Hello, and welcome to on the tiles. I am your host, Thomas Coglan, the Deputy Political Edditer of The Herald. The health system is in a bit of a state. The government spent seven point three percent of GDP on health in the year to June twenty twenty four. It's more than any year in history bar one, which was twenty twenty two when temporary COVID measures pushed us to seven point six percent. When the last National government left office, health spending was five point nine percent of GDP. That was roughly where it was when it took office, which was six percent of GDP. Treasury and twenty twenty one and it's long term insights briefing reckoned health spending would grow to ten percent of GDP by twenty sixty one. Last year, the nominal figure that was twenty nine point nine nine billion dollars. That includes things like acc So what is it buy well Health? New Zealand employees about one point five percent of all New Zealanders, that's all of us, from infants to superinnuitance, and about one in every thirty five New Zealanders who have a job we're looking for a job are employed by Health New Zealand. Despite union reports of a hiring freeze, a public service data out this week showed that Health New Zealand actually added three four hundred net staff since June twenty twenty three, and that figure was current as of December twenty twenty four. So that means that for every net job loss in the core public service as a result of the fiscal spending restraint of the last year, one point twenty five roles were added at Health New Zealand, which is the frontline health agency. The wider health sector, including the funded sector that's providers are private providers of people who do publicly funded work, set at eighty five nine hundred and June twenty twenty, but by June twenty twenty four it was at one hundred and three thousand, three hundred. That means a net increase of eighteen thousand, six hundred people in just four years. The health sector has added roughly the workforce roughly the size of the population of Timidoo since the last National government left office, that's thirty thousand people. Now, very little of this seems to be making a massive difference, or a difference for portional to the amount of money that we spend, the number of people that we hire. From June twenty twenty three to May twenty twenty four, the number of patients waiting longer than four months of treatment range from twenty seven thousand to thirty three thousand. The Auditor General is now looking into wait times. Now, all of this is a very long way of introducing my next guest. How do you make sense of health? How do you make sense of the economics of it? How do you make sense of the funding of it? He's wore many different hats. He was Parliamentary Undersecretary for Health from ninety three to ninety six. He was Health Minister from ninety six to ninety nine. He held the Finance portfolio in nineteen ninety nine and then again from twenty eight to twenty sixteen and twenty sixteen he gave up gave that job up to get the top job, Prime Minister of New Zealand, which means my guest is, of course none other than former Prime Minister Bill English. Bill, thank you very much for joining.

Hello, and welcome to on the tiles. I am your host, Thomas Coglan, the Deputy Political Edditer of The Herald. The health system is in a bit of a state. The government spent seven point three percent of GDP on health in the year to June twenty twenty four. It's more than any year in history bar one, which was twenty twenty two when temporary COVID measures pushed us to seven point six percent. When the last National government left office, health spending was five point nine percent of GDP. That was roughly where it was when it took office, which was six percent of GDP. Treasury and twenty twenty one and it's long term insights briefing reckoned health spending would grow to ten percent of GDP by twenty sixty one. Last year, the nominal figure that was twenty nine point nine nine billion dollars. That includes things like acc So what is it buy well Health? New Zealand employees about one point five percent of all New Zealanders, that's all of us, from infants to superinnuitance, and about one in every thirty five New Zealanders who have a job we're looking for a job are employed by Health New Zealand. Despite union reports of a hiring freeze, a public service data out this week showed that Health New Zealand actually added three four hundred net staff since June twenty twenty three, and that figure was current as of December twenty twenty four. So that means that for every net job loss in the core public service as a result of the fiscal spending restraint of the last year, one point twenty five roles were added at Health New Zealand, which is the frontline health agency. The wider health sector, including the funded sector that's providers are private providers of people who do publicly funded work, set at eighty five nine hundred and June twenty twenty, but by June twenty twenty four it was at one hundred and three thousand, three hundred. That means a net increase of eighteen thousand, six hundred people in just four years. The health sector has added roughly the workforce roughly the size of the population of Timidoo since the last National government left office, that's thirty thousand people. Now, very little of this seems to be making a massive difference, or a difference for portional to the amount of money that we spend, the number of people that we hire. From June twenty twenty three to May twenty twenty four, the number of patients waiting longer than four months of treatment range from twenty seven thousand to thirty three thousand. The Auditor General is now looking into wait times. Now, all of this is a very long way of introducing my next guest. How do you make sense of health? How do you make sense of the economics of it? How do you make sense of the funding of it? He's wore many different hats. He was Parliamentary Undersecretary for Health from ninety three to ninety six. He was Health Minister from ninety six to ninety nine. He held the Finance portfolio in nineteen ninety nine and then again from twenty eight to twenty sixteen and twenty sixteen he gave up gave that job up to get the top job, Prime Minister of New Zealand, which means my guest is, of course none other than former Prime Minister Bill English. Bill, thank you very much for joining.

Us, Good morning, Thomas, and congratulations on looking into all those numbers.

Us, Good morning, Thomas, and congratulations on looking into all those numbers.

Yeah, sorry for the Sorry for the very long rambling introduction. Look, can I just start by asking the most basic of questions, does the health system need more money? Is the problem the aging population and the funding not matching what we need to handle it.

Yeah, sorry for the Sorry for the very long rambling introduction. Look, can I just start by asking the most basic of questions, does the health system need more money? Is the problem the aging population and the funding not matching what we need to handle it.

The health system gets more money every year in a growing proportion of government spending, so it grows at about five or six percent per annum. The odd burst six or seven percent talks about discussion about health cuts quite misleading. The money goes up every year, that's not the issue. I mean, of course we could decide to spend more on it, but as you've pointed out, it's getting more, but it's processing less, it's providing less, not providing health services consistent with that, As you've pointed out, staff have grown quite rapidly. I think from twenty seventeen to twenty to about twenty twenty three, the health the nominal health budget went up sixty percent, six to oh and any politician promising that would have been praised, I think for solving every health problem we've got so no more money at the margins not It's part of an answer in any particular circumstance, but it's not the key issue. The key issue really is for New Zealand now is how to extract itself from what's been one of the worst public sector reforms done that I can remember. The health policy world became dominated by this sort of idealizing of an NHS type system, let's have just one big one. It's precisely the wrong answer to the solution to the problems they diagnosed, and those problems are much more to do with what's driving demand for health services, so the focus. So I've got to undo what was a disastrous reform. It's turned out to have reduced productivity significantly. Even now, it's still hard to find a decider in the health system. So if you've got if you're a clinician with a better idea, if you're someone in the community who wants to help with dealing with homelessness that's feeding people into the health system, you can't find someone to decide. So that's just one of a number of issues that can be improved quite significantly.

The health system gets more money every year in a growing proportion of government spending, so it grows at about five or six percent per annum. The odd burst six or seven percent talks about discussion about health cuts quite misleading. The money goes up every year, that's not the issue. I mean, of course we could decide to spend more on it, but as you've pointed out, it's getting more, but it's processing less, it's providing less, not providing health services consistent with that, As you've pointed out, staff have grown quite rapidly. I think from twenty seventeen to twenty to about twenty twenty three, the health the nominal health budget went up sixty percent, six to oh and any politician promising that would have been praised, I think for solving every health problem we've got so no more money at the margins not It's part of an answer in any particular circumstance, but it's not the key issue. The key issue really is for New Zealand now is how to extract itself from what's been one of the worst public sector reforms done that I can remember. The health policy world became dominated by this sort of idealizing of an NHS type system, let's have just one big one. It's precisely the wrong answer to the solution to the problems they diagnosed, and those problems are much more to do with what's driving demand for health services, so the focus. So I've got to undo what was a disastrous reform. It's turned out to have reduced productivity significantly. Even now, it's still hard to find a decider in the health system. So if you've got if you're a clinician with a better idea, if you're someone in the community who wants to help with dealing with homelessness that's feeding people into the health system, you can't find someone to decide. So that's just one of a number of issues that can be improved quite significantly.

One of the you know, just on if someone came down from Mars, you know, when we still have the DHB system and said, look, I think one of the ways of getting more bang for your buck would be to abolish dhb's. You have a lot of duplication. There are twenty of them. That's a lot of executives, a lot of back office. You abolish the duplicator, you get rid of the duplication, you direct that money to the front line. That means are more efficient. You can see how the economic argument for the health reforms sort of stacks up on that basis. So what has been lost? I mean, first of all, I guess do you agree with that kind of just very simple economic argument that abolishing dhp's and centralizing leads to less duplication and more efficiency in that regard? And then what has happened from that basic economic argument to get to the system that we have now where used there isult I mean, there's a large degree of agreement with what you're saying, which is that the system has gone from being kind of balkanized and difficult to kind of grasp to being centralized in one great organization. But that is actually no easier to get to the bottom of which decision makers make which decisions. Who I need to talk to?

One of the you know, just on if someone came down from Mars, you know, when we still have the DHB system and said, look, I think one of the ways of getting more bang for your buck would be to abolish dhb's. You have a lot of duplication. There are twenty of them. That's a lot of executives, a lot of back office. You abolish the duplicator, you get rid of the duplication, you direct that money to the front line. That means are more efficient. You can see how the economic argument for the health reforms sort of stacks up on that basis. So what has been lost? I mean, first of all, I guess do you agree with that kind of just very simple economic argument that abolishing dhp's and centralizing leads to less duplication and more efficiency in that regard? And then what has happened from that basic economic argument to get to the system that we have now where used there isult I mean, there's a large degree of agreement with what you're saying, which is that the system has gone from being kind of balkanized and difficult to kind of grasp to being centralized in one great organization. But that is actually no easier to get to the bottom of which decision makers make which decisions. Who I need to talk to?

Look, I think the answer to your question is that you can mistake complexity for an efficiency, and someone coming from Mars would probably not diagnose it in that way. I mean, the opportunities for improvement and health are generally about better information flows, incentives, and clearer accountability. And I'll just give you one little example, because it's a project of Became was aware of providers of homeless, providers of getting social providers getting people who are homeless into houses. Were able to show that it reduced the bed nights that a homeless person with mental illness was spending either in a mental health unit or hospital from one hundred average of one hundred and thirty a year to ten across a group of about of one hundred people. Now, that's this whole story about the data flows and information sharing, which was incredibly difficult because health is a very controlling system at the moment, they don't want to share data with anybody. But the real issue was that having seen the clarity of that solution, there was no one in a position to decide to follow through to implement any changes in the system. So you think there's an obvious little problem replicated around the country, small group of people, and there's a lot of these small groups, small groups of people who taken who need an an ordinate amount of service, disproportionate amount of service, but sensible interventions can reduce that pressure on the health system, but more importantly give them a better quality of life. There's no one in a position, no one has a good reason to make that sensible decision. Now, there's a lot of sensible decisions get made in the health system every day. Actually, tens of thousands of people are getting treatment. But if you want to improve it at the margin, to deal with the pressures on the funding that you've talked about, then it needs to reorientate away from centralized control to localized problem solving.

Look, I think the answer to your question is that you can mistake complexity for an efficiency, and someone coming from Mars would probably not diagnose it in that way. I mean, the opportunities for improvement and health are generally about better information flows, incentives, and clearer accountability. And I'll just give you one little example, because it's a project of Became was aware of providers of homeless, providers of getting social providers getting people who are homeless into houses. Were able to show that it reduced the bed nights that a homeless person with mental illness was spending either in a mental health unit or hospital from one hundred average of one hundred and thirty a year to ten across a group of about of one hundred people. Now, that's this whole story about the data flows and information sharing, which was incredibly difficult because health is a very controlling system at the moment, they don't want to share data with anybody. But the real issue was that having seen the clarity of that solution, there was no one in a position to decide to follow through to implement any changes in the system. So you think there's an obvious little problem replicated around the country, small group of people, and there's a lot of these small groups, small groups of people who taken who need an an ordinate amount of service, disproportionate amount of service, but sensible interventions can reduce that pressure on the health system, but more importantly give them a better quality of life. There's no one in a position, no one has a good reason to make that sensible decision. Now, there's a lot of sensible decisions get made in the health system every day. Actually, tens of thousands of people are getting treatment. But if you want to improve it at the margin, to deal with the pressures on the funding that you've talked about, then it needs to reorientate away from centralized control to localized problem solving.

So you're you're a community housing provider or someone in the funded sector, and you use the health data that you do have access to say well, look this is our cost benefit analysis. You write a paper, you prove that, But then you think who do I talk to? You can't really talk to the minister because you know, the minister has got a pretty booked diary. And let's use the Timaru example again and the farmer housing provider and Timaru. That's going to be pretty difficult to get a conversation with the minister. Do I talk to you know, Health HQ and Wellington? Do I talk to the Southern you know? Is that the issue that is not there that they're so centralized there's no way to get into the system.

So you're you're a community housing provider or someone in the funded sector, and you use the health data that you do have access to say well, look this is our cost benefit analysis. You write a paper, you prove that, But then you think who do I talk to? You can't really talk to the minister because you know, the minister has got a pretty booked diary. And let's use the Timaru example again and the farmer housing provider and Timaru. That's going to be pretty difficult to get a conversation with the minister. Do I talk to you know, Health HQ and Wellington? Do I talk to the Southern you know? Is that the issue that is not there that they're so centralized there's no way to get into the system.

Well, in that case, people even people in the health system, didn't know didn't know who they should talk to. And this isn't a system which for twenty five years has said its primary care lead. And so you do wonder what are all the thousands of extra staff actually involved with. While some of it's dealing with growing demand of an aging population, but you've had in recent years a lot of focus on talking and a lot less on doing, a lot of focus on form and structure, and not much focus on results and outcomes shifting gradually and it's a bit painful for the health system, particularly when the leadership of it has yet to settle down. But you know, we do a bit of work on the on the periphery of the health system, and there's the toolkit around now to do a better job of dealing with that. The demand that gives the system a sense that it's overwhelmed. And if you go to an need, they'll say they're overwhelmed. You talk to GPS, they'll say they're overwhelmed. Actually, a lot of that demands predictable if you go and look to the chronic users like the homelessness group we talked about, and there are others people with serious diabetes, older people who are in that sort of difficult period between hospitals and rest homes. The solutions for that At the moment, there's no demand in the system for those solutions. Everyone's just saying, oh, it's overwhelming.

Well, in that case, people even people in the health system, didn't know didn't know who they should talk to. And this isn't a system which for twenty five years has said its primary care lead. And so you do wonder what are all the thousands of extra staff actually involved with. While some of it's dealing with growing demand of an aging population, but you've had in recent years a lot of focus on talking and a lot less on doing, a lot of focus on form and structure, and not much focus on results and outcomes shifting gradually and it's a bit painful for the health system, particularly when the leadership of it has yet to settle down. But you know, we do a bit of work on the on the periphery of the health system, and there's the toolkit around now to do a better job of dealing with that. The demand that gives the system a sense that it's overwhelmed. And if you go to an need, they'll say they're overwhelmed. You talk to GPS, they'll say they're overwhelmed. Actually, a lot of that demands predictable if you go and look to the chronic users like the homelessness group we talked about, and there are others people with serious diabetes, older people who are in that sort of difficult period between hospitals and rest homes. The solutions for that At the moment, there's no demand in the system for those solutions. Everyone's just saying, oh, it's overwhelming.

So it's a way of finding alternative care models for high users and finding some way of I mean, it's a bit of a cliche, but everyone says the worst thing that happened when the health system fails, it's when someone ends up in hospital. You know that you want to do everything. Obviously, every day people need to go to hospital for a number of reasons, and that will never be well, that will never change. But when the health system is at its worst, it is when people who don't need to be in hospital end up in hospital. That's the most expensive thing, probably with the most expensive public service that we provide.

So it's a way of finding alternative care models for high users and finding some way of I mean, it's a bit of a cliche, but everyone says the worst thing that happened when the health system fails, it's when someone ends up in hospital. You know that you want to do everything. Obviously, every day people need to go to hospital for a number of reasons, and that will never be well, that will never change. But when the health system is at its worst, it is when people who don't need to be in hospital end up in hospital. That's the most expensive thing, probably with the most expensive public service that we provide.

That's right, And I think there's two there's two kind of concrete steps I think can be taken. One is they have to set, in my view just the personal opinion, they should separate out the core funding function from the operation of the hospitals. The fact is that the hospitals get more of the money than everyone else. Health New Zealand's primary obligation, whether they articulate it this way, is to their eighty thousand employees. And that's the recent track record. So if the people who run the hospital have control of the whole budget, the hospitals will always be their priority, and that's been borne out by track records. So they should separate out that funder from the hospitals and create some tension between the funders and the hospitals, because what happens now as the hospitals get the line's share of the money, they just turn up every year and so we've got cost pressures and the people are talking to are their owners, not some separate funder. And I think the other thing is primary care has kind of lost its way. I think GPS. I'm married to a GP. They do a great job, they're working hard, but the understanding over twenty five years of primary care lead with the phos it hasn't moved that far. Do Some good stuff happens, but the incentives in there are not strong to achieve the things they want to they say they want to do, and this is one of the fascinating things about health. At the moment, everyone knows what to do, they've just forgotten how to do it right.

That's right, And I think there's two there's two kind of concrete steps I think can be taken. One is they have to set, in my view just the personal opinion, they should separate out the core funding function from the operation of the hospitals. The fact is that the hospitals get more of the money than everyone else. Health New Zealand's primary obligation, whether they articulate it this way, is to their eighty thousand employees. And that's the recent track record. So if the people who run the hospital have control of the whole budget, the hospitals will always be their priority, and that's been borne out by track records. So they should separate out that funder from the hospitals and create some tension between the funders and the hospitals, because what happens now as the hospitals get the line's share of the money, they just turn up every year and so we've got cost pressures and the people are talking to are their owners, not some separate funder. And I think the other thing is primary care has kind of lost its way. I think GPS. I'm married to a GP. They do a great job, they're working hard, but the understanding over twenty five years of primary care lead with the phos it hasn't moved that far. Do Some good stuff happens, but the incentives in there are not strong to achieve the things they want to they say they want to do, and this is one of the fascinating things about health. At the moment, everyone knows what to do, they've just forgotten how to do it right.

So I'm glad you mentioned primary care because that's where I wanted to move too. So I think the current primary care funding model is about twenty to thirty years old. You might have actually been involved with the sort of transition period to it. I haven't actually gone that deep into the archives, but there's a capitation capitation model is the main funding model. What that means is gps get a subsidy from the government from real free patient they have on their books. They get more or less money depending on the person's sex if the male female, and the certain age and depending on their age. So if you're at at the older end of the spectrum, you get your GP gets a larger subsidy because you're likely to see them a bit more. And then if you use the GP more ten times a year, then you get an additional the GP gets an additional payment. Basically, the GP is subsidized to see you. Simeon Brown announced some extra money for GPS a couple of weeks ago, maybe even a month ago now. He said that he was looking to looking to see what could be done about the primary care funding model. It does seem like it's on the government's radar. Everyone does talk about it. Where do you think, I mean, you say, we know what we need to do? What do we need to do? What should we think?

So I'm glad you mentioned primary care because that's where I wanted to move too. So I think the current primary care funding model is about twenty to thirty years old. You might have actually been involved with the sort of transition period to it. I haven't actually gone that deep into the archives, but there's a capitation capitation model is the main funding model. What that means is gps get a subsidy from the government from real free patient they have on their books. They get more or less money depending on the person's sex if the male female, and the certain age and depending on their age. So if you're at at the older end of the spectrum, you get your GP gets a larger subsidy because you're likely to see them a bit more. And then if you use the GP more ten times a year, then you get an additional the GP gets an additional payment. Basically, the GP is subsidized to see you. Simeon Brown announced some extra money for GPS a couple of weeks ago, maybe even a month ago now. He said that he was looking to looking to see what could be done about the primary care funding model. It does seem like it's on the government's radar. Everyone does talk about it. Where do you think, I mean, you say, we know what we need to do? What do we need to do? What should we think?

I think this really about three things in primary care. One is just GP supply. There's too much workforce planning, bureaucratic pretend manipulation about training. Another twenty thirty GPS. Look, that's a useful thing to do, but what's worked has been increasing is just supply and demand. When they increase nurses pay back. In twenty twenty three there was something like nine thousand nurses reregistered thet they were out there. There's no nursing shortage now. In fact, right now you're seeing one of the announcements from the minister, there's four and a half thousand graduate nurses with who they are trying to subsidize into primary care because the hospitals are and can't take more nurses, just suddenly more than is needed. And the same happened with specialists. They got significant and so in GP and this GP's turn, they are on relative compared to professional incomes are relatively lowly paid. If you want more of them quickly, there's a simple, well tried way to do it that has increased the increase the income one way or another. However, the funding work. I think that with the capitation formula, it's fundamentally not it's fundamentally a reasonable system. Right, we've got a reasonable mixed system, but you have got you're going to remember who who does the patient connect with? Well, they connect with their medical practice. It's not just the GP, it's the nurses and other allied health there. But if you think of it as the medical practice, which is you know where the GPS the main service, that's where the decision should be made about what happens. And at the moment you've got a lot of primary care money goes through phos and other other ways. They do some useful stuff, but the incentive should be on the medical practice to manage the patient. So a lot of that money you should come through the medical practice instead of And at the moment you've got essentially bureaucracies either in Wellington Head office or the PHOS trying to design primary care at a time when there's so much opportunity for renovation, you've got telehealth coming, you've got AI coming people. A lot of people still want the face to face. So what you're going to how it's going to evolve is is a nuanced mix of AI support, telehealth service, sometimes face to face. Sometimes. The bureaucracy is in no position to design primary care, and they've been trying to do that for the last ten years without making much progress. So those are a couple of things I think that could help with primary care. Put all the money through the medical practices, and if they need the PAH show services, they'll pay for them and allow.

I think this really about three things in primary care. One is just GP supply. There's too much workforce planning, bureaucratic pretend manipulation about training. Another twenty thirty GPS. Look, that's a useful thing to do, but what's worked has been increasing is just supply and demand. When they increase nurses pay back. In twenty twenty three there was something like nine thousand nurses reregistered thet they were out there. There's no nursing shortage now. In fact, right now you're seeing one of the announcements from the minister, there's four and a half thousand graduate nurses with who they are trying to subsidize into primary care because the hospitals are and can't take more nurses, just suddenly more than is needed. And the same happened with specialists. They got significant and so in GP and this GP's turn, they are on relative compared to professional incomes are relatively lowly paid. If you want more of them quickly, there's a simple, well tried way to do it that has increased the increase the income one way or another. However, the funding work. I think that with the capitation formula, it's fundamentally not it's fundamentally a reasonable system. Right, we've got a reasonable mixed system, but you have got you're going to remember who who does the patient connect with? Well, they connect with their medical practice. It's not just the GP, it's the nurses and other allied health there. But if you think of it as the medical practice, which is you know where the GPS the main service, that's where the decision should be made about what happens. And at the moment you've got a lot of primary care money goes through phos and other other ways. They do some useful stuff, but the incentive should be on the medical practice to manage the patient. So a lot of that money you should come through the medical practice instead of And at the moment you've got essentially bureaucracies either in Wellington Head office or the PHOS trying to design primary care at a time when there's so much opportunity for renovation, you've got telehealth coming, you've got AI coming people. A lot of people still want the face to face. So what you're going to how it's going to evolve is is a nuanced mix of AI support, telehealth service, sometimes face to face. Sometimes. The bureaucracy is in no position to design primary care, and they've been trying to do that for the last ten years without making much progress. So those are a couple of things I think that could help with primary care. Put all the money through the medical practices, and if they need the PAH show services, they'll pay for them and allow.

The actually change the change the just change.

The actually change the change the just change.

How it's routed, and you'll get you'll certainly get more value out of that because the practices are closer to the patient.

How it's routed, and you'll get you'll certainly get more value out of that because the practices are closer to the patient.

And I suppose the practices would would determine whether they see that they're getting value out of the PHOS rather than the PHO. They value themselves.

And I suppose the practices would would determine whether they see that they're getting value out of the PHOS rather than the PHO. They value themselves.

And give them room for innovation, and I think the bureaucracy pulled back from trying to plan all this with Look, they can have nice ideas, but as someone said to me at a conference here that couple of months ago, we've been going They said, Look, we've been going to these collaboration meetings for around primary health care and social determinants of health. You know, the housing people are there, the police are there, the youth workers are there. They said, after three or four years, nothing's really happened, but we all get on well. And that's been a feature of the health system. There's a whole lot of talking with each other and getting on well, and not enough clarity about what each bit of it's meant to be achieving is.

And give them room for innovation, and I think the bureaucracy pulled back from trying to plan all this with Look, they can have nice ideas, but as someone said to me at a conference here that couple of months ago, we've been going They said, Look, we've been going to these collaboration meetings for around primary health care and social determinants of health. You know, the housing people are there, the police are there, the youth workers are there. They said, after three or four years, nothing's really happened, but we all get on well. And that's been a feature of the health system. There's a whole lot of talking with each other and getting on well, and not enough clarity about what each bit of it's meant to be achieving is.

We do seem to be I think all businesses, all all organizations are in the era of the conference. We seem to be in a sort of.

We do seem to be I think all businesses, all all organizations are in the era of the conference. We seem to be in a sort of.

It's too much talking and not enough doing and and too much restating the problem. I mean, how many more times are you going to hear the facts that Maori and Pacific do worse. Well, we've known that for a long time. What we need to hear more about is what they're doing about practical on the ground solutions.

It's too much talking and not enough doing and and too much restating the problem. I mean, how many more times are you going to hear the facts that Maori and Pacific do worse. Well, we've known that for a long time. What we need to hear more about is what they're doing about practical on the ground solutions.

How do you feel about funding extra places at in terms on the supply side? So I think it's you know, it's a demand side solution. I suppose no, I suppose to supply a supply as well if you pay them more on as well. On the supply side, funding more places at med schools, and then and talking with the professional colleges, the Medical Council about how difficult it is for some people to register to practice in New Zealand.

How do you feel about funding extra places at in terms on the supply side? So I think it's you know, it's a demand side solution. I suppose no, I suppose to supply a supply as well if you pay them more on as well. On the supply side, funding more places at med schools, and then and talking with the professional colleges, the Medical Council about how difficult it is for some people to register to practice in New Zealand.

Look, there's star are all part of an answer, but if you want supply now, increase their incomes. It worked with the nurses, it worked with the salary specialists, and it will work with the gps because you've just got a lot of them who have essentially retired from the field. They're just saying, well, it's not worth my time working another day, or I'm going to retire a bit earlier because it's not worth the time and the effort, because the pressure on them these days is pretty intense. Those other solutions will take a long time and produce relatively small.

Look, there's star are all part of an answer, but if you want supply now, increase their incomes. It worked with the nurses, it worked with the salary specialists, and it will work with the gps because you've just got a lot of them who have essentially retired from the field. They're just saying, well, it's not worth my time working another day, or I'm going to retire a bit earlier because it's not worth the time and the effort, because the pressure on them these days is pretty intense. Those other solutions will take a long time and produce relatively small.

Numbers, some incredible number of gps. I think of a frightening number of planning to retire in the next ten years, and I think that everyone who's sort of thinking about ways, I'm ensuring they don't. As part of the problem of Australia. Anyone who can work in New Zealand's more or less can go to Australia. Australia is a richer economy. They are a more successful economy. Australia can pay Australian prices for obviously for health services for health professionals, but it can do that because the Australian health system has access to Australian revenues, mineral wealth, or good Australian stuff New Zealand. Simm Brow mentioned in the press conference the other day that we're trying to achieve parity in some areas of a health system with the Australian system, But of course that means that New Zealand doesn't have access to Australian style government revenues. We're not an economy of the scale that they are. We're not per capital as wealthy as they are, so we're paying Australian prices on New Zealand incomes. That's a huge problem.

Numbers, some incredible number of gps. I think of a frightening number of planning to retire in the next ten years, and I think that everyone who's sort of thinking about ways, I'm ensuring they don't. As part of the problem of Australia. Anyone who can work in New Zealand's more or less can go to Australia. Australia is a richer economy. They are a more successful economy. Australia can pay Australian prices for obviously for health services for health professionals, but it can do that because the Australian health system has access to Australian revenues, mineral wealth, or good Australian stuff New Zealand. Simm Brow mentioned in the press conference the other day that we're trying to achieve parity in some areas of a health system with the Australian system, But of course that means that New Zealand doesn't have access to Australian style government revenues. We're not an economy of the scale that they are. We're not per capital as wealthy as they are, so we're paying Australian prices on New Zealand incomes. That's a huge problem.

Well look, it's a challenge, but it's not a new one. It's been there for a long time. And guess what's going to be there for the next hundred years. These are people in health motivated as much by professional fulfillment as they are by the wages. Because if you really thought the Australian story was very strong to be no health professionals here that will be there, Well, they're not. They're here servicing their own community, their own people, getting your own sense of fulfillment. What they what will help keep them here is a system where they're clinical roles respected, but where they feel like they'll put up with an awful lot if they feel like problems look like they can get solved. That actually the big crowd and the eed is gradually diminishing because someone's figured out what to do about the bed blockers in the hospital, or where there is actually a live, live project out in the community reducing the incidents of rheumatic fever. You know, when health professionals see those sorts of things actually happening, they'll stick around. But if all they see is a kind of blah blah strategy equity everything is a public health crisis kind of rhetoric, well why would you stick around for that if you want to do things right.

Well look, it's a challenge, but it's not a new one. It's been there for a long time. And guess what's going to be there for the next hundred years. These are people in health motivated as much by professional fulfillment as they are by the wages. Because if you really thought the Australian story was very strong to be no health professionals here that will be there, Well, they're not. They're here servicing their own community, their own people, getting your own sense of fulfillment. What they what will help keep them here is a system where they're clinical roles respected, but where they feel like they'll put up with an awful lot if they feel like problems look like they can get solved. That actually the big crowd and the eed is gradually diminishing because someone's figured out what to do about the bed blockers in the hospital, or where there is actually a live, live project out in the community reducing the incidents of rheumatic fever. You know, when health professionals see those sorts of things actually happening, they'll stick around. But if all they see is a kind of blah blah strategy equity everything is a public health crisis kind of rhetoric, well why would you stick around for that if you want to do things right.

So it's a culture that you think it's a culture as much as income and then comes obviously part of it, but it's culture as well.

So it's a culture that you think it's a culture as much as income and then comes obviously part of it, but it's culture as well.

Yeah, I think the two go together. If you get the culture more solue focused, less talkie, and you get the incomes up for the groups who've lagged behind. Then I think you'll get more stickiness in the workforce.

Yeah, I think the two go together. If you get the culture more solue focused, less talkie, and you get the incomes up for the groups who've lagged behind. Then I think you'll get more stickiness in the workforce.

The economists ran The Economists magazine ran a really good piece on the healthcare in the English speaking countries recently. Australia did very well. Australia is a very They always seem to do well in these sorts of things. So and one of the things the economists pointed to is the relatively high uptake of health insurance private health insurance. Now figures these are not from the story, but I dug them up today. As of twenty twenty three, the Financial Services Council thinks that about one point four to five million New Zealanders have private health insurance, about thirty seven percent of US at that time, and the comparable figure for Australia for twenty twenty four was fourteen point eight million ausies or fifty four zero point five percent of the population, and then forty five percent have a slightly lower level just had hospital cover. Do you think one of the things we could look at, I mean that they health economists say that the benefit that health insurance gives is that it's a pricing mechanism. It prices your risk and encourages you to do arious things. Obviously there's a pre existing condition issue, but what I mean do you think that that is part of the story too.

The economists ran The Economists magazine ran a really good piece on the healthcare in the English speaking countries recently. Australia did very well. Australia is a very They always seem to do well in these sorts of things. So and one of the things the economists pointed to is the relatively high uptake of health insurance private health insurance. Now figures these are not from the story, but I dug them up today. As of twenty twenty three, the Financial Services Council thinks that about one point four to five million New Zealanders have private health insurance, about thirty seven percent of US at that time, and the comparable figure for Australia for twenty twenty four was fourteen point eight million ausies or fifty four zero point five percent of the population, and then forty five percent have a slightly lower level just had hospital cover. Do you think one of the things we could look at, I mean that they health economists say that the benefit that health insurance gives is that it's a pricing mechanism. It prices your risk and encourages you to do arious things. Obviously there's a pre existing condition issue, but what I mean do you think that that is part of the story too.

Look, one of these stale arguments, very stale arguments in New Zealanders around privatization. It's like funding cuts. There's no funding cuts and health it goes up every year and there's a kind of political part. Is the ideological thing that you know, seend the right governments cut health funding. That's not happened. It goes up. And the other is privatization. The systems in the world that work are mixed, and you get these outbursts. We're having one a bit now over elective surgery. It's going to undermine the public system. The fact is the public system doesn't need all the needs. You need a mixed system, mixed insurance coverage, public and private, and mixed provision. Unfortunately, in more recent years the policy Ministry of Health two have been actively hostile to private participation. Now, the most interesting innovation in health in the last ten years in New Zealand is the nati far to a nib essentially health insurance scheme in Auckland covering the NATI far to a population. As far as i'm aware there's no official attention to it, probably because it involves an insurance company, but actually the work they've done, have done and are doing there for some of the most needy people in the country is just fantastic and the results are impressive, and there should be a trail of officials and politicians going to have a look at that because it works and it was no initiative of government at all, but it is sort of public private EU operates with public funding and so on. So I think we've got to get in New Zealand, we've got to get past this silly argument about privatization. Focus on results and if you can get better results with a combination of public and private insurance coverage, why not. That's what they do right across Europe. It's what happens in Singapore, it's what happens in Australia. That's not some extremist right wing view. And here there has been hostility to private provision. I've never understood why it matters more who does the job than achieving something for someone with significant health need and then getting the results for the person is what matters. And let's get a bit pragmatic and results focused about who does it?

Look, one of these stale arguments, very stale arguments in New Zealanders around privatization. It's like funding cuts. There's no funding cuts and health it goes up every year and there's a kind of political part. Is the ideological thing that you know, seend the right governments cut health funding. That's not happened. It goes up. And the other is privatization. The systems in the world that work are mixed, and you get these outbursts. We're having one a bit now over elective surgery. It's going to undermine the public system. The fact is the public system doesn't need all the needs. You need a mixed system, mixed insurance coverage, public and private, and mixed provision. Unfortunately, in more recent years the policy Ministry of Health two have been actively hostile to private participation. Now, the most interesting innovation in health in the last ten years in New Zealand is the nati far to a nib essentially health insurance scheme in Auckland covering the NATI far to a population. As far as i'm aware there's no official attention to it, probably because it involves an insurance company, but actually the work they've done, have done and are doing there for some of the most needy people in the country is just fantastic and the results are impressive, and there should be a trail of officials and politicians going to have a look at that because it works and it was no initiative of government at all, but it is sort of public private EU operates with public funding and so on. So I think we've got to get in New Zealand, we've got to get past this silly argument about privatization. Focus on results and if you can get better results with a combination of public and private insurance coverage, why not. That's what they do right across Europe. It's what happens in Singapore, it's what happens in Australia. That's not some extremist right wing view. And here there has been hostility to private provision. I've never understood why it matters more who does the job than achieving something for someone with significant health need and then getting the results for the person is what matters. And let's get a bit pragmatic and results focused about who does it?

And so just to pick up on that, you felt that the bureaucracy not it wasn't just a sort of less right political thing playing out in parliament, It was a bureaucratic problem as well. That the bureaucracy is really hostile to that.

And so just to pick up on that, you felt that the bureaucracy not it wasn't just a sort of less right political thing playing out in parliament, It was a bureaucratic problem as well. That the bureaucracy is really hostile to that.

Yes, that's right, and some of them are quite open about. I mean the PHO is quite open about being opposed to corporate ownership of medical practices. Well, actually it's none of their business who are the practices. What matters is can a sixteen year old a sixteen year old girl with depression and other physical problems get the treatment and support that she needs when you know they struggle to afford the transport public transport costs to get to the GP clinic. You know, those are the kind of problems that we should be focused on.

Yes, that's right, and some of them are quite open about. I mean the PHO is quite open about being opposed to corporate ownership of medical practices. Well, actually it's none of their business who are the practices. What matters is can a sixteen year old a sixteen year old girl with depression and other physical problems get the treatment and support that she needs when you know they struggle to afford the transport public transport costs to get to the GP clinic. You know, those are the kind of problems that we should be focused on.

And in terms of so what I mean, so the uptake of public of private health insurance, private health cover, I mean tax can you can look at tax concessions or I mean perhaps a fringe benefit tax for employees.

And in terms of so what I mean, so the uptake of public of private health insurance, private health cover, I mean tax can you can look at tax concessions or I mean perhaps a fringe benefit tax for employees.

You know, Look, I have been through that argument many times. I'm not a fan of tax concessions for it because it so regressive. I mean, it's higher and come people get the benefits of it. You know, you you were the people who can who will they know how to get the best out of the service, and they actually still use the public service fairly extensively. So no, not a supporter of tax concessions. And I don't think there is any broader political support for it.

You know, Look, I have been through that argument many times. I'm not a fan of tax concessions for it because it so regressive. I mean, it's higher and come people get the benefits of it. You know, you you were the people who can who will they know how to get the best out of the service, and they actually still use the public service fairly extensively. So no, not a supporter of tax concessions. And I don't think there is any broader political support for it.

And what was so, how would you encourage it? Then?

And what was so, how would you encourage it? Then?

Oh? Well, I think the private insurers have to encourage it by doing a good job, you know, offering better coverage at lower prices. That's how they'll attract people into it. But I think the the the the right response of the public system is to work with those who do that and when and when when you when you get the blend right, it works well. So one of the projects I was involved in was down in the far down and down south getting the small hospitals out of public ownership. And most of them are south of Tamaru and they're in community ownership or community owned companies. And since they moved out of public ownership, there's been no five thousand person health marches like they used to be in the early nineties. And they are a great mix of private non government ownership. They get the public funding for the public services into those into their hospitals, and they are great examples of fully integrated care in a community of a type which academically the policy people want to see. But to get it you need that public private mix, public coverage, private ownership, and the community supports the service. So this goes back to the point I said before. We actually a lot of the solutions are known, a lot of them have been in place before. We've just forgotten how to do it because there's too much talk about how what what I've seen branded is everything is you know, everything is public health crisis, everything is everything is mental health. Well that's that's, you know, sometimes a useful discussion. But if that's all you're doing, you're not actually solving problems.

Oh? Well, I think the private insurers have to encourage it by doing a good job, you know, offering better coverage at lower prices. That's how they'll attract people into it. But I think the the the the right response of the public system is to work with those who do that and when and when when you when you get the blend right, it works well. So one of the projects I was involved in was down in the far down and down south getting the small hospitals out of public ownership. And most of them are south of Tamaru and they're in community ownership or community owned companies. And since they moved out of public ownership, there's been no five thousand person health marches like they used to be in the early nineties. And they are a great mix of private non government ownership. They get the public funding for the public services into those into their hospitals, and they are great examples of fully integrated care in a community of a type which academically the policy people want to see. But to get it you need that public private mix, public coverage, private ownership, and the community supports the service. So this goes back to the point I said before. We actually a lot of the solutions are known, a lot of them have been in place before. We've just forgotten how to do it because there's too much talk about how what what I've seen branded is everything is you know, everything is public health crisis, everything is everything is mental health. Well that's that's, you know, sometimes a useful discussion. But if that's all you're doing, you're not actually solving problems.

Do you think they sort of we should be more specific and what we and what the problems are. So, yeah, this specific problem, how do we solve it?

Do you think they sort of we should be more specific and what we and what the problems are. So, yeah, this specific problem, how do we solve it?

Look, the policy system should be banned from producing the five hundred and thirty sixth Analysis of the aging population and its effect on health budgets. It should be required once a month to produce a solution to one more smallish problem that's actually solvable. Now. I think that would sort out who's capable of solving problems and who just keeps writing more strategies and action plans and needs analysis, which is another one. Needs analysis is dead cheap, easy with modern data and technology. So a lot of what the policy function is carrying out these days is actually a significant distraction from getting value for money and health.

Look, the policy system should be banned from producing the five hundred and thirty sixth Analysis of the aging population and its effect on health budgets. It should be required once a month to produce a solution to one more smallish problem that's actually solvable. Now. I think that would sort out who's capable of solving problems and who just keeps writing more strategies and action plans and needs analysis, which is another one. Needs analysis is dead cheap, easy with modern data and technology. So a lot of what the policy function is carrying out these days is actually a significant distraction from getting value for money and health.

It's lay two blue skies and not enough to benefit analysis.

It's lay two blue skies and not enough to benefit analysis.

It's not even blue skies. It's just the same old gray skies of complaining about how hard it is. Well, you know, it might be hard for you as policy analysis, the damn sight harder for people aren't getting the service they deserve. Get up on Tuesday morning and feel pretty sick, like you know, and have to wait for eighteen months to get their hip pain dealt with. So you know, I've got really allergic to this, the kind of psycho health crisis babble which solves nothing. Go and solve a real problem.

It's not even blue skies. It's just the same old gray skies of complaining about how hard it is. Well, you know, it might be hard for you as policy analysis, the damn sight harder for people aren't getting the service they deserve. Get up on Tuesday morning and feel pretty sick, like you know, and have to wait for eighteen months to get their hip pain dealt with. So you know, I've got really allergic to this, the kind of psycho health crisis babble which solves nothing. Go and solve a real problem.

They do. I mean, I use the OAA a lot to get papers out, and you do. You do have to say that there is a the ratio of very broad kind of papers about large problem yea, the agent population for example, massive problems. There are a lot of the relative to the papers about very specific targeted sort of this is an issue that is coming up. Here's how you might solve it. It seems to be.

They do. I mean, I use the OAA a lot to get papers out, and you do. You do have to say that there is a the ratio of very broad kind of papers about large problem yea, the agent population for example, massive problems. There are a lot of the relative to the papers about very specific targeted sort of this is an issue that is coming up. Here's how you might solve it. It seems to be.

Or another layer there, which is how do we arrange funding so that someone has a good reason to resolve that issue. I talked about earlier on chronic of homeless homeless guys with mental illness who are taking a lot of hospital beds right now. There's there's a whole lot of socioeconomic explanations for why they are how they are, and you can go off to a conference and feel good about that, but that is actually a real there's real suffering there. There's real things going on right now now as it happens. He's just often the problem solving these problems often about information flows. So in that case, it actually took nine months to get the hospitalization data with the consent of the individuals. It took nine months to get it out of the health system because are such a closed, controlling entity, and that behavior completely contradicts the endless analysis where they where people say we want to deal with the social determinants of health. Well, the entities who do deal with it, housing providers, people who help people find jobs, dealing with youth mental health. The health system usually won't share any information with them to help them solve the problem that the health system has that is overwhelming demand and that the individuals have.

Or another layer there, which is how do we arrange funding so that someone has a good reason to resolve that issue. I talked about earlier on chronic of homeless homeless guys with mental illness who are taking a lot of hospital beds right now. There's there's a whole lot of socioeconomic explanations for why they are how they are, and you can go off to a conference and feel good about that, but that is actually a real there's real suffering there. There's real things going on right now now as it happens. He's just often the problem solving these problems often about information flows. So in that case, it actually took nine months to get the hospitalization data with the consent of the individuals. It took nine months to get it out of the health system because are such a closed, controlling entity, and that behavior completely contradicts the endless analysis where they where people say we want to deal with the social determinants of health. Well, the entities who do deal with it, housing providers, people who help people find jobs, dealing with youth mental health. The health system usually won't share any information with them to help them solve the problem that the health system has that is overwhelming demand and that the individuals have.

Who deserve support, and this is a privacy they site. But the data should be anonymous, didn't it.

Who deserve support, and this is a privacy they site. But the data should be anonymous, didn't it.

Well, there's plenty of ways these days of using synthetic data and nominized anonymized data, sort of random non identified data. There's no will. The will at the core of the health system is still of the public health opera. Not I'm not talking about the clinicians here, but the public health administration is control of information.

Well, there's plenty of ways these days of using synthetic data and nominized anonymized data, sort of random non identified data. There's no will. The will at the core of the health system is still of the public health opera. Not I'm not talking about the clinicians here, but the public health administration is control of information.

And this is this is an example that you had when you were minister, or is it one that's st been aware of more recently?

And this is this is an example that you had when you were minister, or is it one that's st been aware of more recently?

We have a we run a business that measures social impact, so we get to see the interactions with the health system and information flows is one of the one of the key problems, and it comes down to some very boring technical issues which if resolve, would allow a whole lot of goodwilled people to to follow their own common sense to resolve issues that we all believe can be improved.

We have a we run a business that measures social impact, so we get to see the interactions with the health system and information flows is one of the one of the key problems, and it comes down to some very boring technical issues which if resolve, would allow a whole lot of goodwilled people to to follow their own common sense to resolve issues that we all believe can be improved.

Just just finally, it's some it's March. The moment, it's a budget by lateral season. I know that Finance Minister Nicola Willis is having budget by laterals. I think last week she had some, she had some this week. If you were in the chair your you know, go back to when you were Finance minister Tony Ryle comes at you with a health budget bid. What questions are you asking? What do you want to see from that budget bid?

Just just finally, it's some it's March. The moment, it's a budget by lateral season. I know that Finance Minister Nicola Willis is having budget by laterals. I think last week she had some, she had some this week. If you were in the chair your you know, go back to when you were Finance minister Tony Ryle comes at you with a health budget bid. What questions are you asking? What do you want to see from that budget bid?

To get it out of the line, Well, I think the key thing is not to spend too much time nickel and diming for the last fifty million. Health has the extraordinary privilege that they get first call on apart from the automatic ones like National super and Benefits, first call on the government's discretionary funding and they get well over half of it now every year. The key questions are what are you doing to increase the transparency and accountability in the system and what are you doing to solve the odd problems that represent future challenges for government. Now you can't stop a population aging, but you can deal with You can deal with homelessness, you can manage chronic disease is better and if you think about it as the finance minister, you know the poll of people who have diabetes represent a significant opportunity to reduce future cost, but more importantly, a significant opportunity to improve their lifestyle the quality of life if we can reorganize ourselves, because often the problem here is you know, you could say to the diabetic, we've got to change your diet. Well, some of them will, some of them won't, but often the easiest lever for changes is the policymakers and bureaucrats changing their behavior. So given that, say you take diabetes an example where it's intensive as very well understood. The treatments and support that's needed is very well understood academic literature and clinical experience, but no one's in charge of doing it. And despite twenty five years of PHO lead primary care, they haven't got much better at it either. And even where people say they have, they haven't got systems for showing the making progress. Because as a finance minister, you might say, look, if you're able to reduce the incidence of this phenomenon, whatever it is, with diabetes by ten percent, I'm willing to pay for that. But if you can't show me, I'm not willing to pay. And that's what I found most challenging as finance minister the system that the publicly delivered services usually can't show you whether they're making progress. But at the same time they impose fairly significant requirements on non government delivery to be able to show that they can change the world or they won't get any money. So I would say to the Finance minister, you must lift the standard of evidence quiet for the assertions, and you must they must be able to show you. There's a feedback loop where if they said this program is going to this program is going to fix all the problems with diabetes auromatic fever, well come back in twelve months time and show us whether it did or it didn't. That last but is almost always missing. But it's powerful if you can get it in place.

To get it out of the line, Well, I think the key thing is not to spend too much time nickel and diming for the last fifty million. Health has the extraordinary privilege that they get first call on apart from the automatic ones like National super and Benefits, first call on the government's discretionary funding and they get well over half of it now every year. The key questions are what are you doing to increase the transparency and accountability in the system and what are you doing to solve the odd problems that represent future challenges for government. Now you can't stop a population aging, but you can deal with You can deal with homelessness, you can manage chronic disease is better and if you think about it as the finance minister, you know the poll of people who have diabetes represent a significant opportunity to reduce future cost, but more importantly, a significant opportunity to improve their lifestyle the quality of life if we can reorganize ourselves, because often the problem here is you know, you could say to the diabetic, we've got to change your diet. Well, some of them will, some of them won't, but often the easiest lever for changes is the policymakers and bureaucrats changing their behavior. So given that, say you take diabetes an example where it's intensive as very well understood. The treatments and support that's needed is very well understood academic literature and clinical experience, but no one's in charge of doing it. And despite twenty five years of PHO lead primary care, they haven't got much better at it either. And even where people say they have, they haven't got systems for showing the making progress. Because as a finance minister, you might say, look, if you're able to reduce the incidence of this phenomenon, whatever it is, with diabetes by ten percent, I'm willing to pay for that. But if you can't show me, I'm not willing to pay. And that's what I found most challenging as finance minister the system that the publicly delivered services usually can't show you whether they're making progress. But at the same time they impose fairly significant requirements on non government delivery to be able to show that they can change the world or they won't get any money. So I would say to the Finance minister, you must lift the standard of evidence quiet for the assertions, and you must they must be able to show you. There's a feedback loop where if they said this program is going to this program is going to fix all the problems with diabetes auromatic fever, well come back in twelve months time and show us whether it did or it didn't. That last but is almost always missing. But it's powerful if you can get it in place.

And so that's the tafutawara. The hospitals, the tertiary level stuff massive demands on the public purse, but you're not you aren't necessarily seeing what you're getting for it. Whereas if you have community organizations the funded sector, they say, well, look we might be able to offer you this. The demand to prove that they can offer you that is so great that they're not getting a looking at the money whereas if the same standard were applied to the hospital system, to the tertiary level system, you'd get a very different outcome.

And so that's the tafutawara. The hospitals, the tertiary level stuff massive demands on the public purse, but you're not you aren't necessarily seeing what you're getting for it. Whereas if you have community organizations the funded sector, they say, well, look we might be able to offer you this. The demand to prove that they can offer you that is so great that they're not getting a looking at the money whereas if the same standard were applied to the hospital system, to the tertiary level system, you'd get a very different outcome.

Well, remember a scrap of years ago, a bit of out a date on this, this guy called Dave Latally in South Auckland who does fantastic work with obese people, a great motivator, saves lives and there's a great what's a video on on social media where he's using a chainsaw to demolish a wall because the guy who was in there was too big to get through the door, and the Tafida Aura decided to set up an obesity clinic essentially competing with what he was doing. Instead of him getting the funding, now he may have got some since because Dave's a great communicator and very persuasive. Yes, but that's a and could show results, like you could see what was actually happening. Now the clinics at the uppatient clinics at the hospital would not be subject to the kind of demands that were made on him. And actually, so you want a funder who's sitting there going okay. So obesity at scale is an ongoing problem for us as well as for those patients. Let's find who can deal with it best. What you actually have is if at the moment as the funding goes through the hospital, because that's the top priority, and they'll set up an expensive, expensive clinic which may or may not whose effectiveness may or may not be measured.

Well, remember a scrap of years ago, a bit of out a date on this, this guy called Dave Latally in South Auckland who does fantastic work with obese people, a great motivator, saves lives and there's a great what's a video on on social media where he's using a chainsaw to demolish a wall because the guy who was in there was too big to get through the door, and the Tafida Aura decided to set up an obesity clinic essentially competing with what he was doing. Instead of him getting the funding, now he may have got some since because Dave's a great communicator and very persuasive. Yes, but that's a and could show results, like you could see what was actually happening. Now the clinics at the uppatient clinics at the hospital would not be subject to the kind of demands that were made on him. And actually, so you want a funder who's sitting there going okay. So obesity at scale is an ongoing problem for us as well as for those patients. Let's find who can deal with it best. What you actually have is if at the moment as the funding goes through the hospital, because that's the top priority, and they'll set up an expensive, expensive clinic which may or may not whose effectiveness may or may not be measured.

Just just the last question, what do you think of the new multi year funding funding system for health. It's now funded on a cross pressure multi year basis. Actually, Bloomfield said ten years. That's a very long period of time. The current plan is for three years. What do you think of that system?

Just just the last question, what do you think of the new multi year funding funding system for health. It's now funded on a cross pressure multi year basis. Actually, Bloomfield said ten years. That's a very long period of time. The current plan is for three years. What do you think of that system?

Look, I don't think that makes a lot of difference. You know, it's going to go up five or six percent compound per year, and it might be a bit more. So let's just say for the next ten years that's going to happen. And that is the truth of it. It doesn't matter what the partisan claims are. It'll either go up five or six or a bit more seven or eight. The real issue is how how are we using the money? So let's stop wasting time on that rhetorical scrap and look at the productivity of the system. And you know, he has a very basic set of numbers. You've quoted big increase in health professionals through the throughput of the system. In patient and outpatient discharges and GP visits hasn't changed much over that time, but there's something like twenty percent more doctors and nurses now. They're not all sitting around lazing being lazy. But it is a legitimate question to say, okay, we should be getting more value for those inputs. That's where the debates should be, rather than this time wasted on a funding track every finance minister knows is going to go up pretty much the same every year for the next ten years.

Look, I don't think that makes a lot of difference. You know, it's going to go up five or six percent compound per year, and it might be a bit more. So let's just say for the next ten years that's going to happen. And that is the truth of it. It doesn't matter what the partisan claims are. It'll either go up five or six or a bit more seven or eight. The real issue is how how are we using the money? So let's stop wasting time on that rhetorical scrap and look at the productivity of the system. And you know, he has a very basic set of numbers. You've quoted big increase in health professionals through the throughput of the system. In patient and outpatient discharges and GP visits hasn't changed much over that time, but there's something like twenty percent more doctors and nurses now. They're not all sitting around lazing being lazy. But it is a legitimate question to say, okay, we should be getting more value for those inputs. That's where the debates should be, rather than this time wasted on a funding track every finance minister knows is going to go up pretty much the same every year for the next ten years.

Ran well, Billinglish, Thank you very much. That was there was fascinating stuff. I really really really appreciate your time and insights into into the state of the health system.

Ran well, Billinglish, Thank you very much. That was there was fascinating stuff. I really really really appreciate your time and insights into into the state of the health system.

Thanks for joining us our problem, Thomas Sinky.

Thanks for joining us our problem, Thomas Sinky.

That was on the tiles for another week. You can find us on iHeartRadio or Worrithervi your podcast

That was on the tiles for another week. You can find us on iHeartRadio or Worrithervi your podcast