New Zealand’s health system is bearing the brunt of decades spent unraveling a once proud and effective network of public health and prevention.
Kuia Ann Shaw, based in Palmerston North, the first nurse to be named New Zealand’s public health champion, said it was “terribly sad” to see the current stress on patients and first-line health workers line.
She was responding to a series of reports about pressures on emergency departments, wait times for primary care appointments and delays in planned care at overcapacity hospitals.
The situation was as bad in Manawatū as anywhere else.
* Incredible ED care despite stress praised by mother and daughter
* Medical Officer of Health Alistair Humphrey was fired for being ‘unmanageable’
* Shamubeel Eaqub: Health leads to an unhealthy generation gap
Figures released by Health Minister Andrew Little last week showed Palmerston North Hospital held the national record for the number of people waiting more than 24 hours in the emergency room to be admitted – 97 people in April.
But that wasn’t surprising, the 80-year-old grandmother said.
People knew in the 1990s what was going to happen and she thought the healthcare system had been in crisis ever since.
Shaw speaks as a former public health nurse, health promotion manager and last senior public health nurse based in Tairawhiti, with over 50 years of experience in public health practice and advocacy .
She was most recently Health Promotion Coordinator for BreastScreen Coast to Coast and is still active with the Cancer Society and other organizations.
Shaw said she was constantly surprised at how few politicians and other health service decision-makers understood or were curious about what had worked in the past.
“In the 1950s and 1960s, we were among the best in the world.”
There were public health nurses in every school, providing a point of contact that a team of nurse practitioners working in primary care today could not hope to match.
“Then we reduced a system that was New Zealand only.”
She does not understand why the number of hospital beds has been reduced in the face of a growing population.
She thinks the transfer of nursing education to polytechnics and universities has hurt the ability of healthcare staff to work as a team, and that student loans have discouraged new trainees.
Above all, she blamed Rogernomics policies in the 1990s when health services became competitive and regional health boards were transformed into crown health enterprises.
The networks providing information on health, housing, education – the determinants of “Public Health” beyond the sole control of the health system – have been eroded.
This undermined a long history of preventing ill health by enjoying a Maori definition that used the full continuum, from spirituality, environment, culture, housing, education, employment, justice to disability, illness and the medical model of hospitals.
“What has been missing since then is building on the strong prevention system that New Zealand has developed.
“Prevention may cost more at the start, but less at the end.
“It’s interesting to look back, but it’s so boring.”
Stuff Health reporter Rachel Thomas talks to National Health Party spokesperson Dr Shane Reti about how he would solve, what he calls, a health system crisis.
Communities needed to be given the support and information to decide for themselves what to do, not have it decided for them by a distant bureaucrat, she said.
During the latest health reforms and a recent meeting with Little in Palmerston North, she saw a silver lining of this change, with locality planning being rolled out to places like Horowhenua where it already existed strong links between health and other services.
One of the main goals of Te Whatu Ora/Health New Zealand was to keep people, their whānau and communities healthy and out of hospitals – not just to care for them when they got sick.
The focus on equity for Maori also appealed to Shaw after being immersed in Tairawhiti – “what’s good for Maori is good for everyone”.
Shaw said a key challenge would be rebuilding the public health workforce.
Te Whatu Ora chief executive Margie Apa has already acknowledged long-standing issues of labor shortages, burnout and underinvestment, and believes the new system could better address them.
Shaw’s view resonates with the current Public Health Association of New Zealand.
Alana McCambridge, senior policy analyst, said the current challenges in the health sector stem from a combination of issues, exacerbated by the Covid-19 pandemic, and while grappling with the biggest reforms in the health in 20 years.
Issues included a focus on illness rather than wellness, a lack of investment for many years in health, and in locally trained health personnel.
Efforts to intervene early and prevent health problems have been undermined by the lack of spending on public health.
Public health represented on average 3-4% of the total health budget.
“If we are serious about addressing the underlying determinants of health and the needs of the population now and in the future, we need to bring that total to at least 10%,” McCambridge said.
She said there had been a reluctance among public health staff to engage in political action, “that’s where we were most effective.”
As for Shaw, she will continue to bid and advocate for better health, duties she said she would never properly step down from.
“As a grandmother of 10 children, I would love to see the mess in the healthcare system improved, not only for everyone’s future, but also to ensure a fantastic professional future for the fourth generation of my whanau. “