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Updated strategy reframes health agenda.

THE DRAFT updated health strategy represents a fundamental shift from universal public health and primary health care to commissioned, community services that are tightly targeted and outcomes-focused, according to NZNO's submission on the strategy.

It says the changes signalled in the draft update and in a raft of other government health and social policy reviews, plans and strategies, indicated "a politically-infused and ideologically-driven agenda", rather than one informed by evidence. The focus of the original health strategy, released in 2000, was on improved population health and equity. But this focus had now shifted to a "purely fiscal approach of investment in health based on actuarial risk of individuals' ill health".

Better access for 'worried well'

NZNO believes the draft strategy may increase access to health care for the "worried well", but will not improve outcomes for the most vulnerable. It has reframed inequity in terms of ethnicity, rather than the broad range of socio-economic factors, such as poverty, poor housing and precarious work, which underlie health disparities.

NZNO wants a comprehensive public health model, such as Te Whare Tapa Wha, which encompasses both individual and whanau empowerment, and social responsibility for health.

NZNO is concerned at the emphasis on information technology as a solution to many health issues, rather than as a tool to enhance, rather than replace therapeutic relationships. The strategy does not acknowledge inequitable access--the digital divide - cultural preferences, or the level of health literacy needed to self-manage health.

The draft strategy has five strategic themes: people-powered; closer to home; value and high performance; one team; and smart systems. NZNO's submission says "people powered" is very different from people-centred health care and is not the same as empowering people. It points out that delivery of services closer to home means people must be connected to their communities and communities must be integral to the delivery of health and social services. But this concept is invisible in the strategy, which relies heavily on "self-management". Rather than being designed for value and high performance, the health system needs to be fair and responsive to all. Nurses have reacted very negatively to the "marketing language" of "one team" and "smart system" and suggested "working together" and "an integrated system".

NZNO does not believe the "road map of actions" to achieve these strategic principles would work. "The strategy must affirm the intrinsic value of health equity, identify the main drivers of health disparities and have specific actions to alleviate them."

NZNO believes the strategy points to a more generic health workforce, with a far greater use of unregulated workers and volunteers. While welcoming the clear intention to use skills across the whole health workforce, NZNO is disappointed at the lack of priority given to planning for the number of qualified health practitioners New Zealand needs.

The submission was prepared by senior policy analyst Marilyn Head and is available on NZNO's webiste:

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Title Annotation:news & events
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:1USA
Date:Dec 1, 2015
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