Red Alert

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Subsidised Private Healthcare

Posted by Iain Lees-Galloway on June 22nd, 2010

Peter Dunne and Southern Cross Healthcare want the Government to subsidise private health insurance.

Superficially, the argument that incentivising the use of private healthcare (specifically elective surgery) in the hope that it will reduce the burden on the public system and cut waiting lists makes sense.

But, like so many ‘common sense’ policies, a closer look at the details reveals more than a few fishhooks. To me, there are two principal problems with this policy: Workforce capacity and acuity.

The fact is that most surgeons working in the private sector also work in the public sector. There isn’t a bunch of bored private sector surgeons sitting around awaiting a flood of subsidised patients to come through the door. Until that changes, sending more patients to private surgical hospitals will simply draw resources away from public hospitals, exacerbating the situation for those who cannot afford health insurance. That will increase health inequalities, a concern expressed yesterday by health economist Robin Gauld.

Then there is the problem of complicated surgeries. Private hospitals only take the most straightforward cases. That is not meant to be a disparaging comment, it’s just a fact that private hospitals are not set up to deal with additional complications that may arise from other conditions the patient may have – it’s not their core role.

So, many people (particularly older people) with insurance will still need to use the public sector in order to get the additional care required to get them safely through the surgery.

Australia has strong incentives for those earning over $100,000 to take out private health insurance. This was a topic of discussion on the recent Health Select Committee visit to Australia. One of their ministry officials told the committee that many people who take out insurance will still often use public hospitals precisely because of the additional care that is available. His personal view was that the effective relief on the public system is negligible.

There is a role for the private sector in health care. But if there is money to spend in the health system, there are more cost-effective and future-focussed places to put it than private surgical hospitals.


Ryall won’t answer the obvious question

Posted by Iain Lees-Galloway on June 16th, 2010

Tony Ryall appeared before the health select committee this morning to answer questions on the health budget.

I put it to him that the fact that DHBs are cutting frontline services tells us that the small increase in the health budget is not enough to cover the cost of maintaining current services.

So I asked him if he thought that reducing the supply of health services would reduce the demand. (ie if you take the service away, will the community suddenly no longer require it?).

He completely avoided the question instead choosing to talk about his pet projects. When I attempted to get him back on track, the chairman, Paul Hutchinson, shut me down.

Put simply, health services for those who need them are not a priority to this Government.  National’s priority is tax cuts for those who don’t need them. No wonder the Minister is so evasive.


A Four-Year Term?

Posted by Iain Lees-Galloway on May 18th, 2010

We’ve just passed the half-way mark of this term of Parliament. As a first-term MP I can tell you it has flown by and I can’t believe we will be back into election year next year.

A lot of people in my electorate have commented that our 3-year term seems incredibly short.

Most have stated a preference for a four-year term, but wouldn’t want to go as far as five years.

I guess under FPP we didn’t want to wait too long before we got to tell our MPs how they were going. But under MMP would we be better off with a slightly longer term?

(Not to say I don’t relish the chance to go back to the ballot box next year!)


Smoke-free 2020

Posted by Iain Lees-Galloway on May 14th, 2010

Today I’ve joined the Maori Affairs Select Committee in Christchurch to hear further submissions on their inquiry into the affects of tobacco on Maori.

Although there is a huge number of organisations submitting, there is a very clear theme: That New Zealand should have a target of becoming smoke-free by 2020.

Today in particular we have heard a lot of calls for prohibition as part of a package of initiatives to reduce smoking rates. I’m not yet convinced the benefits outweigh the negative aspects of prohibition.

But what it is time to do is look at a broader spectrum of options to reducing smoking rates.

Recently Parliament increased tobacco excise tax. It was another step in the right direction. However what we are being told is that taxation is just a small part of the answer.

Key initiatives that keep coming up include:

  • Banning tobacco displays
  • Plain packaging
  • Increasing funding for quit smoking programmes
  • Licensing tobacco retailers
  • Legalising less harmful alternatives like e-cigarettes

I reckon the submitters are right. It’s time to pick up the pace. It’s also time to shift some of the attention off measures that penalise smokers (like tax) and onto things that will hit the industry and retailers a bit harder.

We’ve done well over the last 20-30 years but change has been slow. Should we continue the incremental changes or be really bold about eradicating the avoidable damage and costs associated with tobacco?

 

 


National: No New Ideas

Posted by Iain Lees-Galloway on February 15th, 2010

Simon Power is the MP for Rangitikei, the electorate that completely surrounds mine in Palmerston North. I see quite a bit of him and get on with him quite well. Generally speaking I think he’s one of the more sensible Nats and definitely one of the most competent.

But Simon’s response to the Misuse of Drugs Act review is wrong. To dismiss such a comprehensive piece of work out of hand not only shows disdain for the Law Commission but for the people of New Zealand.

It’s an issues paper, which means it is open for discussion and consultation. But Simon has shut down the discussion and basically told us there is no point in engaging in the consultation. All because John Key decided he would make a ‘war on P’ central to his popularity strategy.

Of course the National Party is a conservative party so it’s not great surprise. But should being conservative be an excuse to ignore any new ideas?

It seems new, good ideas don’t get much air time at cabinet. Look at what the first year of National-led government has brought us: Laissez-faire economics, tax-cuts for the rich, cuts to the public sector, National Standards in primary schools. All old ideas. All bad ideas.

I hope the bigger thinkers in cabinet can start having a bit more say. C’mon Simon, you’re better than this.


Misuse of Drugs Act issues paper published

Posted by Iain Lees-Galloway on February 11th, 2010

The Law Commission has just released its issues paper on the Misuse of Drugs Act (MoDA), titled Controlling and Regulating Drugs.

This paper (all 400 pages of it) is the result of two years’ work after the Labour Government invited the Law Commission to start work on a review of the MoDA.

Still need to read through it. Some key areas of interest and no doubt debate include:

  • No change to the law regarding the large-scale profiting from dealing in drugs.
  • A new framework for dealing with new psycho-active substances – essentially prohibition until appropriately analysed and regulated.
  • Potential for changes in the way possession is dealt with – especially looking at greater use of diversion and treatment rather than conviction.
  • Potential for differential response to ‘social supply’ and dealing for profit.
  • Greater resources for treatment.
  • ‘Civil Detention’ – ie compulsory treatment where it is believed this is appropriate and only as last resort.

Worth having a good read of this to take it all in.

Lianne Dalziel and I are as keen to hear your thoughts as the Law Commission is.

Consultation closes 30 April 2010.

Update: Simon Power rejects medicinal cannabis use.


Health System on its Head

Posted by Iain Lees-Galloway on February 8th, 2010

Last month when Rahui Katene suggested more public money be put into providing stomach stapling operations as an answer to obesity-related health complications I knew in my gut that it was the wrong message and needed to be challenged.

But I also know a couple of people for whom this type of operation has been extremely beneficial and has extended their life expectancy immensely. As a final option – when all other avenues have been explored – it should be considered.

Today, however, the completely arse-about-face approach to healthcare the National / Act / Maori Party government take has taken a step into the ludicrous.

Reports this morning bemoaning the additional costs to ACC of dancing-related accidents typify the thinking:

Prevention = Bad, Cure = Good
                             or
 Long term plans = Bad, Short-term stats in time for the election = Good

Should we discourage kids from playing sport because they might get injured? Should we not go to the gym because we might pull a muscle? Should we all sit on the couch and watch TV or play Playstation rather than go for a walk as a family?

And having lived that type of lifestyle, will the Government then pick the tab on surgery to make it all OK?

There is no sense whatsoever in taking away the services that teach people to take responsibility for their own health and assist people to make early interventions and then putting more ambulances at the bottom of the cliff.


Rich Patient, Poor Patient

Posted by Iain Lees-Galloway on January 22nd, 2010

Health Minister Tony Ryall says a proposal to introduce a two-tier system allowing private medical care in public hospitals is “worth a look.”

He should rule this insanity out right now. The idea that our hospitals have the capacity to deliver private health care on top of their current workload is so far removed from reality it’s staggering that Ryall would even countenance the idea.

Just this morning in my own electorate, Mid-Central DHB informed staff that it would be closing surgical beds due to a drop in acute surgery needs. I understand that when asked why the beds couldn’t be used to boost elective surgery numbers, management replied that surgeons were unavailable due to their private sector commitments.

If there isn’t the capacity to meet current needs, where will it come from to meet the additional requirements of fee-paying patients?

That aside, the point of having public hospitals is that everyone gets access to medical care based on need, not wealth. The kind of queue-jumping this would encourage is totally unacceptable.

Just where is Tony Ryall taking our health system?


Price of alcohol

Posted by Iain Lees-Galloway on September 22nd, 2009

This is my second post on matters raised in the Law Commission’s review of Alcohol Legislation. The previous post on the Purchase Age is here.

The question of pricing comes up a lot in discussions about ways to reduce harm caused by alcohol abuse. Much of the evidence available suggests that increasing the retail price of alcoholic beverages does in fact lead to a decrease in binge drinking and other harmful activities.

You may or may not agree with this. If you do, the next question is how best to go about achieving this.

The two options are:

  1. Increasing excise tax
  2. Establishing a minimum price for alcoholic beverages

These two are not mutually exclusive and could be used either in combination or separately.

So the two questions are: Should we be increasing the price of alcohol and if so how best do we go about it?


Conference Fashion

Posted by Iain Lees-Galloway on September 12th, 2009

OK I’ll try to offer something a little more valuable later in the weekend but I can’t help a quick post on something I’ve noticed over the last few hours.

Conferences (and bus trips) are a chance for MPs to perhaps relax a notch and for people to see us as real human beings, not just faces on the telly.

So it’s interesting to see how the fashion sense kicks in when we get out of the uniform suit and tie (gender biased I know – the women get a bit more flexibility in standing orders… and I’m not brave enough to comment on what they’re wearing!!).

Some of us manage to embrace the opportunity to dress for comfort alone. Me, I’m in t-shirt and jeans. Chippie takes it up a notch with a Labour branded polo. Trevor is in his obligatory black long-sleeve T.

Others, although out of the suit, don’t seem able to let go of the jacket. Stu Nash manages jeans and jacket whereas David Cunliffe hasn’t gone much further than ditching the tie.

And then there’s David Parker. I wonder if he’s got pin-stripped PJs because I’ve never once seen him out of a suit.

I have to admit, you do become sensitive about what people think when they see you out and about, especially if you’re just trying to relax with the family. 

Funny the ways this job pervades every aspect of your life.


Alcohol Purchasing Age

Posted by Iain Lees-Galloway on August 26th, 2009

The Law Commission’s Alcohol Issues Paper is, I was told by Sir Geoffrey Palmer, 1.4 kg heavy. It is probably one of the most comprehensive reviews of liquor issues ever created.

At this stage, the law commission is making no recommendations. The issues paper is out for consultation through to October after which the Law Commission has until the end of March to report back to Parliament.

So Lianne Dalziel and I though we’d post some of the issues on Red Alert and give you the opportunity to comment on them one by one.

And since the purchasing age is the point getting the most attention, let’s start there and get it off our collective chests…

There are a range of options for the purchasing age: Stay at 18 or increase to 19, 20 or 21.

There is another option also proposed: Split the purchasing age so it would be 18 for on-licence premises (ie pubs, restaurants etc) and 20 for off-licences (supermarkets, wholesalers etc).

Comment away…


Surely Tariana Must be Getting Frustrated?

Posted by Iain Lees-Galloway on August 24th, 2009

Tariana Turia thinks I’m grandstanding, but last week we saw another example of the Maori Party not being listened to in Government.

The gap between what the Maori primary healthcare workforce can earn compared with their counterparts working for GPs or in DHBs is significant and is making life hard for their employers who are bleeding staff on a daily basis.

When negotiations started between the Nurses Organisation and the employers, Tariana had plenty to say. When they joined forces and petitioned Parliament, Tariana had plenty to say. When they made their submission to the Health Select Committee Tariana (by then a Minister) still had plenty to say (only this time attacking DHBs for not doing enough to address the problem).

But when the Government announced last week that they refused to even investigate the problem, Tariana was silent – until contacted by the media, when she decided to have a crack at me rather than addressing the issue.

I’m sure she is working hard to lobby the Nats on this and other issues. But if Ryall isn’t listening, what good does it do her or her constituents?


Law Commission ‘Alcohol in our Lives’ issues paper

Posted by Iain Lees-Galloway on July 30th, 2009

The Law Commission’s ‘Alcohol in our Lives’ Issues Paper was released today. My copy arrived at 11:45 so I haven’t had much of a chance to go through it yet but suffice to say Lianne Dalziel and I will be giving the report very serious consideration. Any discussion welcome here and I’ll post again when I’ve digested some of the material.


Drinking Tonight?

Posted by Iain Lees-Galloway on July 17th, 2009

A while back Geoffrey Palmer said that if alcohol was classed under the misuse of drugs act it would be a Class B drug.

Should alcohol, and for that matter tobacco, be classified on the same scale as other mind altering substances?

Why / Why not?


Westminster Delegation – Day 5

Posted by Iain Lees-Galloway on June 28th, 2009

The final day of activities was, to be fair, somewhat more sedate than the previous four days. But that didn’t mean it wasn’t equally informative and useful.

We got out of London for the first time to spend the day in with Conservative MP John Howell in his electorate of Henley, described by both the local paper and the MP himself as one or the more ‘opulant’ parts of the UK.

After a breifing from one of John’s staff members on the demographics and issues of the electorate, we headed into the town of Henley-on-Thames (of rowing fame) to visit thier rowing museum and meet with local business people.

From there we went on to visit a 600-acre pig and crop farm. Following a tour of the farm we had afternoon tea with a group of local farmers. Topics of interest were the EU, subsidies, complience issues….

Final boarding call, I’ll finish this in NZ.


Westminster Delegation – Day 2 Part 1

Posted by Iain Lees-Galloway on June 24th, 2009

If I covered every aspect of day two this would be an excruciatingly long post so here’s a quick run down of the itinerary and a bit of detail on a couple of things. Carol Beaumont will also post on her highlights.

We met with three MPs to discuss current issues in UK politics. We then had a presentation on community cohesion and urban regeneration. Next was a visit to MP Betty Williams’ office followed by a reception and lunch at the House of Lords hosted by Lord Speaker Rt Hon Baroness Hayman. After lunch was a briefing on pay and allowances and standards in public life, then a meeting with Rt Hon Kevin Barron, Chair of the UK Health Select Committee. The day ended with a briefing on UK security and counter terrorism.

Expenses and allowances dominated almost every conversation (the record for not discussing it was 40 minutes at the counter terrorism briefing). As one MP put it in our first session – “there is no political scene at the moment. We are absolutely paralysed by the expenses issues.” Whilst there are many examples of inappropriate claims, there is a bit of a media beat up going on too. Notorious claims like the moat and the duck house, for instance, were never actually paid out. But change does need to happen.

Interestingly, those changes look as though the UK system will start to look very similar to our own system. Use of the second home allowance will be more restricted (as ours is to hotel bills, rent or mortgage interest) in fact possibly so restricted that it will be impossible for MPs to cover all of their costs if they rent or purchase a home near Westminster, which is perhaps going a bit far.

Employment of staff is quite different here. Staff are employed directly by MPs who draw on an allowance pool to fund their staffing costs. It is more flexible in that MPs can decide how many staff they want and what they will pay them (within a set allowance cap) but also more open to abuse or at least the appearance of abuse than our system of set staffing numbers who are employed by parliamentary services. The MPs here were interested in our system, but a bit reluctant to make the change although I expect they will end up having to do it anyway.

As you might imagine the Health Select Committee meeting was a highlight for me. What I found particularly interesting is that the Government MP chairing the committee had no problem whatsoever using the committee to thoroughly scrutinise, criticise and make recommendations to the executive of his own Government in a way that is not quite so apparent in our system. He is proposing a comprehensive select committee inquiry into Social Care (more or less what we think of as Aged Care) to create a document that can inform the policies or any future Government over the next twenty years.

The UK Health Committee recently came to NZ (we met them briefly) to study PHARMAC, Alcohol policy and issues, Patient Safety and ACC. Basically as far as I can tell most of the health issues we are dealing with, the UK is grappling with too. That includes my particular interest at the moment, Tobacco Displays.

Right, time to stop. This is getting too long and I need my breakfast.


Delegation to Westminster – Day One

Posted by Iain Lees-Galloway on June 23rd, 2009

Day one of the Commonwealth Parliamentary Association (CPA) delegation visit to Westminster kicked off with a briefing from the NZ High Commission in London. We discussed some of the key issues our diplomats over here are working on with the UK parliament, in particular the Youth Mobility Scheme, immigration in general, the Air Passenger Duty, EU Dairy Subsidies, Agricultural Trade and Food Miles.

An interesting fact we were given was that 99.75% of New Zealand’s food and beverage exports to the UK are transported by sea (food miles tend to be calculated assuming air travel).

The rest of the day was spent in Westminster. The first briefing was from the UK CPA branch about CPA activities and the structure of the UK parliament. We had a general discussion comparing and contrasting our two systems. Obviously we had a lengthy discussion about expenses and allowances as well as proportional representation, reform of the House of Lords and the election of the Speaker which was to occur later in the day.

One difference that really stands out is that whipping isn’t nearly as strong here as it is back home. The election of the speaker, for instance, is a secret ballot (a new process being used for the first time) and many MPs have been able to break from their party leaderships’ position and cross the floor without causing a crisis. I suspect there are two things at play here: The shear number of MPs (646, although two do not take their seats at present) means it is hard to stop factional groups forming, at least around specific issues, and the considerable majority that Labour holds means a few lost votes aren’t going to bring the Government down in a hurry. Also, parties don’t have the same influence that they do in a proportionally representative parliament.

We then had lunch with three UK MPs. Carol Beaumont and I had an interesting discussion with Meg Munn, MP for Sheffield Heeley about increasing the proportion of women in parliament and specific measures UK Labour has undertaken to achieve this.

After lunch we sat in the gallery of the House of Commons to watch the nominees for Speaker deliver their speeches. A straw poll amongst the 6 of us picked Sir George Young based on the speeches although we all noticed eventual winner John Bercow but thought he might be a bit too much of a maverick. He probably is and that might just be a good thing.

The final briefing of the day was from the Parliamentary Office of Science and Technology about their function in Westminster and work they have done to provide MPs and Lords with advice on Climate Change.

A really great start to the week. I hope the rest of the visit lives up to it.


Greens Get Both Bills!

Posted by Iain Lees-Galloway on June 18th, 2009

The Greens have continued their run of luck in the ballot.

The two bills drawn today were Jeanette Fitzsimons’ Sustainable Biofuel Bill and Catherine Delahunty’s Customs and Excise (Sustainable Forestry) Ammendment Bill.

Next ballot possible in two weeks.


The Faux Conscience Vote

Posted by Iain Lees-Galloway on June 17th, 2009

Tonight we’ve been debating Brendan Burns’ Sale of Liquor (Youth Harm Reduction) Amendment Bill which is supposed to be a conscience vote.

First speaker for the Nats was Sandra Goudie who said “We will be opposing the bill.”

That was then retracted by Jonathan Young who then gave a very similar speech to Sandra’s as did every National Party speaker that followed.

They had done well to not refer to their block vote until David Bennett got up and again slipped into using (the royal?) we in reference to their party position opposing the vote.

Not a great start for new Chief Whip Tremain.


Just what IS Tariana doing?

Posted by Iain Lees-Galloway on June 17th, 2009

A couple of weeks ago I asked Tariana Turia a question in the house about the international evidence supporting a ban on tobacco displays, something that she has publicly supported even though her colleague Tony Ryall has dismissed the idea.

I was working on the basis that the National Party ministers aren’t listening to their partners in the Maori Party. But as the questioning continued (amidst a volley of points of order regarding what Mrs Turia is and isn’t responsible for) it turned out that even though Tariana has publicly asserted her support for banning point of sale tobacco advertising, she has at not time advised Minister Ryall that he should go ahead with the select committee recommendation that tobacco products should be out of sight.

Which got me thinking: Just what is she doing?

So I asked written questions to see which groups actively campaigning for greater tobacco control she had met with. Of the 15 organisations I asked about she had met with just 3 – Te Hotu Manawa Maori, Te Reo Marama (TRM) and ASH.

It’s probably not fair to expect her to have met with them all, but the two she hadn’t met that stuck out like a canine’s proverbials were the Cancer Society and the Smokefree Coalition, the two organisations leading the campaign against Tobacco Displays.

I don’t think anyone really expected Maori Party ministers to have all that much say in this Government. But just how much effort is Tariana putting in to making her voice heard?