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Good investment in health for 2020 would start with public health and primary care

12 May 2020 Sarah Dalton - For NZ Doctor

By now, finance minister Grant Robertson will have delivered the Budget.

It is not that I see the Budget the same way as kids see Christmas but, as I write this before the 2020 Budget is unveiled, I am thinking about the wish list I would give him.

My first and greatest wish is the one that I suppose is least likely to happen. Investing in health takes longer than one electoral cycle, so I really wish that we could get multiparty agreement – an accord, if you like – on a long-term commitment on how we invest in our health system.

The next bit would be our public health capacity.

Prime minister Jacinda Ardern has already said she thinks it is a good idea, so give that a tick.

Bits and pieces falling out of the public health investment might include safe and fluoridated water supply, water-only schools, a sugar tax and some healthy food regulation. I’m taking the contact-tracing stuff as read, because we all know how important that is now.

After that, my list would cover access to primary healthcare. Here at the Association of Salaried Medical Specialists, we think multipurpose hubs are the go; a handful of places already have these.

They provide medical, midwifery, pharmaceutical, mental health and allied health services in a one-stop-shop, along with (if we are really lucky) social work and community support.

These should be low cost and/or free, which means funding and working conditions for GPs probably needs a look.

In our view, salaried positions work better, particularly in hard-to-staff places. But we would think that, wouldn’t we?

Next would be better integration between primary and secondary services, along with fairer funding of the non-DHB providers such as Family Planning, which picks up so many crucial primary and preventive health functions, along with specialist work.

And did I mention it does all that on the smell of the proverbial oily rag? Let’s remember to be kind, and make sure these great services don’t
have to keep trading on the goodwill of their hardworking staff.

Finally, because I am not a greedy person, and I know Mr Robertson has a lot on right now, we would like to keep some of the good things we have learned from the COVID-19 lockdown.

Let’s not throw the baby out with the bathwater, but let’s be kinder to the environment, think about the way we’re building and refitting our health infrastructure. Let’s fix health IT. We could fly less and Zoom more.

But whatever we decide, let’s remember to factor in the advice of our senior doctors. If we have learned nothing else over the past couple of months, we have learned that they know what they are talking about.

And by now I will know if I was wishing into the wind.


Sarah Dalton’s column for NZ Doctor – 20 May 2020