Quietly scrapped national health targets, no replacement yet

Health Minister David Clark has decided to quietly scrap national health targets, without debate, without evidence, and without anything yet but a vague promise to replace them with.

There is nothing in the Beehive media releases, but yesterday National claimed Government axes National Health Targets

The Government’s quiet shelving of National Health Targets is bad news for Southland says local MP, Sarah Dowie.

“It is outrageous that the Government has done away with the targets which include a set of six major indicators, which measured DHB’s throughput in surgeries, cancer treatment, Emergency Department waiting times and childhood immunisations, as well as B4 School checks and help for smokers to quit.

“Just as they scrapped National Standards within education, they have done away the Health Targets that ensure public reporting of DHB’s performance with no plan of how to effectively manage and monitor the healthcare of New Zealanders.

“Minister Clark needs to realise that you cannot effectively operate healthcare systems on anecdotal evidence.”

Simon Bridges (RNZ): Ditching health targets is ‘absolutely outrageous’

The targets were put in place by the former National-led government in 2009.

They focussed on six areas: increased immunisation, faster cancer treatment, shorter stays in emergency departments, improved access to elective surgery, helping smokers to quit and raising healthy kids.

Mr Bridges said it was absolutely outrageous that the government had canned the targets.

He said it was a prime area where the government could be held to account.

“Over time dropping the targets, losing the accountability will mean more illnesses and more fatalities in our health system that could have been prevented.”

The Health Minister’s office…

…said the old targets would not be published, and new targets were being developed.

Meaning the old targets are being scrapped,

Acting Prime Minister Winston Peters…

…said National had the wrong end of the stick.

“They are not correct in saying we’ve dropped health targets, we just think those health targets were such a miserable failure that we have to find something that works and that is better, and that’s what we are working on at the moment.”

Peters proves himself incorrect in the same sentence.

Stuff:  How’s your DHB doing? Govt does away with National Health Targets

Public reporting of District Health Boards’ (DHB) performance of procedures including elective surgeries, cancer treatment times and Emergency Department wait times, has been axed.

It also appears a new project to publicly measure elective surgery referrals and rejections has also been quietly shelved, with the Ministry of Health failing to release updated figures since the election.

Health Minister David Clark said the targets created “perverse incentives”, particularly in relation to surgery – but the Opposition said there was no evidence to suggest that’s true.

And while there has been no announcement, the National Patient Flow project – which measured the number of patients being turned away from the operating table – has not released any updated figures since September last year. That project was launched following intense political pressure from Labour, over surgical unmet need.

Clark has given an assurance that more surgeries would be performed, but there was currently no public measure of that.

Just trust Clark’s word, with no numbers?

“As minister, I’m concerned about the perverse incentives that exist under the existing targets, whereby we’ve had what were traditionally cheaper surgeries performed in more expensive environments and so not spending the health dollar as wisely as it could be spent,” he said.

Clark, who has also implemented a complete review of the health sector, said the current system wasn’t “fit for purpose”.

Nationals health spokesperson Michael Woodhouse asked Minister Clark about it in Parliament yesterday.

8. Hon MICHAEL WOODHOUSE (National) to the Minister of Health: Why does the Government intend to dispense with the national health targets?

Hon Dr DAVID CLARK (Minister of Health): The previous Government’s health target data has not been published since August 2017. I want a health system that has honest and transparent reporting.

Woodhouse complained that his question ‘why’ wasn’t answered, but I think it is established under Speaker Mallard in Parliament that avoiding answering is an obvious answer of not disputing what was asked.

Hon Michael Woodhouse: Does he stand by his statement that the targets create “perverse incentives”; if so, what is his definition of “perverse incentive”?

Hon Dr DAVID CLARK: A good example of a perverse incentive is to recall what happened toward the end of the previous Government’s tenure, when the overall statistics showed that the number of electives was going up, yet in centres like Northland, Auckland, Counties Manukau, Bay of Plenty, and Waikato, if Avastin injections and skin lesion removals were taken out of those pumped-up statistics, the actual number of surgeries was dropping. Despite a growing population, the actual number of surgeries was dropping. That Government should hang its head in shame. That is the result of nine years of underfunding.

Hon Michael Woodhouse: Given that, is it his view that eye procedures designed to save the sight of patients with macular degeneration, or skin procedures aimed at improving the prognosis of cancer patients, are not worthy of undertaking or counting?

Hon Dr DAVID CLARK: We know that skin lesion removals can be performed for roughly half the price in a primary care setting as compared to being performed in a hospital setting. So it doesn’t take a rocket scientist to work out that if you can afford to perform twice as many surgeries, more lives will be saved.

Hon Michael Woodhouse: Is it appropriate to describe the saving of more than 700 lives a year by implementing targets to improve emergency department waiting times, as reported in the New Zealand Medical Journal last year, as a perverse incentive?

Hon Dr DAVID CLARK: I don’t think anyone is saying that about that target. We will continue to monitor a range of measures, dozens of measures, through the Ministry of Health, and the district health boards will be held to account for improved performance.

Hon Michael Woodhouse: What possible benefit to New Zealanders can come from the dispensing with of publicly stated targets that improve surgery throughput, reduce waiting times, improve health, and quite literally save lives?

Hon Dr DAVID CLARK: I disagree with the member’s characterisation. What we know is that that set of targets was driving a set of behaviours which may have led to the public health dollar being more poorly spent, with health consequences for New Zealanders. By defending a set of targets with perverse outcomes in it, the actual fact is that that member and his former Government may well have been driving poorer health outcomes for New Zealanders.

Audrey Young points out Labour ditches national health targets with no debate on their value

At no point during the election campaign last year did Labour or its coalition partner campaign to get rid of national health targets.

So the decision Health Minister David Clark to drop national health targets came like a bolt.

In fact for the past six years Labour and Jacinda Ardern in particular have insisted there is value in having specific targets in the area of child poverty in order to measure progress.

Ardern won that argument. There has been wide buy-in to that argument, which makes Clark’s decision when it comes to public health the more bizarre.

It was a decision that did not go to Cabinet – and should have.

The least that the new Government could have done was come up with its own priorities or have some new form of accountability in place before ditching the targets.

Quietly dropping the targets without saying so and without debate is a concern, especially when there is nothing in place yet to replace them.

Dominion Post editorial: Trust me, I know what I’m doing

Health Minister David Clark is scrapping National Health Targets that publicly address district health boards’ success or failure in achieving, among other things, reasonable treatment times, numbers getting surgery, waiting times in emergency departments, and immunisations.

Incredibly, the National Patient Flow project, which monitors the number of people turned away from surgery, and which Labour supported while in opposition, also appears to have been sidelined.

In making these changes, he has criticised the “perverse incentives” created by the previous monitoring regime. Also, Labour has intimated that the DHBs and the previous National government padded the statistics with easier procedures, that they gamed the system. Trouble is, there’s no evidence. Just a “vibe”, it seems.

No evidence, just Clark thinking he knows best. That’s a concern, especially in health.

This Government has set aside an extra $31.5 million for elective surgery; Clark insists that will mean more operations and that the performance of the Ministry of Health in delivering those will be monitored.

But we just won’t have the regular, public updates to help verify that.

What we do have is the minister’s assurances that more operations will be done, at lower cost, with more beneficial outcomes.

He appears to be asking us to simply trust him.

Trust a politician? If things don’t go according to plan politicians are notorious for hiding bad news.

Clark had better hope that there is a perceptible improvement or he could come under fire in the future.

33 Comments

  1. David

     /  June 27, 2018

    Nice work Clark, 17 billion and no measurement so no way of seeing who and what is effective.
    Minister captured so wage increases of 9% and no performance measurement.

    • PDB

       /  June 27, 2018

      The fact that dropping the measurements was one of the first things this govt did when put into power shows where their priorities lay. Like education this govt doesn’t want the public to be able to ascertain how well they are doing. Canning measurements with vague promises of replacing them with something else will only be believed by their most ardent supporters.

      ‘Most open and transparent govt ever’ is looking like another Ardernism whereby you publically state something positive and in the same breath do the compete opposite.

    • duperez

       /  June 27, 2018

      The simplistic dismissal about ‘no measurement so no way of seeing who and what is effective’ is a bit like some of the rhetoric about not using the “National Standards” system in schools. To some with more than a tad of political motivation, that change meant anything or nothing would be done in schools to assess kids’ learning.

      The suggestion that suddenly DHBs and the Ministry of Health are not going to measure and assess, as an argument should bypass ICU and head straight for the morgue.

      • PDB

         /  June 27, 2018

        The only one spinning politically is yourself (as per usual). The argument is that they have scrapped measurements with no measurements to replace them and no promise that any measurements put into place in future will be publically available – hardly ‘open and transparent govt’ as promised is it?

        The fact the measurements were dropped without any cabinet discussion, any mention pre-election or without any public statement appears to have escaped you.

        • duperez

           /  June 27, 2018

          What doesn’t escape me are desperate efforts to disparage anything the government does with automatic inferences that anything they do will mean the demise of New Zealand and then espousal of that certainty. That and an absolute determination to not trust the government.

          • PDB

             /  June 27, 2018

            With their track record already why would anybody ‘trust’ this govt? The list is already extensive as to how non-transparent and closed they have been including making it harder than the last govt to get official information, undermining govt organisations (RNZ & the DHBs), getting rid of a whole industry on a whim without official advice or consultation with the public/ stakeholders/cabinet (oil & gas), creating slush funds for Wisnton & backtracking on most election promises just for starters.

            You obviously think quietly ditching health measurements and replacing them with no measurements is good for the country? The idiocy of that point of view is summed up in this bit from the Herald:

            “And while there has been no announcement, the National Patient Flow project – which measured the number of patients being turned away from the operating table – has not released any updated figures since September last year. That project was launched following intense political pressure from Labour,over surgical unmet need.”

            So not have the govt ditched measurements National thought were important but they also ditched a measurement brought in due to pressure by Labour themselves whilst in opposition!

            The only ‘desperation’ is you going about your day saying ‘nothing to see here’ in every post and hoping the govt magically improves.

  2. If you don’t measure it, you can’t fix it. Or prove that it’s working, for that matter.

  3. Gerrit

     /  June 27, 2018

    As the government no longer requires measured health targets, it means a large number of administrators are surplus to requirements and can be fired.

    Freeing up expenditure money to feed the nurses union demands.

    Simple really.

    • David

       /  June 27, 2018

      Do you really think that having no accountability because there are no standards, targets, measurements in place that the health system will miraculously give better performance ? Sure that always happens which is why the most successful enterprises ever don’t bother with performance measurements.

      • Gerrit

         /  June 27, 2018

        I dont know what enterprises you have worked in but ALL the ones I worked in had a performance measurements to aid management.

        Towards the end of corporate days we changed from line reporting to exception reporting. So if your budget required X and you only achieved Y, it would prompt an exception report.

        But a performance report none the less.

        And successful enterprises don’t measure the bottom line? How the heck do they know they are succesful? Could be loosing big time and who would know till the customers stopped buying or the creditors stopped supplying raw materials.

  4. Blazer

     /  June 27, 2018

    Winston sums it up well…

    ‘They are not correct in saying we’ve dropped health targets, we just think those health targets were such a miserable failure that we have to find something that works and that is better, and that’s what we are working on at the moment.”

    • Hi Blazer, I heard (without evidence) that your house has a leaky roof. I propose we knock the whole thing down immediately, and form a working group to discuss how you might be housed sometime in the future. We have to find some better plans. Don’t worry that it’s winter, we’re doing our best and are confident it’s all going to work out… sometime.

      • PartisanZ

         /  June 27, 2018

        Poor, overblown analogy IMHO … Blazer can simply go on living in the house as before … just as the health system can and will go on functioning as before …

        Your metaphor might work if you were talking about Housing Standards … but there’s still nothing in Health Targets to compare with your “immediate demolition” or, for Standards, immediate eviction …

        Gezza would say … “Try again and report back” … but I’m not like that …

        • Let me understate it then. In what world does it make sense to dismantle a structure without having ready any idea or suggestion of what to replace it with? Accountability is the bare minimum I would have thought.

          • PartisanZ

             /  June 27, 2018

            They’re not dismantling a structure …

            They are dispensing with one way of measuring a complex system’s success.

            I admit, it’s not a good look not to have a new measuring criteria in place.

            However, this hardly puts the structure itself in danger.

      • Blazer

         /  June 27, 2018

        Hi Duncan…I heard about someone who on the flimsiest ,unscientific evidence was booted out of their state house for meth contamination and had their whole life turned upside down.
        The Govt responsible for that calamity begins with N….for no idea,I suggest.

    • He contradicts himself.

    • David

       /  June 27, 2018

      Let’s hope you end up in the health system that has no accountability for the treatment you receive…opthamolgic hopefully might open your eyes.

  5. Loki

     /  June 27, 2018

    Socialists don’t like being measured on results

    • Blazer

       /  June 27, 2018

      tell that to…Sir Ralph Norris…and…

      • High Flying Duck

         /  June 27, 2018

        Was Norris not judged on his results? He resigned because of the Fletcher issues didn’t he?

        • Blazer

           /  June 27, 2018

          yes but the point is he didn’t like it at all….tarnished his reputation….diddums!

    • PartisanZ

       /  June 27, 2018

      Just as well they’re not socialists then, isn’t it … ?

      They’re maybe slightly further Left towards the Social Responsibility, Public or Command Capitalism end of the all pervasive Capitalist continuum – still quite close to Centre – rather than to the Right, Individualized, Privatized or Laissez Faire end …

    • David

       /  June 27, 2018

      Because generally there are none.

  6. NOEL

     /  June 27, 2018

    This one is on NHS in the UK but bearing in mind that many measures used by the Health Department here have their origin in the NHS page 11 is interesting.

    • Kitty Catkin

       /  June 27, 2018

      What an interesting article, and it’s transparent, too.

  7. Steve Grant

     /  July 4, 2018

    Great news. The gross targets and associated punitive measures have predictably been a disaster. The reported measures are misleading at best.
    The emperor has been shown to have no clothes.