Health Minister Dr Shane Reti has addressed the coalition Government's health targets on Q+A this morning.
Reti said the health targets had been reintroduced because they direct resources and attention, hold the sector accountable, and set a "very clear agenda" for the direction of the health system.
The Government targets include:
- Faster cancer treatment - 90% of patients to receive cancer management within 31 days of the decision to treat.
- Improved immunisation for kids - 95% of children to be fully immunised at 24 months of age.
- Shorter stays in emergency departments - 95% of patients to be admitted, discharged or transferred from an emergency department within six hours.
- Shorter wait times for first specialist assessment – 95% of patients to wait less than four months for an first specialist appointment.
- Shorter wait times for treatment – 95% of patients to wait less than four months for elective treatment.
When asked if emergency departments "gamed" the system previously when there were long ED wait-time targets, Reti said his understanding was they did and that he would be "watching very carefully around gaming of the targets."
"With knowledge of what some of the gaming was, you can mitigate that and you can reduce it, so it's not gamed as much."
A key recommendation to reduce it from a 2019 Auckland University study on the subject was an independent verification unit.
Reti said it was "nothing [he'd] had in [his] workstream," but that it could happen in the future.
Being really clear about classifying where the clock stops and starts would be a "large part" of making sure gaming did not occur, he said.
"You can start the clock at different times, and once you know what the gaming is, you can make it very clear. No, a movement from here to there is not the end of the clock for an emergency department; it actually ends when the patient moves up, moves up to the ward."
Reti said a target set around GPs would need to be "achievable as well as ambitious."
Half a million adults and 73,000 children were unable to get an appointment with their GP in New Zealand last year, according to Health NZ.
He said a discussion with primary care about what would be a "reasonable target" was still to be had with the sector, "particularly in the context we have at the moment with a constrained workforce."
"It's not a target that I would take out myself without deep discussion with primary care as to what do you think it should be, what is achievable and what might the milestones be to get there?"
Reti said the general practice funding model has "been broken for a while" and that the capitation funding "makes no sense."
"Imagine this - you're the healthiest person in New Zealand within a certain demographic, and then you're the illest person in New Zealand - practices receive exactly the same capitation funding for each - for the healthiest and the most ill."
He said he was working on an alternative to change the structure of primary care that he would like to see in the next 12 to 15 months.
It would probably consist of two parts — new funding and redistribution of existing funding.
Stopping nurses going to Australia was a "challenge", Reti said.
"Interestingly, the internationally qualified nurses, a large number of them actually move on to Australia, even though we've had a large number of IQNs come in in this last quarter.
Discussions had been had with the Nursing Council to prevent New Zealand becoming a "stepping stone to Australia."
"Maybe our greater attention should be for our domestic nurses; we've all had investment in them, and they're the ones who are looking to move to Australia."
When asked about the construction of hospitals in Dunedin, Whangarei and Hawke's Bay, Reti said that they remained "priorities."
"They're currently through business cases. They need to have that done before we get to the funding discussion."
An Infrastructure Commission report found that New Zealand would have to spend $115b on hospitals over the next three decades.
"The estimated annual requirement for new hospital buildings is almost equivalent to a new Dunedin hospital every year, from 2033 to 2052," the report read.
It also found that of all infrastructure considered, hospitals were the ones that had been most underfunded.
Reti said that was a funding discussion across all of government.
"Health has funding needs, education has funding needs - this is the discussion of getting an economy back on track; it's a discussion of prioritising infrastructure."
Fast-track consenting processes and infrastructure programs showed the government's "ambitions for infrastructure", he said.
During National's election campaign, it specified 13 cancer drugs that the government would fund independently from Pharmac.
When asked what was to stop pharmaceutical companies from charging whatever they wanted for these drugs, Reti said that they would also want to provide other drugs to Pharmac as bundles.
When asked about smoke-free legislation, Reti said that the number of lives it could have saved were between 4000-8000.
"But what we've also said is, 'Look, the smoke-free rates are coming down from 8.6 to 6.8 - one of the biggest gaps we've ever had, and we remain committed to driving them down - that's the context for the smoke-free legislation."
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