Beyond the Spin

New Zealand's success at eliminating COVID in 2020 saw the Sixth Labour government receive international praise and fanfare. In the early stages of the pandemic, our small island nation demonstrated the virtues of evidence-based governance and of listening to the science on issues. This reputation was perhaps prematurely embraced, a point made clear by the recent pivot from an elimination framework guided, by public health experts, to an opening up strategy which marginalises that very same expertise and prioritises business interests. There’s a lot to unpack in this, and I’m sure these are themes and topics I’ll find myself returning to in this newsletter. This week I want to focus on the dilapidated state of our healthcare system, how it got to such a breaking point and why our lack of healthcare capacity may have been the real impetus behind New Zealand’s elimination strategy. This is the hidden story behind New Zealand’s COVID ‘success’.

In plain words, New Zealand’s healthcare system is in disrepair. Just talk to any healthcare practitioner working in it and they will tell you the same thing. The system is not just stretched - it is overloaded, overwhelmed, and simply does not have the capacity to meet demand. Every year, particularly in winter, the media regales us with horror stories about overfilled emergency departments, short-staffing crises and the ensuing negative health outcomes for patients. This sad state of affairs is normalised to such an extent that the public response is not outrage - justly deserved - but resignation. This is partly because these stories are presented to us with an air of inevitability, and while health unions call for fixes to “unsafe staffing” and “healthcare funding” we rarely hit on the root causes of the issue. It is essential that we do so now, and more importantly, it is vital that we become outraged. Successive New Zealand governments have steered us again and again through the car crash that is our public health system and they must finally be held accountable. How many lives have been lost due to the growing inaccessibility of primary healthcare? The lack of mental healthcare? What about the long delays in getting simple diagnostic tests? Are people presenting to overfilled emergency departments always getting the treatment they need, and do they stick around when met with long wait times and overburdened workers? What about the fact that New Zealand has the worst access to medicine in the OECD. The human cost of the neglect of our healthcare system is enormous.

As may be expected, the broken state of our healthcare system left us totally unprepared for a pandemic. Many nations faced similar problems, it’s true, but consider the stats as related to our neighbours and allies. New Zealand has one of the lowest levels of ICU beds per capita in the OECD. With 4.6 beds per 100,000 people, we trail behind the United Kingdom at 6.4,  Australia at 9, France at 16 and Germany at 34. In 2018, 17 percent of planned surgeries had to be postponed due to ICU capacity. Compare this to Australia where only 1.7 percent of planned surgeries had to be delayed due to a lack of capacity. This is not a new problem, the Ministry of Health itself noted in a report in 2005 (!) that there were serious issues with the “piecemeal” and “ad-hoc” manner in which intensive care services were structured. The report went on to make a host of recommendations that were never actioned- mostly because they required investing in our health system and healthcare workers. 15 years later, another review was commissioned to assess ICU capacity and provision.  Let’s not wait around for more of the same conclusions - this is a funding issue that no Government has been brave enough to fully tackle. I speculate that funding - or lack thereof -  is also a big part of why New Zealand went ‘hard and early’ on eliminating COVID before Delta, vaccines and public non-compliance made elimination no longer tenable. If COVID had caught the health system with its pants down, without the buffer and protection that vaccination offers, it would have been a calamity. We didn’t stand a chance with 4.6 ICU beds per 100,000 people. Let’s not even get started on the critical shortage of healthcare workers, particularly nurses - another thing healthcare workers and public health experts have been warning about for decades to little effect. 

Looking at healthcare expenditure from 2009 to 2018- adjusted for inflation and population change- there is a cumulative decline in healthcare funding. This has resulted “in an effective reduction in funding for health services.” Is it any wonder that healthcare, particularly nursing, is no longer an attractive career proposition? Successive governments have treated the healthcare workforce with contempt. Always looking for ways to keep costs down, this involves not paying them decent wages but also making healthcare workers do more and more work. Understaffing our healthcare system for decades is a dangerous gamble with rising stakes, not an accident. The lack of workforce planning is neglect at its highest level.


Again this is not new, it is a trend that stretches back to the Fourth Labour government and Rogernomics. Like most things going wrong in New Zealand, it has a lot to do with neoliberalism. Is anyone else seeing a pattern? Can we speak plainly about the material causes of this nightmare? You never hear about it in the mainstream media. The business and the political establishment have colluded to transfer enormous wealth from our communities, the working class, to the owning class - those who can afford private healthcare, incidentally. This is the scandal of the century, leaving us with a broken system and no public conversation about who broke it and why.

Now hold on Justine, aren’t you making a leap? How do free markets, a lack of regulation and the privatisation of goods and services equal a broken health system? Doesn’t this demonstrate the inefficiencies of the public sector? No sorry right-wingers that just doesn’t add up. Luckily history offers us the receipts so we can do the math. Neoliberal reforms of public services were a big part of the larger political and economic transformation of the country. Public healthcare was transformed, the aim was to “strip government trading departments of their social objectives and turn them into profit-making standalone businesses”. Transforming us from social democracy to a “profit-making state” was central to Rogernomics. Back in the day, they called this new way of operating ‘New Public Management’ and it sought to embed business culture into our public services. The expertise of healthcare clinicians and public health academics were sidelined. At every level of leadership, the keys to our public services were handed to money men, accountants and business people who were there to count beans and make sure we did not spend one cent more than allotted. Before Dr Ashley Bloomfield became the Director-General of Health, the role was held by Chai Chuah, an accountant who came to the health sector from PricewaterhouseCoopers. 

The fact that a doctor now occupies the Director-General role is progress but that’s also what tends to happen under a Labour government. Minor positive tweaks are made to ameliorate the negative consequences of neoliberal governance, in order to right the shore up enough support to keep voters happy until next polling day. The Sixth Labour government seems to understand that we need an overhaul in healthcare. Their plan to centralise our healthcare system is very positive in theory, but nursing leadership is conspicuously absent from the new centralised health board and the government is spending millions on consultants from big corporate firms to help them manage the transition. At the same time, the government has also given a few spare million to health, nothing extravagant - but our healthcare system has not received the shot in the arm it needs. Instead, the Government has spent a year in needless scraps with nurses and healthcare workers over their poor pay and working conditions. It is a mixed bag and avoids the elephant in the room. We need to re-orient our public services towards meeting public needs, and we need to redistribute wealth and resources back into our public services and communities. The profit-making state is a failure, it has caused untold human misery and will continue to do so unless we take immediate action. A glance behind the curtain of New Zealand’s world-class COVID response reveals a story about austerity, dumb luck, and the high costs of putting profit before people. 

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