Brian Easton says being the Minister of Health is one of the toughest jobs in Cabinet and being the Prime Minister or Minister of Finance is easy in comparison

This is a re-post of an article originally published on pundit.co.nz. It is here with permission.

The Minister of Health is one of the toughest jobs in Cabinet. 

In comparison, being the Prime Minister or Minister of Finance is easy. While recovering from an emergency operation, unable to move or sleep with all the tubes stuck in me and my stomach in turmoil, I dreamt that the Prime Minister had asked me to be Minister of Health.

Here is my maiden speech.

The core of my philosophy as a Minister of Health is captured by American author Simon Sinek, who said:

     “Senior doctors and especially hospital administrators don't know what their job is. When you ask them ‘what is their priority,’ they say ‘patients’. It's not. It is to take care of the people who work in the hospital – of the people who take care of the patients. Every administrator, every senior doctor, every senior nurse should be preoccupied with one thing and one thing only: are my doctors OK, are my nurses OK, is my staff OK? And if they get that right, they will devote their time and energy to taking care of each other and their patients.”

As a representative of the public, I am on the side of frontline staff, because they are on the side of the public. That does not mean we will always agree. I am constrained by the available funding from the Government. That constraint exists as long as the public does not demand higher taxes to finance the public services it desires.

Within Cabinet, I shall be pushing for a bigger share of the funding for healthcare services, but I acknowledge that some of my colleagues are just as passionate about their portfolios. The funding constraint means that sometimes the frontline staff and the Minister will be in conflict over remuneration or over resources for a particular treatment. Things may get a bit tense, but I will listen respectfully and ask you to be just as respectful about the funding constraint the Minister faces.

You can help by ensuring that the resources you use, including your time, are effectively deployed. This whole-of-system, continuous-improvement approach is different from the past, which charged managers with seeking efficiency. The reality is that if medical professionals do not take responsibility for the resources they use, then the managers will. Past experience indicates those managers are often unsympathetic to Smek’s approach and often not well informed about medical issues.

Certainly, management should be concerned with efficient uses of resources, but I want to keep management structures flat. Hierarchical structures isolate top management from their frontline staff and this isolationist culture trickles down to lower management levels.

While the Sinek quotation is about hospitals, it applies just as much to those in the primary sector – general practitioners and paramedicals. We have a particular problem with GPs. Many are nearing retirement. That’s one reason why we have increased the number of medical school places. It is true many doctors and nurses are heading offshore. We need to know why. It is not just pay. I have asked for exit studies to inform us.

I am very supportive of giving greater authority to senior paramedicals such as ambulance crew, nurse practitioners and pharmacists to prescribe routine treatments. I want to keep GPs focused on the difficult end of primary care. I see, for instance, no point in doctors having to approve every elderly driving licence renewal.

I worry that we are drifting towards a pill-popping culture, which focuses on medication as a solution to everything. I want a primary care service concerned with prevention, early detection and effective interfacing with secondary care.

That means I am committed to public health and preventive measures. We need to get our vaccination rates up. We have been doing well on the campaign against smoking (the black market aside), but we need to do better at reducing abusive drinking and we need to take the obesity epidemic more seriously.

When we compare the New Zealand healthcare system with the world’s best, we find that ours is up there with them. They are all striving to do better, of course, and so must we.

The one dimension where we do badly is access. Inside the system, a patient’s treatment is typically of the highest quality. But too many people cannot get inside. We do not even know how much unmet healthcare need there is, although we know that there are particular problems among some ethnic groups and in rural areas. I have asked for a national survey to give us a base to tackle the access problem.
Another access problem is GPs’ referrals to secondary care which are either denied or end up on waiting lists involving unreasonable waiting times. That’s more resources.

As far as buildings and equipment are concerned, I was disappointed to read in the Treasury's 2025 Investment Statement: 
   

“[...] hospital and healthcare buildings are on average 45 years old but have a typical life of 50 years. Some of those are facing issues with mould, leaks, use and seismic risks, while many require upgrades or replacement.”

But I was appalled to read the accompanying footnote:

“Health New Zealand still need to undertake a comprehensive conditions assessment to get a full understanding of the condition and performance of the entire health estate.”

‘Still need’. Let’s get on with it.

When I accepted the Prime Minister’s appointment, I said I would only do so if I was also made an Associate Minister of Finance. That is because I want to prioritise finding a better way to fund the hospital rebuilding program. The current system is limited because we target an arbitrary net debt level rather than match our borrowing with investing in the future.

I have been particularly concerned that the public health system outsources to the private sector at times because that inadequate investment program means public healthcare lacks buildings and equipment. In effect, we are outsourcing medical care as a way of getting around the debt target. I am not opposed to outsourcing per se, but doing it for accounting rather than medical reasons is just stupid. Ultimately, it is destructive to a quality and comprehensive public healthcare system.

My maiden speech as Minister of Health has covered many topics rather lightly, as is the nature of maiden speeches. It has identified some areas where we shall be putting more effort. But to finish by repeating my message.

We have a healthcare system which is comparable to the best in the world on most dimensions, once the patient is inside it. They seek to improve – so must we. Our system achieves so much because it is founded on a strong public healthcare system with unified funding. But what really makes it achieve so much is the quality and commitment of the staff. This Minister will work with them to reinforce those strengths and eliminate weaknesses.

At the hospital, when they removed the tubes, my stomach had settled and I was sleeping well; I realised this was all a hallucination. But it reflected the way I had put my trust in my GP, the ambulance service and the hospital medical team and how well they had served me. We should build a healthcare system around that trust.

*Brian Easton, an independent scholar, is an economist, social statistician, public policy analyst and historian. He was the Listener economic columnist from 1978 to 2014. This is a re-post of an article originally published on pundit.co.nz. It is here with permission.