North & South magazine has pronounced self-described ‘socialist’ and medical humanitarian Philip Bagshaw as their ‘New Zealander of the Year’. What’s going on? Has North & South had a leftwing turn? What has the relatively unknown radical Bagshaw done to deserve such high praise from the conservative media? And what does this award say about the state of Labour and National’s health ‘reforms’? [Read more below]
Philip Bagshaw is the co-founder of the Christchurch Charity Hospital, which officially opened in late 2007. This is a $6m volunteer hospital set up, according to last month’s North & South magazine, as ‘an answer to the inequities of a health system where only the illest and richest get treatment and a rejoinder to the politicians and bureaucrats who quietly countenance such a state of affairs’ (Mike White, pp.33-34). The hospital receives no state funding and all operations are performed entirely free of charge. It is both remarkable and regrettable that such a hospital is ‘based solely on the voluntary labour of doctors and nurses, and the community's generosity’. And although it’s currently the only one of its type in the country, it could soon be replicated elsewhere due to the failing public health system that’s been mismanaged, ‘reformed’, and under-funded by recent Labour and National governments.
The charity hospital has been established for patients who cannot get treatment in the public sector and cannot afford private care. North & South says that according to Bagshaw, the hospital is an absolute necessity because there are many conditions that, ‘while not fatal, are life-restricting, frequently painful and often lead to more serious and expensive complications’. Such ‘sufferers have been assessed as needing surgery but can’t even get on a hospital waiting list let alone on an operating theatre, instead being left to languish in a no-man’s land for years’ (p.34). Bagshaw says the free surgery should prevent people with easily treated conditions deteriorating to the point where they end up in emergency departments. Unfortunately, according to Bagshaw, this is generally what happens in the current system, which he gets incredibly frustrated about.
Is charity a solution?
Surely the launch of Bagshaw’s Charity Hospital is a landmark backward step in time for health in this country? It seems that the public system is so sick that it can barely be called Universal Health Care anymore. New Zealand is reverting to a system that is more and more like that which existed prior to the creation of the welfare state by the First Labour Government. The introduction of free health care by Mickey Savage’s government effectively ended charity hospitals. The First Labour Government argued that the sick should not have to grovel for charity, and instead that the government should fund hospital care for all. But with the arrival of Bagshaw’s project, it is clear that this progressive vision is dead.
Therefore New Zealand is seeing the emergence of a three-tier system whereby the wealthy are treated by private heathcare and insurance, the most desperately ill – if they have an adept GP – can get to the top of the public system’s waiting lists, and at the bottom a charity/volunteer sector picks up some of those who fall between the cracks. And the fact that charity is clearly finding its way back in the health system is also evidenced by the fact that Wellington Hospital – or their charitable foundation – has recently had to send out 15,000 letters begging for donations so that new furniture can be purchased for the rebuilt hospital.
It seems that philanthropy is emerging as a significant part of New Zealand’s social service provision. As relayed in the recent blog post on Religious charities, New Zealanders now give $1.27 billion to philanthropic and charitable causes, and there’s now 97,000 non-profit institutions to which a million of us donate our time.
Therefore it’s not surprising to read in the North & South article on Bagshaw, that he says, ‘The only overt criticism he’s had is that the hospital is letting the government off the hook by doing operations the politicians won’t pay for’ (p.37). And while obviously Bagshaw’s philanthropy project is highly commendable, this criticism does indeed ring true. After all, there should be caution that such charity hospitals don’t play into the hands of those who wish to see the continuing run-down of the public health system. One astute political activist has compared the charity hospital to the role played by volunteer food-banks that have grown together with the rise of neoliberalism since the 1980s:
There is a parallel here with the work of food banks which do a magnificent job in their field but by doing so inadvertently let governments off the hook regarding social policies which simply do not meet the needs of the increasing number of less well-off people.... The more that charitable organisations take over what are rightly government responsibilities the less inclined those governments will be to implement policies which provide for all New Zealanders' needs.
Labour and National’s health reforms
So what does Philip Bagshaw have to say about healthcare under neoliberalism in New Zealand? Not surprisingly, Bagshaw claims that his ‘hospital is a permanent reminder of how the health system is failing thousands of New Zealanders’ (p.34). Furthermore,
We are facing a crisis in the health system in proportions never before seen in this country. There is a growing quantum of unmet need and it's getting bigger and bigger and nobody knows what to do with it.
Bagshaw is also keen to highlight ongoing general problems within New Zealand's health service: ‘I think there are serious generic problems with the health system around the country which haven't been addressed’. In fact, such statements aren’t just recent pronouncements. According to an article in The Press from October 2004, ‘Bagshaw has been a vocal health critic for years, railing against burgeoning management structures, staff being treated as commodities and patients as income-generating units’.
‘Patients are dying’ report
In 1996 Bagshaw and his colleagues Stuart Gowland and Professor Gary Nicholls outlined the chronic failures at Christchurch Hospital in a report entitled Patients are Dying. They put their careers on the line by raising safety concerns, but these were then vindicated by an extensive inquiry by then Health and Disability Commissioner Robyn Stent. Stent’s report identified the existence of a ‘dysfunctional and grief-stricken health system’, and it pointed the finger at causes such as the aggressive business model pursued by the hospital management and inadequate government funding. Bagshaw and his colleagues were subsequently presented with an international academic freedom award from Noam Chomsky.
Health Board ‘window dressing’
Bagshaw then took his campaign to another level by getting elected to the Canterbury District Health Board in 2001. He quickly discovered, however, that he couldn’t fix the system from within, and he’s described his time on the health board as three of the most disappointing years of his life. He found that the DHB actually exercised little power and was ‘continually, stymied by the bureaucracy and mistrusting management’ (p.34).
Bagshaw’s experience led him to publicly dismiss Labour’s new health board regime as dysfunctional and undemocratic, and he called for them to be scrapped. He explained that the DHBs are ‘merely window dressing’ with decisions made centrally by the Health Ministry and handed down.
Part of the problem is that although the 21 district health boards have seven elected members, up to four additional appointees are made by the government to each board, and the key positions of chair and deputy chair are chosen by the health minister. Furthermore, although it is not commonly known, all the board members - including those elected - are accountable only to the minister of health. The Labour Government’s 2004 Crown Entities Act deliberately states that all members of the DHBs are individually and collectively accountable to the health minister. And on top of this, the minister of health has extensive abilities to direct the board and can even dismiss any of their members. (This has been done a number of times, when members have been replaced by professional financial advisers). This strict ministerial accountability was justified by the previous Minister of Health, Annette King, who cited the fact that the boards manage central government funds as a reason for the strong central control. Bagshaw therefore says that without reforms to this undemocratic structure ‘we might as well abandon the DHB and go back to local commissioners’.
Public (mis)management
Due to his negative experience of managerialism in the reformed public health system, Bagshaw has become a leading critic of the implementation of New Public Management reforms in New Zealand. He faults what he calls ‘the competitive, corporate style of management’ in the public sector. Bagshaw says that ‘According to managerialist ideology there is little difference between managing a tyre factory, a public hospital or a university’. And although such management techniques are expected to cut costs through business efficiencies and competition, because these generic managers know little about their areas of control and have little sense of public duty, Bagshaw says that they’ve mismanaged everything in the public sector.
He’s particulary critical of the new language of managerialism being used in health: ‘We’ve developed this endless Orwellian speak. When we want to ration things we talk about “prioritization”. When we want to hide things we go on and on about “transparency”’ (p.34). Bagshaw’s example of this is: ‘Hospital managers pay lip-service to this “Everyone should be treated in a timely fashion” idea – that’s just nonsense’ (p.34). According to the North & South article, Bagshaw notes that ‘he believes the cult of management has perverted medicine in New Zealand’ and says ‘I think you’ll find the majority of doctors think the system’s rubbish’ (p.35).
Humanitarian and pioneer
Is Bagshaw actually qualified to give such dire verdicts about our health system? It seems so. Bagshaw is one of the country’s leading surgeons. Here’s a few additional details about him:
- He researches and teaches at Otago University’s Christchurch School of Medicine
- He played ‘a crucial role in introducing revolutionary keyhole surgery into New Zealand and establishing the national liver transplant unit’ (p.36)
- He was named chairman of the country's Council of Medical Colleges in 2004
- He’s apparently ‘One of the few surgeons who refuses to work in the private sector’
Furthermore, Bagshaw’s humanitarian character is confirmed by his colleague Randall Allardyce, who says that he’s never heard Bagshaw even mention money or pay:
He’s unbelievably generous. You’d only have to indicate there was a need and he’d be there with a chequebook open. He thinks of money as something to be spread around rather than coveted and hoarded. In today’s “me, me” selfish society people are a bit like Fagin in Oliver Twist – you’ve got to pick a pocket or two. Phil’s never picked a pocket – he puts things in people’s pockets (p.36).
Conclusion
All doctors apparently sign up to the statement: 'I will come for the benefit of the sick', which is at the heart of the Hippocratic Oath. It’s a pity that our politicians and political parties don’t have to believe in anything like this. It certainly seems that they don’t care much for the sick, if we judge them on the current public health system. Much of contemporary New Zealand politics is instead indicative of an individualized society where political parties and politicians ultimately believe in little more than the individual voter. As Bagshaw himself states, the neoliberal reforms meant, ‘We became an “I, me, me” society’ (p.34).
The growing public profile that Philip Bagshaw has gained (albeit not due to his own intentions), and the fact that he’s being awarded the title of ‘New Zealander of the Year’ by a conservative and popular magazine, says a lot about the state of healthcare and politics in this country. Quite simply, North & South’s award is a terrible indictment on Labour and National’s health ‘reforms’.
