Эксперты призывают вернуть профессиональное медицинское руководство в систему здравоохранения Новой Зеландии

On the ground floor of the Ministry of Health’s headquarters in Wellington is a wall of photographic portraits. Each portrait is of leaders of our health system across time, back to 1901 when the ministry was first established as the Department of Public Health. Since then, 18 directors-general have led the department, making it an exclusive club. But because Kiwis are allergic to tall poppies, the portraits hang without ceremony next to a secondary stairwell. We have, from the outset, traditionally hired leaders with experience in the health sector to run the ministry. The most recent examples are Dr Ashley Bloomfield and Dr Diana Sarfati, who both trained as medical doctors before choosing to specialise in population health. Last year, our government changed tack and hired Audrey Sonerson, the then-chief executive of the Ministry of Transport. Around the same time, Shane Reti, a respected GP from Northland, was replaced as Minister of Health by career politician Simeon Brown, the then-minister of transport. This “fresh pair of eyes” approach is known in health circles by another name: corporatisation. It’s a strategy that governments have tried before, ostensibly to reduce spending, lift efficiency and make our health system operate more like a business. In the corporate world, the core function of a good leader is to maximise revenue and minimise costs. That’s why the CEO of Air New Zealand could theoretically become the CEO of Fonterra. The product may change, but the job remains the same. Business is business. But here’s the thing: health isn’t business. To each New Zealander, health is an intensely personal affair. A brush with a serious illness or the death of a loved one reminds us with sharp acuity that without our health, we quite literally have nothing. For five million New Zealanders, the health system is the single most important lifeline they have. For this reason, well-run health services are just about the best thing our society can do for itself. The health system is likely the most complex, multifaceted organisation in the country, carrying high stakes and a low margin for failure. It requires the second-largest budget of any sector after social security, employs the second-biggest workforce after education, and is tasked with delivering healthcare to every New Zealander from Stewart Island to Cape Reinga, not to mention the Chathams and protectorates. On top of this geographic challenge, our population is both growing and ageing, which means more of us are developing resource-intensive diseases such as cancer. We’re diving into a tidal wave of obesity-related illnesses such as diabetes, kidney failure and heart disease; and rapid changes in technology are creating a new catalogue of mental and physical illnesses. Our sick New Zealanders often have more than one chronic condition, making clinical management a tightrope walk of fixing one thing while not disturbing another. Hidden within these challenges are deep and unfair disparities in health outcomes along ethnic and socioeconomic lines. Our two-tier public-private system probably makes these disparities worse, and also means that at any one time, more than one system may be trying to organise and co-ordinate care for the same people. From the cabinet table down, our current approach to health-system governance seeks to oversimplify this complexity into simple corporate terms, such as spending reductions, workforce trims and department mergers. But the core function is not to produce a return on investment, nor to run on a shoestring budget: it is to prevent disease, treat illness, save lives and ease suffering. Given this immense responsibility, we need steady, experienced hands who understand inside-out the strengths and challenges inherent in the system. We must demand a return to expert health leadership, both now and on the hustings.