Industry View: Wellbeing Budget missed chance to boost digital health funding
Picture: NZ Health IT CEO Scott Arrol
There was a missed opportunity to invest more in technology as an enabler of the required increased levels of mental health service access and delivery.
The Government’s Wellbeing Budget is to be applauded for the focus it clearly has on changing the paradigm when it comes to mental health and addiction. The wellbeing priority of “taking mental health seriously” is a significant signal that there is going to be a whole new approach to mental health and addiction in this country.
There is no doubt that this part of the health sector has been struggling for a long time, with funding and services not aligned with the growing and changing demands placed on it.
Close to $1.4 billion of operational spend allocated to mental health over the next four years, and $823 million of this targeted at investing in services from prevention through to intensive intervention, has signalled the need for massive policy, regulatory and cross-agency collaboration not seen before.
Challenges across sectors
The health, justice, corrections and housing sectors, and the Police, are in the spotlight when it comes to their ability to work together while bringing their diverse groups of service providers along for the journey.
This will be no simple task, as the majority of service providers are small- to medium-sized non-government organisations that have been living hand to mouth for a long time. They have proven their resilience over many years of hard work, and I have no doubt that they won’t shy away from the challenges ahead.
However, they will also need a great deal of support to make the necessary changes to their structures and governance, and operational and service delivery models, essential for what is coming at them over the next four years. There will surely be some consolidation in this regard.
Change in delivery model
The new frontline service for mental health has been set a target of supporting 325,000 people to access the new model of primary mental healthcare by the end of its roll-out. This new service is considerably different to the current delivery models.
The Minister of Health has described a range of services that include GPs being able to “physically walk with their patients to a trained mental health worker”. Presumably, this means a handover occurs at that point and also that the GP, the mental health worker and the patient are all in the same building.
Of course, the Minister also describes other types of services that will be provided, as he’s quite right in stating that there cannot be a one-size-fits-all approach.
Investment in headcount
The Wellbeing Budget describes an initial investment of $48.1 million in 2019/2020 to expand primary mental health and addiction support. This will then steadily increase as workforce and capacity increases to total $455.1 million over the full four-year period.
Clearly, this requires an investment in people (headcount) that the sector has not seen before. This brings concerns about the ability of the sector to deliver on these numbers, how it will be monitored to assess whether targets are met and, if not, what interventions there will be.
It is understandable that this initial focus on headcount has to happen in order to make the required shift from where things are now to where they need to be. It also sends a strong policy signal to the sector and the public that mental health and addiction is a high priority.
We’ve also got to balance this with the fact that the primary care sector is already under immense pressure and is now expected to take on this additional responsibility. This part of the health sector will have to make its own significant changes to be able to deliver on these expectations.
Role of technology
This is where technology should be coming into play as an enabler of the changes and to support the increased levels of service access and delivery.
Sadly, the funding levels fall disappointingly below expectations, with a specific Budget line of only an additional $20.8 million over the same four-year period for digital and telehealth services for people seeking support through 1737 and other existing telehealth services.
There’s absolutely nothing wrong with this if all that’s required is to keep doing what’s already being done, just more of it (58,000 more responses per year).
As a percentage of the total spend this equates to at best only 1.5 per cent extra and it doesn’t allow for innovation outside of services already being provided.
While the current providers of digital-type services are doing an excellent job, it doesn’t take a lot of thought to realise that the demand on the whole sector is going to be so large that delivery, based on such high levels of headcount, is going to very quickly become overwhelmed.
Under-investment in digital technology
This is where digital technology, through a much wider range of solutions, from mobile-based apps, virtual healthcare, telehealth to texting and more, must be recognised with far greater importance than currently is the case.
Just as a one-size-fits-all approach won’t work for physical service delivery, neither will it do the job when it comes to digital technology.
Unfortunately, this level of under-investment in digital technologies has been happening for the past 20 years and can be seen in the strain across the sector when it comes to building our digital capabilities and capacity.
It is difficult to accurately pinpoint exactly how much is specifically being spent on digital technology in New Zealand’s health sector. At best it appears to be around the 2.3 per cent mark (or $280 million), which is based on district health boards reports on how much was spent as a proportion of their Vote Health allocations in 2016/2017.
In terms of international trends of investment in health IT, it is generally accepted (based on Gartner research) that the global industry average is 4.6 per cent and that, on average, 74 per cent of this goes into the ‘run’ category (keeping systems going), 17 per cent on ‘grow’ and nine per cent on ‘transform’.
Based on New Zealand’s level of investment, we’re not even reaching the run category level, let along having anything in the pot for transformation and innovation. As usual, New Zealand’s number eight wire approach means we punch well above our weight but risk the wire breaking when the strain gets too much.
Relating that to this year’s Vote Health funding of nearly $20 billion, with approximately $14 billion going to the DHBs, we could make a best guess that the digital spend will be somewhere between $300–$450 million (based on 2.3 per cent).
This falls way short of the amount that should be invested when we use Gartner’s 4.6 per cent average, or $650–$920 million. This is about what the whole health sector could really do for New Zealand if it was fully enabled by digital technology.
Need to change measure of success
We need to move away from headcount as the main measure for success (or failure). It hasn’t worked for the past 20 years and it’s not the solution for the next 20.
This doesn’t mean people working in the health system losing their jobs to technology – we all know there’s a global shortage of health workers and many are not working at the optimal level of scope.
It does mean investing in technology in balance with headcount to enable future-proofed health services for our citizens who have ever-growing demands on the sector.
So, coming back to the priority of “taking mental health seriously”, I am looking forward to next year’s Wellbeing Budget increasing the allocation to digital technology by at least double.
Similarly, for the health sector as a whole there need to be a specific appropriation line for digital technology. This would send a message that New Zealand understands and is embracing the full potential that technology provides when standing alongside healthcare delivery rather than as an adjunct to it.
Scott Arrol is the CEO of New Zealand Health NZHIT.
Regular column by Scott Arrol, NZHIT CEO