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Kevin Hague is a current Green MP, and looks after their health and sport policy. In the interest of providing something of note to the P.E. students that isn’t on the sport pages, I asked him about what policies he advocates for in the complex network of elite sport and school activities. I also asked him about health and mental health policy.

We have a big P.E. department down here, and it was explained to me that the National Government’s initiative Kiwisport is one of the main changes they’ve made to sport policy in the last six years. Would the Greens keep Kiwisport?

I’d want to talk to P.E. teachers about how the programme is working in practice. When National introduced it, I was pretty strongly critical, because the programmes that they ditched to free up the funding to do Kiwisport were programmes that were more broadly based, and focused on getting larger numbers of kids physically active more generally than sport.

The Green Party says sport is great for those kids who are suited for it and like it, but a pure focus on sport stops physical activity for a whole bunch of other kids for whom sport is not their thing. Walking might be, or biking noncompetitively. Or yoga. We used to have a whole bunch of programmes that were designed for making everyone active; money got pulled out of those and got put into Kiwisport, which no doubt was good for some kids, but probably bad for a whole lot of others.

Now it may be that in some schools that they’ve been able to apply the money more generally to be able to still achieve the goals of the old programmes, and if that is possible within constraints, I would rather adjust than overturn. So, if it’s possible to just adjust Kiwisport to ensure that all schools are doing that general participation thing, that’s what we would do.

Would you change the nature of the split funding so that there are more resources given to sports clubs and schools?

I’m not sure, to be honest; and I think probably school-based programmes are hugely important. So we want to make sure that they are adequately resourced. There’s a project that’s called Project Energise, which started in the Waikato actually, and has been extended a little bit. That’s actually shown really good results, and that’s about physical activity every day for primary school kids and actually preschool as well, so early childhood education. I want programmes like that in every school.

When it comes to the funding of sports clubs, I guess the big issue is that the actual need is currently hard to determine because they’re getting so much revenue from the gambling industry, from pokies trusts and things, which we want to axe. We don’t want sport being funded by gambling, so what we will need to do is quantify how much money that is, and how much money the sports clubs need, because it’s unfair on the sports clubs to simply pull that money out. It’s likely that more money will need to go into sport, probably through something like the health sponsorship council, which started a transitional fund when tobacco sponsorship was banned. Health sponsorship council got set up to provide sponsorship funding for sport and other things that tobacco had been sponsoring. So that you didn’t make everyone go cold turkey-

Hahaha, great pun.

Oh, I’m sorry, I didn’t mean it … Cause otherwise a whole lot of other things would fall over. So what we want to do is make sure that sports clubs actually have the appropriate level of funding and sports trusts as well, which is the other level.

Do you support the sport-through-investment scheme whereby teams and athletes that have the potential to do well and to win are the ones who get the funding?

No. I guess there are different reasons why the state is interested in sport. And I would argue the main reason is that physical activity results in healthier people who actually would have better outcomes in every aspect of their lives because of physical activity. So that’s primarily why you do it, and ultimately (although it’s hard to directly link up the consequences to the action), you’ve got reduced health spending as a result of that, because people don’t get as sick.

Now that’s not primarily about elite sport; so you probably do elite sport, I guess there’s an argument around elite sport that says if New Zealanders are doing really well on the international stage, that will reverberate. So the fact that the All Blacks are a really good rugby team probably inspires a whole lot of people to actually get involved in physical activity. One of my sports is cycling, so I see Anton Cooper winning the gold medal at the Commonwealth Games for mountain biking and he’s … 18, 19, and that will probably inspire other kids and young people to actually take up biking. So there is a role for government funding of elite sport associated that.

But otherwise it’s just kind of national identity and feel good and potentially a bit of marketing; that would be the argument for funding America’s Cup, for example; it’s basically entirely about marketing New Zealand. So you’d have to do the equation then not on the physical activity it promotes, but whether it returns money to our economy. If it doesn’t, then no.

You would support dishing a bit of funding to teams and initiatives that don’t have major sponsors?

Yes.

One of the main arguments you hear tossed around about privatising healthcare is that higher profits drive innovation in the health sector. How would you encourage this innovation without privatisation?

In my experience, I’ve seen the best innovation come from necessity actually, which is an example of a totally reverse argument, which says if you’re short of money, then you innovate. Not that I’m suggesting that as an approach, but in my experience I think where I see the most creative thinking is where people are secure but motivated around quality improvement. For example, Counties Manukau DHB has got a partnership with a National Institute of Health from the US (and I think there’s now a UK partner as well), and it’s like an international healthcare quality improvement collective, and they’re doing really interesting things.

I was on the quality improvement committee – well, I was the West Coast DHB Chief Executive before I became a politician – and again what I found was that people really wanted to find ways of improving quality. There’s no sense of “everything is as good as it can be;” people are genuinely excited about quality improvement cycles. What they get turned off by is where you do a pilot but there’s never any money for it to actually get rolled out, and it never goes anywhere. There’s 15 different pilots happening around the country, and there’s no commitment to making the system learn from the best of those things. Those are the things that turn people off.

When I look at private healthcare, I don’t see a lot of innovation. Well, innovation perhaps in cost control, but I think there are some counter examples. Kaiser Permanente in the United States actually has pioneered quality improvement and patient flow kind of stuff, but I look at the private sector in New Zealand, and I do not see that as a significant source of innovation in our environment. It’s clearly not generally true that profit motivation drives innovation at all, and as I say, some of the best innovation has occurred in really resource-constrained environments.

Do you support making dental care cheaper?

Yup, but that gets to the boundary between public and private, of course … What we’ve got now is a situation where healthcare costs have grown, and bridging the gap across the things that are privately funded becomes increasingly unaffordable. All anyone can do is nibble around the edges, which is why our primary care policy extends to 18; it’s not primary care for everyone, because we know that that’s an unaffordable cost at this point. On dental, we’ve already got free dental to the age of 18; our policy this time around will extend that to students, beneficiaries, and superannuitants. Most DHBs have some schemes for low-income adults as well, but it tends to be urgent care, so it’s not really a comprehensive service at all.

What sort of initiatives do you support to strengthen how we deal with mental health in New Zealand?

Well, again, the first thing is more resourcing. And it gets back to the question of “what’s the overall resourcing for the healthcare sector?” So if you under-resource, then heaps of things don’t have the money to actually play the role that they should. Mental health is a classic. Always described in the past as a ‘Cinderella service’ – constantly overlooked and in the corner. We had the blueprint and the mental health commission. So the blueprint basically set out, “here is the amount of each mental health service you need in each area.” And in the mental health commission, so there was dedicated funding each DHB got for that; the mental health commission saw money going into it. All DHBs except West Coast DHB, in fact, just saying, failed to meet their blueprint volumes …

Now the mental health commission has been disbanded, and it’s not available to ensure that DHBs put the money where it’s supposed to go, so things are drifting backwards. What we would do is, first of all, ensure, as with every health service, prevention in the first place, so addressing those environmental determinants like marginalisation, poverty, racism, and discrimination. [The] next level is self-care, so actually providing resources for person in the lounge to actually say, “I’m struggling with feeling depressed, stressed, overwhelmed, super anxious, where can I turn.” Helplines and services that people can go to directly. Ensuring that primary care actually has a full range of brief interventions that GPs or practice nurses can themselves do directly; a bit of that’s happening and good referral pathways into other mental health services both specialist in-patient acute services and community based services …

Pretty much the only bit of that whole spectrum that’s properly funded now is, and even that you’d argue probably not, is in-patient acute. Every other thing is underfunded and underdeveloped. All of those bits need attention and, in particular, the thing I’d say is the biggest problem is that the residential support services, so people who’ve got significant mental illness, right now or episodic, who need some level of support but who are not in fact acutely ill will end up staying in acute units because there isn’t some other service to discharge them to, which then in turn means that your acute unit with people who actually don’t need that level of service, which means if you’ve got someone who’s acutely ill in the community, there isn’t a bed to refer them to in the acute unit. So you’ve got a total mismatch of need and service. So improving the capacity of community based services actually changes that.

DISCLOSURE: Carys is a Green Party hack who is hardcore hacking it up for the election. But don’t worry – she has a few National Party friends who don’t hesitate to send in angsty letters to the editor when she strays too far into shill territory.