A story too familiar for comfort

On 4 January the British newspaper the Guardian published an insightful article by its health policy editor Denis Campbell: https://www.theguardian.com/society/2022/jan/04/nhs-is-in-crisis-but-the-roots-go-much-further-back-than-omicron?CMP=Share_AndroidApp_Other.

Campbell is an experienced journalist. He’s been writing for the Guardian and its sister weekly the Observer about the United Kingdom’s National Health Service (NHS), public health and medicine since 2007.

On this occasion his focus is on the devastating impact on the NHS of the highly transmissible omicron variant of Covid-19. To call it a crisis feels like an understatement.

Omicron is rampaging through the UK and causing massive destruction in the NHS, including out-of-control hospitalisations. The NHS’s dedicated workforce from general practitioners to ambulance drivers to health professionals in hospitals are overwhelmed as well as many being widely infected themselves.

The ultimate paragraph

But, as a good journalist should, Campbell goes further. Omicron’s devastation can’t be seen it isolation. The roots of this crisis that has been imposed on the NHS go back much further.

This is well summarised in the journalist’s following concluding paragraph:

Today’s immediate, escalating NHS crisis has long roots, which are also political roots. Years of decisions by David Cameron, Theresa May and Boris Johnson, especially their inaction on staffing, left it enfeebled and woefully underprepared for this level of extreme pressure, which the critical incidents and unavailability of ambulances dramatically illustrate. The service’s many supporters can only hope that it does not break altogether in the coming days.

Boris Johnson: A mix of callousness and incompetence

The roots of the crisis

Johnson’s leadership is characterised by a deadly combination of callousness and incompetence. But the roots of the crisis predate him. These long roots can best be described as woeful neglect of the NHS workforce.

Is there not something too familiar for comfort about woeful workforce neglect? Is this more than David, Theresa and Boris? In New Zealand, particularly since 2009, successive National and Labour led governments have also woefully neglected the health workforce employed by district health boards (DHBs) responsible for the provision of healthcare to geographical defined populations.

Health professional shortages are prevalent across the spectrum in all DHBs. They include medical specialists (nearly 25%), nurses and a large range of other allied professional groups such as psychologists, radiation therapists and physicists.

This is what Jacinda Ardern’s government inherited after the 2017 general election. Continuing the previous woeful neglect is how it responded. The only exception was nurses but this was limited. It only happened because of a successful collective bargaining campaign from their union, the New Zealand Nurses Organisation, which won the hearts and minds of  the public. Further, although still early days, substantive improvement has yet to materialise.

Consequently both the United Kingdom and New Zealand respectively had excessively overworked and fatigued (many burnt out as well) NHS and DHB workforces when the coronavirus pandemic first arrived in early 2020. Both Johnson and Ardern inherited this situation but both continued the woeful neglect response.

Contrasting outcomes

The outcomes for both countries could not be more contrasting. The best indicator of the effectiveness or otherwise is the mortality rate per one million population. As of 6 January, for the world as a whole had 695 deaths per million. Compare this with 2,194 in the United Kingdom. Then compare both with New Zealand’s 10 per million.

The explanation is easy. New Zealand followed the science (mostly) with its zero tolerance elimination strategy. The UK government’s response was callous and incompetent implementation of the much less effective alternative mitigation strategy. It included ignoring or delaying actioning the advice of science. Indecisiveness is a generous description.

Jacinda Ardern: kind and followed the science

New Zealand’s public health measures were fit for purpose (public safety); the UK’s were fit for high mortality.

But along comes omicron

But New Zealand is still vulnerable with the arrival of the omicron variant. At the moment (touch wood) it is being held at the border. Our position is also helped  by having one of the highest vaccination rates for adults and teenagers in the world.

But, unless the government significantly slows down the arrivals tap and strengthens protective border entry requirements, omicron will get into the community. It would make a big difference if the vaccine rollout for 5-11 year olds was well underway before this happens.

The omicron experience around the world including Australia, North America, the UK and Europe is horrific, not just the massive daily infections but also the huge influx of hospital admissions.

Owing to omicron’s high transmissibility (much higher than the highly transmissible delta variant), if or when it enters communities hospitalisations in Aotearoa will go through the roof. Vaccination rates and good public health measures should mitigate somewhat (the extent to which is unknown).

But it is difficult not to see our public hospitals and those who work in them being overwhelmed in terms of capacity and personal health. Labour’s continuation of National’s woeful neglect of this remarkable workforce will significantly worsen such a disaster.

Too much familiarity

The UK’s response to the pandemic was callous and incompetent. Its approach to its health workforce was unkind and uncompassionate. New Zealand’s response to the pandemic was kind and competent. But its approach to its health workforce was also unkind and uncompassionate.

What makes things worse is that both governments are intending to restructure their health systems in the midst of the pandemic. Now that really is shared lunacy. Too much familiarity for comfort indeed!

5 thoughts on “A story too familiar for comfort

  1. NZ is a gateway for NZ citizenship. Once medical personal get Citizenship, it’s straight to Aussie for higher wages and cheaper housing.
    Remember John Key and his promises we would equal Aussie wages…
    Aussie banks rule us.
    Just for fun check out who owns the Aussie banks.

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    1. The issue is:

      * price, not funding. The lobby should be for lower prices not more funding and lower prices do not mean lower standards.

      * high barriers to entry. Training takes too long, people who take time out can’t get back in and registration hurdles are ludicrous.

      * the MECA allowing doctors to work two jobs is the biggest problem the sector faces. The doctors are conflicted between their two jobs, it reduces competition and it puts up price. It is allowed in no other industry for very good reasons.

      * Better management of conflicts of interest. Even if a doctor does not have a direct relationship with a drug company they are tied to them by the need to get patients on trials, There is therefore a relationship and a conflict. There is also a conflict between their public role and private business which is completely unmanaged.

      * Entitlement. You know it’s endemic.

      * Lack of diversity. You know it’s a problem.

      I suggest
      * the MofH takes over registration of the medical workforce
      * the practice of treating medical professionals and their friends and families with a higher priority than other people in the public health system ends and equity is at the core of rationing decisions
      * Ending clinicians control of rationing due to their obvious conflicts of interest
      * the time to train a doctor should be halved
      * Nurse training is returned to on the job and not a degree
      * The number of specialists trained should be doubled and starting earlier
      * bonds for a lengthy period of time for those who train in NZ
      * lower barriers to entry for imported labour in a system not run by the professions
      * allowing a lot more people to prescribe drugs
      * having a separate and more direct path for training GPs
      * stopping doctors from working in both the public and private system
      * requiring private hospitals to be actual hospitals not just rooms to rent to consultants who aren’t on staff so no one has any liability
      * allowing doctors to be sued
      * allowing the Health and Disability Commissioner to investigate complaints of not being referred for treatment, instead of the current situation of only investigating errors in actual treatment
      * making private insurers cover procedures that are expensive such as transplants, rather than cherry pick low risk procedures
      * making private insurers cover vaccinations and other public health procedures
      * NZ should lead a global push to regulate the global monopolies who over-charge for everything medical
      * faster investigation of ludicrously expensive medical devices that don’t justify the expense
      * disclosure of trips and other incentives to doctors for use of various medical products
      * disclosure of performance measures for health professionals
      * disclosure of variances from medical guidelines by health professionals
      * Regular reviews of ludicrously expensive drugs
      * speeding up acquisition of cheaper versions of drugs. If people want the branded product they can pay the difference.
      * introduce systems of part-payment in the public system.
      * require the MoH to monitor and audit procedures in private hospitals
      * Charge medical insurers if patients are transferred from private hospitals from private hospitals.

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      1. Entry standards are important for patient protection. Many different countries, including European, have different training requirements often linked to the nature of their health systems. Paediatric training in the US is quite different (less specialised) from New Zealand.

        The MECA covering specialists and other senior doctors and dentists has a conflict of interest clause covering tangible competition.

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