Govt out of pan and into fire on health funding

Opinion: It is often said the public demand for health services is insatiable because healthcare affects everyone directly. Dramatic advances in medical science over the last half century or so, enabling the earlier identification and successful treatment of previously killer diseases, alongside rapidly improving new medicines have increased public expectations of what the health services can do.
But that has also left governments around the world having to make hard choices to meet ever rising impatient public demand for more and better health services. Inevitably, it comes down to how best these services can be rationed to meet as broad a spread of needs as governments can reasonably afford.
New Zealand is no different in this regard. For many years, successive governments have struggled to stretch health resources to best meet professional and public demand and to ensure our health services remain at least on a par with those of comparable countries. As they do so, governments have usually attempted to respect the intensely personal nature of health concerns, and show special sensitivity in their approach, knowing they will never completely satisfy the public’s interest.
By and large, our public health system has struggled on in this environment. A pragmatic balance has been established – on the one hand, there is general criticism of health services, whoever is in power, but, on the other, most people nevertheless consistently report their personal dealings with the public health system have been positive.
But every now and then, a tin ear approach by a government on a specific health subject tips the normal stream of quiet complaint over the edge into full, visceral outrage.
The Government’s health tin ear is unusually insensitive. Within a few months of taking office, it was already looking likely to renege on its major election promise to fund new cancer drugs, matter-of-factly announcing that no funding would be set aside in this year’s Budget to implement the policy. Initially, it seemed unconcerned by the adverse reaction this caused, perhaps calculating that the numbers of people likely to be affected was not that great. It then tried to argue that the Budget omission was not significant, because the policy would still be honoured, but not just yet. It seemed oblivious to the sense of betrayal felt by cancer patients and their families who had been so looking forward to the promised new drugs being funded.
The Government quickly backed down and announced a package that went way beyond what it promised last year. But the damage had been done. Instead of gaining credit for what is the most extensive cancer drugs funding package ever, the Government ended up looking like it had hurriedly caved in to the public outrage its Budget oversight had caused.
A reasonable take-away from this may have been that the Government would have learned from this experience about the risks inherent in playing fast and loose with health policy decisions that directly affect people’s lives. It may have been expected to have then developed appropriate political strategies to ensure there were no future repetitions.
But the news about Dunedin Hospital last week suggests not. An announcement that projected cost blow-outs on the current rebuilding plan have caused the Government to look again at the shape and form of Dunedin’s new public hospital. This has been widely interpreted as meaning the project is about to be cancelled. The focus on the cost blow-outs meant the Government’s apparent commitment to a new hospital got completely lost in the original announcement and seemed like an afterthought when it was confirmed a few days later.
To the more than 35,000 people who protested in Dunedin last Saturday, it simply looked like the cancer drugs saga all over again – a promise made in the heat of an election campaign that the National party was struggling to honour. Moreover, as with cancer drugs, it initially appeared to look as though it did not understand what all the fuss was about. The line taken seemed to be that in straitened economic times difficult decisions must be made which people need to understand.
But in its haste to “get things done” this managerialist Government eschews the lessons of history. Some of the most poignant political images from the 1990s were of masses of people encircling their threatened local hospitals in “Save Our Hospitals” campaigns. They highlighted the depth of feeling people have about retaining hospital and health services.
Nothing has changed today. If the Government thought otherwise in respect of Dunedin Hospital, it was a combination of breathtaking naivety and arrogance. After all, the redevelopment of Dunedin Hospital has been on the books for at least a decade, from the time of the last National-led government. Local public expectation was therefore strong, so the vehemence of last weekend’s protest should not have been unexpected.
All of which makes the way the Government announced it was reviewing – not abandoning – the scope and form of the project look that much more inept and insulting to the local community. The sour taste left will take time to disappear, even after Dunedin’s new hospital is eventually built (in whatever form).
The cancer drugs funding and Dunedin Hospital decisions show the Government lacks empathy when it comes to sensitive health decisions. Whereas the previous government often overplayed empathy to the point of insincerity, there are times when this Government veers to the other end of the spectrum. It needs to demonstrate more balance and sensitivity when announcing difficult decisions. 
Prime Minister Christopher Luxon likes to remind people he used to run an airline. But under his leadership Air New Zealand cut provincial air services on a whim, a practice being continued by his successor, with little apparent regard for the impact on local communities.
The Dunedin Hospital furore may teach Luxon the hard way that voters will not tolerate the same approach to upgrading public health services.