Health’s share of Budget 2013 has been described as “lucky” in a tight budget and also as a “standstill” budget for health by nursing leaders.
Memo Musa, the new chief executive of the New Zealand Nurses Organisation said while there was some funding for additional initiatives the bottom line was that it was a “standstill” budget for district health boards.
“Our assessment is that DHBS will still be looking to make efficiency gains to be able to invest in some of these areas and this will have an impact on the way services are delivered going forward,” said Musa, a former DHB chief executive himself.
Jenny Carryer, executive director of the College of Nurses, said it appear that health had been lucky in a tight Budget and it had been good to see “some small attempts” to address poverty in children but much more was needed.
She also noted the “remarkable” amount of mentioning made in the Budget of nurse-led services in primary health care which she said was an “excellent development”.
“But holding the postgraduate funding at the same level is of concern as developing nursing services must be underpinned by high uptake of postgraduate funding especially in light of the move towards increased registered nurse prescribing.”
Debbie Davies, a spokesperson for NZNO’s College of Primary Health Care Nursing, said the Budget brought no surprises with most new spending aligned with government priorities.
Daryle Deering, president of the New Zealand College of Mental Health Nurses, said a test of this and future budgets was how effectively it addressed key issues like growing inequality and the related drivers of poor health, including mental health, particularly poverty. “A priority needs to be placed on the health of our children and youth, families and communities which requires an integrated whole of government approach.”
Musa said NZNO’s quick assessment of the Budget’s Vote Health was that was not enough money to retain current services and pay for new initiatives.
“However having said that I think NZNO is cautiously optimistic about some of the aspects of the Budget for example the extra funding or investment for rheumatic fever, aged care and dementia services and diabetes and heart disease will go a long way to addressing some of the key issues or disparities in health in those particular areas.”
“Unfortunately those particular investments don’t go far enough, in NZNO’s view, to address the social determinants of health. Examples are housing, overcrowding, poverty, food in schools and general equity in accessing health care, particularly for Pacific and Maori.”
He said DHBs will most likely still be required to achieve efficiency gains and he believed any savings should be used to improve health outcomes and ensure quality and safety rather than helping an organisation’s bottom line. “So health staff, from my perspective particularly nurses, have the right tools and the right environment to do what they are trained and educated to do - which is to provide quality, excellent nursing or health care and interventions to people who need them.
With new funding agreements for primary health organisations soon to be released Carryer said she was also surprised by the extension of Care Plus funding “rather than a fuller examination of service models better designed towards improving long term condition care”.
Deering said was pleased to see the Budget setting targets for extended primary mental health consultations with a GP or practice nurse as it linked in with the College’s mental health credentialing project (funded by Health Workforce New Zealand) to build the practice nurses confidence and capability in meeting mental health and addiction needs.
She was also pleased to see funding for a mothers and baby mental health initiative. Though she thought the Budget funding for pre-employment drug testing was “questionable” without targeting the underlying influences on substance abuse that include poverty, unemployment and the “excessive availability and commercialisation of alcohol”.
Davies said she was worried that the large portion of increased health spending was allocated to district health boards for growth funding and inflationary measures and wondered whether this would end up aimed at secondary care and how much primary health would get.
Increased spending on disease screening, prevention, health promotion and long term condition care – which can be primarily be provided by nurses – was positive but how each DHB and primary health organisation administered that funding was the question, said Davies. She said she would like to see the funding going towards enhancing successful initiatives so they gain traction and increased funding going to developing a more integrated approach across the primary and secondary sectors.
“Primary health care nurses are well placed to continue to serve vulnerable, underserved and high needs populations, we need to ensure the environment is flexible enough for this to occur.”
Also positive was funding for child health, like rheumatic fever and older people and disability carers plus the investment in other health determinants like healthy homes and rent affordability, said Davies.
