Mr Tamihere was speaking at Health Central’s ChalkTalks, held in Wellington this week. With the recent release of the interim report from the Health and Disability System Review, members of the Chalk Talks panel were asked if they agreed with the interim findings that our public health system needs to change significantly, and funding alone will not guarantee improvements.

When asked about an opinion column he had written for the NZ Herald, in which Mr Tamihere argued that too much power rests with family doctors, he said there should be greater devolution in the sector.

“We want greater devolution of service through a whole range of other related ‘trades’ from scripting over the counter at pharmacies to experienced practice nurses stepping up to the mark. They triage as it is, and they should be honoured and respected for doing a lot of the heavy lifting in primary health. The idea that a pharmacist who is really well trained can only use a certain percentage of that training across the counter is unfair in a modern society.

“There are a lot of opportunities to devolve and to ‘mana up’ a whole range of trades that can make a major contribution. At the end of the day, everything goes through a chokepoint where a certain guild will have a greater say, that’s yesteryear in terms of that,” he said.

Mr Tamihere maintains that the fiscal settings of the 1980s and ‘90s are holding the country in a headlock, and it’s time to have a ‘grown-up conversation’ about how to change the settings and devolve in a range of sectors, including health.

“What we do in this country is we invest in the ‘up cycle’ of the economy and we don’t invest in the ‘off cycle’. You have to start to fund in the down cycle as much as the up cycle, so you get continuity of pipeline and infrastructure. That orthodoxy has to change,” he says.

Fellow panellist Ian Powell, executive director of the Association of Salaried Medical Specialists. agreed with Mr Tamihere that there is a place for devolution in the sector.

“Within our DHB system there is a lot of scope for devolvement down. We certainly advocate what we call distributed clinical leadership, but I think that concept can go beyond clinical. Many parts of the workforce are responsible and have the authority and capacity in terms of numbers to take greater control over how things are done.

“Things have to be co-ordinated because it’s an integrated system, but I think you can make much better use of the workforce in our hospitals and the wider DHBs than is being made at the moment,” said Mr Powell.

While there is a lot of innovation in health care, Mr Powell said there is potential for it to go further in systems and clinical service delivery improvement.

The health review panel chaired by Heather Simpson will be delivering its final report in March and is seeking input from the health sector.

“The report is very much a summation of what works well and doesn’t work well in the NZ health system. It doesn’t give us any recommendations – they did suggest some key areas are addressed: inequality of health for Māori, Pacific and low socio-economic people; system stuff around how DHBs are organised and some leadership in the health sector, ” said Professor Gregor Coster from Victoria University.

“The report is very good – it’s 312 pages long and what it does say is that we have a very good health system and we shouldn’t lose sight of that. But at this stage it doesn’t give use any light of how we are going forward,” he said.

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