Opinion
30 FARMERS WEEKLY – farmersweekly.co.nz – May 3, 2021
Reforms must heal country’s wounds Alternative View
Alan Emerson
I’VE been interested in the recent health reform announcements and the reaction to them. Simply, the Government intends to abolish our 20 District Health Boards (DHBs) and replace them with a single health authority. I’ve differing views on the issue. The first is that in the Wairarapa we have a good DHB. My experience has been that it functions well with the resources it has. The news stories that regularly come out suggest many other health boards don’t share that commitment to their local communities. Further, we can elect local people to DHBs. That gives me some assurance that the organisation is locally-focused. The broader issue is, however, that the current system isn’t working, as shown by the regular horror stories coming out of the health sector. DHBs have been around in their current form for 20 years, but essentially for much longer. They were first mooted in the 1970s. The Muldoon government introduced Regional Health
Boards and then Labour morphed them into DHBs. Logically that tells me that the DHBs time has come. They were designed for another world and they’re not working in this one. In addition, the total population of New Zealand is similar to many medium-sized international cities. Would an international city of five million people have 20 health authorities? I think not. I have two major issues. The first is that the devil is in the detail. There’s a lot we just don’t know. Health Minister Andrew Little told us that the new system will “do away with duplication and unnecessary bureaucracy”, and I support that.
While I’ll support the thrust of the reforms, doing away with the DHBs and their duplication, I remain unconvinced that a single, centrallybased organisation will provide better outcomes. He added that “we need more health professionals and a bigger health spend”. That’s reassuring. However, what we don’t know is what the new system will achieve that the existing system doesn’t. The second is that while I can accept axing DHBs having a central authority, casting pearls to
YES, BUT: Alan Emerson believes that while District Health Boards are no longer fit for purpose, he questions whether the Government’s reforms are going to benefit those who need it most.
the provincial swine fills me with horror. There are many examples of central authorities showing a complete lack of knowledge and understanding of rural communities, and essential water would have to be one. We had worthy bureaucrats in Wellington deciding what they think is best for you and me, with blissful ignorance of the issues and practicalities. The shambles of gun licencing is another. Farmers need firearms to control the many pests occurring in NZ in addition to sporting needs. The police, by their gun licencing protocol, don’t have a clue. Getting back to health. While I accept there will be four regional hubs with further offices, I remain unconvinced they will understand rural needs. In an excellent article in last week’s Farmers Weekly, Gerald Piddock talked to Rural GP Network chief executive Grant Davidson. He made some extremely valid points. The first is that rural GPs need to be included at the design stage of any new system. I agree. It will be interesting to see if the
Government picks it up. He also suggested that a rural lens needed to be put over the new systems implementation. That needs to happen. He told us that the current system is not working in rural areas, and that tells me there needs to be change. We’re told that the 700,000 rural people deserve a good system. I accept it costs more to service rural people than those in the city, but we’re told that rural people are reluctant to seek medical health unless they absolutely need it. The Davidson king-hit is his statement that “if we want equitable (rural) health outcomes, we need inequitable inputs to get there”. So, what we’re going to have is a central system as against a regionally-based one. We’re told our present system is “fragmented and convoluted”. The review of the system, led by Helen Clark’s former chief of staff Heather Simpson, states that it had led to “inequitable outcomes in health for Māori and Pacific communities, as well as disabled people”. I’d add rural. Ubiquitously, in my view, we’re going to have one central
agency plus one for Māori, yet the Simpson report tells us that it is Māori, Pacifica and the disabled that are failed by the current system. The Rural GPs tell me that the present system disadvantages “the 700,000 rural people”. Why then have a separate system for Māori, when the Government’s own research says that it is not just Māori but Pacifica and the disabled that are missing out? And I’ve just added rural. There’s a further question I have. Is it because of racial or socio-economic issues and, in both cases, why? I’d suggest we just don’t know. While I’ll support the thrust of the reforms, doing away with the DHBs and their duplication, I remain unconvinced that a single, centrally-based organisation will provide better outcomes. I also remain unconvinced that concentrating on Māori while ignoring Pacifica, the disabled and rural is fair and equitable.
Your View Alan Emerson is a semi-retired Wairarapa farmer and businessman: dath.emerson@gmail.com
The world as we now know it From the Ridge
Steve Wyn-Harris
WATCHING the second wave of covid-19 sweep devastation through India is a good lesson in guarding against complacency for our own country. Just a few weeks ago, India’s government was insisting that it was in the endgame in its fight against the virus. It relaxed restrictions against
scientific advice and is now seeing more than 300,000 new cases each day, daily deaths above 3000 people and total deaths of 200,000. There is speculation that all these figures are lower than reality and that it is far worse. It would seem that a new variant has arisen there being dubbed “the double mutant”, but is not yet known if its more infectious or that the vaccines will have less potency over it. India with its population of 1.4 billion people, in quite dense clusters, is not just a problem for India but for the whole world. With more infections and faster spread, it gives the virus more opportunities to mutate and the chances increase of a new strain appearing that is not affected by
the vaccines that are currently being rolled out. Then we are back to square one if that should happen. Then the hubris of nations well into their vaccination programmes will come home to roost. Likewise, our own pride, comfort and gratefulness for having kept the virus offshore and mostly locked up in isolation centres will be all very well, but the realisation that we may need to remain an island nation bubble for some time to come will dawn on us. With other countries like Brazil, Pakistan, Papua New Guinea and the like struggling to contain this virus, it’s becoming increasingly likely that this pandemic will be with us for a few more years yet.
Likewise, our own pride, comfort and gratefulness for having kept the virus offshore and mostly locked up in isolation centres will be all very well, but the realisation that we may need to remain an island nation bubble for some time to come will dawn on us. Particularly if the vaccine rollout is too slow or more than 20% of populations choose not to be
vaccinated, thus preventing herd immunity. What surprised me a while back when I was reading up on the history of the Bubonic Plague (Yersinia pestis) bacterial infection, is that it is still here in pockets around the world, including the US. It’s the same disease that devastated Europe by killing half the population in the mid-1300s and was known then as the Black Death. Over subsequent centuries it caused several more pandemics. In the southern US, wild rodents carry the bacteria but there is only an average of seven human cases a year as folk know
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