Labour's health spokesperson Ayesha Verrall says the government's "five major health targets" announced earlier today are an afterthought, with no deadlines as to when they will be met.
Prime Minister Christopher Luxon and Health Minister Shane Reti spoke at Whangārei Hospital after a visit to the radiation oncology facility there.
The targets are:
- Cancer treatment: 90 percent of patients to receive cancer management within 31 days of the decision to treat
- Child immunisation rates: 95 percent of children to be fully immunised at 24 months of age
- ED stay times: 95 percent of patients to be admitted, discharged or transferred from an ED within six hours
- First specialist assessment wait times: 95 percent of patients to wait less than four months
- Treatment wait times: 95 percent of patients to wait less than four months for elective treatment
Verrall said they ignored general practice and primary care, which was the part of the health system New Zealanders used most.
She said she was concerned that the targets could be "gamed".
"[During] the last National government we saw people taken off waiting lists to make those lists appear shorter and patients can be moved into virtual wards to make their time in the emergency department appear shorter than it really is."
Verrall said it was essential to have a goal of a high immunisation rate for children, but Health Minister Shane Reti needed to say when that would be achieved.
"When I was minister my expectation was that they had to get there within two financial years."
Verrall said the targets were "empty goals".
"Dr Reti promised ambition but essentially ... without a deadline how's he going to mobilise the system to get there."
There were multiple problems with the targets, she said.
"I think the targets do not have a deadline and therefore they do not function, they also do not focus on the parts of the health system we need them to focus on."
Verrall also criticised the government's cancer treatment target which aimed to have 90 percent of patients to receive cancer management within 31 days of the decision to treat.
In terms of cancer treatment it was essential to get people diagnosed quickly, she said.
"The most important time for people waiting for cancer treatment is the time from when you're suspected of having cancer to get all your investigations done - biopsies and scans.
"They've [the government] chosen the period after that once it's completed through to when you get your treatment."
Verrall said it was pointless to wait four months to have the initial tests done and then to quickly go to treatment and Reti needed to focus on the earlier part of the process for that cancer target.
It was easier to get a patient into cancer treatment once they had had all their tests done because there was no bottleneck there, Verrall said.
The bottleneck in the system occurred at the point where the patient had scans and biopsies so the decision to treat could be made, she said.
"I suspect there's been a prioritisation over the things that are easy over the things that matter."
Verrall pointed to an article in the New Zealand Medical Journal which she said stated cancer survival rates would not improve until there was a focus on early diagnosis.
Overall, Verrall said she did not believe the targets would deliver "meaningful health outcomes for New Zealanders" because they focused on the parts of the health system that were "easy to measure and easy to deliver on".
Verrall said there needed to be changes to the general practice funding system but the government's challenge was to do that in the context of tax cuts.
GPs see vaccinations as an underfunded 'labour of love'
Whangarei GP Geoff Cunningham said the new targets did not address pay parity issues, which was driving many general practice nurses - who are the main vaccinators - into the hospital system, where they could earn 20 percent more.
Primary care doctors were "passionate" about vaccinations, however, "and we are going to try our best".
According to Te Whatu Ora statistics, 6.4 percent of parents decline vaccinations for their two-year-olds, and that number could grow over time.
"It's going to be a mission to turn around the minds of the parents who are declining the vaccinations."
This was because there had been scepticism around Covid-19 and misinformation around vaccination, he said.
"These vaccinations are safe and in my mind they're vital.
"We run a real risk in New Zealand of having pandemics of measles and [other] dreadful diseases.
"We've forgotten how serious and debilitating and deadly these diseases are because we haven't seen them around because our vaccination rates have historically been very high ... but now that rates are falling to 83 percent for two year olds - really we've got to get these rates up."
This would require primary care to be properly resourced so they could keep their nurses, he said.
The proposal for pharmacies to manage the immunisation schedule suggested there was an "agenda".
GPs and practice nurses did more than just deliver vaccinations, he said.
"We're the ones who look at the kids when they come in, check their overall health, who talk to the mums about how things are at home, how breastfeeding is going, things like postnatal depression. This isn't just about vaccination - these visits are so, so much more than that and that's what general practice specialises in."
Government payments for vaccinations had not kept up with inflation over last two decades, he said.
"This is more of a labour of love for general practices, but it's a very important part of what we do."
Cancer treatment stymied by 'bottlenecks'
Cancer Society medical director Dr George Laking said the target that 90 percent of patients received cancer treatment within 31 days was introduced by the previous government.
"There's a lot of machinery and apparatus still in existence for meeting the cancer targets because the previous Minister of Health Tony Ryall introduced that concept some years ago, and most of the cancer treating services have stuck with that idea ... because we like the idea of treating people with cancer in a timely way."
There were two key deadlines in cancer treatment, he said: the 31 days from referral by their primary care GP to having a diagnosis of cancer and meeting with a specialist, then the second 31 days which was the time until starting the treatment.
"It's interesting that the targets in front of us now don't seem to have that first 31 days, which is a significant bottleneck for quite a lot of people."
He said debates about cancer treatment targets and what they could actually achieve were nothing new. "For example, if it leads to a fixation on numbers rather than actual things happening that matter."
But "everyone who looks at something like a target can appreciate the basic idea of it, which is to hold yourselves and hold your system accountable to doing something in a reasonable amount of time - that's an appealing thing to have."
Having enough specialist workers to provide that treatment was an ongoing issue.
"You need to have people with postgraduate training pretty centrally involved in looking after people with cancer...
"We really shouldn't underestinate the target - that is not now a target - for diagnosis in time.
"The cancer care system absolutely depends on a high-functioning primary care GP system for people actually to have cancer diagnosed so we can do something about that and treat it.
"Quite a lot of people who have cancer diagnosed completely bypass general practice and cancer only ends up being diagnosed after they front up at emergency departments, so that is one indicator for us that there is quite a large amount of need to step up capability in the general practice side of care."
