http://www.stuff.co.nz - BEN HEATHER - Last updated 05:00, December 6 2014
There's a doctor in the House now
DAVID WALKER/Fairfax NZ
HEALTH MINISTER: Jonathan Coleman was appointed to the $15.6 billion health portfolio.
The new Health Minister may be confessing to a few "puffs" of cannabis in his youth, but don't expect him to go soft on drugs.
Jonathan Coleman has moved quickly to make changes since becoming the first trained doctor in the role in more than 70 years.
He has dumped the controversial cost-cutting agency Health Benefits Ltd (HBL), which his predecessor Tony Ryall vigorously defended in the face of revolt among district health boards.
And he is also pushing a more aggressive shift of health services, and potentially funding, from hospitals and into medical centres.
But in other ways, Coleman will be toeing the political line. Anyone hoping that the former GP might take a more health-focused approach to drug use will be disappointed.
Coleman said he had smoked cannabis (although never "a whole spliff") once or twice in his 20s.
As a GP, he had regularly treated drug addicts, including prescribing methadone, particularly while working in London.
"[But] my clinical experience has led me to the view that decriminalisation isn't going to work and the policy settings at the moment are the right ones . . . We need less marijuana in society, not more," he said.
Drug Foundation executive director Ross Bell said Coleman was just the latest in a string of politicians admitting to youthful drug use.
But he was disappointed Coleman's medical experience hadn't led to a shift away from punishing drug users.
"If they [the politicians] had been convicted for that use when they were young, they wouldn't be in the position of being ministers of the Crown now," he said.
"Why do they think we should give young people today a criminal conviction for the same thing?"
Bell said politicians shied away from changing drug policy because it was widely considered political poison.
But there was a global shift away from a "hard on drugs" approach - for example, some US states had legalised marijuana - and New Zealand was falling behind.
"I think now they are really misreading the public mood."
Drugs aside, Coleman so far appears to have been given a cautious thumbs-up by the medical fraternity in his first months in the job.
He has spent much of his time in a hectic nationwide tour of all 20 district health boards, speaking to doctors, nurses, patients and administrators.
It was these talks that led him to dump HBL last month and shift responsibility for finding roughly $620 million in savings in the next four years to DHBs.
Association of Salaried Medical Specialists executive director Ian Powell said HBL was unpopular with doctors, who had welcomed its demise.
"So far the signs are positive. He did surprise us in a pleasing way with the decision on HBL."
In a speech at the association's conference last week, Coleman said DHBs should be running ideas past their senior doctors, a comment that went down well with the crowd of specialists.
But one of Coleman's biggest aims is moving patients out of hospitals, where they are being treated by medical specialists, and into the care of GPs and nurses in the medical centres, most of which are privately owned.
He said that rising rates of chronic disease such as diabetes, cardiovascular diseases, and obesity meant it was more effective, and cheaper, to act earlier, in the community.
This would require a big shift in everything from monitoring diabetes to moving minor surgery from hospital to GPs and primary care nurses.
This is already happening in some DHBs.
"It's not a matter of cutting stuff in the hospital, it's a matter of moving things into the community and keeping people out of the hospital."
A major aspect of this policy is obesity, where Coleman plans to use his other ministerial hat, sport and recreation, to encourage more people - particularly children - into physical activity.
However, he has ruled out more restrictive policies, such as the sugar tax being pushed by some public health experts as the most effective solution.
"We don't think taxes are an answer to this. We don't see any evidence that that works internationally."
The New Zealand Medical Association has been pushing for action on obesity, including a sugar tax.
Chairman Mark Peterson, a GP, said early impressions of the new minister were positive and he still hoped to talk him around.
"We have some more advocacy to do on that."
Possible headaches looming for Coleman could be finding the money to make that push into primary care without reducing hospital services.
Peterson said that although he welcomed more responsibility for GPs, shifting services into the community would not automatically reduce demand in hospitals.
Any shift would require extra money rather than a reshuffle of the deckchairs.
"If you reduce hospital capacity in that process that will create some serious problems."
- The Dominion Post"