“If you don’t have your health, you don’t have anything.”
— Chuck Pagano, US (former American football coach and player)
To be honest, anyone could have come up with that quote. It is attributed to Chuck Pagano, but I know tens, if not hundreds, of people who have said the very same thing, without knowing it was a “quote”. I’ve said it myself on very many occasions.
It is so true, so real, that ‘If you don’t have your health, you don’t have anything’ has no need of being a quote. It is a truth that most of us know and understand, a truth that anyone who has been ill, even temporarily, knows all too well.
That said, you have to ask yourself how on earth we have ended up with a health system as broken as ours is now.
In April 2021, I wrote an article for the Auckland Women’s Health Council Newsletter on the health system overhaul that had been announced that March by then Minister of Health, Andrew Little.
In that article I wrote:
We not only need a health system that delivers equity and excellence, but we need a health system that is properly resourced and funded, that is able to address staffing shortages, particularly in nursing and midwifery.
We need a health system that is good enough to retain staff at all levels, rather than one that exhausts and burns out staff forcing them to leave. The changes need to extend to how we train and resource the people who staff all levels of the health system, for example training that addresses the acknowledged institutionalised racism seen in some of our DHBs. We need a health system in which delays in diagnoses and treatment are in the past; a health system in which there is a cultural shift in the provision of services so that complaints to the Health and Disability Commissioner drop year on year rather than rise.
It is important that this overhaul, in whatever shape and form the Government decides it must take, is completed; that a shiny new, functional, equitable and whole health system emerges. What we must avoid is a partially completed overhaul that is neither fully new and functional, nor old, flawed but familiar, because a half-renovated health system may well be worse than what we already have.
I went on to say:
It is critical that there is cross party support and commitment to change and improvement. In all likelihood it will take longer than the current term of government to achieve the health care system they are setting out to build. In the event that there is a change in government at the next election, an incoming government must be committed to continuing to implement the changes to the health system. There is precedent for incoming governments to undo the work of previous governments, to abandon initiatives in health.
Ten days out from the 2023 general election, this is exactly the situation we find ourselves in, exactly the situation I wrote that we MUST avoid: a broken, on its knees health system.
A ‘new’ health system that is not functional, equitable or whole.
A ‘new’ half-renovated health system that IS worse than what we already had.
A ‘new’ health system, parts of which the National Party is already talking about dismantling as well as rescinding some of the legislation that underpins it.
No matter how bad people’s lives are in today’s world – post-pandemic, climate change emergency and cost of living crisis – when you decide how to vote consider that if you don’t have your health, you don’t have anything.
If nothing else, consider the health policy and promises made by each party, when you think about how to vote. And remember the promises made at election time are not always delivered on.
The Policies!
LABOUR
- Extend the age of free breast cancer screening from 69 to 74;
- Implement a national endometriosis action plan that will improve education about the condition and improve clinical management and care;
- Make cervical screening services free between the ages of 25 to 69 years, saving up to $100 in co-payments.
- Grow our dental workforce through a targeted immigration campaign and training 30 more dentists per year – an increase of 50%.
- Work to improve existing free dental care for under-18s.
- Progressively expand free basic dental care, starting with 390,000 under 24-yearolds from 1 July 2025, and growing to nearly 800,000 under 30 years olds across the next term of Government.
- Increase targeted oral health promotion to keep Kiwis healthy and prevent small problems from becoming large ones.
Better access to health professionals:
- Work to increase access to general practices and after-hours care where there is limited provision or where practices have closed books.
- Reshape the general practice funding system to better reflect patient need, including making a commitment to increasing cost pressure funding for primary care.
- Implement our comprehensive plan to grow the general practice and primary care workforce.
More surgery, lower wait times:
- Deliver 3,500 more cataract surgeries so that everyone in New Zealand can access surgery according to the same clinical criteria.
- Clear the backlog of people waiting more than one year for treatment (other than orthopaedic surgery) by 31 December 2023.
- Clear the waitlist for people waiting more than one year for orthopaedic surgery by 30 June 2024.
Improving access to mental healthcare:
- Expand primary mental health services to 3.5 million New Zealanders.
- Expand Mana Ake to 195,000 primary and intermediate school aged children.
- Deliver He Tapu te Oranga, our 10-year whole-of-society and whole-of-government suicide prevention strategy.
Health workforce: More doctors, more nurses:
- Training an additional 335 doctors every year from 2027;
- 95 additional places in each of 2025, 2026, and 2027 on top of the 50 more places starting next year;
- Increasing the total number of doctors trained to 874 each year;
- 12 more psychiatry trainees a year;
- 50 percent more dental student places;
- Implement the 700 extra nursing places per year from 2024;
- Pay equity for midwives;
Pharmac: More funding for more medicine:
- Increase Pharmac funding by more than $1 billion over the next four years:
- $181 million of funding a year from 2024/25 so Pharmac can continue to meet the ongoing cost of the additional treatments;
- an extra $50 million for new treatments from 2024/25, rising to $100 million per year in 2026/27.
A new hospital for the people of Hawke’s Bay:
- At a cost of between $700m and $1.1 billion, the new hospital will be fully funded in Labour’s fiscal plan over the next decade.
NATIONAL
Deliver more nurses and midwives:
- incentives to encourage more Kiwis to study nursing or midwifery;
- bonding to keep nurses and midwives in New Zealand after graduation;
- competitive immigration settings to attract more overseas nurses and midwives.
- extend free breast cancer screening for those aged up to 74 years;
- the number of free mammograms a woman can have will increase from 18 to 20.
- establish a third medical school at the University of Waikato, with satellite training centres in regional areas;
- increase the number of medical school placements at Auckland and Otago by a total of 50 from 2025 in addition to the 50 extra places already funded at Budget 2023. Combined, this will see an additional 220 extra doctors graduating a year by 2030.
Helping more Kiwis fight cancer
- will pay for 13 cancer treatments (lung, bowel, kidney, and head and neck cancers) not currently available to NZ patients, that are helping extend survival rates in Australia;
- will allocate $280 million in ring-fenced funding to PHARMAC over four years to pay for these therapies;
- will reintroduce $5 prescription fees for those who can afford to pay; those on low-incomes and superannuitants will receive free prescriptions and the cancer treatments will be available to all patients with clinical need, as assessed by their doctors.
Targeting better health outcomes
Will bring back targets for important measures:
- Shorter stays in emergency department – 95% of patients to be admitted, discharged or transferred from an emergency department within six hours.
- Faster cancer treatment – 85% of patients to receive cancer management within 31 days of the decision to treat.
- Improved immunisation – 95% of two-year-olds receiving their full age-appropriate immunisations.
- Shorter wait times for first specialist assessment – a meaningful reduction in the number of people waiting more than four months to see a specialist (target to be set in government).
- Shorter wait times for surgery – a meaningful reduction in the number of people waiting more than four months for surgery (target to be set in government).
- will help deliver faster access to mental health services for vulnerable New Zealanders by boosting community providers and NGOs;
- will do this through the Mental Health Innovation Fund, which will initially see up to $20 million in matching funds distributed to community mental health organisations
In addition to the above policies, National promises to:
- Improve cancer management for breast, ovarian, bowel, and prostate cancer.
- Extend free postnatal stays for mothers of newborn babies to three days.
- Provide free continuous glucose monitors to type 1 diabetics aged under 18.
GREENS
- Ensure public healthcare services are timely, accessible, and meet the needs of everyone in Aotearoa – including progressively expanding the health services offered through the public system.
- Empower and resource the Te Aka Whai Ora (the Māori Health Authority) to work in an equal partnership together with the Ministry of Health and Te Whatu Ora (Health New Zealand) to improve outcomes for whānau, hapū, iwi and hapori.
- Ensure our health system provides appropriate and respectful care for everyone, recognising and honouring diverse life circumstances, and meeting the needs of marginalised groups who currently face barriers to care.
- Increase funding for PHARMAC so that it can invest in new medicines and health care devices to enhance treatment outcomes and quality of life.
- Ensure all healthcare workers have fair wages, and workload and conditions that support their wellbeing and the quality of care of their patients.
- Create Healthy Air standards for ventilation of buildings to reduce the spread of airborne illnesses, and provide targeted funding support for retrofits to meet these standards.
- Provide universal, free and accessible diagnosis, treatment and management for all illnesses and injuries — including fully-funded public provision of dental care, general practitioner clinics, ambulance and emergency services, aged care, palliative care, and mental health services.
- Free dental care for everyone including:
- Free annual check-ups and cleanings available to everyone
- Free basic dental care, such as fillings, sealants, and extractions for anyone who needs them
- Mobile dental vans and funding for community dental clinics, including marae, so no one has to travel long distances to look after their teeth.
- Reconfigure our health system towards recognising and acting on oppressive and intersecting biases (e.g. racism, sexism, ableism, fatphobia, ageism, queerphobia, transphobia) and the knowledge and skills required to work with affected communities, such as Deaf and disabled people.
- Support the Mental Health and Wellbeing Commission to transform mental and emotional wellbeing care, monitor services, and lead a whole of government approach that holds it to account.
- Increase the affordability of healthy foods and restrict the marketing, distribution and affordability of unhealthy and processed foods and beverages.
- Invest in and ensure timely and equitable access to the most up-to-date research, procedures, medicines, diagnostics, vaccines and other health technologies—including gender-affirming healthcare and rare disorder treatments.
- Meet union demands for fair wages, pay parity, a reasonable workload and conditions that support the wellbeing of health workers.
- Centre health, health equity and community empowerment in climate change research, planning and responses.
ACT
Pharmac
- Seek an independent review of Pharmac’s operating model for greater transparency and timeliness in decision making, a more strategic focus, and a productivity perspective based on real lives.
Subsidies for private hospital elective surgeries
- Publicly subsidise more of the common elective surgeries in private hospitals through competitive tender. This will utilise spare private hospital operating capacity, reduce public waitlists, and free up public hospital operating theatres for urgent and major surgeries.
Improved primary healthcare in rural New Zealand
- Seek to attract more doctors and primary healthcare professionals under a new immigration policy and establish better pathways for training and accreditation.
Private provision and leaseback of public hospitals
- Allow lease-back and build arrangements with large, reputable global infrastructure investment groups for the refurbishment of existing public healthcare infrastructure and the construction of new facilities.
Mental health and addiction services
- Establish Mental Health and Addiction New Zealand (MHANZ), a standalone agency on a national scale, empowering patients to choose between a range of providers, rather than simply accepting what their DHB offers.
- Take the $2 billion per annum currently spent through the Ministry of Health and DHBs, and channel it to providers of care, and ultimately patients, through an upgraded Mental Health and Wellbeing Commission.
Easing the health workforce crisis
- Create an easier pathway for doctors trained in comparable overseas jurisdictions to practise in New Zealand. Currently, even a top Harvard doctor would have to be supervised for 6-18 months before being allowed to independently practise.
- Increase GP funding by 13%, the equivalent of 2.5 million GP visits per year.
- Enable physician assistants to take on less complex tasks to take pressure off GPs
- Give the Minister of Health the ability to override unnecessary red tape and bureaucracy
- Increase the resilience of the healthcare system with intelligent forecasting of future requirements, improving upon current simplistic models.
NZ FIRST
- get rid of Pharmac and replace it with a model that works, then add an extra $1.3billion per year to its currently grossly underfunded budget.
- ensure Pharmac has more funds to get the medication to the people that need it most.
Prioritise recruiting specialists and nurses.
Invest in groundbreaking medical technology New Generation Rapid Diagnostics.
Repeal the Therapeutic Products Act
Fund residential care for the aged.
Covid Pandemic:
- end vaccine mandates;
- ensure a full scale, wide ranging, independent, one year inquiry conducted publicly with local and international experts, into how the Covid pandemic was handled in New Zealand.
TE PATI MĀORI
- Increase funding for Te Aka Whai Ora (Māori Health Authority) – 25% of all health funding to be transferred to and administer by the Te Aka Whai Ora.
- Free primary care for whānau earning less than $60,000.
- Free dental care for whānau earning less than $60,000.
- Free delivery of medication to houses for whānau earning less than $60,000.
- Implement A Māori Health Card – Whānau in control of the health services they need: issued to all Māori linked to their NHI number and ensures that health funding follows the Māori patient and not a Hospital, a Primary Healthcare Organisation, or a General Practice. Health must be about the patient, and funding must follow that patient’s preferences.
- Invest $1 billion per annum in health workforce development.
- Accelerate and protect Mātauranga Māori Models of Health.
- Establish a comprehensive Kaupapa Māori Mental Health Service.
- Drop Māori cancer screening By 10 years.
- Increase funding for Pharmac.
- Establish a Māori Accident Compensation Authority.