Analysis: Health Minister Ayesha Verrall isn’t willing to say her 24-point plan to reduce pressure on the health system over winter will avoid any delays to planned care.
Some procedures may still be postponed if hospitals hit a crunch, though this will be a tool of last resort to ease demand rather than the first lever pulled, as in past years.
Instead, Verrall hopes to shift as much hospital demand to primary care as can be safely done, and then shift some GP demand to pharmacists and community health providers.
The central issue in the health system – a lack of staff – can’t be solved overnight. In fact, it will take years to address.
In the meantime, the new approach makes sense as a way to make better use of existing resources. It does come with a risk, which officials acknowledge, that the pressure could simply be reallocated to a different part of the sector.
There are shortages everywhere – emergency departments, hospitals, doctor’s offices, aged care and even pharmacies. If the health system as a whole has a capacity cap and demand exceeds that cap, sloshing the demand around within the sector won’t obviate all unmet need.
This is National’s line of attack, with health spokesperson Shane Reti saying the workforce shortage is the only thing we should be focusing on. Enough of the ideas in the plan – like allowing pharmacists to treat minor ailments or empowering GPs to order radiology services rather than having to refer patients to hospital – are sufficiently common sense that everyone would support them. Politically, therefore, highlighting the ongoing staffing crunch is the best tactic for the Opposition.
Health bosses and Verrall now believe they’ve done everything they can on the immigration front to bring in new health workers. The next step is to boost the domestic workforce pipeline, especially since overseas nurses tend to leave within a few years of arriving. Developing and training Kiwi health staff is therefore the long-term solution, with announcements on that issue expected shortly.
Right now, though, Verrall is pulling out all the stops she can. With the winter plan, she certainly has an eye on alleviating pressure this winter. But another is trained on the horizon and how the new health system can be used to offer a new model of care for patients.
The winter plan is a test-run of a range of ideas piloted on a local level. They’ll now be expanded to the regional or national scene, but cautiously, with extensive monitoring before they bed in permanently.
The scheme to allow pharmacists to treat minor ailments like eczema or skin rashes is a perfect example.
This has first been trialled at a pharmacy in Upper Hutt and several in South Auckland over the past year. In Upper Hutt, people who turn up for treatment who would normally be referred to GPs are instead given a consult if the issue is minor. Often, they can walk out with the medication they need, with the whole process free of charge.
In South Auckland, the effect has been even more significant. There, pharmacists have been able to treat respiratory conditions for under 14s. Cases who might have unnecessarily tied up a hospital bed are instead given paracetamol and sent home with monitoring. The programme is credited with reducing the burden on Middlemore Hospital during what was already a tough winter last year.
Northland, Auckland, Tauranga, MidCentral, Wellington, Christchurch and Invercargill will now all have access to this scheme over winter. Given there are 825 pharmacies in these regions over winter, that gives people many more options for minor health conditions than having to go to the GP, which costs money, is often less conveniently located and places pressure on an over-burdened primary care sector.
Overall, Verrall says, she wants healthcare to be closer to home, easier to access and cheaper. The added benefit is that people with less severe health issues don’t clog up emergency departments and hospital wards, during an expected influenza wave, with potential for another Covid-19 wave or even measles outbreak also on the horizon.
In the wake of the emergency phase of the pandemic, health officials have also noticed a disturbing trend in demand for care. While demand used to spike during winter and then fall back down, it now remains elevated after successive winter surges. It’s more of a staircase ramp-up in healthcare need, rather than the old wave pattern, because of increasing complexity of medical issues, an ageing population and ongoing pandemic effects from post-Covid-infection issues and deferred planned care.
This means the pressure-reducing co-benefits of these novel approaches to care will continue to be needed even after winter wanes. Expect to see these programmes continue on, albeit with any tweaks or changes necessary to improve them further.
The centralised health system gives the Government more power than before to directly influence how people get healthcare. The Government is eager to exercise that power to reform the accessibility, affordability and proximity of treatment – even if it isn’t a panacea for hospitals during winter, it’s still a step in the right direction.