Health systems specialist Ian Powell looks at changes to the the health system and how Kāpiti can maximise its opportunities from the changes.
For over 30 years (until 31 December 2019) I was the Executive Director of the Association of Salaried Medical Specialists. This included being their main advocate and spokesperson. I knew nothing about health before I was appointed. But I had studied Middle East politics at university. As it turned out this was all I really needed.
Given the complexity of what they do and working in the highly integrated and complex health system, working for medical specialists taught me so much. This experience fits me well to hit the ground running should I earn the privilege to be one of the three elected Kāpiti Coast districtwide councillors.
Particularly given the more vertical and centralised health system that we now have, it is essential that KCDC adopts as a core priority the advocacy of increased healthcare access for Kāpiti residents. This is not KCDC providing health services; this a central government taxed funded responsibility. But it does mean advocating to the new Health New Zealand (Te Whatu Ora) the importance of addressing Kāpiti’s serious deficiencies in accessing quality healthcare either in a timely manner or at all.
KCDC needs to look at both measures that can be implemented sooner and those for which implementation would be later. First focus on what the more accessible services are before considering any structures that might be needed.
I also learnt about the social determinants of health such as low incomes, poverty and housing. These are the biggest drivers of poor health and consequently demand for healthcare and health costs. Just as the health system can only mitigate these effects, so can KCDC in areas such as healthcare access, affordable housing, and promoting the living wage to local employers.
My health system work involved working with both central government (Health Ministry, Treasury and Health Minister) and local government (district health boards). From this experience I learnt that things should be done locally, unless it made better practical sense to do them nationally or regionally. This is relevant both to Three Waters governance and the forthcoming review of local government.
If one could not learn from medical specialists the threat of climate change both to New Zealand and the rest of the planet in general and to the health system in particular, what could one learn? This learning included the cumulative effect of many small measures such as reduce, reuse and recycle and the importance of giving greater urgency to the good higher level work already undertaken to date by KCDC.
I learnt the importance of empowering the health workforce. Our health system would be in a much better state today if doctors, nurses and other health professionals were empowered to lead improving healthcare design, configuration and delivery. I learnt that decisions that made good clinical sense also made good financial sense.
“It is essential that KCDC adopts
as a core priority the advocacy of increased
healthcare access for Kāpiti residents.“
Translate that to local government. Empower communities in order to improve the quality of Council decision-making. Ensure that infrastructure development makes both good environmental and financial sense.
Also, increase Council staff job satisfaction by empowering them more in the performance of their work. Empowered staff can lead to a better return from the health dollar. This includes improving internal systems and significantly reducing the use of business consultants (something which has bedevilled the health system).
I got to know complexity which prevails in the health system. It begins with good diagnosis. The best surgeons will have poor clinical outcomes if the prior diagnosis of physicians, radiologists or pathologists is not up to scratch (pathology laboratories affect around 70% of clinical decision-making).
But so many reviews of health system improvement begin without a diagnosis of what is the problem they are trying to solve. This guaranteed both failure and wasteful spending. Think about the application of this approach in terms of the Council’s Gateway fiasco.
I learnt the importance of working collaboratively, especially with those with which you might disagree. I did this for over 30 years with health managers and health ministry officials. It is always possible to establish a point of connection and build on that.
Finally, I learnt the importance of voice. If you don’t give voice to your concerns and initiatives both around meeting room tables and in public, you don’t get anywhere. I was the main representative and spokesperson for salaried medical specialists throughout these three decades. It is ‘business-as-normal’ for me.
Consequently, if I’m elected, I’m confident that what I’ve learnt from this rich experience should help enhance the quality of Council decision-making.
Ian Powell is standing as a Districtwide candidate for the Kāpiti Council.
