09 May

Focussing Health

Published by MacDoctor on May 9th, 2009
8 Comments »

Tony Ryall has announced that the ten health indicators of Labour have been pared down to 6. I have already blogged on how I thought those targets were hopelessly unfocussed and soft. Particularly the four that have been removed. As usual, the media have provided no hard analysis of the four that have been removed, preferring to record the frenzying of the drones who stand to lose their livelihoods. Here (PDF) is the original paper on the health targets. The removed and modified targets are:

Target 2: improving oral health – Dentistry is important, but it is hardly a critical health indicator. Is there any member of the public who thinks the health system is failing because they see a person with bad teeth? Oral health indicators are almost meaningless as a marker for the success of our health system. They serve only to distract DHBs from the vital things such as ED functioning and surgical and cancer waiting lists.

Target 5: Reducing avoidable hospital admissions – This has been changed to the more easily defined target of reducing ED waiting times. Determining whether an admission was truly avoidable or not is fraught with difficulty. Many admissions to hospital, for instance, are not made for medical but for social reasons. Are these avoidable? Yes, but only if there are much better social systems in place, especially for the elderly. This is hardly within the ambit of DHBs.

Target 7: Improving Mental Health services – This, of course, is a worthy goal and Ryall says that it is still National’s aim. But the index marker for target 7 was the production of written plans for mental health patients, not actual mental health outcomes. Essentially, they were monitoring the paperwork, rather than patient care, mainly because outcomes are very difficult to measure in mental health. This was not a helpful target for DHBs and Ryall is right to remove it.

Target 8: Improving nutrition and physical exercise and reducing obesity – Another set of targets that have very little to do with the functioning of the health system. No one argues that these things are not important, but they are a poor fit with the medical model of health. Obesity, for example, is not a medical problem but a social problem with medical consequences. The health system manages certain types of preventative health (vaccinations, blood pressure and cholesterol checks) quite well but generally handles social problems poorly. Obesity requires a holistic approach rather than a medically driven one.

Target 10: Reducing the percentage of the health budget spent on the MoH – Another worthy goal, but hardly a measure of the success of our health system. I think we can trust National to attend to this without the incentive of targets.

Labour doubled the health budget in a decade and had precious little to show for it. Public perception was that the health system was worse, rather than better. The original health targets were specifically designed to give the impression that Labour was making inroads on improving health. By padding the program with soft targets, they ensured that the impression would be a positive one (which they then used just prior to the election). Ryall has taken this self-promotion and made it in to a real tool to measure DHB performance. He is clearly on the right track here as the outrage of the bureaucrats indicates:

“Obesity Action Coalition executive director Leigh Sturgiss said she was disappointed for the “myriad” health workers who had been working on nutrition and exercise initiatives.

““There’s just unequivocal evidence that we are getting fatter as a nation and we need to stop the increase in obesity, particularly with our children.”

“She questioned where responsibility for nutrition, physical activity and obesity fell if not with DHBs. “It’s too big for the individual person to cope with. You need a supportive environment.” [Emphasis Mine]”

“Myriad” health workers? Doing what, exactly? Apart from a couple of advertising campaigns and some annoying lawmaking, I have seen nothing useful come out of the efforts of these industrious hoards. And the reason why is obvious. They think it’s “too big for the individual person to cope with”. This is despite the fact that it is only the individual who can take responsibility for his lifestyle. No amount of nannying will help a person exercise and eat right. Such a change of lifestyle can only come from conviction – and conviction is not the same as persuasion.

It is exactly this sort of frivolous, barely accountable bureaucracy that these new targets will do much to counter. The trick is to pin down the targets with hard numbers that cannot be fudged and make sure that the right people are held accountable for them. So far, these targets seem like a good start.

Now that there are 40% fewer numbers to monitor, could we have 40% fewer pen-pushers, analysts and advisors monitoring them?

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