The Militant(logo) 
    Vol.61/No.13           March 31, 1997 
 
 
New Zealand Gov't Slashes Public Health  

BY RUTH GRAY
CHRISTCHURCH, New Zealand - A recent series of public controversies have spotlighted the continuing decline in free, publicly funded health services in New Zealand. These debates have been particularly heated in Christchurch, over calls for a public inquiry into "patient safety" and a recommendation to set up a private heart surgery unit.

These controversies highlight the conflicts that have been generated by assaults on healthcare initiated by the National government elected in 1990. The so-called reforms implemented by that government launched a process aimed at reversing the right to free public healthcare - a right that was won by the working class in the 1930's.

Since 1993, public hospitals have been divided up among 23 Crown Health Enterprises (CHE) that compete with each other and with private interests for government funding through four Regional Health Authorities.

The National/New Zealand First coalition government, elected in October last year, reaffirmed this principle in its coalition document, which states that the health system is required to run "in a business-like" manner.

The first act of the newly-formed government regarding health policy was to announce in February that it would not be holding a public inquiry into patient safety at Christchurch's public hospitals run by Canterbury Health. The Christchurch Hospitals' Medical Staff Association chairperson, Stuart Gowland, told the Christchurch Press the decision was "approaching the level of a scandal."

For more than a year now the Medical Staff Association has been in conflict with their employer, Canterbury Health, over declining standards of patient care. The Association has been campaigning for a public inquiry and joint decision- making in clinical matters.

In place of such an inquiry, Minister of Health, Bill English, is backing an investigation begun by Robyn Stent, the Health and Disability Commissioner. Last December, Stent said she was "concerned about health professionals exploiting people's fears about hospital safety as a tactic in industrial negotiations or other lobbying activities."

Medical Staff Association condemned the investigation by Stent on the grounds that it is being held in private, and that prejudicial statements were made by Stent. To back up their demands for the public inquiry, the Medical Staff Association and Christchurch representatives of the New Zealand Nurses Organization released a report that lists incidents affecting patient safety. The report also identifies four potentially avoidable deaths at the hospital in 1996.

Documents released to the media January 31 by parliament member and Alliance Party leader, James Anderton, support these claims. The documents report that a man died because senior medical staff were too busy with other patients to treat his bleeding peptic ulcer. Another death occurred when a woman who was sent to hospital by her general practitioner died of heart failure after waiting over four hours for treatment.

Private surgery unit in public hospital
The Southern Regional Health authority announced on February 28 that it would grant the contract to provide heart surgery to a private bidder - a joint consortium of the Healthcare Otago Crown Health Enterprise and the Southern Cardiothoracic Institute. This decision followed many years of public demands for such a unit to be provided in the city, the largest in the South Island. Candidates for heart surgery now have to travel 360 kilometers (225 miles) to Dunedin. The private consortium outbid other contenders - including one by Canterbury Health - to make the service part of the hospital's budget. The private heart unit will be set up at Christchurch Public Hospital.

The decision has been greeted with a mixed response among working people in the city. An article by Press journalist David Gee in the March 4 edition of the paper reports a phone-in survey on the decision: "One caller, Maggie Lawson, echoed the sentiments of many when she said: `I am angry about the decision that a private, money-making company will be involved in our hospital. The people are entitled to a public-funded and public-run service.'"

While the reforms have increased the market for private healthcare and insurance, the latter remains a parasitic growth on the public system. This is because for most major operations like heart surgery and kidney transplants, everyone has to rely on the public system. The private heart unit in Christchurch, if it goes ahead, will rely on public hospital facilities.

This means that having the ability to pay will not completely protect the wealthy from the crisis in public health. This fact generates the continuing scandals plaguing the health "reforms."

One of the main products of these assaults has been to ration healthcare. In Christchurch, for example, over the last two winters non-urgent surgery has been postponed while the hospital struggled to cope with increased admissions mainly caused by winter respiratory infections and influenza. While this is a yearly phenomenon, there is no funding provision for extra beds.

`Nightmare on night shift'
The problem of staff cutbacks and unfilled vacancies was vividly illustrated by an article entitled "Nightmare on the Night Shift," written by nurse Howard Brown, in the August issue of the Nursing New Zealand journal. Brown describes how he and a colleague struggled to care for 23 patients in the acute medical ward at Hamilton's Waikato Hospital one Saturday night.

According to the Association of Salaried Medical Specialists Executive Director Ian Powell, the government had forced Health Waikato to cut its budget by $30 million in the last three years. The Coalition for Public Health commented that the number of nurses employed by Health Waikato fell 15 percent between 1990 and 1994. They added that during the same period there was a 12.4 percent fall in the number of nurses working nationally in public hospitals. Yet the number of patients being treated at public hospitals has risen.

In Hawkes Bay, a pilot scheme is being launched to replace nurses with "clinical associates" who will have two weeks training. They are to replace nursing jobs by providing basic care for less pay.

The lack of resources and funds for public health has led to burgeoning waiting lists across the country At Auckland's Green Lane hospital, one patient a month is dying while waiting for urgent cardiac surgery, according to the head of cardiology John Neutze. The Australasian College of Radiology reports that in many parts of the country people are waiting almost three months for cancer treatment.

To reduce waiting lists the government is forcing CHEs to introduce a booking system that will reduce waiting times to six months. This is a precondition for qualifying for $130 million of additional government funding. Under the booking system patients are allocated points by clinicians. If a patient scores above a certain threshold the operation will be done in six months. If the patient scores below the threshold the patient is referred back to their general practitioner

The Central Regional Health Authority, which covers the capital city of Wellington, plans to drop 770 people from its waiting lists using this system. Criticizing this move, Wellington Medical school professor of surgery Geoffrey Horne, told the Christchurch Press, "I believe most people deserve their place - I am not aware of anyone on my waiting list who is there for some kind of recreation. This is just a rationing system. It is not to improve efficiencies."

Another target of cuts to healthcare has been the wages and conditions of health workers. Last August, Christchurch Public Hospital contracted out its catering services to P&O Services. The new contractor then offered existing staff an employment contract that cut wages for weekend work and overtime and did not recognize length of service and experience. Other cuts were also made to sickness, holidays, and bereavement leave.

A year earlier P&O Crothals won the hospital's cleaning contract and demanded that the existing workforce reapply for their jobs for inferior wages and conditions. The cleaners responded with picket lines outside two Christchurch hospitals. Their lone action, however, was insufficient to prevent P&O hiring replacement workers and implementing the contract.

Ruth Gray is a member of the Engineers Union.  
 
 
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