INsite editor Jude Barback asks Labour’s new spokesperson for Health, Dr David Clark, about Labour’s stance on issues relating to aged care, home health and retirement, and the party’s priorities when it comes to older New Zealanders.
1) Labour/Green/Grey Power aged care inquiry: How is the inquiry going so far?The New Zealand Aged Care Association (NZACA) was initially concerned the inquiry was an attack on their sector as it appeared to focus on the fact that “many of the same problems with quality and consistency of home support services and aged residential care remain” since the 2010 inquiry. What are your views on quality and consistency around aged care?
Clark: The inquiry has drawn large crowds in towns like Takaka, Levin and Rotorua. We are about halfway through this cycle of meetings and lots of quality evidence is flowing in. The feedback has been generally that the problems raised in the 2010 inquiry have not been followed up at a Government level. While some in the sector are defensive and see an inquiry as an attack, members of the public attending welcome the opportunity to share concerns and plaudits. The inquiry has heard about a wide range of issues: everything from the lack of incentives for local government to build pensioner housing, to the turnover amongst carers. It is nine years since we were last in Government, so we will use the inquiry findings to report back and formulate policy when we become the Government in September.
2) Equal pay: If the Government-union-provider negotiations result in a lift in wages, this would be great for workers, but how are aged care organisations expected to fund the increase? If there is a lift in provider funding – where is it coming from?
Clark: Health is a priority for Labour. We have clearly signalled that a Labour Government will restore funding in Health that has been lost under this Government. The $1.7 billion dollars’ shortfall that Infometrics identified using Treasury figures – as having been required (but not supplied) to meet demographic and cost pressures over the past six years – has had a significant impact on the sector. We have said we will meet future cost-pressures and backfill the $1.7 billion over time. Some of this will come to Aged Care.
3) Rest-home level care: The current emphasis on ageing in place is great but it has seen a trend towards older people being assessed as requiring residential aged care at their most frail. They are consequently assessed as needing hospital-level care and enter care with very high needs and co-morbidities. This means they are increasingly bypassing rest home-level care. Due to this changing trend, many small rest homes are struggling and an increasing number of facilities are closing, which results in less choice for consumers and people having to go into care further away from their home and family. Do you think we should be looking to phase out rest home-level care? Or if not, how do we retain our small rest homes?
Clark: Accommodation options at every stage is an issue that is being frequently raised with us at the Grey Power meetings. This is something that we will acknowledge in the report and look to address in Government.
4) Palliative care: The reality for many aged care providers is that they are effectively providing end-of-life care for the majority of their residents. This care is complex and costly to deliver and therefore the aged care sector is pushing hard for a palliative care supplement. What changes would you like to see to the way palliative care is currently funded and organized in New Zealand?
Clark: Andrew Little told the Aged Care Conference members last year that Labour is determined to end the current practice by the current Government of treating quality palliative care as a “nice to have” in our health system. Labour will bring palliative care into the core public health service, and we will fund it properly whether in a hospice, in aged care, or in the community.
5) Inconsistency between DHBs: One topic that often crops up is how funding levels and contracts vary so much from one DHB to another. At the NZACA conference, several speakers including Labour leader Andrew Little, pointed to the inconsistencies across DHBs as an area they would like to see addressed. How do we even out the playing field for providers across the country?
Clark: How district health boards are funding older persons services is something that we will examine closely in Government. There has been a real issue of district health boards squeezed by funding constraints, adding criteria to home and community support services to constrain client and service growth. As well as this, DHBs have been dipping into other allocations to pay for expenditure in overstretched areas such as mental health services.
6) Home & community support services: The HCSS sector is bordering on crisis point, as it moves to a regularised workforce, including the implementation of guaranteed hours and training-related pay. How would you improve working conditions and the funding environment for HCSS?
Clark: This is something that we will be looking to address in the report! You are absolutely right, it is near crisis point. As I mentioned earlier, DHBs are changing the way they provide home and community support services due to funding constraints: moving from household management support to personal care only. This compromises an older person’s ability to stay in their home for as long as possible. We are also hearing about high turnover and low recruitment due to low pay amongst the workforce.
7) Minister of Health and Aged Care: The sector is advocating for a Minister of Health and Aged Care and capacity within the Ministry to support this. What are your thoughts on this idea?
Clark: Our immediate priority is to fix the funding issue in health as that is what is leading to a lot of the problems that we are seeing right now across the sector including aged care. The Associate Minister of Health (currently Nicky Wagner) has the portfolio delegation of aged care. It does exist and there are staff in the Ministry of Health but because this Government doesn’t treat this area as a priority, there is no visible work programme and policy development. This has been happening all across health where the resources and leadership has been found lacking.
8) Your vision for aged care in New Zealand: I’m eager to hear your vision for aged care in New Zealand. What are the key barriers to achieving this vision? And what is the plan for overcoming these barriers?
Clark: Labour has always stood for affordable access to quality health care. This will mean an appropriately resourced sector that provides real choice to elderly people facing decisions about housing, care, and independence.
9) The personal question: I think our readers would love to know a little more about you as a person, so please feel free to share!
Clark: I am passionate about health, having been regularly exposed to the sector from a young age. Having previously served as a nurse, my mother began retraining as a doctor while I was still at primary school in Auckland. She then went on to spend most of her medical career as a GP working with underserved communities.
I have long had a particular affinity with older people. I was very close to several of my grandparents as a child, and into my adult years. I enjoyed the company of the many elderly folk in my local church parish who fussed over me when I was a child, and was also cared for over many years after school by local retired folk whilst my mother was engaging in ongoing education.
My own tertiary studies focused on German Language and Literature, theology and philosophy. Whilst completing my PhD, I became engaged in competitive cycling and completed the New Zealand Ironman at Taupo for the first time. I am an ordained Presbyterian Minister and spent time in the late 90s working in a parish in Auckland. I worked at Treasury for a few years, and prior to entering politics spent four years running an independent residential facility for around 180 students at the University of Otago.
Although my more recent political, public sector and portfolio history has largely been focused on economic and financial matters, I have also been Associate Health spokesperson to Annette King over the past two years and have benefited greatly from her mentoring and support.