Well, we know where we're goin'
But we don't know where we've been
And we know what we're knowin'
But we can't say what we've seen
And we're not little children
And we know what we want
And the future is certain
Give us time to work it out
Songwriters: David Byrne / Tina Weymouth / Jerry Harrison / Chris Franz.
Yesterday, RNZ reported on the government’s intention to reduce waiting lists by outsourcing some operations to private hospitals.
This morning, a second report provided more detail about the risks of doing so, following Health NZ’s release of an un-redacted memo, which had been released by Simeon Brown, at the time of the first report, but with entire pages blanked out.

Outsourcing for political gain.
As we’re all aware, some of us painfully so, surgery waiting lists are far longer than anyone would want. Other than those who might benefit from the failure of the public health system.
The reasons for this are well understood. Long-term underfunding, exacerbated by the COVID-19 pandemic's lengthening of waiting lists and subsequently worsened by this government's efforts to cut costs at a time when the sector needed to catch up.
“Health NZ has a target of treating 95 percent of people waiting for elective surgery within four months. As of January, only 60 percent of people were being treated within that timeframe.”
Simeon’s plan is for Health NZ to improve its numbers, presumably in time for the next election campaign, by outsourcing many simpler operations to the private sector, leaving the more complex cases to the public health system.
Sounds good, doesn’t it?
If the surgeons in the public system are overworked, then use the ones in the private system. Brilliant, right? Well, not if they’re the very same doctors, which in many cases they are, undertaking work in both the public and the private sectors.
“Most surgeons already work long hours, including evenings and weekends,” Australasian College of Surgeons' New Zealand chair Ros Pochin said.
“There are some surgeons who work purely privately, but most work privately and publicly, so there isn't a cache of private surgeons sitting there twiddling their thumbs in the evenings and weekends who can suddenly call in.”
In March, Simeon Brown announced that more than 10,000 surgeries would be outsourced to the private sector at a cost of $50 million.
On the face of it, that sounds good, the government putting additional money into operations. However, they aren’t, as the money will come from existing budgets, gained through “ongoing operational efficiency.”
Ahh, isn’t that nice? The public sector achieves efficiency savings, and the resulting funds are allocated to the private sector to undertake some of their work.
Again, aside from concerns about diverting public health funding to for-profit operators, this seems plausible if we imagine for a moment that the health sector can squeeze out $50 million in efficiencies.
So what’s the problem?
But wait, there’s more. It isn’t a proportion of the workload being outsourced; it’s the easy stuff. Private suppliers are being given multi-year contracts for “high-volume, low-complexity cases,” while “high-complexity work will be completed in-house.”
Like many of you, I have spent time in our health system over recent years, and what a tale of two systems it is.
Our public system is run-down and tired; many of the buildings seem decades overdue for refurbishment, and the staff appear constantly rushed and overworked.
Private clinics, on the other hand, feel more like an upmarket hotel; there seem to be more staff than they could possibly use, and if you look at the itemised bill at the end, the price per line item is truly eye-watering.
Does it really make sense to have the simplest work done in such an environment while leaving all the serious stuff in the public system? Surely, it would be more cost-effective to increase public system capacity to meet the ongoing and obvious need.
There is nothing wrong with spreading the cost of infrastructure, such as new hospitals, over many decades and borrowing at low interest rates to do so. That has got to be better than shovelling money into the furnace that is private healthcare.
Labour's Ayesha Verrall said of the move, “That means that people who have more complex conditions won't necessarily be the people targeted by the government initiative to bring down the waitlist, and it probably means longer waits for them.”
Ros Pochin noted, “Outsourcing is essentially an admission that we have not got an adequately funded and resourced health system.”
As mentioned earlier, the Health NZ memo provided by Simeon Brown had been heavily redacted, which included all of the risks and mitigation strategies the committee suggested being covered up. This morning, however, RNZ were reporting on an un-redacted version which Health NZ had subsequently provided.
Simeon Brown's office blanked out warnings about serious risks in surgery outsourcing.
One risk the unredacted memo showed was the loss of specialist surgeons, anaesthetists and medical imaging technicians from public health to private hospitals. Technicians had already been lost, as the private sector dramatically enhanced salaries to attract staff.
The memo states that “any degradation of the ability to maintain staffing in public will significantly threaten overall production and hospital flow, including for acute care work,” which was redacted in the version provided by the Minister in response to an Official Information Act (OIA) request.
Therefore, the risk is that by losing such staff, “waiting times for cases not suitable for outsourcing will likely increase.”
This move will be beneficial for the many thousands of people waiting for operations, improving their quality of life and reducing their pain. Still, it is incredibly concerning if the approach increases waiting times for more complex cases, which will be undertaken in the public system—the memo indicates that such cases would particularly include cancer surgeries.
So what’s the alternative?
Everyone would agree that our public health sector is overstretched, and ongoing demand necessitates change.
Outsourcing the least complex work to a private system is akin to a business opting to utilise expensive contract staff, but only giving them the simplest tasks to perform. It is a poor financial choice and runs counter to the government's initiatives to reduce the use of contractors and consultants in the public sector.
Surely we need to bite the bullet, build the hospitals, fund the surgeons and make our health system something we can be proud of, rather than just the overworked people within it.
To those who say we can’t afford it - it’ll be a damn sight cheaper in the long run than outsourcing ongoing demand to the private sector.
We need long-term thinking, not short-term measures that temporarily mask problems for political purposes while kicking the can down the road.
We need a government brave enough to say this is what healthcare is going to cost, we’re going to have to borrow for some of the infrastructure, but we fundamentally believe in providing a first world public healthcare system where people can receive the treatment they need without having to wait an unreasonable amount of time for it.
It’s not much to ask, is it?
It should be the absolute priority of the Health Minister, rather than redacting documents to conceal the sector's concerns from the public.
What do you think? Outsource the easy stuff for private sector profit, or fund the public health system so that it is fit for purpose?
Next year, New Zealand will elect its next Minister of Health. Dr Ayesha Verrall or Simeon Brown. Seems like a bloody easy choice to me.
Ngā mihi,
Nick.
To end, musical genius David Byrne is 73 today, so here is Road to Nowhere, which could’ve been the title of that Health NZ memo.
Two choices for the next health minister, one candidate has the letters DR before her name, the other carried a stool around to see above the counter in a bank.
What fundamentally p*sses me off about this is that 'outsourcing to the private sector' means that previously XY% of my tax dollars go directly to public Health services, but now only X% goes to the service, and Y% becomes someone's profit.