How is the Government's health?
By Richard Harman (author)
The new Government appears to be groping its way in the dark as it tries to get together some figures to indicate how much its new spending proposals are going to cost.
While it does so, National are demanding that it sticks rigidly to the forecasts that were contained in its pre-election Budget Fiscal Forecasts.
But like a number of other areas facing the Government at present, it is very early days made more difficult by the absence of the Prime Minister for the first week of Parliament’s sittings and the absence of her Chief of Staff, Mike Munro, who is ill.
Ministers are clearly scrambling to get on top of their portfolios.
Requests for an answer to a question to the Minister of Health, David Clark, were unanswered last night because his press secretary said he was in continual meetings without even a five-minute break.
Another press secretary to a senior Minister said that even his own texts to the Minister were going unanswered.
In this atmosphere, the precision that National is looking for is unlikely to be achieved.
It won’t be till the half-yearly Economic and Fiscal Update – due some time in mid-December --- that we will be able to get any idea of how much the Government is likely to be spending and as a consequence how much it will be able to do in its first year.
That didn’t stop the former Finance Minister, Steven Joyce, from yesterday in Parliament asking his successor, Grant Robertson, whether he was committed to $7.92 billion of additional operating spending on health between now and 2022.
Joyce is quoting the total expenditure proposed by Labour in its most recent Fiscal Plan released after the Pre-Election Fiscal and Economic Update on August 23.
Evene Labour staffers admit that was an estyimate, perhaps more an edcuated guess of how much might be needed.
After all, Oppositions do not have access to the wealth of financial data that Governments do.
Robertson’s answer was interesting.
“The Government is committed to properly fund health,” he said.
“And we will also start to restore the billions of dollars of underfunding in health that has built up over the last nine years.
“As the member knows, the specific dollar allocations to achieve this will be set out in the Budget documents, but the expenditure levels in his question are our starting point. “
It is the use of the phrase “starting point” that raises questions (which POLITIK is awaiting answers to from the Minister).
It suggests that the new Government may be expecting some surprises once they get into the full details of health expenditure.
They shouldn’t be surprised.
One of the most potent elements in their campaign was their criticism of National’s constraints on spending on health and the impact it had had on people.
This was graphically demonstrated just a fortnight after the election with a paper in the New Zealand Medical Journal which showed that Dunedin Hospital was sending patients referred for knee or hip operations back to their GP for further investigation to keep them off the hospital books so that the hospital could meet the Government’s surgical waiting time targets.
The study said the patients sent back became “invisible” to the system and that up to 41% of all patients being sent to hospital for knee or hip operations ended up that way.
It's reasonable to conclude that if that was happening with Dunedin orthopaedic patients, it was happening with all sorts of other patients at hospitals from one end of the country to the other.
Nevertheless Jonathan Coleman, the previous Health Minister who defended his elective surgery targets in the face of constant criticism that they were not meeting the real needs of patients, asked the new Health Minister, David Clark how he was expecting to deliver on his promised increase in elective surgeries, when he said that he wouldn't commit to a specific target?
Clark said: “ We will be building capacity over time, and we will, of course, be mindful of the backlog that has been generated by the previous Government.”
But what no one knows is how big that backlog is and how much it might cost to fix it.
That will be one of the first hard decisions for this new Government --- do they try and fix it as fast as they can or do they stick within the fiscal limits they have imposed on themselves.
This is one of the reasons why bank economists are forecasting that Labour will end up borrowing more.
The ANZ’s Chief Economist, Cameron Bagrie, has argued that over the next four years that extra borrowing could come to $13 billion. The ASB, on the other hand, says it might only be $1 billion.
Sources close to Robertson say he has seen nothing yet which indicates that the fiscal plan will not stand.
But it’s early days; Labour’s promise to deliver better healthcare was a major factor in its election.
Even National Party MPs concede that privately.
If there are surprises inside the health system – and the Dunedin Hospital study indicates there may well be --- then this will be a major political crisis for the new Government.