Archives for posts with tag: Zero GP Fees for Under Sixes

I’ll start with some praise. Without a doubt the most positive development for Capital & Coast in 2012 was that all children aged 0-5 now receive free GP care at every practice in our district, at any time day or night.

This has been a consequence of the National government’s election promise to extend free 0-5 visits to cover after-hours care; and they deserve credit for following through on that.

Moreover, in the Capital & Coast and Hutt Valley districts, the flow-on effect of this has been that all of the remaining practices that had been dragging their heels for years on signing up  for the free 0-5 visits during the day have now done so. Perhaps they were worried parents would take their kids to the newly-free after-hours clinics instead. In any case, we now have 100% coverage for this vital policy! Congratulations and thanks to the CCDHB staff involved in negotiating those sign-ups.

Some credit for this achievement also ought to go to Wellington Central MP Grant Robertson. As Labour’s health spokesperson last year he pushed Mr Ryall tirelessly to extend the 0-5 policy to cover after-hours, and during the election campaign achieved that aim. (Due disclosure: Grant is an old friend, and I work with him in my day-job. Even so, I think this is a fair enough call.)

On the negative side of the ledger, the funding cuts to Newtown Union Health Service was the big issue for me — and many others — this year. Newtown Union serves one of the most deprived communities in Wellington city, and the Board’s decision this year to endorse cuts to its funding makes a mockery of our pious talk about tackling health inequalities. Kudos to the United Community Action Network and Dr Ben Gray from Wellington Medical School for their passionate defense of the service.

We also need to recognise that, although Newtown and its supporters made the most noise, CCDHB has also instituted cuts to a range of services for high-needs populations, including Porirua Union and Community Health Service.

As with the earlier praise, blame for this needs to be apportioned.

Firstly, to Health Minister Tony Ryall and the National government. His funding of the DHB sector and health more generally has been woefully inadequate, and it is a pity that he has largely escaped criticism for that so far.

The Council of Trade Union’s economist Bill Rosenberg has produced an excellent series of papers showing the amount of money the health sector needed just to stand still, and this year’s Budget once again fell well short of that. Basically, DHBs needed about a 4% funding increase just to avoid going (further) backwards, and they only got about 3%. And they were already in the hole from two ‘austerity’ Budgets prior to that.

We mustn’t fall for the spin. This is not ‘fair’ and it’s not ‘necessary’. New Zealand’s business activity is sluggish at the moment, but that doesn’t mean it’s smart to start short-changing basic health services. The claim that we ‘can’t afford’ to invest in health is incorrect and economically illiterate. New Zealand is richer (including in inflation-adjusted and per-head-of-population terms) than it has been at virtually any time in our past. We’re apparently so rich that we could afford (in 2010) to give a massive tax-break to the most well-off, least-needy people in our community. Yet we can’t afford to fund health properly? Rubbish!

It was inevitable that this choice by the Minister would lead to tougher and tougher times for DHBs around the country, and harder and harder decisions as they try to make ends meet. And, sure enough, stories have begun to trickle out about the consequences of underfunding.

But — this doesn’t exempt the members of our District Health Board from culpability. Yes, it’s been tough. But we’ve accepted the Minister’s austerity agenda without a peep. In fact, Capital & Coast’s public utterances have seemed to so thoroughly owned and supported the drive for cuts that it seems as if we’re suffering from Stockholm syndrome.

And, even within the savings drive, did the axe really need to fall on our poorest communities??

In this regard, an honourable mention goes to my Board colleague Helen Ritchie who has stayed staunch and consistently voted to protect rather than cut services.

I should also add, that alongside these wholesale cuts, the austerity agenda has also threatened to contaminate a range of other initiatives that appear to have a defensible clinical rationale, but which are also being implemented in a way that seeks to return savings to the DHB. Our rationalisation of home-based support contracts for older people attracted controversy, and in fact we have only just recently won a court case taken against us by one of the unsuccessful providers. And we are currently undertaking a restructuring of our funded services for people who have high or complex mental health needs.

A second negative theme of this year has been secrecy. As a board member who is committed to reporting on our decisions as a DHB, it’s been an ongoing frustration how much of what’s important happens – and stays – behind closed doors. Often the public agenda is little more than a news update – barely worth reporting on — and then we discuss and debate for hours about things we’re forbidden from discussing with our electors.

If the democratic deficit in health governance is to be closed, then major changes are needed here.

So that, in brief, was 2012. Next year is an election year — in October 2013 the population of Wellington, Poirura and Kapiti will have the opportunity to judge the elected members of the Board and consider the merits of new applicants for these roles.

Ahead of that, I’ll need to make a decision about my own plans, and I’ll have more to say about that in the New Year.

For now, though, I’d just like to say thanks to everybody who has read this blog, or given me help and support over the course of 2012. See you next year!

Last month I reported that the Board had had some unofficial indications about the government’s Zero GP Fees for Under Sixes after-hours election promise. It seemed like only one provider in each territorial local authority (TLA) area would be funded to offer free after-hours care.

In the CE report in our papers for this month’s meeting (p. 14), we were told the following:

No new information has been received form the Ministry of Health (MOH) with respect to free under 6s.

Staff are awaiting clarification of expectations and indications; a verbal update will be given at the meeting.

But at the meeting we were advised that there was nothing more to report, as no further information had been forthcoming. Despite the fact that, supposedly, this initiative is to come into effect from the middle of the year.

Not very helpful.

During the election campaign last year, National promised to:

Work with local primary care networks to provide free after-hours GP visits to children under six.

Zero GP Fees for Under Sixes after-hours will make it easier for those families who need their child to see a GP or nurse outside of business hours. This will also help reduce the increase in young children presenting at busy hospital emergency departments.

Most children under six in Greater Auckland now get free after-hours doctors’ visits. This is because of a new city-wide after-hours network established by the District Health Boards (DHBs) in Auckland and local GPs in September.

We will extend Zero Fees for Under Sixes to after-hours throughout the country by working with DHBs, local primary care networks, and after-hours clinics. Currently 87 per cent of under sixes are covered by the free GP visits daytime scheme.

That sounded positive, even if the commitment had been made in order to pre-empt an anticipated Labour Party promise along the same lines, and even though the $7 million price tag was to be funded from “efficiencies” elsewhere in Health.

But when I read the update on this initiative in this month’s CE report to the Board (see page 16) that Capital & Coast would only be receiving $400,000 as its share of that $7 million, it really struck me that this wasn’t very much money to fund this additional entitlement.

So in the public part of our Board meeting on Friday, I asked the management about this, and was rather surprised by what I learned.

First of all, despite this being the government’s flagship health promise, the DHB has yet to receive any formal notification about this initiative, and they do not yet know when it is supposed to commence.

But also, and specifically on the question of whether we could afford to implement this for $400,000, it seems that the plan at present is that, rather than this being a general entitlement, only one provider in each territorial local authority (TLA) area will be funded to offer free after-hours care. For Capital & Coast that would mean one provider in Wellington, one in Porirua, and one in Kapiti.

I’ll be watching further developments on this initiative with interest, and will be interested in feedback on whether people feel the government is keeping faith with its election promise with this one-provider-per-TLA approach.


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