GPs calling for reform of New Zealand's health system after hard lessons learned from Covid-19 want the delayed Health and Disability System Review to be released.
Hospitals set up in preparation for Covid-19. Photo: Ministry of Health / Supplied
The plight of a terminal cancer patient who spent days, isolated in a half-full hospital, waiting to have a procedure that should have taken an hour is just one example of failure in a health system with 20 DHBs for a population of five million.
Doctors say the time is right for serious reform, with the Medical Association and General Practice New Zealand both calling for the government to release the Health and Disability System Review recommendations which were due out in March.
The review, chaired by Heather Simpson and backed by a panel of health experts, aimed to ensure the health and disability system was better balanced towards wellness, access, equity, and sustainability.
Its interim report found the health system's structure was overly complicated and lacked leadership, and said people using the services need be placed at the heart of the system.
However, it did not provide recommendations - something the final report which was due in March this year was intending to do.
NZ Medical Association chair Kate Baddock told RNZ's Morning Report the Covid-19 coronavirus had forced the health system to adapt, and the lessons from it should not be lost.
"I don't think any country was ready for this pandemic but I do think it has highlighted a need for us to look at how much of our health system should be centralised and how much of it should be decentralised and managed centrally or locally."
"We do have extraordinary circumstances, but as you know extraordinary circumstances often serve as a wonderful platform for disruptive innovation to take place" - NZ Medical Association chair Kate Baddock
"For instance general practice and within hospital settings where a lot of what was delivered face-to-face is now being delivered virtually - innovation is occurring and what you want to be able to do is take some of that and embed it into our future."
NZ Medical Association chair Kate Baddock Photo: RNZ/Karen Brown
She said the reasons for the delay of the Health and Disability review were understandable during the crisis, but now was the right time to be looking at how to improve New Zealand's health system.
"We haven't asked for this to be released earlier even though it's now at least a month since it was due to be released because we appreciated that we were still in crisis," she said.
"Things are now under control and this situation we currently have may last the next six to 12 months.
"This is a good time to see what the report actually says ... to have the report delivered and received by government so they can look at what has been suggested.
"This is a good time to start to digest the contents of that report and look at what we should be doing so we can shape the future the way we want it to be."
She said the NZMA supported having fewer - or at least more centralised - DHBs.
"It might not be that they become fewer in number but rather, as I say, that they regionalise the way they do things."
She said it could resemble the way Auckland's DHBs were working together, but more so. There were also changes needed to the structure of general practice.
"Absolutely - you'll have heard about the cash crisis that occurred in general practice when we first went into level 4 lockdown and that is because of the dependency upon the capitation that comes through from the government.
"That has been chronically underfunded for a decade.
"I would absolutely hope that the report addresses the way that general practice and primary care is funded and how that needs to change also."
As to why the review hasn't been released, Prime Minister Jacinda Ardern previously said: "We decided, of course, that we wanted to allow ourselves the time and the space to deal with the pandemic we have in front of us before considering some larger, wider-scale health system reforms."
"I think that's the right decision. I don't think it would be right to plough into that when we're right in the middle of managing a global pandemic," Stuff reported her saying.
The final report has been completed and will be presented to the government when they request it.