Throughout my career working in the health sector I have known about the challenges of managing expectations. The public purse is never big enough to meet expectations and rationing is part of running a tax payer funded health and disability system.

Te Pou o te Whakaaro Nui aspires to help support people to deliver world class mental health, addiction and disability services. For the most part, we do well. As part of an international benchmarking forum we can compare our results to other OECD (The Organisation for Economic Co-operation and Development) countries. Whilst we are not at the top of the league table, we are not at the bottom. The question I think that is important to ask is - are we okay with being in the middle of the pack? Should we aspire to do better? Be number one in the world? I believe we should and can. New Zealand punches well above its weight in other areas. We are great when it comes to rugby and yacht racing. So why don’t we aspire to be part of a highly valued health system?

New Zealanders have always valued the public service as being free and accessible. But we believe it’s now time to acknowledge that due to population growth and changes in our social and economic structure, we cannot deliver first class health services in the same way we have done in the past.

Is it time to have more transparency on what we can do well with the public funding that is available. Maybe we can be clear about what services can be offered and let the public know this – and then also talk about the gaps in services. Reframing the conversation about what we could be doing if we had the opportunity to organise and fund our services differently.

Te Rau Hinengaro: The New Zealand mental health survey (2002) enabled us to understand what our community needed. This research population health study provided evidence on the need . The survey provided insight about how we could meet the needs of different parts of our community, who required support with mental health and addictions issues. This study was based on similar studies in the UK and Australia. These countries have since done further research and gathered an evidence base for the needs of their communities. How has this helped them? Having this sort of evidence assists with prioritisation, understanding service models and investment. It helps provide an objective view on targeting resources. New Zealand is now lagging behind countries who have a similar health system. Our challenge is being able to identify our mental health and addiction priorities based on research and evidence. It’s great that we have a health survey and are getting better at collecting information on current service performance - but what we don’t have is an understanding of the gaps of our services based on evidence.

Now more than ever, it is a challenge to manage expectations within the mental health, addiction and disability sector. We are hearing that services are struggling to meet demand. We know the workforce numbers need to grow in line with population growth. However, what we don’t know and understand is the gaps in services to meet the needs of our population. We need solid evidence to clearly understand what can be managed in the current system with the current funding – and know where the gaps in services exist. I am advocating strongly for better evidence on describing the gaps.

We are working hard to support our workforce with knowledge and skills to support consumers and whānau. We also need to be realistic about what cannot be done with the current funding. This will enable us to find and provide new community solutions.

I’m interested to hear your feedback on this issue.

Ngā mihi nui,

Robyn