi driver but indeed I did jump in a cab last night on my way here and then the conversation turned to what I'd be doing this morning and of course the moment he heard that I'd be talking to Pete Hodgson he started telling me about his dodgy hip, but in actual fact what had happened to him was he'd been told he'd be on a waiting list for several years, he decided he wasn’t prepared to do that, he dug into his own pocket spent 14,000 dollars and got it done privately, says it's the best 14,000 dollars he's ever spent, so you know there are those ongoing tensions there.

Like Jenni I wasn’t terribly impressed I think Pete Hodgson at the moment is a little bit like a possum in the headlights, just looking at it from a political perspective he's taking on probably the most difficult portfolio in government at a very difficult time, I understand he's been told by Dr Cullen to put the screws on health spending, Annette King had something of a dream run when she was doing it, she'd also been the opposition spokesperson before that so she knew the round a lot better and she got on quite well with some of the DHBs, Pete Hodgson slightly more prickly a character too.

LISA Thank you to our panel this morning.

ENDS