If wishing made it so ...

17:28 Jun 25, 2012 186

The Prime Minister has had another Announcement Monday: this time it's a series of five-year targets for the public sector.

On one hand, the Better Public Services targets are generally laudable. On the other, there is this graph, Figure 2 in the Better Public Services: Supporting vulnerable children section, accompanying the target to "Reduce the incidence of rheumatic fever by two thirds to 1.4 cases per 100,000 people by June 2017.":

What the actual fuck? Did the poor civil servant who had to draw that graph believe it? Does anyone actually believe it?

Rheumatic fever is a classic case of a problem that, if not addressed, will cost the country far more in the long term than seriously addressing it would. So it is good that the Prime Minster should name it as a priority. But it's also a disease that closely correlates with poverty. Is it something that can only be fixed by the Health minister? And does anyone seriously think things will proceed as the graph suggests?

It doesn't fill me with confidence that according to Jessica Mutch, who was at the post-Cabinet press conference, John Key said "some of these targets are very aspirational" and his Treasurer Bill English said "we're not saying many of them are aspirational." Indeed, I'm confused.

But there is certainly more substance in this week's Monday Surprise than in last week's risible blurt about national standards. The relevant page on the State Services Commission website actually contains links to Cabinet papers and background material. So perhaps it should be welcomed.

Can you help me out here? It's a big week and I don't have time to research this properly, but I'm keen to tap your knowledge and research skills. Vent if you must, but I'd like to know what degree of credibility I ought to be extending to this initiative. Is it just this week's asset sales misdirection? Or something better than that?

186 responses to this post

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Idiot Savant, 18:03 Jun 25, 2012

I think its pretty obvious how they're going to achieve that target: not hospitalise people with rheumatic fever. Duh!
As for how to get medical professionals to cooperate with that, I forsee funding cuts for DHBs not meeting the target. With proper incentives in place, the problem solves itself.
(The problem of course being "stats about rheumatic fever that make us look bad", not the actual incidence of rheumatic fever in the community).

Palmerston North • Since Nov 2006 • 1717 posts Report
Idiot Savant, 18:16 Jun 25, 2012

And a little more seriously: the relevant page on the website does include some "policy". here is how the government plans to reduce RF:
# provide throat swabbing and treatment to children at high risk
# raise community and health sector awareness of the disease
# improve knowledge of rheumatic fever through surveillance and research
# work across government agencies to address risk factors like housing conditions and hygiene in schools – for example, by ensuring hot water and soap are available.
The first bits might do something around detection, but that will lead to more hospitalisations, not less. As for the latter, it seems the government thinks this is about dirty filthy poor people (rather than substandard housing and overcrowding), and that the best solution is for nanny to give them a good scrubbing. I guess the real problems are just too tough and too expensive to tackle.
Meanwhile, here's how they plan to reduce long-term benefit numbers:
# we will work with a wider range of clients to break the pattern of welfare dependence
# we will invest our resources smarter to get the best results
# we will improve the model of service delivery.
Which is pure buraucratic waffle. The core problem here isn't poor service delivery, its jobs. Absent a plan to create some, this target is bound to fail (except of course they'll juke the stats so they meet it)

Palmerston North • Since Nov 2006 • 1717 posts Report
Rob Stowell, 18:17 Jun 25, 2012

There’s also the big ‘target’ of getting 20,000 people off unemployment benefits.
The article parrots a bit of moaning about how expensive these unemployed people are:
Currently 12 per cent of New Zealand’s working age population is on a main benefit and more than 230,000 children live in benefit-dependent homes.
The annual cost of working age benefit payments is more than $8 billion.
And after a little concern-trolling, we get to the great mechanism for reducing unemployment:
Being out of work increases the risk of poverty and the longer a person is out of the workforce the harder it is to re-enter, Social Development Minister Paula Bennett said.
“Welfare reform will require more working age people to look for work and the Government is targeting those who can work but have been on a benefit long term."
More people will have to look for these ‘ghost jobs’, and will be ‘targeted’ when they fail to find them.
From the State Sevices Commission page:
What are we doing to achieve this result?
As part of Welfare Reform, the Government will actively promote participation in paid employment and give people the support they need to take on paid employment.
In addition to a stronger work-focus for more people, achieving this result will require an integrated cross-agency approach that addresses the causes of long-term welfare dependence.
We have three overarching strategies for reducing long-term welfare dependence:
we will work with a wider range of clients to break the pattern of welfare dependence
we will invest our resources smarter to get the best results
we will improve the model of service delivery.
A more detailed action plan will be released in the coming weeks.
Brilliant ideas keep leaping forth from the top-notch thinkers in our govt, eh? Can't wait for the details.

Whakaraupo • Since Nov 2006 • 2120 posts Report
Stephen Judd, 18:20 Jun 25, 2012

I’m interested in knowing what latitude public servants who want their target bonus will have. The government is supposed to set policy, not public servants. I can’t say I’d be very motivated by a challenging target if I couldn’t have my way in how to achieve it.
Which also leads me to see this as a sort of blame-avoidance rhetorical manouevre. There is an underlying assumption that the state of affairs is the result of the level of effort of the public service, not of the policies they execute. Bah. Let’s see cabinet ministers have targets set with penalties for failure, as soon as they get their warrants…

Wellington • Since Nov 2006 • 3122 posts Report
Russell Brown, in reply to Rob Stowell, 18:32 Jun 25, 2012

Brilliant ideas keep leaping forth from the top-notch thinkers in our govt, eh? Can’t wait for the details.
The early leader in the race to identify the most risible government gibberish. Jesus wept.

Auckland • Since Nov 2006 • 22850 posts Report
Sacha, 18:42 Jun 25, 2012

To be fair, the Budget's investment on rheumatic fever is big enough to make a significant difference (though I'd be surprised if it is as steep as that graph makes out). Ministry of Health details here.

Ak • Since May 2008 • 19745 posts Report
Hebe, 18:46 Jun 25, 2012

Progress will be monitored using one key measure – the number of working-age people continuously receiving JSS for more than 12 months.
The core KPI: what happens after the targetees come off the JSS is not the government's business. The important thing is that the numbers are cut, some would say slashed by near 20 per cent. In other words, let them eat cake, starve or find a job; their choice.
The most disturbing thing is that half the people on this JSS are sickness beneficiaries. Sick people must work? Or is it that the govt believes too many people are receiving the sickness benefit unnecesarily; if that is so, please explain. Or are the most vulnerable being targeted?

Christchurch • Since May 2011 • 2899 posts Report
Robyn Gallagher, in reply to Rob Stowell, 18:46 Jun 25, 2012

Brilliant ideas keep leaping forth from the top-notch thinkers in our govt, eh? Can’t wait for the details.
Here's a suggestion - they could run a workshop for longterm unemployed where they talk about how jobs are really cool and talk about the benefits of employment, such as money, holidays and FREE Nescafe.

Since Nov 2006 • 1946 posts Report
Sacha, in reply to Rob Stowell, 18:47 Jun 25, 2012

There’s also the big ‘target’ of getting 20,000 people off unemployment benefits.
Crucial to recognise it's not just about unemployment benefits, but sickness, invalid and DPB as well. Based on the WWG report and govt's response so far, it's likey to be those groups that show the most reduction in registered numbers.

Ak • Since May 2008 • 19745 posts Report
Sacha, in reply to Hebe, 18:48 Jun 25, 2012

Sick people must work?
that's what the WWG and Minister have said, yes.

Ak • Since May 2008 • 19745 posts Report
Russell Brown, in reply to Sacha, 18:50 Jun 25, 2012

To be fair, the Budget’s investment on rheumatic fever is big enough to make a significant difference (though I’d be surprised if it is as steep as that graph makes out). Ministry of Health details here.
Thanks for that. It was your earlier tweet that made me want to explore it a bit further to see what was fo' real.

Auckland • Since Nov 2006 • 22850 posts Report
Rob Stowell, in reply to Russell Brown, 18:53 Jun 25, 2012

words now failing. just going outside to kick something (inanimate) :-)

Whakaraupo • Since Nov 2006 • 2120 posts Report
Sacha, in reply to Russell Brown, 18:54 Jun 25, 2012

Wish I remembered where some of the relevant policy development info was kept - and that there was more I could say. A journo/researcher could approach the Ministry..

Ak • Since May 2008 • 19745 posts Report
Sacha, in reply to Russell Brown, 18:56 Jun 25, 2012

The RF investment also has a much better return that any of those silly new highways.

Ak • Since May 2008 • 19745 posts Report
Sara Bee, in reply to Stephen Judd, 19:02 Jun 25, 2012

I think the "blame the public servants" is more than an underlying assumption -"We're making the public sector leaders accountable for achieving things that make a real difference to the lives of New Zealanders, not just managing a department or agency," he said (Bill English).

Dunedin • Since Nov 2006 • 67 posts Report
Hebe, 19:06 Jun 25, 2012

Anyone who knows these things: is there any breakdown of the types of illnesses people on the sickness benefit have. How detailed is it (ie mental illness is not clear enough -- it needs to be broken down into specific groupings)? Will recipients with certain types of dianoses be targeted, or will everyone on that sort of benefit be intensively "advocated for"?

Christchurch • Since May 2011 • 2899 posts Report
Kumara Republic, in reply to Sacha, 19:09 Jun 25, 2012

There’s also the big ‘target’ of getting 20,000 people off unemployment benefits.
The way things are going, that would make for a pretty big tent city. Not to worry, Treasury can tell us that each tent can fit maybe 3-4 people to make the most efficient use of space.

The southernmost capital … • Since Nov 2006 • 5446 posts Report
Sacha, in reply to Sacha, 19:10 Jun 25, 2012

Correction: Invalid benefit isn't part of the new JSS category.
As part of Welfare Reform, a new work-focused benefit category called Job Seeker Support (JSS) will be introduced from July 2013. As at April 2012, 78,074 people had been receiving the benefits that will make up JSS for more than 12 months. This was made up of:
38,927 (approximately 50%) receiving Sickness Benefit
23,031 (approximately 29%) receiving Unemployment Related Benefits
12,212 (approximately 16%) receiving DPB sole parent whose youngest children are over 14 or DPB Women Alone
3,904 (approximately 5%) receiving Widow’s Benefit with no children or whose youngest children are over 14.
On introduction of JSS, all of these client groups will have a full-time or part-time work expectation (unless granted a temporary deferment).
The Government’s target is to:
reduce the number of people continuously receiving these working-age benefits, which will become the new JSS, for more than 12 months by 30%, from 78,000 in April 2012 to 55,000 by 2017.
Many beneficiaries do want to work at least part-time. Cutting their income eligibility just transfers onto them and their families most of the cost of mismatched labour market provisions (actual jobs, flexibility, transport, childcare, personal support, access provisions). We've already seen the queues for basic supermarket jobs. Brighter NZ my arse.

Ak • Since May 2008 • 19745 posts Report
Hebe, in reply to Sacha, 19:20 Jun 25, 2012

Brighter NZ
Yeah righter.

Christchurch • Since May 2011 • 2899 posts Report
mic weevil, in reply to Sacha, 19:31 Jun 25, 2012

Brighter NZ my arse.
& "# work across government agencies to address risk factors like housing conditions and hygiene in schools – for example, by ensuring hot water and soap are available."
There y'go. all clean and bright now. Rheumatic fever all gone! aspiration achieved!

auckland • Since Nov 2006 • 52 posts Report
George Darroch, in reply to Idiot Savant, 19:32 Jun 25, 2012

I don't work on rheumatic fever, or any other respiratory disease so this really isn't my area. I can't tell you how much impact these will have. But the first three of those are fairly standard in malaria; diagnosis and treatment, surveillance, and community education. In diseases which are easily recognisable by non-experts, community education is more than a token response, it's crucial to reducing the disease below transmission thresholds.
They're reasonable policy responses. They would have consulted within the area before choosing them. And cutting the incidence of a disease by two thirds in just five years is a useful target, if it drives the necessary responses and causes an increase in the scale of investment. But the gap between aspiration and implementation is something to be questioned. If they put very large amounts into this, then they could get there - but such amounts are almost certainly something that would have to show up on budget balance sheets. If there isn't a funding announcement then the target is useless. Particularly when the Government is undermining the underlying conditions which facilitate the spread of the disease.
I like the immunisation target though. And the repeal of s59 is likely to have had its intended impact in removing the expectation that violence against children is acceptable (under any circumstance). So, a little progress: it's not all negative.

WLG • Since Nov 2006 • 2264 posts Report
Sacha, in reply to George Darroch, 19:33 Jun 25, 2012

If there isn't a funding announcement then the target is useless.
24m

Ak • Since May 2008 • 19745 posts Report
Lilith __, in reply to Sacha, 19:36 Jun 25, 2012

Many beneficiaries do want to work at least part-time.
I can’t imagine how this can work out. WINZ spends time and money harassing sick people and solo parents, while there are able-bodied and unencumbered folk who can’t find jobs??
How can this not be an embarrassing and total failure?
Next up: beneficiaries surveyed for possible precious-metal content.
A spokesperson said:
“New Zealand beneficiaries are potentially highly prospective for a wide range of minerals. The Government would like to see New Zealand maximise the benefits of safe and environmentally responsible development of beneficiaries by reputable operators.”

Dunedin • Since Jul 2010 • 3895 posts Report
Idiot Savant, in reply to Hebe, 19:41 Jun 25, 2012

Anyone who knows these things: is there any breakdown of the types of illnesses people on the sickness benefit have.
here
Psychological or psychiatric conditions 41.5
Musculo-skeletal system disorders 15.2
Accidents 7.7
Cardio-vascular disorders 5.3
Pregnancy-related conditions 2.2
Other disorders and conditions 28.2
Obviously not as detailed as you'd like.

Palmerston North • Since Nov 2006 • 1717 posts Report
George Darroch, 19:49 Jun 25, 2012

Sacha, that sounds about right. Good. (Again, huge caveat about non-knowledge).
You can reduce disease radically even if the underlying conditions remain. Panama is nearing malaria eradication, and it still has the same swamps and forests that felled tens of thousands while they were building the canal. China and Sri Lanka are in similar situations.
I don't think this policy announcement is awful. I think this Government's approach to public health is awful, and this amelioration doesn't change that.

WLG • Since Nov 2006 • 2264 posts Report