Source: Association of Salaried Medical Specialists
How do we ensure our health system is capable of meeting current needs, responding to a future pandemic, and helps rebuild the economy – it all starts with this month’s Budget writes ASMS Executive Director Sarah Dalton as published in The Sunday Star Times.
We are lucky that our hospital capacity has not been tested by the Covid-19 pandemic.
The ‘go hard, go early’ response from the government was necessary. It knew the health system was in no shape to cope.
Our lack of pandemic preparedness showed up as recently as last October when the Global Health Security Index (GHSI) gave New Zealand a score of just 54 out of 100 points and ranked us 30th among the 60 high-income countries reviewed. New Zealand scored poorly in early detection and reporting of epidemics, along with the availability of doctors and hospital beds.
Pre-Covid, hospitals were already on the edge. We have medical workforce shortages and not enough acute hospital beds. Infrastructure is creaking and waves of patients are missing out on treatment. Typically, hospital occupancy in urban centres is at or beyond 100% and that is without factoring in winter surge. We cannot afford to return to these occupancy rates as part of the new business as usual.
As hospitals gear up and elective surgeries resume after the four-week lockdown, District Health Boards are facing an estimated backlog of well over 20,000 elective inpatient treatments, along with thousands more outpatient treatments. A further estimated 60,000 specialist appointments were also parked. The Southern DHB Chief Executive told a Board meeting last week that it could take a year to catch up on cancelled and postponed surgeries. We think he’s being optimistic.
The Covid backlog comes on top of what is already a massive group of patients who are missing out on treatment because they are “not sick enough”. We estimate that number is close to half a million New Zealanders.
Let’s stop for a minute and reflect on that: around half a million kiwis do not have access to the specialist care they need.
This “unmet need” includes people with non-urgent conditions whose treatment is deferred because hospitals are too full, and they do not meet treatment thresholds. A number of these people experience significant pain, and reduced quality of life while they wait for care. Another way to describe unmet need is health rationing.
The Government is now faced with the task of addressing unmet need plus current need as well as increasing the health system capacity to meet future shocks – all while rebuilding the economy with less tax revenue. This is a tricky equation to solve, and one that needs flexible thinking.
We need a policy mind-shift, from perceiving the health spend as a drain on the economy, to recognising that it is part and parcel of achieving economic growth as well as our people’s health.
Investment in health services creates jobs and income, directly and indirectly. Hospitals are among the biggest employers in the regions, and staff income generates wider regional employment. Treat the people who are waiting months and years for surgery, get them healthy and they will also be better able to contribute to our economic recovery.
Last year an ASMS-CTU health budget analysis conservatively estimated that a decade of health funding shortfalls meant this year’s budget would need over $2.5 billion extra just to restore the value of funding to the 2009/10 levels. And those levels were far from ideal.
The Covid crisis has exposed many shortcomings, particularly in our public health capacity and the government has already announced extra resources for public health units and to boost ICU capacity.
But if we are serious about rebuilding our health system, we need additional operational funding of $1 billion in this year’s budget, along with an indication that the accumulated shortfall will be addressed over the next four years.
Putting the numbers aside, what we really need to see are better conversations about how we are going to manage this massive health need, both now and in the future.
Part of this is meeting current demand with current workforce, but part of it is looking at training, succession-planning, access to balanced, manageable workloads for frontline health workers, and management of existing patient backlogs.
Investing in health takes longer than one electoral cycle. So, let’s remember something else we’ve learned from lockdown – let’s be kind to current us and future us – let’s agree that timely, affordable access to healthcare is important to our country. Let’s invest in a shared vision for our health system, embodied in a multi-party political accord.
Only this level of commitment, investment, and planning, will help us all to get well and stay well – soon.