Having the Government own and operate public hospital buildings makes about as much sense as flying 10,000 officials to Bali to talk about climate change.

I suppose if you're reading this and you are an imbecile, you'll figure it makes a lot of sense. In that case, I suggest you check out the state of a public hospital.

Last week, I spent time visiting Rotorua Hospital. I didn't see patients scrubbing toilets, but I did see doctors and nurses administering first-class care and treatment, focusing on getting patients well enough to return to a healthy life. Nothing remotely resembling the Third World there.

Cast your eye around the state of the buildings, however, and it's clear much work needs to be done. "Add-on" wards connected by rambling corridors, elevators out of order and slow as a wet week when they are working, graffiti, fat patients in dressing gowns sucking on cigarettes right underneath no smoking signs in carparks, threadbare and torn sheets on the beds. It's all a bit sad.

So what has the district health board (DHB) done? Hired more managers, the same as every other DHB around the country where, according to National's Tony Ryall, more bureaucrats than doctors have been hired in the past seven years.

Right now the public health system employs 10,000 hospital managers, and that excludes 1250 in the Ministry of Health and goodness-knows-how-many in public health organisations. By my calculations, that's roughly one hospital manager for every 400 New Zealanders and that is sick. At Wellington Hospital they came up with a plan - axe 50 doctors.

We spend $5 billion a year on health and we think it's okay to send first-time mothers, who've just given birth after a difficult labour and an episiotomy, home directly from the delivery suite.

New Zealand has a dangerous shortage of midwives, largely for two reasons. One, it takes four years to train, or retrain if you're middle-aged and not wanting to quit the work force, so like every other vocation that's now become an academic exercise, you emerge with a "qualification in how to live your life with a student loan". And two, because the College of Midwives insists midwives complete time-consuming papers and reports every year when they are struggling to give proper care to their clients.

Meanwhile, doctors who haven't disappeared overseas for better conditions, seem to be going on strike with alacrity, and other health professionals like radiographers are paid a pittance for a thankless task.

But we must have all those managers to take care of building maintenance. I bet it took a full day for some bureaucrat to get the lift fixed at Rotorua.