Barely a day goes by without concerns loudly and forcefully expressed by advocates, health unions, lobby groups, and members of the public about the functioning of the health system.

In turn these concerns are amplified by the media, such that we now apparently have a “health crisis” on our hands, which the Minister of Health is then reviled for being loath to admit. And yet health funding has increased 40% over the last five years, an increase I have never seen even close to being matched before in my near-half century academic career in health policy and health services research.

So, is there a health crisis, as so frequently leads the news?

We simply don’t know – and we should. We should have the objective, independent information available that would allow us to draw that judgement. But we don’t.

The public is done a great disservice by the lack of availability of such information.

During my just-completed three-year term on the Auckland District Health Board, we had at our fingertips a complete dashboard of key information about the functioning of health services in the region, mainly hospital-focused but also relevant to primary and community services.

That has all disappeared. We now have a series of irruptions of concern often based on single cases, anecdotes, questionable data, and special interests. This is not to deny that where there is smoke there may be fire, and that these are all real experiences with real consequences, but without a larger picture of information we cannot easily pass judgement on the scale of the problem and how to address it.

My tenure on the Auckland DHB ended mid-2022. That’s just a few months ago. In the previous three years Auckland was in the eye of the storm, including the onset of Covid, and yet not once were we as a board tempted to call our circumstances a health crisis. Critical in some areas, yes, and under severe stress, but not a continuing crisis.

Our management team were generally able – just – to deal with “the slings and arrows of outrageous fortune” that were hurled at us as almost every conceivable adversity and setback came our way. Indeed, I wrote a column extolling their efforts, and the effort of the organisation as a whole.   

But at no time was the state of services declared a crisis. Yes, management had to do things differently. For example, they had to get senior doctors to be present on the wards at week-ends in order to make judgement calls on whether or not patients could be discharged, thus freeing up beds for new admissions, including those coming from ED.

Can we get to a position where information on the functioning of the health system can be publicly available and form the basis for informed debate, rather than just relying on claim and counter-claim?

A recent example of what can be done is the establishment of the Cancer Control Agency (CCA) in 2019. This is an area of great debate and public concern, well populated by advocacy and lobby groups. The CCA publishes a series of informative reports on the sector, including on cancer drugs. As a result, much of the heat has gone out of debates in this area. Debates are better informed, and as a consequence more productive.

The public would be better served by the availability of timely, searching, and comprehensive data on the functioning of the system, including key elements of infrastructure such as equipment, facilities, and IT.

This is not just a matter of health. Recently we learn of unexpectedly high failure rates from a trial run of NCEA numeracy and literacy tests. Is this the way to find out these things?

In Australia there is a comprehensive, longitudinal analysis of basic educational attainment information called NAPLAN. The results from that work are available for debate and, indeed, they show that Australia is suffering a decline in some key educational standards (see graph below) But that is a far more comprehensive and continuing assessment of the sector than what we have available in New Zealand.

Water infrastructure would be another example. How did we get to a situation where depreciation, while set aside, was not invested in key infrastructure (see graph below)? Again, we have been operating for decades without publicly-available information on essential infrastructure with enforceable requirements to show prudence in providing for future generations.

The startling thing is that in many instances the data required to underpin such publicly available information dashboards on key services are already being collected as part of the management of these services. Thus, on the Auckland DHB we were in many instances just collating information that was already being collected for clinical and administrative services. The same could be said of education, water infrastructure, and other essential services.

Is there a health crisis? Maybe. A water infrastructure crisis? Probably. A decline in educational attainment? Perhaps. But let’s have the information on which to make those judgements.