The Dim-Post

November 13, 2012

Rating the Ministers

Filed under: Politics — danylmc @ 8:42 am

The Herald’s gallery team ran a report card rating government Ministers a year into their jobs, and I saw some bafflement on Twitter about how anyone could possibly look at, say, Paula Bennett and think that she’s doing well in her portfolio.

It’s true that if you look at Bennett’s performance in terms of statistical indicators – unemployment keeps rising, her welfare reforms are costing $400 million dollars and the total number of beneficiaries is only down marginally since last years election, not to mention the massive data breach in her department – she’s been a total disaster. But from a purely political perspective she’s done an amazing job of selling the urgent need for her welfare reform to the public. National has comprehensively won the debate on welfare; it owns it as a political issue and that’s mostly down to Bennett.

To my mind their most impressive Minister has been Tony Ryall. If National can run a more effective health system for less money than Labour, why would anyone vote them out of government? (The answer to this question is Hekia Parata.)

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41 Comments »

  1. I was more impressed with the 7 out of 10 that John Key got. It seemed like he lost about 7 points for … everything then gained 4 back due to the ineptitude of our major opposition.

    Comment by David C — November 13, 2012 @ 9:12 am

  2. It comes down to what a Minster’s job actually is. Staying in power or improving the country.

    Comment by nigelsagentinthefield — November 13, 2012 @ 9:13 am

  3. @Nigel – Exactly. Clearly the media is willing to assist this government in the former.

    Comment by alex — November 13, 2012 @ 9:22 am

  4. If National can run a more effective health system for less money than Labour, why would anyone vote them out of government?

    Vote Health (Budget estimates 2008): $12.24b (Labour’s last budget)
    Vote Health (Budget estimates 2012): $14.12b (National’s most recent)

    Inflation of just under 10.1% from 2008 (Q2) to 2012 (Q2).

    2008 health budget in 2012 dollars: $13.47b.

    Conclusion: I haven’t a clue how effective the health system is under National compared to Labour, but National is spending more money on it than Labour was.

    Comment by Graeme Edgeler — November 13, 2012 @ 9:37 am

  5. Ask any diabetic in the country and they will tell you how Tony Ryall has cut type 1 diabetics off at the knees that are dependant on injecting insulin 4 – 6 times a day, and testing blood sugar levels 10 times a day to stay bloody alive! Insulin is not a cure for this cruel disease that typically occurs in children as young as new born’s. Diet,, life style, exercise, do not come into this equation unlike type 2 diabetics. After contracting a virus the childrens/teenagers pancreas shuts down, and never makes insulin again. People in NZ die annually in their sleep with this condition, it is life threatening. Tony along with Pharmac decided that these people as my 16 year old daughter is one, go on sole supply for their testing meters and strips from South Korea. These meters need to be 100 % accurate at all times, night and day. We have been issued with utter crap and shit that do not work in NZ conditions. Give me a gun and in the same room as him,, and it would give me great pleasure to carry out the act all diabetics in NZ wish would happen!

    Comment by Alison Deaker — November 13, 2012 @ 10:12 am

  6. way to go with the death threat alison!

    Comment by merk — November 13, 2012 @ 10:53 am

  7. Given that the source is basically the National Party, I’d assume that they didn’t give each and every cabinet minister all nines because:
    1. it would be a bit bloody obvious
    2. some of them are at odds with the faction the writer(s) favour

    And if the health system’s so wonderful, how come DHB heads are leaving because they can’t implement budget cuts without compromising service and how come everyone tells me I should be spending thousands on private insurance because the public service is inadequate?

    Comment by richdrich — November 13, 2012 @ 12:53 pm

  8. First DimPost death threat? The recently appointed editor of Truth would be proud of us…

    Comment by GreenSteve — November 13, 2012 @ 1:38 pm

  9. Ask any diabetic in the country and they will tell you how Tony Ryall has cut type 1 diabetics off at the knees…

    Any of them except me, perhaps. I’ve yet to see any of this gear that supposedly doesn’t work under NZ conditions, and am happy to give Pharmac the benefit of the doubt until I do.

    Comment by Psycho Milt — November 13, 2012 @ 1:49 pm

  10. Surely those scores are out of 100 ….. aren’t they?

    Comment by Darren — November 13, 2012 @ 2:55 pm

  11. I think the scores are inflated. But the good news is that if you dropped each score by about thirty percent, it would all be about right.

    Comment by Dan — November 13, 2012 @ 3:57 pm

  12. @alison

    I am a paediatrician who runs a clinic for more than 60 diabetic children and teenagers. I do not often defend Pharmac but in this case the decision to tender for a sole supply of blood glucose meters is not the disaster you try to paint it in your death threat . My patients who have had to switch to the Caresense meter actually like it and have had no problems. At the same time new funding for Insulin Pumps and consumables, although cumbersome to apply for, is an undeniably good thing. Also, Pharmac have listened to some extent to criticism and many of my patients already using Optium meters have the option of staying with this as a funded option.

    Overall, New Zealand has an efficient and effective public health service by international comparison. Health is a complex business, there are always plenty of bad news stories and anecdotes and plenty of opportunities to judge services retrospectively after bad outcomes. But as a doctor and a parent of 7 kids I am more than happy to trust the public service for all my families health needs. Not because Tony Ryall is doing a good job but because , no matter who is in power, the vast majority of public health staff are great people who work hard and believe in what they do.

    Comment by PPCM — November 13, 2012 @ 4:39 pm

  13. I think that some areas of health of are working well under Ryall. What is being cut is the long-term, preventative health programmes – so we might end up paying a whole lot more say 10 years down the track because some of the funding that is being cut now.

    Comment by LucyJH — November 13, 2012 @ 5:38 pm

  14. “efficient health system”

    Had a stay in hospital recently?

    Comment by MeToo — November 13, 2012 @ 5:52 pm

  15. Alison Deaker

    I sympathize with what you and your family have had to go through under Tony Ryall and National. It is most definitely a human rights issue and I feel embarrassed as a New Zealander and very worried that you have been treated in such a disgraceful manner.

    Comment by Dan — November 13, 2012 @ 6:27 pm

  16. As somebody who has had recent experience with our hospital system, the cuts in personnel are having an effect. My son had had back surgery, surgeon had told him not to move, let alone sit-up, so why would they bring him cornflakes for breakfast?
    I know it is a trivial example, but is symptomatic of the state our once world class health system is in.

    Comment by Stephen Doyle — November 13, 2012 @ 6:44 pm

  17. @Me too

    Have I had a hospital stay recently? As it happens, yes. Shoulder surgery last thursday in Hawkes Bay Hospital. Preop care including ECG, bloods etc was brisk and…yes…efficient. Quick, efficient, good food, good pain relief, single nights stay. Not much sleep though…too many interuptions for blood pressure checks etc.

    @stephen doyle

    Cornflakes? Really? Is that the worst example you can come up with? Presume he survived his tax payer funded surgery?

    @Dan

    The “human rights” also include the need to balance available resources with population need. If that means some diabetics don’t get to choose from the 50 or so available glucose meters from around the world…is that terrible?

    @LucyJH

    Completely agree…pertinent comment.

    Comment by PPCM — November 13, 2012 @ 7:44 pm

  18. The decline of our health system can be traced back to as early as 2009. We’re talking a mere eight months after National was elected. I couldn’t get a scan that I felt I needed, because of the budget cuts. Four years previously under Labour, there wasn’t any problems.

    Comment by Dan — November 13, 2012 @ 8:22 pm

  19. @Dan

    So let me get this straight because I value your opinion…a disgruntled parent of a diabetic has to switch brands to a perfectly good glucose meter and you are embarrassed to be a New Zealander. And you don’t get a scan that YOU felt you needed a few years ago and that is evidence of National mismanagement of the entire health service.

    You are taking the piss surely?

    Comment by PPCM — November 13, 2012 @ 8:48 pm

  20. Not a mismanagement of the entire public service, but that, along with other things that happened to other people at the same time, hints at an attitude towards the health sector that is very different from Labour’s. National have this attitude towards public education as well. There are also qualities known as compassion and empathy that I let out of the bag every once in a while when I feel that others are somewhat disregarding the fact that a person’s comment came from an emotional perspective.

    Comment by Dan — November 13, 2012 @ 9:29 pm

  21. Lucy’s right. They’ve also cut the regular surveys of NZ health that were started before the current government, surveys which were giving us a clearer picture of the state of our health and where the problems lie. For ideological reasons they’ve cut these. Proper survey research isn’t cheap. But not knowing is more expensive.

    Comment by George D — November 13, 2012 @ 9:37 pm

  22. This is pure media bullshit claptrap and the press gallery trying to justify its existence. Yawn!

    Comment by peterlepaysan — November 13, 2012 @ 11:00 pm

  23. 16.The decline of our health system can be traced back to as early as 2009.

    Mate, I’m not exactly a National cheerleader but you can’t surely be serious that you think their powers of mismanagement are so epic they can turn around a portfolio as big as health in just 4 months? They hadn’t even had their first budget at the time.

    Comment by Vanilla Eis — November 14, 2012 @ 6:55 am

  24. It’ll be interesting to see how Ryall goes with the merger of back office shared services for the DHB’s. The idea sounds great in principle and could save money in the long term. But the size and complexity of the task makes it comparable to the supercity merger except without any of the planning and transition budgeting. Without a clear plan there is a very real risk that the DHB’s lose all the benefits of being decentralised but gain none of the benefits of centralisation.

    Comment by RobertH — November 14, 2012 @ 7:24 am

  25. 16.The decline of our health system can be traced back to as early as 2009.

    Mate, I’m not exactly a National cheerleader but you can’t surely be serious that you think their powers of mismanagement are so epic they can turn around a portfolio as big as health in just 4 months? They hadn’t even had their first budget at the time.

    Excellent point. Plus, National’s first budget included an *increase* in health spending at over 3 times the rate of inflation.

    Comment by Graeme Edgeler — November 14, 2012 @ 9:23 am

  26. Given that our population is both increasing and aging, it seems a bit unfair to blame National for raising the Health budget each year.

    Personally, me and many friends and members of my family have had a lot of contact with the health system over the last 4 years. Two cases of cancer, an elective surgery, numerous tests and a number of pregnancies, including some quite prem babies. In all those cases I’d say we have had good care. Maybe not perfect care or really lavish care as you might get in a private American hospital but, on the other hand, we have ALL been eligible for care, regardless of our wealth. Also none of us financially crippled by trying to pay off the bills. Obviously, everybody makes mistakes, even surgeons and nurses. Some people are injured by our health system, rather than helped, and that’s awful. Overall, however, I think it’s pretty good and I’ve never seen any serious data (like OECD reports) to suggest that it isn’t.

    What bothers me is the lack of focus on future issues. For example, how we will provide care for our aging population over the next 30 years? Will we cut services elsewhere in the system or will we put a greater focus on palliative care for those over a certain age or level of frailty? What are we doing to try and reduce obesity and early onset diabetes? Is gastric surgery at 18 really the best solution for the current generation of obese adolescents?

    Comment by LucyJH — November 14, 2012 @ 9:40 am

  27. Glad you had a good stay at Hawkes Bay Hospital PPCM. My experiences are with the Waitemata District Health Board; perhaps it is unfair to generalise to other parts of the country.

    Here’s my anecdata.

    I don’t know of a single woman who liked her stay in hospital after having a baby (apart from me and that was because my baby was early and I got special treatment). The biggest issue after noise (which prevented any rest) was the complete lack of support because of low staffing levels. This includes women who had c-sections – which is major surgery – being left to care for a new baby on their own while recovering from surgery/doped up on morphine/ attached to a drip etc. Even in the case of twins! My sister in law spent the first night after having twins by c-section on her buzzer because she couldn’t care for her crying babies, but the only staff she saw were people popping their heads in the room to say “busy right now!”. This is not only bad for the mother’s recovery and morale, but bad for the babies who can suffer brain damage if they dehydrate because the mother is unable to feed them.

    Actually the cornflakes story *is* important. Sick/injured people need the right food at the right time to aid their recovery. July this year a friend was told by her hospital doctor – after eating the meal she was given but was the wrong meal for her condition – that it was her responsibility to make sure she was given the right food as the food system in North Shore Hospital was not to be trusted. My partner only got the correct meals delivered after being absolutely insistent that he be fed the meals that were ordered, not what was on the trolley. His meals did turn up – but about 2 hours late in each case, and only because he was coherent enough (he was on minimal morphine) and insistent enough to put pressure on the staff. What if he had been elderly and suffered from mild dementia? Or did not speak good English? Or was generally a shy, non-confrontational person?

    LucyJH’s point about the looming demographic crisis is an important one. Another story from my partner’s recent (August) experience in NSH: in the emergency ward and the post-surgery ward, dementia patients were mixed in with the other patients. No extra staff despite these patients clearly needing extra care and causing disruptions for the other patients. In one case a fight broke out between two elderly patients with dementia, one of whom fell over and broke his hip. My partner had spent 15 minutes pressing his buzzer from the time the fight first started to escalate, but saw no staff until some *minutes* after the old guy was on the ground screaming in agony following his fall. Dementia patients need extra care but there isn’t even enough care for non-dementia care patients. I wonder how this incident was written up? Just a fall, probably, with nothing about inadequate staffing and how preventable this whole thing was. I also wonder what the old guy’s wife was told. Just a fall, probably.

    Most people I know speak well of the nurses and doctors they encounter and everyone is grateful we have good acute and emergency care and we are not denied care because we don’t not have enough insurance. They don’t complain about the actual medical treatment they receive – it is everything else that seems substandard. And these everything else’s do impact on health and recovery.

    Comment by Me Too — November 14, 2012 @ 11:20 am

  28. Tony Ryall is exactly where Labour is lacking- a long serving competent minister. All Labour seems to have is first termers who want to be prime minister and is very short on the competent generals. Need proving wrong on this!

    Comment by sheesh — November 14, 2012 @ 11:24 am

  29. Vanilla Eis

    All I know is that under Labour, I got the help necessary and under National, I didn’t.

    Comment by Dan — November 14, 2012 @ 11:48 am

  30. Dan – I think the point is it’s a pretty vague correlation with a miniscule data set.

    You wouldn’t draw any inference if, for example, your first visit when Labour was running the show was on a Tuesday and under National’s remit, you visited hospital on a Friday, that based on these instances alone, the health system doesn’t work towards the end of the week (or on days of the week that start with the letter ‘F’).

    Comment by Gregor W — November 14, 2012 @ 1:07 pm

  31. I think there’s a huge correlation there. I wasn’t allowed a scan because of budget cuts that happened under National. This is not the same as not being allowed it because it was thought unnecessary.

    But what adds weight to the correlation is other people that experienced difficulties at around the same time. This was after National announced their first budget. I do remember that they said something about adding money to health, but I also member lots of people moaning that they were making themselves look good and weren’t actually putting nearly enough money into health as Labour had done.

    Comment by Dan — November 14, 2012 @ 2:52 pm

  32. As someone who has had 33 operations, I have a fair amount of experience of the health system under both National and Labour governments, and changes of government don’t seem to make a difference to quality of care.

    However, I do get the impression that National focus a bit more on quantifiable ‘deliverables’ like elective surgery and cancer treatment, while Labour concentrate a bit more on preventative stuff like immunisation and early identification of problems.

    Comment by kahikatea — November 14, 2012 @ 3:26 pm

  33. I think there’s a huge correlation there. I wasn’t allowed a scan because of budget cuts that happened under National. This is not the same as not being allowed it because it was thought unnecessary.

    So are you saying that a clinical specialist said “You can’t get this scan – that we believe you need – because of budget cuts lumped upon us by the present National Government.” as opposed to “You don’t need this scan”?

    Forgive me Dan, but I find that incredibly hard to believe.

    Comment by Gregor W — November 14, 2012 @ 5:13 pm

  34. It was accepted under Labour, but not National. You know, there’s this thing we’ve got in this country where women’s health is spoken about freely and proudly while men’s health sits on the backburner quietly. When lumps triple in size and increase in number over the course of four years, and you were allowed a scan when you only had small lumps, and a new government was elected the previous year and has just announced budget cuts not long before, you put all those facts together.

    Comment by Dan — November 14, 2012 @ 5:30 pm

  35. @me too and lucyJH

    I am sure there are variations in the quality of care between different DHBs. In fact I know there is as I see the evidence in my work.

    I think the major variations are in the “hotel” functions such as food and parking and accessible non-clinical support. I agree that these functions are important to overall recovery but I think the standard of direct acute clinical care is less variable and pretty high by international standards.

    I do not think it matters much who is Minister of Health. I have said in plenty of meetings that it is a much harder job being a DHB CEO or COO than being minister. I could be minister, Dan could be minister….good and bad things would continue regardless.

    The real leadership would come when a minister stopped looking at health issues within the election cycle. We are seriously about to be overwhelmed by a tsunami of obesity, diabetes and elderly care. No western nation has good plans to deal with this….lots of discussion and hand-wringing at the ministry, endless plans and reports… No real leadership from the left or the right.

    At least NZ has done a fair job at controlling the pharmaceutical spend. Pharmac does it’s unpopular job pretty well. We are going to need more strong unpopular decisions around what care we should and should not fund into the future.

    Comment by PPCM — November 14, 2012 @ 6:43 pm

  36. And with Pharmac under potential pressure from Big Pharma by way of the TPPA…

    Comment by DeepRed — November 14, 2012 @ 7:48 pm

  37. @ Me Too. It is interesting that you saw mothers with prem babies have a better time in hospital. By a weird coincidence, most of the woman I know who have given birth lately have either had babies that were prem or had other complications. And before anybody says it – no, they weren’t all old mothers, most of them were very early 30s and one was mid 20s. So perhaps I’ve just got a bit of a skewed sample :)

    With regards to the food, your story actually reminds me that one of the big problems we had (and one of the only problems) was with requesting vegetarian meals. First off, during a stay in hospital of about 10 days my relation was bought a meal with meat in it for dinner probably about 5 times. This is despite selecting the vegetarian option every time. This particularly mattered since they were waiting for an elective surgery and were nil by mouth until 5 pm, so dinner was pretty much their only meal.

    Second, it proved almost impossible to get a vegetarian meal with protein in it (they would just give you say mashed potatoes and peas). So in the end I just ended up cooking meals and bringing them. However, this is obviously not an option for those who are less well off/don’t have the supportive partner. My relation still lost about 10 kgs in a frighteningly short time, although some of that may have been their illness as well… But that was really our main and only niggle with Waitemata DHB.

    Comment by LucyJH — November 14, 2012 @ 8:26 pm

  38. Yeah, I would focus more on preventative treatments because that’s where my passion lies.

    Comment by Dan — November 14, 2012 @ 10:08 pm

  39. Hi PPCM – good to see you running the spoilt patients complaining about the taxpayer-funded surgery line in the same breath as mentioning your 7 children. Does the fact that you can afford to spawn, maintain and educate so many indicate that you and your professional colleagues are being remunerated a little too generously by the taxpayer, then?

    Comment by Tim G. — November 15, 2012 @ 2:06 am

  40. I’ve worked in a hospital when Labour were in govt and now with National and haven’t noticed any marked change. Which is a mixed blessing, some changes I think would be beneficial weren’t done by Labour and aren’t being done by National.

    The general trend towards efficiency which includes such measures as shorter post-operative stays continues now as it did under Labour. The food can be as bad now as it was under Labour.

    There’s the effect of tighter budgets but that was a feature under Labour as well.

    Pharmac continues to operate as it did under Labour and continues to get flak from people who feel their health has been compromised by the deals Pahamac achieves even though those deals have on the whole meant we’re less beholden to Big Pharma and in the long term have show no negative effect.

    Recently I’ve had some bad experiences in dealing with a hospital as regards the treatment of a family member but I wouldn’t generalise from that to make conclusions about the system as a whole.

    Comment by NeilM — November 16, 2012 @ 1:36 am

  41. @TimG

    I can’t see where I used the term “spoilt patients” Tim, or anywhere I even implied it. I was simply trying to point out, as I have in other comments, that complaining about cornflake and food issues seems pretty trivial compared to the quality of your surgery or your health care. I have worked in public hospitals long enough to know that a lot of patients have a pretty hard time despite the efforts of some wonderful staff.

    And yeah seven kids is a mite excessive. I love the use of the word “spawn” as if I ejaculated on a load of eggs in a stream somewhere…I like to think both my marriages had some tender and romantic moments.

    As a full time public hospital doctor I think my remuneration is fair and certainly allows me to raise seven wonderful, bright kids. Having said that I trained 13 years to get my specialist qualifications, have stringent ongoing professional development requirements, work 60 hours a week and am frequently in the hospital in the early hours of the morning. At my age, and after all that rampant spawning, it can be a stressful existence.

    Cheers.

    Comment by PPCM — November 16, 2012 @ 10:05 am


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