Source: Association of Salaried Medical Specialists – Press Release/Statement:
Headline: Counting and choosing when it comes to health
One of the things that Covid has taught us is that our health system is fragile. It needs to be protected. It needs to be shored up. It needs sustained investment. ASMS Executive Director Sarah Dalton looks at what specialists and the health system need to see in this year’s Budget in an opinion piece for the Sunday Star Times.
Budgets are all about numbers, right? Economists argue that budgets are as much about making choices as they are about numbers. So, let’s have a look at both.
Our members are senior doctors and dentists who choose to work in our public health system, many deciding to come back to New Zealand after completing a decent chunk of their training overseas. We are lucky to have them all working in Aotearoa. We are lucky that many left viable, lucrative jobs overseas, and brought their skills home. The question is – will they stay?
New Zealand’s public hospital system relies on more than 2,400 overseas-trained specialists. That’s about 42% of our current DHB senior medical workforce. We need roughly another 1,400 specialists if we really want to get ahead of rising acute demand – that is the urgent or unplanned health care a person receives for an illness or injury. In New Zealand acute hospital admissions are increasing at more than twice the rate of population growth and displacing non-urgent admissions.
If we can’t get on top of this burgeoning health need, more of us will be doomed to life on a waiting list, of not being able to get a medical appointment when we need one, and when we do, being asked “do you have health insurance?” or “can you afford to go private?”
One of the things that Covid has taught us is that our health system is fragile. It needs to be protected. It needs to be shored up. It needs sustained investment. This is where the numbers come in.
Last year was the first time in more than a decade that health got a real boost in the Budget, but it was seen only as a first step. Even the Health Minister at the time said you cannot put right many years of under-funding in a single Budget.
In real terms, DHBs received $400 million in new operational funding, but because of their large deficits ($1 billion in 2019/20) much of that appears to have gone on helping them reduce their debt as the Government puts pressure on them to break even.
So, it is fair to say that the additional operational funding, while welcome, has gone largely unnoticed at the coalface.
The Government is now embarking on a generational health restructure which is due to go live in July next year. The cost of that is yet to be determined.
Irrespective of the shape of the new system, it will rely on its people and the skills and commitment of doctors, nurses, and allied health professionals to care for us when we are sick or injured, wherever we happen to be.
My question is this: how many of these critically needed workers will still be working in our public system come July next year? So many of them aren’t just metaphorically ‘sick and tired’, they are fatigued, burned out, tired of battling cramped spaces, old IT and infrastructure, and significant staffing shortages. In many hospitals, bed occupancy rates are regularly running at 100% with frontline cancer and mental health services, to name just a couple, desperately overstretched.
Since the government’s ill-advised “pay restraint” announcement we have had a deluge of emails from doctors and dentists who have had enough.
Here is a small taste:
“As a result of this announcement I have already looked at ads for my specialty in Australia and will continue to do so.”
“I and many colleagues I have spoken to who were contemplating moving more time out of public to private (but we’re not doing so at this stage) are now determined, this was just the push we needed!”
OECD data highlights our health worker deficit, especially in comparison to Scandinavian countries. New Zealand’s health and social care workforce comprised about 11% of the total workforce in 2018 while in Scandinavia it ranged from 17%-20%. In New Zealand there were 59 health and social care workers per 1,000 population, compared with between 84 and 107 in Scandinavian countries.
With our system facing major workforce shortages and carrying vacancies up and down the country, we can ill-afford to lose more to the private sector or overseas.
So, what can we do to keep them? What choices might our government make?
One important choice would be to invest an extra 5% of GDP into social spending. That would still leave us trailing countries like Denmark and Norway but would make a decent dent in the ongoing under-investment in health, and social determinants such as housing, welfare, and employment.
We could also think harder about the cost-benefit equation around our health spend. Overseas studies have found that every dollar a government spends on health returns a fourfold economic benefit.
As we try and rebuild our post-Covid economy, we need to view health sector investment (including wages) as an asset, not a burden.
A new World Health Organisation report stresses that governments need to maintain a higher level of public spending on health for the wider benefit of society despite expected budgetary pressures following the pandemic. And to quote WHO official – “Health investment is the smartest investment – it pays off”.
So, let’s choose to value and invest in our people – the doctors, nurses, medical technicians, lab workers, dentists, midwives. Let’s keep them here, let’s make a health system where people want to work, and where they can build safe, sustainable careers.
Let’s lift our people up, rather than pushing them away.
As published in the Sunday Star Times 16/05/2021
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