Lessons from a Pandemic.
- We can pull together.
Despite our differences, Kiwis have shown incredible solidarity and emerged as world leaders in the fight against COVID-19. Physical, mental, financial and social sacrifices, made by all of us, have meant we are flattening the curve.
- We’ve been fighting with one hand tied behind our back.
Moving towards the next stage, the elimination of COVID-19, requires rapid detection, contract tracing, and other public health measures. However due to chronic under-resourcing and under-valuing of our Public Health sector, their ability to perform this critical task is limited. This means we risk losing the hard-fought progress we’ve made.
- We have local epidemics to deal with too.
Even though investing in public health is a good deal, long-standing local epidemics are continually swept under the rug. Preventable conditions like diabetes, rheumatic fever, syphilis and others, all at dramatically higher rates than most developed nations - are all right at home, in ‘God’s own’.
More saliently, we witnessed the horrific measles outbreak of last year, which shamefully led to the deaths of many of our Pacific neighbour’s children.
- A strong Primary Health sector is pivotal to a functioning system.
With one hand behind our back, it might soon be joined by the other. Frontline GPs, Nurses and their clinics have scrambled to fight COVID-19 and now struggle to remain open. Adding to the pressure, chronic underfunding has left General Practice exposed during a time where patients are most vulnerable.
For the rapid detection required and to provide our on-going care needs, we need to ensure a robust and secure Primary Care sector.
- We’ve had opportunities before.
In the 1990s, New Zealand had a strong independent body whose sole purpose was preparing and supporting the Public Health of all Kiwis. Headed up by the renowned Dr David Skegg, the Public Health Commission (PHC) was tasked with such a job. Unfortunately, the influence of the tobacco, dairy, alcohol and food industries were too tempting for the Government of the day, causing it to be disbanded. This was a significant loss for all Kiwis and a win for corporate interests.
Even now, the Ministry of Health’s executive leadership doesn't include the director of Public Health.
- Now is the time for a healthcare revolution.
TOP would start by resurrecting the independent PHC or similar, that would support and expand our COVID-19 response, deal with local epidemics, and prepare for the next inevitable pandemic.
We would rationalise the inefficiencies of District Health Boards and the Ministry of health, by replicating the successful independent funder model (think Pharmac). This would work nationally, across clinical guidelines, medicines and new technologies. It would have a strong mandate to invest in evidence, cost-effectiveness and wellbeing.
That doesn’t mean cutting healthcare funding, it simply means putting money where the best health returns lie.
We would improve our Primary Health Sector by supporting General Practice through funding based on the individual needs of the patient (just as the Government is doing with school funding as a replacement for the decile system). Patients and whānau would be at the centre of multidisciplinary community teams. These teams would utilise all available services by including a range of services, including mental health, allied health and NGOs.
This would be supported by a comprehensive national health IT system, where a patient's records follow them, rather than the other way around. Too often siloed, provider-centric communication shut patients and whānau out of informed decision making. Even with IT facing clinicians, a dog's breakfast of systems means that they too struggle to access and analyse important population and patient-specific data. We would look to innovative countries like Estonia, who are leading the way through an integrated, decentralised, person-centred IT system.
- We’ve flattened the curve - now let’s squash the gap.
For far too long inequities have persisted in our system. We’ve continued with the same approaches and (surprise surprise) got the same poor outcomes. Pivotal to squashing the gap is engaging and empowering our local communities, and including holistic approaches like the successful Whānau Ora model. Decent funding of Primary care and a multimodal approach to determinants of health is needed. But this won’t be the end of it, as confronting this challenge will require an unrelenting commitment.
- We will do better.
Fundamentally, our team of five million has shown an incredible ability to come together during testing times.
Let’s continue this momentum and create a robust, prepared and proactive Healthcare system.
To view TOPs health policy:
Policy in a minute video - click here
Brief - click here
Comprehensive - click here
"The challenges ahead are severe. But if we learn the right lessons from this catastrophe, we can emerge not weaker, but stronger – better equipped to deal with the existential risks of the future." Toby Ord
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