National Health (Board)

I see Labour is bellyaching about the proposed new National Health Board again.

“Labour’s health spokeswoman, Ruth Dyson, said Mr Ryall had already make up his mind about the future direction of health services.

““This is more about Mr Ryall trying to impose his own vision for health than about a genuine attempt to make the current health system work better,” she said.

““A strong Ministry of Health entrusted with promoting national priorities, combined with DHBs managing health needs within their own communities, is a far more compelling recipe for improving frontline services than simply adding an expensive layer of national bureaucracy on top of what already exists.”

“Ms Dyson said an NHB looked very much like the failed Health Funding Authority model of the 1990s.”

A strong Ministry of Health? Really? The Ministry of Health under Labour has spent nine years massively increasing bureaucracy in the system by insisting on endless reports and statistics for no apparent reason other than to occupy the time of people in the Ministry of Health. The absolute last thing we need is to give these people more responsibility!

This is not to say that the Ministry has no use. It is vital that someone translates government policy into actionable items. It is just as important that the MoH not be allowed to have executive function. Bureaucrats make lousy bosses.

And the NHB looks absolutely nothing like the HFA model – although it could do, if Tony Ryall really wanted to screw things up.

A National health board is, in my opinion, good for one thing only – purchase co-ordination. I do not mean this in the HFA sense of purchasing medical services. That is a model that would only have worked in a medical economy about 10 times bigger than ours. No, what I mean is the co-ordination of buying programs for items that all DHBs require. For instance, monitors, defibrillators and ventilators (I can hear anaesthetists screaming in the background, because they can’t have their favorite ventilator). Frankly Pharmac could be devolved into the NHB with no real loss and considerable administrative savings. Co-ordination of software rollouts across the country and provision of a national database would be possible. All of the national prevention programs, including vaccinations could be placed here, freeing the DHBs to concentrate on local services, as they were originally meant to.

Savings would be considerable as each DHB would no longer have to duplicate a national service. Purchase coordination would also mean that New Zealand could obtain the best prices for electronic equipment by nomination of a preferred provider who gives a substantial discount , even though a hospital may only be purchasing a few pieces of equipment. A National Health Board would also take the pressure of smaller DHBs to amalgamate with larger DHBs as their local function would become clearer.

There is also no reason why the NHB should not have oversight of the provision of services, as long as it does not degenerate into the ridiculous micromanagement of the old HFAs and their DRGs. (note to Mr. Ryall: never allow anyone to attempt to use a research tool as an economic performance indicator – please)

And a little gem from the doctor’s union to close:

“The Association of Salaries Medical Specialists said it creating an NHB would risk “a paralysis in decision-making”.”

And they would know…

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