Forum 2019 - Health and Disability System Review

The Health and Disability System Review Interim Report was released by Review Chair, Heather Simpson to the Minister of Health on 3 September 2019. The report does not make recommendations but does provide an outline of what the review panel has heard during engagement with the public and sector and to provide an early view of the thinking.

The session was presented by Heather Simpson, who was joined by Expert Review Panel members.

Heather Simpson, Chair of Health and Disability System Review

Video: Heather Simpson - Forum 2019 - Health and Disability System Review

[Heather Simpson presenting to an audience as part of the Health and Disability System Review session of Forum 2019]

Keriana promised to put the mics down low enough for us short, older people. She didn't get quite low enough.

Good morning, and thank you for this opportunity to explain why we haven't got the answers yet, but more than that, I want to take the opportunity really just to reiterate some of the messages from the report. You'll be pleased to know that I'm not going to go through the 302 pages, because I know that all of you will have already been through them all, so we don't need to.

It's been interesting since we put the report out. I think the most common response to us-- or the one that was actually given to us, the polite one-- was that it was a good read and that it told people everything they already knew. So I thought, well, that's good. I wonder why it took us so long to write, really.

But my response to that, as it seemed it meant to me, that either all the people I spoke to had only read their chapter, which I suspect was the most common response, and so, therefore, they thought they knew it all, or they had read it, but started another bit and given up, or they really did read it all and knew it all already, and I wondered why they weren't already on the panel.

But which ever one of those categories you fit into, the question that arose from me is if we did already know that-- and I absolutely accept that there was nothing in that report that somebody in the system had not talked to us about, right? We didn't make any of that up. What we did do is we listened to everybody around the system.

We then did a better checking, because sometimes, believe it or not, sometimes, people believe things which aren't actually true. And there are quite a few times in the health system that we get told about how the system works or why something doesn't happen one way because of some rule that somebody made, and when I go to look for that rule, it's not actually there. And so we did a bit of checking to try and actually clarify some of those points about it. And I'm still trying to work out because I have been around every DHB apart from Capital Coast, but never mind. I visit that on a regular basis. So it's OK.

Every DHB told me with a straight face that they were unfairly penalized by the population-based-funding formula. So Capital Coast Health, you must be getting a hell of a big share of it because everybody else is not, according to them. And I did a math degree a long time ago, so I'm being good about looking back through my notes to work out how everybody can be so far below the average. I haven't worked it out yet, but that's why we haven't finished the report.

But I suppose the other thing about the report is that accepting that there is nothing in there that is new, what I think is new, and what I think the panel has done well is put it all in one place. And that is what we do not do well or have not been doing well, in my view, in the system.

So a real message from that report is that if we want to change the system, if we want to make the system more equitable, if we want to make it more effective, if we want to make it more sustainable, we cannot do that by changing only one part of it. And it doesn't matter which part you are passionate about. You cannot fix that part all on its own.

And so the problems we have, I believe, in the system is not because of ill will of any part of the system. It's not just because this part of the system doesn't talk to that part of the system. It's that we treat the parts of the system as independent, but then we focus too much on those. But it also tells us that if we want to fix the sorts of parts of the system that worry us most, i.e., why is it that Maori life expectancy is so much worse than pakeha life expectancy? Why is it that people with disabilities have worse health outcomes? Why is it that Pacific people don't feel able to access the system, right? All sorts of issues.

If we go in to address those problems, the message we are trying to give you from the report is that we need to start with some of the fundamental issues in the system. So to fix Pacific Health or Maori Health, we have to start with also fixing things like data. If we don't bother to collect the information that tells us what is happening in the system, it is not surprising that we don't address the problem.

And the system has been horrible at ensuring, as a system, not as one little part of it, but as a system, we have collected the appropriate data and we have used the appropriate data. You can all tell me about lots of examples of where you've got wonderful datasets or that or wherever, or you know that, and we heard yesterday about the improvements coming from health care homes because they were actually managing the data. But it's not moving right through the system.

So the question now is not what is wrong with the system. We've tried to lay that out. We've reflected back to what you've told us is not working as well as it could within the system. And let me remind you that the report also says-- and we need to be proud of this-- we do have a good health system. We have one of the best health systems in the world. It doesn't mean it hasn't got problems, but it does mean that we shouldn't knock it too much, right? It provides a lot of good health care for a lot of people, just not all the same everywhere, which is not so good.

But I would also say that most of the answers are, also, already in the system somewhere, all right? So don't hold your breath waiting for this panel to come up with a system design which you've never seen anywhere, right? We've talked about good examples already yesterday, and people are really proud of things which are going on in their DHB or in their practice or in their community. The challenge for the system is how do we ensure that those good things that have been tried out and work in one place actually get translated into things which improve the whole system? So which is partly why one of the biggest sort of directions of change that we talk about is the need to make the system operate as a system, instead of operating as 20 different systems, because at the moment, that's probably the biggest barrier to actually it moving on.

Hint-- we get a system which to the public looks a whole lot more complicated than it needs to. As we say in the report, health systems will always be complex. They don't have to be as complicated as the one that we make. And, again, why did it take a 302 pages? What's that, really? Because there's a lot of moving parts and so we have to try and get it more support.

I'm not going to go on anymore about where we think we're going yet because the panel is all going to respond to the questions. Let me just say, though, that to reiterate, that I think the message and the challenge I put out to each of you in the next few months, as we keep on coming back asking you more questions, is to really focus on thinking about, OK, we do understand the problem, but we've known about these problems for a long time. So what is it that has stopped us solving the problem before, right?

And as I've said to many of you and things, it can't be just because the other person doesn't do things right. So what can each part of the system do and how can it work better with other parts of the system in order to move the system forward?

I would tell you the answers to all it, but it would remove the excitement and, anyway, I haven't got them worked out yet. So the panel is going to give you some indication of where the thinking is going. We've tried to give you that indication in the report, anyway, but don't expect the answer yet. Thank you.

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