MacDoctor on Labour and Health
June 28th, 2009 at 2:16 pm by David FarrarMacDoctor nails it here:
If you were wondering why Labour spent so much extra money on Health without actually improving the health of New Zealanders, nor their access to services, puzzle no longer. Ruth Dyson reveals all. She is complaining that some of the health promotions that were dear to Labour’s heart have been cut or seriously curtained. Things like cancer “control”, heart promotions and the diabetes “get checked” programme. …
No, Ruth, these are NOT frontline services. They never were and they never will be. These are all Labour’s attempts at preventative health promotion and, as such, provide no health service at all. This is not to say that preventative health is necessarily useless, just that they are not frontline services. They are not delivering medicine, they are delivering social change. At least, they might be delivering this.
That is a great line – they are not delivering medicine, they are delivering social change.
That does not mean all public health activies are not worthwhile, but they are not the same thing as actually giving someone an operation, a prescription etc.
The biggest problem with all of these preventative health schemes is that no one appears to have bothered to examine whether they are making any difference. Labour’s attempt to monitor results of these campaigns (now removed from the health reporting list by National) were so wishy-washy and soft, that it was impossible to tell from the data whether they were successful. That does not seem like a good use of taxpayer dollars to me.
Take the diabetes programme “get checked”, for example. This programme, unlike most, actually has links to hard data like blood results, blood pressure readings and hospital admission rates for diabetes and diabetic complications. All the hard evidence shows that the programme has made virtually no difference to the quality of diabetic control.
Huge amounts have been spent on programmes that *might* improve health outcomes. But what data there is, is patchy.
Diabetics who normally don’t attend their regular check-ups don’t abscond because they can’t afford it, they don’t come in because they can’t be bothered. Diabetes is one of those diseases that kill you slowly, like high blood pressure (only worse). People don’t like to see the doctor unless they are sick. So they don’t. All that “get checked” does is make it cheaper for the people who would have regularly attended their doctors for diabetic monitoring. It is a subsidy for diabetics. Nothing more, nothing less.
More middle class welfare.
There is nothing wrong with this. It is just not something you want to fund at the expense of real frontline services like outpatient visits and elective surgery.
Which is what Tony Ryall is sensibly targeting.
Labour’s singular failure in health is their constant focus on what would be nice at the expense of focussing on what is truly needed.
Dead on target here.
Nobody is saying that heart prevention programmes are invariably a waste of time. We may demonstrate that they may be very useful indeed at reducing long-term heart disease. But it is not right that a dozen people should die because they can’t get heart surgery in time in order to fund a social intervention. Particularly one that does not have demonstrable benefits.
This is how Labour managed to double health spending but almost make no impact on waiting lists etc.
June 28th, 2009 at 2:26 pm
…care to answer Mallard ??? Easy to waste other peoples money aint it ya prick…
Vote:June 28th, 2009 at 2:30 pm
This is one of the reasons why Labour boosted health expenditure by 3.5Bil a year, and yet the waiting list doubled. It is so incompetent it is breath taking.
Vote:June 28th, 2009 at 2:32 pm
In the words of my generation: “pwned!”
Vote:June 28th, 2009 at 2:38 pm
At least $1million per week on “tobacco control ” and every year more and more people smoke. Despite the lies from the MOH. Most of these shitforbrains just do not understand that if it is not working that means it is time to try something else. And stop wasting our money!!!!!
Vote:June 28th, 2009 at 2:41 pm
In the words of my generation… what the fuck does “pwned! ” mean ??
Vote:June 28th, 2009 at 2:42 pm
As I’ve said before, if Ryall wants to improve health outcomes then an obvious target is to look at the way that hospitals manage their operations (not surgery, their general operating practices).
They’re appalling.
I recall several years ago one mid-NI Health Board dramatically reduced wait times and improved outcomes merely by implementing APPROPRIATE Lean Six Sigma practices into their hospitals. Those sorts of things should be disseminated throughout the Health Service. It saves millions, when done APPROPRIATELY.
Doctors and health professionals are great at their professions, but they really really suck, when it comes to managing their time and productivity properly. This is a no-brainer for those of us in most industries, it’s expected. However, it’s not in Health. Why?
One example: a relative was recently awaiting discharge from Wgtn Hospital. She waited from 9:30AM to 5:30PM for the House Surgeon to get around to writing her a script for three medications. What she needed was well understood, it didn’t take any diagnosis, all she needed was that script. It took them 8 hours. FFS.
Another example: How many of us have experience of waiting at A&E for hours and hours and hours and hours and hours???
Of course, it’s understood health brings urgent cases. However, that’s the nature of the industry, it’s a well known problem. So you build in allowances for that into your processes.
My point is: no-one has ever systematically tackled this issue. All it would take is for Ryall to say: “do it.” And those two words alone, would save tens of millions, when done APPROPRIATELY.
Vote:June 28th, 2009 at 3:01 pm
It’s an internet meme designed to confuse and exclude the uninitiated, in order to decrease their sense of self-worth and thus enhance our own.
Vote:June 28th, 2009 at 3:04 pm
The social fiddling side of medicine is perfectly suited to contracting out. That way you get a controlled budget, concrete objectives.. and easy closure if its decided its not needed.
JC
Vote:June 28th, 2009 at 3:07 pm
During the 2008/2009 financial year $68 million was spent on 116 NGOs for ‘obesity control’; $46 million handed over to NGOs of tobacco control and the list goes on and on for alcohol and gambling. Labour raped the taxpayer to pay for the nanny state. Ryall should launch an investigation into these groups. The highly paid CEOs of certain ‘state-sponsored’ groups should be worried about issues of accountability.
Vote:June 28th, 2009 at 3:11 pm
So why are we paying taxes to fund “real frontline services” for people who “can’t be bothered” to look after themselves in the first place? There’s no choice but to state fund accident and emergency services given the history of the system (basically there’s no other service provider) but it seems that the time has long since come for people to pay for their own healthcare in non-trauma situations. Might make more of a difference in motivating people to live healthier and look after themselves.
Vote:June 28th, 2009 at 3:21 pm
So this “health spending” actually went to who? Advertising companies?
Vote:June 28th, 2009 at 3:29 pm
Labour was very good at curating layers of bureaucracy. They were good at having meetings on meetings.. on how to do things.. without actually doing anything.
Vote:June 28th, 2009 at 5:06 pm
A whole new concept in health care you have created here Mr Farrar.
‘An ounce of cure is worth a pound of prevention.’
We could call it David’s law.
Vote:June 28th, 2009 at 5:23 pm
Liarbour used the health system to launder taxpayer money to pay off tit sucking parasites happy to sell their souls and their votes to the socialists. Some of the biggest “donors” like the EPMU were happy to be a cog in the money go around machine. Yes the socialist pricks spent billions on health but you would have to be thick as two short planks if you believe there were no ulterior motives for the huge spend. No wonder the health system is so sick, you can’t get a good hand if the deck is stacked.
Vote:June 28th, 2009 at 5:46 pm
Sonic: I don’t think anybody is arguing against prevention…. just arguing agaisnt inefficient boards and taskforces set up without clear ways of measuring goals, and with little or no accountability for the money spent. Prevention is only worth it if it WORKS
Vote:June 28th, 2009 at 5:59 pm
The people on those waiting lists must really love their socialised medicine! It therefore seems the way to produce the Labour desired “social change” is to make people pay for their health care by deconstructing socialised medicine, thus encouraging healthier lifestyles and behaviours in people who actually have to pay to get better. The people waiting for their free health care are obviously so enamoured of the idea of getting something for nothing that they don’t seem sufficiently bothered about the dismal quality of that care to just give it up and go and pay for their own. Think of the extra health complications created by people staying on waiting lists for months because they want to get something for free! Socialised medicine encourages unhealthy lifestyles AND unhealthy health care!
Vote:June 28th, 2009 at 6:12 pm
It was also Labour’s way of ‘advertising’ how careful and caring the ‘Party of Government’ was.
Millions of TV dollars spent on promoting ‘Health Issues’, and advertising the Labour Party at the same time.
Like Kiwisaver’s huge TV spend pre-election.
What I feel is wrong is the constant message being portrayed to M-people, and PI folk.
The sub text is that ‘Labour looks after its own’, and ensures further dependency.
Frankly I find the constant use of Ethnic minorities to be highly bigoted and racist against the bigger Euro Pakeha population.
Are we worth less than Brown folk?
Or in reverse, it could be seen as highly patronising.
The reality is that it was intended only to show how caring Nanny Labour were. Period.
FFS, they will be buying votes using KFC next!
Vote:June 28th, 2009 at 7:00 pm
‘Labour’s singular failure in health is their constant focus on what would be nice at the expense of focussing on what is truly needed’
This doesn’t point to what actually is truly needed. The prevailing system views people as members of population groups, not as individuals. Funds are allocated on the basis of the perceived health needs of health based population groups. Yet everybody presents as an individual. Too bad if the funding allocation for your presenting health need has now been spent. National continues to happily manage such a top down system where bureaucrats and politicians guess on your behalf.
It gets worse, irrespective of the quality of the guesses; Any organization which has its money coming in from the top as opposed to coming in the door with the customer will struggle to focus on the customer and will capture excessive amounts internally, happily whistling up own collective admin process asses, as we have witnessed over the last 10 years while the coalface still starves. No ideology here, doesn’t matter whether this is a private corporation with a slush of new shareholder funds or a govt dept with a slush of new taxpayers money
Productivity concepts like Lean, Six Sigma and Constraints Management can offer massive value to hospital management. In US, practitioners in the aforementioned have their main growth in the health care sector. However these improvement methodologies are inherently systemic, which is why the real benefits don’t come through in the form of transformed patient centric organizations because the hospital system beyond the coalface of ward and patient management has no outcome to turkey vote for an early christmas.
Vote:June 28th, 2009 at 7:09 pm
Liarbour drank all the piss, National has to deal with the hangover.
Vote:June 28th, 2009 at 7:14 pm
“Liarbour drank all the piss, National has to deal with the hangover.”
Fantastic Anology!
All the Country needs now is counselling on not getting into that situation again, ever!
Vote:June 28th, 2009 at 7:17 pm
Prevention is most definitely better than cure, IF IT WORKS. It seems like these stats suggest that the approaches to prevention haven’t really worked as well as hoped, but I don’t think that should mean giving up on focusing on prevention. It just means we need to do prevention better.
Vote:June 28th, 2009 at 7:18 pm
In face of comments above I think it would be a brave politician to continue with any preventative measures. Medical care is a question of priorities and rationing. It is the brave person who decides to slow down the rate of treatment for the sick to give the money to preventative programmes. Just as we spend so much money on drink driving and still there are lots of people killing themselves and their freinds by drink driving and those that don’t success get caught by the police in checks … but there is no discernable result for those who decide not to drink and drive.
So apart of Sonic’s comment I see nothing but stupid politicising in this thread, along with bigotted ignorance.
The only way to meet the demand is to reduce the need, to reduce the amount of rationing currently going on, with little chance that I can see of a early solution when I read comment as above. Labour were on the right track and the only excuse for National is that we have entered tough times.
Vote:June 28th, 2009 at 7:43 pm
jcunkz… if we were against prevention we would be arguing agaisnt vaccinations and such, however we are not because we are agaisnt onnly those methods that do not work, e.g. the diabetes get checked campaign – unless you can in fact provide evidence that it has accomplished anything I suggest it would be better to move thsoe funds elsewhere.
Vote:June 28th, 2009 at 8:41 pm
Labour never wanted the population to be healthy, if in fact they were, they would have no voters. They want people to feel like they cannot exist without them………. The PC world we live in wants to have their hands held 24 / 7…..
The vast majority of humans have no accountability, it is everyones fault but there own…
I attended my Pop’s funeral on Friday last week, was a wonderful funeral, he was in WWII. The part of the funeral talking about the war and when he came home etc, the key take home was that “we just had to get on with it, carve out a new life and future” None of this namby pamby shit that the world owes me!
RIP Pop…..
Vote:June 28th, 2009 at 9:22 pm
JCUNKZ, you fall into the classic trap, as does Sonic, the belief that “doing something” must be good if you mean well. The real issue Macdoctor is railing against here is that under the previous government some hundreds of millions seems to have been “invested” in preventative sloganeering and politicing and there has been no apparent return on those funds. A waste in other words. There is evidence for some specific targeted preventative campaigns having positive effects, vaccination perhaps (although probably not the Meningitis campaign), but for almost all the others, we seem to have received nothing at all but a load of well paid bureaucrats in Wellington and a lot of execrably poor fear based advertising aimed at the “social evil du jour”.
Prevention may well be better than cure, but first be sure you’re getting prevention. It would appear we have been receiving the prevention you get when you don’t get any prevention. In that case we’d be a lot better off with cure without the empty little slogans.
Vote:June 28th, 2009 at 9:27 pm
Ed, campaigns like this tale years to work through the system, anti-smoking information in primary schools now cannot be measured for what, 16 years?
If there is evidence that these things do not wok I’d like to see it (this post has only assertions not evidence) but this sounds to me like the preface to cuts in preventative health programs, in the mistaken belief that curing someone is better than preventing them from getting ill in the first place.
Vote:June 28th, 2009 at 9:54 pm
Sonic, you are making a statement of faith, nothing more. It is only your assertion that these things will have an effect and frankly, for most of them I doubt that they will. Certainly no evidence has been adduced to demonstrate such. MD introduces at least one intended to have a much shorter term impact, the diabetic campaign, and the evidence appears to be that it has had no impact.
And 16 years at the current accelerating rate of spending …. You need more than that to defend so dogmatically as you have.
Vote:June 28th, 2009 at 9:55 pm
Sonic continues to get confused.
Goes with having the IQ of a Diet Yoghurt.
Go on Sonic, tell us what your degree is?
Vote:June 28th, 2009 at 10:10 pm
Ultimately helen and her cronies killed many kiwis by poor quality funding.
many of those kiwis will be labour supporters too.
Quite shocking.
Vote:June 28th, 2009 at 10:25 pm
Labour’s focus has always been to get elected to power. Once in power the aim is to stay in power. It really is that simple. It never has and never will be about doing what is right or efficient. Every Labour decision is based on the potential electoral advantage. Their strategy is to make more and more people dependent on all or part of their income by having a Labour government in power. ie. more and more public servants. More and more people receiving government subsidies and benefits for being ill, being disabled, being poor, being a pensioner, being a student, being a bludger, being a parent, being a grandparent of any of the above. Being sick, being injured, being sad. Get this number over 50% and they win permanent election. Turkeys don’t vote for Christmas and Labour always treats people like turkeys. Truss them up fatten them and feast on their bones.
Vote:Labour exists for Labour. It is that simple.
June 28th, 2009 at 10:32 pm
Got any evidence these campaigns do not work ED?
considering a) the huge health benefits fron catching disease early and b) the proven success of such campaigns in the past (ie smoking) I’d need some evidence that the common sense approach of prevention being better than cure is somehow wrong.
Glutaemus, I do have a degree of doubt that anything you say when drunk makes any sense. Will that do?
[DPF: You have it the wrong way around. Is there any evidence these campaigns have worked?]
Vote:June 28th, 2009 at 10:43 pm
Sonic,
Drunk? How does that work?
It is 11.42 in the UK at the moment.
Good body swerve on the question though. Laddie.
Vote:June 28th, 2009 at 10:56 pm
The British National Health Service was based in 1948 on the socialist myth that prevention was cheaper than cure. Preventing illness such that there will be less future patients is a blindingly obvious saving till you use your brain. There was a commission of enquiry , I believe in the early 1960′s, into the economic benefits of having everyone in the UK stop smoking. The finding was that the costs of such an outcome would bankrupt the UK. Instead of saving money it would be horrendously expensive. On average smokers who quit would live for 6 more years. 6 more years as a pensioner receiving a pension and yet still of course dying , but not quickly from a massive heart attack, but slowly from debilitating illness requiring costly care. Nothing has changed. The economics of health remain the same. Smokers pay tobacco tax and income tax for perhaps 50 years. Ideally from a revenue point of view they retire for 2 years and then die quickly and cheaply. Every government knows this and the lower socio-economic groups of society do not. They are simply tax fodder.
Vote:June 28th, 2009 at 11:12 pm
Glutaemus “t is 11.42 in the UK at the moment.”
Well I would count that as sun being over the yardarm time, you certainly write like a drunk.
I’d say I had a degree of difficulty following your logic!
“There was a commission of enquiry , I believe in the early 1960’s, into the economic benefits of having everyone in the UK stop smoking. The finding was that the costs of such an outcome would bankrupt the UK. Instead of saving money it would be horrendously expensive”
Care to give us a link to this report, or should we file it under “Right wing myths”?
Vote:June 28th, 2009 at 11:37 pm
Franks Commision of enquiry 1966 pre internet
Vote:June 28th, 2009 at 11:50 pm
Reminds me of the definition of a socialist as being someone who thinks a nice idea is a good idea.
Vote:June 29th, 2009 at 8:06 am
There is no doubt that prevention is better than having to cure the sick … an ounce in time saves nine etc …. but when you are trying to change peoples’ bad habits .. many promoted by big business for profit … it takes a long time so I suggest that most of you are just too impatient and too willing to attack things becuase you believe they are left wing. Changing habits needs to start in early childhood and that means to see results one has to wait perhaps twenty or many more years.
So perhaps you have a point to critisise programmes designed for adults and all should be scrapped in favour of early and childhood programmes. The only trouble with that for the right is that many in the teaching profession appear to be left wing and future children could be infected with the ideals of the left, a fate worse than death for many here I’m sure.
Vote:June 29th, 2009 at 9:05 am
You apparently are so enamoured of the ambulance at the bottom of the cliff that you will refuse to pay for a fence at the top. It is very clever to call preventative medicine a “social change” program. It is a subtle falsehood that allows you to inflame the comments section here, but it IS a falsehood. “Prevention” is almost invariably more effective on a population basis, than “cure”, as can be seen from the statistics of all the countries that practice these strategies and their respective outcomes.
The principle example of this focus on cure is the USA, which boasts the highest per-capita health-care costs on the planet and ranks best (nope) second best (nope)… try 37th best in terms of per capita health outcomes. They have other problems (being totally privatised in terms of insurance) but the focus on cure rather than prevention is a big part of that.
All that said, I don’t think labour did things well, did things efficiently or provided appropriate levels of care or supervision. Feel free to rubbish the rubbish, but don’t make the mistake of calling preventative care a “social program”. It isn’t. It is hard to measure the results over months, it takes years and decades to see effects, but the results are there and epidemiologically quite certain. It is a point at which focusing on the short term can COST you money (and health) in the long term.
respectfully
Vote:BJ
June 29th, 2009 at 12:13 pm
“That is a great line – they are not delivering medicine, they are delivering social change.”
Getting fewer people to become fat and unhealthy and a drain on the public health service is social change that I could get excited about. I just don’t see how anyone could seriously expect a “Push play” advert on TV to do this.
Vote:June 29th, 2009 at 12:28 pm
Well said Ratbiter. The person watching TV instead of doing something has already made his choice. Yawn. Change the channel.
Vote:June 30th, 2009 at 2:38 am
Looks like Mac Doctor has taken off his doctor hat and put on his tory hat.
Also again we see the latest in emerging trends from National, it is no good their own succeeding unless others fail, I guess your worried that Labour put down the ground work for so much improvment for the poor that you’ll have no one left to beat up on.
As for prevention vs cure, money does not come into it, the right is happy to waste money left right and centre (just like on a massively inefficent criminal justice system) as long as it is not them suffering for it, just another tool to keep the poor down.
Vote:June 30th, 2009 at 11:33 pm
> it seems that the time has long since come for people to pay for their own healthcare in non-trauma situations
I would be curious to know how far you’d go with this.
I am a Type 1 diabetic. If I did not “look after myself” (and specialist visits are an important part of this) my kidneys would fail a decade or so down the track. I would then become a (very expensive) ongoing “trauma situation”. Health is too complex an issue to be covered by a blanket statement like that.
That said, I agree that Labour’s spending on social engineering via the health system was utterly disgusting.
Vote: