Help! I’m drowning in tick-box exercises and black-hole dreaming

Believing that clinical leadership depends on having “skin in the game”, I continue to see patients three days a week. I also consult on my days off.

On the two days I am not at my desk, those consults are with Pharmac, Medsafe, the Ministry of Health and every other professional organisation currently requesting free insights from clinicians to be able to tick the we-have-consulted-with-stakeholders box.

As a concerned citizen, I find the time to comment on the constant stream of proposals, tweaks, sticking plasters and disconnected amendments that currently stand in for anything that could approach a coherent health strategy.

More and more, this feels like pointless activity for the sake of it, a true feedback loop. In the past month alone I have been asked for and have provided advice on expanding prescribing rights to ADHD medications, breast screening service standards, proposed availability of the Mirena intrauterine system directly from clinics without the need for a prescription, the ACC Recovery at Work initiative, and, most recently, major changes to workforce regulation via the now-infamous Putting Patients First: Modernising health workforce regulation consultation. Infamous, in that it was a consultation in the loosest sense of the word – two announcements concerning practitioner scope and regulation made by health minister Simeon Brown even before the consultation period had closed.

No acknowledgement of how these insights may impact policy making is ever received from the black hole from which light cannot escape (known as the Ministry of Health), and no further dialogue is sought. Increasingly, health policy decisions appear to be predetermined, politically motivated, and often highly conflicted rather than informed by clinical evidence. Why else would we see egregious examples of policy that may cause harm, such as the repeal of New Zealand’s world-leading Smokefree legislation?

In a populist world, expert opinion is unwelcome, and as a result, fewer clinicians raise their voices. The ones who do risk censure by their employer if they work for Health New Zealand Te Whatu Ora or – worryingly – by ministers.

Associate health minister David Seymour recently advised public health leaders to get “back in their box”, rather than speak up on the big issues affecting the population’s long-term health. Curiously, these issues correlate strongly with the level of activity of their associated political lobbyists – tobacco, alcohol, fast food, and as we saw recently, infant feeding.

These glaringly obvious conflicts of interest, coupled with Trumpian levels of staff turnover at the top of the health system over the past two years, have undermined confidence in the ability of leadership to “get stuff done”. Examples of jaw-dropping ball-dropping have led to a loss of trust in political leadership and the political system itself.

Doctors are tuning out and moving abroad or into the private system as they struggle with the sense of moral injury brought on by being unable to provide the level of care their patients need in the publicly funded system. The values of this system have abruptly changed: Orwellian doublespeak has replaced a focus on equity with a cry for “fairness”.

It is obvious that securing a healthy future for the population of Aotearoa involves thinking further ahead than the quick-win-focused three-year political cycle (a cycle that shortens further when health ministers change mid-term, taking their pet policies with them).

It also appears to involve more than legislation since it is obvious that the Pae Ora (Healthy Futures) Act passed in 2022 has not led to the implementation of any of the strategies sitting under it.

We have been told repeatedly that clinical leadership is valued, only to have that leadership ridiculed, ignored or devalued – see the resignation of the director-general of health, Diana Sarfati. It takes much for mild-mannered medics to rise up and rage against the machine, but we may have reached such a point.

As I write, a senior doctors’ strike is taking place across the motu to widespread patient and primary care support. Health Coalition Aotearoa recently launched the “Level the Lobbying Playing Field” campaign to highlight the impact of lobbying on policy making. A “Hīkoi for Health”, led by clinicians Art Nahill and Glenn Colquhoun, is making its way down the country to Wellington, collecting patient stories and grassroots ideas for improvement. And a bipartisan approach to health, including creating a long-term health plan with ring-fenced funding, seems like an idea whose time may finally have come.

Former director-general of health, Sir Ashley Bloomfield, has raised this issue, as has Opposition health spokesperson Ayesha Verrall. Their approaches may differ, but both acknowledge that the current situation is chaotic and not in the best interests of New Zealanders. As Dr Verrall wrote Mr Brown recently, “New Zealanders are sick of the ongoing politicisation of their healthcare system. They want to see a bipartisan approach to delivering high-quality healthcare that is both equitable and sustainable.”

What will it take to begin these discussions in earnest? It’s time to start the conversation.

Orna McGinn is a specialist GP and chair of the New Zealand Women in Medicine Charitable Trust