Health Minister: “we won’t be able to afford everything straight away”

Minister of Health David Clark has conceded on Q&A that there is not enough money available to pay for all Labour’s election promises, like reduced doctors fees and pay equity for nurses. He blames it on the competing demands of other parties in Government, and ‘underfunding’ by the last Government – Health is always underfunded in that it is never possible to afford all the needs and demands.

Corin Dann: It’s interesting talking to people in the health sector this week. One in the nursing sector said to me they voted National because even though they were sympathetic to many of the things you’re doing, because they didn’t believe you would have enough money left after making all your promises for the nurses, for their pay settlement. And that’s the reality, isn’t it? The nurses aren’t going to be able to get what they want because you’ve got so many other things to pay for.

David Clark: We’ve set aside money across health. We’ve said that we want to spend more money, and we did say we wanted to spend more money than our opponents. But we won’t be able to afford everything straight away. Nobody pretends we can. We won’t be able to afford everything in our first Budget. We’ve got to do it step by step. And there is a backlog of underfunding. We’re going to take steps to address that.
Corin Dann: You went into the election campaign making it clear you would deliver all this money and you would deliver all these promises.

David Clark: We will deliver the promises we make.

Corin Dann: In the first term?

David Clark: In the first term.

Corin Dann: All of them?

David Clark: Corin, all of them, subject to any new information that comes to hand.

The ‘new information that has come to hand’ since Clark became Minister is that the Government has already committed a large amount to things like the benefit increases, fee-free tertiary education and the Provincial Development Fund, and there isn’t going to be enough available for everything promised for Health.

Corin Dann: So new hospitals, what about—Let’s just stay back on the nurses’ pay very quickly. Because the issue here seems to be pay equity, isn’t it? That’s the big problem you’ve got looming. Are nurses going to get pay equity this term?

David Clark: Pay equity is further down. It was in the negotiated offer that went forward previously, pay equity – a shift towards that. It is huge. Let’s not pretend it’s not. It’s a serious issue, but it does need to be tackled.

Corin Dann: But why shouldn’t they get pay equity when other parts of the health sector are and we’re hearing stories of nurses who feel like they’re earning less than caregivers when they’re 20 years experienced or whatever. Why shouldn’t they be getting pay equity now?

David Clark: Well, they should be getting pay equity, but there is a process to work through to work out how we do that.

Corin Dann: It’s money, isn’t it? Because according to the advice given to the Labour Party during the coalition negotiations, the estimated cost from collective bargaining and pay equity, if you join them together, for the health sector over three years is $750 million. You don’t have it, do you?

David Clark: Yeah, these are big sums. Of course we have the money. We have budgeted really carefully. Labour Governments and coalitions with Labour in them are held to a higher standard. We know that.

I’ve heard this claimed before, as far as I know it is subjective and unsubstantiated, and I call bollocks on it.

David Clark: And that’s why we did our sums very carefully when we were in opposition, and the promises that have been made in the coalition agreements and the confidence and supply agreements will be kept. We have accounted for them and we will deliver on them.

But when?

Corin Dann: Let’s look at primary healthcare. Is that going to be the big focus for you in many ways? Because that’s what’s going to make the big cost savings, isn’t it?

David Clark: Absolutely. Longer-term, it will. In the short term, we’ve got so much unmet need. Last year over 500,000 New Zealanders couldn’t afford to go to their GP. One in four adults in New Zealand now cannot afford to go to their GP in any given year for reasons of cost.

Corin Dann: So will we see in the Budget you deliver on your promises to bring GPs visit down by, what, $10 on average? From $40 to $30?

David Clark: We’re going to have to phase some of these initiatives. There’s no doubt about that. I’m not going to skate around that, and I’m not going to make the Budget announcement today, you understand that, Corin.

Corin Dann: But you are signalling that that’s not coming all at once?

David Clark: We will make healthcare more affordable, and that includes primary care.

Corin Dann: So when can someone expect to see the average get down to 30? 

David Clark: Corin, I can’t announce that today. We are phasing our priorities, but we are absolutely committed to the principle of making sure New Zealanders can afford to visit their GP.

So a policy promise has become a principle that may be phased in at some time, perhaps.

Corin Dann: And you’ve got a national cancer agency you’ve got to do?

David Clark: Yep, we’ve got lots of things we’ve announced– 

Corin Dann: Will we see that this term?

David Clark: We will see some progress in that regard. I’m having policy work done now to tell me what the best way is of delivering those things. We’re in government now, and that’s different. I do have access to a lot of researches, to the best international evidence, and I want to make sure that every dollar I spend goes as far as it can possibly go as Minister of Health and of course as Associate Minister of Finance.

Being in Government is different to being in an election campaign, and being Minister of Health is different to being Opposition spokesperson on Health. You don’t need the best international evidence to know that it is very difficult to meet all the demands of the Health portfolio.

There will never be enough money to afford everything that is wanted, especially with substantial spending commitments for other things like education, social welfare, housing, transport etc etc.

Clark has since confirmed that the Government won’t be able to meet all their promises ‘straight away’.

NZ Herald: Health Minister David Clark says coalition funding pressures have delayed cheaper doctors’ visits for all

Labour’s promise to cut the cost of going to the doctor by $10 from July 1 this year will now have to be phased in over time, Health Minister David Clark has said.

He points to Labour having had to meet the cost of new priorities from agreements with the New Zealand First and Green parties, Labour’s partners in Government, as the reason the full policy cannot be implemented from July 1 as promised.

Clark’s admission is the first time a minister has conceded that an election promise may have to be delayed.

Labour promised that from July 1 this year, the cap on doctor’s visits for very low-cost access practices would be lowered from $12 to $2 for those aged 13 to 17, and from $18 to $8 for patients age 18 and over (it is already free for 0 to 12 year olds).

For visits to other GPs it promised, from July 1, to reduce the average cost from $30 to $20 for teenagers and from $42 to $32 for adults, and to cap the maximum fee at $59 from $69.

The policy was estimated to cost $213 million a year.

Clark made it clear today the policy will now have to be phased in but has given no hint as to how.

“I am pursuing the principle that we get more affordable access to primary care in this country,” he told the Herald. “And what happens when you form a coalition Government is that you agree priorities and we are responding to the priorities as they are outlined in the confidence and supply and coalition agreements.

“I am pursuing cheaper doctors’ visit but I am signalling that that will be phased over time.”

Perhaps there will be a clearer signal of what sort of phasing in over what time in the budget.

I don’t recall Clark or Jacinda Ardern or Grant Robertson saying “we won’t be able to afford everything straight away” during the campaign. A lot of criticisms were directed at Steven Joyce when he pointed out a large difference between spending promises and available funds – the infamous fiscal hole.

Health can be a particularly emotive issue on a personal level, people’s health and lives are at stake.

We know a perfect ‘fully funded’ health system is impossible, but what we should expect from our politicians and our Government is honesty that not everything can be delivered due to competing demands.

Leave a comment

35 Comments

  1. Blazer

     /  April 30, 2018

    this is a recipe for perennial disappointment….’ but what we should expect from our politicians and our Government is honesty ‘.

    Reply
    • David

       /  April 30, 2018

      I think the point is 6 months ago their numbers were robust and peer reviewed and they could afford everything, since then the surplus has increased by 500 million bucks but they cant afford to fulfill their promises. Not a huge amount of honesty and we have kinda got used to National delivering what they promised, GFC and Quake notwithstanding.

      Reply
      • Blazer

         /  April 30, 2018

        what exactly did National promise….missed it?

        Reply
        • Callum

           /  April 30, 2018

          National set, measured and publicised a range of targets for DHB’s. Perhaps you missed all the full page adverts and media stories on it.

          Reply
          • Blazer

             /  April 30, 2018

            did you leave off…’and didn’t meet them’!David is being more macro than just health.

            Reply
            • Callum

               /  April 30, 2018

              And showed significant improvements in a lot of areas, particularly ED waiting times. But you can’t see that of course as it doesn’t fit your narrative. I expect we will soon be back to Labour sending people to Australia for cancer treatment given their expertise in health.

  2. David

     /  April 30, 2018

    The lucky thing for Clark, like Twyford, is all the failures to deliver..well anything will only annoy their base who are tribal.
    The only thing that may tip them over is if they dont deliver and Robertson goes into deficit, Trudeau is facing this where he is delivering loads of virtuousness but the fiscal numbers are worsening and nothing of substance is getting done and aside from millennials he is toast in the polls.

    Reply
    • Traveller

       /  April 30, 2018

      Throughout Nats reign, David Farrar has published all the stats re the vast improvement of all health markers under National. There were planeloads of cancer patients travelling for radiotherapy in Aus for years under Labour and that’s just the one appalling stat.

      Cancer treatment wait time, emergency wait times, immunisation, teen pregnancy, smoking and drinking all down. Actual medical staff well UP.

      He’ll get this out soon I’m sure and the reality check will mean an even higher bar that Labour’s spin doctors will have to meet.

      Reply
      • PDB

         /  April 30, 2018

        No public service will ever be happy with their levels of funding and this govt is seen as a ‘soft touch’ and in debt to the unions so the cries of poor mouth have become louder since they came in. The new govts fixation with throwing more money at them without a full understanding of where existing money is going is a flawed one.

        Reply
      • Blazer

         /  April 30, 2018

        attributing these to Nat…’Cancer treatment wait time, emergency wait times, immunisation, teen pregnancy, smoking and drinking all down. Actual medical staff well UP’…is ludicrous.As for Farrar and his…stats…do me a favour.

        Reply
        • High Flying Duck

           /  April 30, 2018

          Just because National actually did the above is no reason to actually attribute them…
          Once more, you simply cannot face facts that prove your narrative is false.

          Reply
          • Blazer

             /  April 30, 2018

            Nat allocated the health budget…there are many inputs that determine ..outcomes.

            Reply
            • High Flying Duck

               /  April 30, 2018

              National set specific goals around ED treatment waiting times, cancer treatment and elective surgeries.
              These goals which were worked through in conjunction with the Ministry resulted in significant improvements in these areas.

              “To make sure these people don’t spend too long waiting for the care they need, the Government introduced a target for reasonable timely care.
              This target is to have 95 percent of patients admitted, discharged or transferred from ED within six hours. ”
              “Since the target was introduced in 2009, national performance has increased from 80 to 93 percent.
              That’s less waiting for everyone.
              ‘There’s no longer a DHB in New Zealand where a large number of people are staying longer than six hours in the emergency department,’ Professor Mike Ardagh says.
              This achievement is despite the growing demand on emergency departments.”

              https://www.health.govt.nz/system/files/documents/publications/targeting-waiting-times-nov13-v2.pdf

            • High Flying Duck

               /  April 30, 2018

              Elective Surgery:
              “:Over the past five years, elective surgery has seen an average increase of more than 8000 discharges a year, and in 2012/13, a total of 158,500 people had elective surgery. This is a big improvement.”
              “To make this happen, DHBs across the country are looking at the big picture: how people access surgery, when and where assessment
              and treatment is available, and who is providing the care.
              This whole-of-system approach ensures that hospitals are better able to match resources with demand, which Clare Perry says is really important.
              ‘DHBs are improving the flow of patients to enhance quality of care and maximise scarce resources. Safety, timeliness and patient-centred care are critical.’

            • High Flying Duck

               /  April 30, 2018

              Cancer Treatment:
              “Since January 2011, DHBs have worked hard to make sure that everyone who needs radiation treatment receives it within four weeks of the first specialist radiation oncology assessment. In 2012, more than 8000 patients received radiation treatment within the four-week target. This is a significant improvement on the long waits of over six weeks experienced by some patients as recently as 2008.
              In addition, chemotherapy wait times were included in the Government’s Shorter waits for cancer treatment health target from 1 July 2012.
              Chemotherapy uses drugs to slow the growth of cancer cells or kill them.
              The combined radiotherapy and chemotherapy target has been achieved nationally since its introduction”

            • PartisanZ

               /  April 30, 2018

              Are Labour-led actually proposing to change, slow, belay or destroy any of these seemingly impressive outcomes?

            • NOEL

               /  April 30, 2018

              Targets can be deceptive. The 6 hour ED, which I suppose is better than the Brit NHS target of 4 hours, can come back to bite.
              The 86 year old pensioner who was discharged from hospital at 2 in the morning requiring and expensive taxi ride home then returned by ambulance the next day one example.

            • Callum

               /  April 30, 2018

              Noel that is true, but what should have happened is the pensioner was admitted which woulds also meet the 6 hour target.

            • Kitty Catkin

               /  April 30, 2018

              I don’t see why someone shouldn’t pay their own way home when they have had treatment paid for by everyone else. There are shuttles that transport people to and fro for a donation; he could have used one of those. He could have dozed in a waiting room. He could have rung someone.

      • duperez

         /  April 30, 2018

        Traveller, I think you are being a mite unfair to Farrar. He published any stats about any markers under National which suited him. And any other stuff which wasn’t stats which might have suggested a golden glow or added to one.

        Reply
  3. unitedtribes2

     /  April 30, 2018

    I think Steven Joyce miss calculated. It was twice that number.

    Reply
  4. Grimm

     /  April 30, 2018

    How many labour voters will even care?

    Prior to Jacindamania, Labour we’re headed for electoral oblivion, so hardly anyone believed that there was any substance or work behind their policies. We now know that was well founded. There was/is none.

    And no one voted for Jacinda because she was going to “fix” the health system, or anything else of substance.

    Reply
    • Alan Wilkinson

       /  April 30, 2018

      So true. Stupid voters elected a stupid government.

      Reply
      • Blazer

         /  April 30, 2018

        ‘In politics stupidity is not a handicap’. Napoleon Bonaparte

        Reply
        • admiralvonspee

           /  April 30, 2018

          ‘Never interrupt your enemy when he is making a mistake’. Napoleon Bonaparte

          Reply
          • Blazer

             /  April 30, 2018

            is scuttling your own argument ,your Achilles ..heel…Admiral?

            Reply
            • admiralvonspee

               /  April 30, 2018

              Read it as you please old bean, I’m a benevolent sort 🙂

      • PartisanZ

         /  April 30, 2018

        Stupid citizens continue to participate in a stupid system of governance …

        Whether you like him/them or not, Palmer and Butler are correct, what we need is ‘democratic renewal’ … the reform of democracy itself …

        Reply
  5. NOEL

     /  April 30, 2018

    More savings could be made if the Deprivation Index was changed from locality to the individual using the NHI information.
    Stop the wastage of people getting in their car to travel half an hour away to a Doctor in a low index area.

    Reply

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