Stephen McKernan.
Feature
Picture of health
by Joanne Black
The size of the budget he oversees is not the only startling statistic new Director-General of Health Stephen McKernan can recite.
Many people probably don’t know that every six years New Zeal-anders’ life expectancy increases by two years. A girl born today can expect to live until she is just past 81, a boy to 77. Not only that; for the first time, the life expectancy of Maori and Pacific peoples is increasing at a faster rate than for Europeans, so at least one ethnic inequality gap is closing.
Director-General of Health Stephen McKernan says the figures are among many positive trends in the health system that get scant public attention because everyone is so busy debating elective surgery, even though it comprises just four percent of health spending.
McKernan also says that despite the widespread impression of a bulging health bureaucracy, the Ministry of Health consumes just 1.5 percent of the total health budget.
The new director-general, who has been in the job for just two months, does not hammer these points home as part of any overt attack on the media. He is either too savvy to do that in this, one of his first media interviews since taking over arguably the most difficult job in the public service, or possibly he is simply resigned to the extreme difficulty of getting good news reported. A patient who has had her heart surgery postponed for the third time, or one who has just been removed from the waiting list and referred back to his GP, makes a far bigger impression on the public than even the most sophisticated spin of any positive health trends.
McKernan says he is the first to acknowledge that there are places where the system can and should perform better but he says there should also be time for reflection on what the sector does well.
“The Americans spend twice the [proportion of] GDP we do on health yet they still have 40-50 million people with no real access to health care. If you compare us to a lot of places we do really, really well, and we need to acknowledge that. The Commonwealth Fund is one of the most well-respected international commentators on health and with the amount of money that goes into our system, and the life expectancy of individuals within our environment, we compare extremely well. We’re in the top three in terms of performance. For the amount of resources going in, our outcomes, in terms of health status, are incredibly good.”
One of the areas the New Zealand system is extremely good at is acute care. “We hear a lot about electives in New Zealand but you don’t hear of ambulances driving round cities looking for emergency departments to drop people off at, which you do hear in many international cities. We have a highly qualified experienced workforce who do very well.”
The resources McKernan now oversees in the health system are, by New Zealand standards, huge. Vote Health has $10.6 billion to spend in the current financial year and the allocation is likely to continue growing annually. Only Welfare has a bigger budget. Yet the amount the country spends on health does not stop the constant clamour for more cash.
McKernan’s background is in health administration; most recently he spent four years as chief executive of Counties Manukau District Health Board and before that four years as head at Hutt. Well-liked and respected in the health sector, at 44 he is young to hold the top job in health administration, and is only the second person in the position without a medical degree. He does not think that puts him at a disadvantage because no matter the background of the director-general, it is impossible to appease all the speciality groups, individuals and interest groups with their various demands, he says. Part of the job is to sort the lobbyists from the advisors and to take good advice.
It is only to be expected that doctors will want to act in the best interests of their patients. “That’s what they’re trained to do, but health management needs to take consideration of all the people who are not sitting in front of the doctor at that time. We would have this discussion at Counties where we would talk with clinicians who would say, ‘Look, I want to act in the best interests of the patient’, and I would say, ‘Yes, and as a health manager I must also consider the needs of the other 445,000 people who are not sitting in front of you when decisions are being made that might impact on their ability to access health care.’”
Although intellectually everyone knows the resources of the health system are finite, and that a decision made to spend extra somewhere in the system means less is available to spend somewhere else, McKernan says it is still a struggle to build public acceptance of the idea that the system has limits. Wherever the cut-off line is drawn, be it in entitlement to rest-home care, a geographical boundary for a DHB area or the level of need required before a procedure will be performed, some individual or group will always fall just outside where the delineation occurs. They are often the ones whose stories end up in the media.
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