Monday, 7 February 2011

Policy advice at the Ministry of Health

Seems I'm not the only one who's been disappointed in the quality of policy advice coming out of the Ministry of Health.

Here's Martin Jenkins's report:
Policy advice within the Ministry is, on the whole, perceived to be of variable quality in terms of responsiveness and the technical quality of options and analysis. Consistent feedback about the quality of advice was received from both external and internal stakeholders. Quality issues were cited by internal Ministry staff at all levels.

Within the Ministry there are pockets where high quality analysis produces good quality advice. The Ministry has some individuals who are highly skilled in policy and the Ministry relies heavily on these individuals, particularly when under pressure to deliver advice. This group is estimated to consist of 20 to 30 individuals (out of a total of approximately 160 full-time equivalent staff [FTEs] inputting into policy advice spread over 450 individuals).
I'm told the actual number is 10-15 rather than 20-30.

They note NZIER finding that while quality has improved, remaining areas of concern include:
  • recommendations being given without basis
  • lack of international evidence
  • lengthy papers
  • advocacy dominating rational analysis [really?! Though they may mean advocacy on X, already decided by the Minister, creeping into a paper on Y.]
They recommend, among other restructuring, a strategy group including a Chief Health Economist and a second health economist; a system policy group to include three health economists whose work would be peer reviewed by the Chief Health Economist; and health economists within a bunch of other groups.

The final policy decision document that came out in December took some of those recommendations. The document suggests improvements in sign-off processes for papers sent externally [and, hopefully, for crazy estimates of the health costs of X] and external review by NZIER of policy advice given to the Minister. The latter is an improvement, but only through ex post shaming. NZIER will be running quarterly reviews of provided advice rather than ex ante checking. In the case of Associate Minister Turia, it won't help; I'd expect Ryall to be checking his reports more carefully and acting on them.

MoH also recognizes its deficiencies in economics:
Submissions validated a move to more explicitly incorporate economic input into the Ministry’s policy analysis. Skilled health economists are in short supply, and I agree with submissions that suggest more effective use of economists generally will assist greatly in lifting performance in this area.
The Tobacco Policy & Implementation team becomes Tobacco Programme Implementation - hopefully signalling an end to new initiatives. And perhaps its work will eventually undergo internal review before turning into big scary and baseless headlines.

I have no expertise in internal organization and reorganization. But I hope this means I'll have less to complain about from MoH in years to come. Andrea had better start training some skilled health economists!

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