Editorial: DHB reality not healthy

Health Minister Jonathan Coleman

It's unlikely that Health and Education have been the most sought-after Cabinet portfolios for many years.

Education has always been a tough job, particularly for National governments, the teacher unions seemingly being programme to oppose anything espoused by a National minister on principle, although to be fair, some of the ideas touted over the last decade or two have been asking for trouble.

It's been a different story for Health over the last 10 years. A series of ministers, starting with Tony Ryall, have done all that their party could have asked for in that they got the portfolio out of the news. Jonathan Coleman has largely maintained that low profile.

Gone are the days when the daily news diet featured stories about people dying on waiting lists, or patients with horrific health problems being denied the treatment they desperately needed. Dr Coleman can also take genuine credit for maintaining what appears to be, statistically at least, a good performance by the 21 district health boards.

If elected councillors are publicly accountable for failings, perceived or real, in local government, the same should apply to elected members of the DHB. We elect them, and the least we can expect is that they will talk to us.

Like everything these days, the DHBs' performances are analysed relentlessly, and while there are always variations, they are portrayed as doing well, and more importantly, improving in a number of areas. It is not unusual to see the Northland DHB leading the way in terms of providing access to core services, reducing waiting times and increasing elective surgical procedures.

On that basis the minister and all those below him can take a good deal of credit, not least when one considers the financial problems that hampered the current government's first years in power.

At a time when many countries' economies were in meltdown, our public health service continued to improve, despite the fact that health is widely perceived, by political critics and the general public, as being significantly under-funded.

The reality is that there will never be enough money in this country to provide the public health service that everyone wants. Health services become increasingly expensive as medicine and technology improve, and public expectations rise. Health ministers have always had to cut our coat according to a fairly limited supply of cloth, and that isn't going to change.

But while Dr Coleman and his predecessors have done a good job of communicating their expectations of the DHBs, and have given credit where it has often been due, there are signs that the public health system is not as healthy as it might be, or at least as it is portrayed to be.

One sign of that is the ongoing friction between the DHBs and their junior doctors, who claim that the system jeopardises their health and the safety of their patients.

More reliable, perhaps, are the stories that surface from time to time from disgruntled patients, most importantly from our point of view involving Whangarei Hospital. Jimmy Croft was the most recent to complain, last week, after he waited six days for surgery on a broken ankle.

The DHB's response was that the delay could be sheeted home to a spike in acute admissions.

That's far from unreasonable. Patients have long been triaged, and it is only to be expected that those whose lives are at greatest risk will be treated first. It might not be of great consolation to the patient who's repeatedly bumped off the surgical list, but that's a reality that has to be accepted.

The DHB also says it is making investments and changes aimed at reducing the potential for patients like Mr Croft to be left waiting. Obviously it is aware of the problem, and is trying to do something about it. The question is how much it can do with its current funding. And Mr Croft, it seems, is far from alone in forming a negative view of the state of surgical services in Whangarei. Judging by the response to his story, he was by no means an aberration.

One woman said she had the same experience with a broken ankle - a temporary cast in Kawakawa then a four-day wait in Whangarei, nil by mouth until around 8pm when it was decided that that surgery would not happen that day, with treatment for pain and inflammation burning her stomach so badly that she couldn't eat anyway, or lie down.

Another wrote of a child with a badly broken arm and a woman with a bad ankle fracture, both of whom had to wait four days (when once upon a time they could have undergone surgery almost immediately at Kaitaia).

A man with a dislocation, fracture and severed ligaments in one elbow waited five days for surgery, nil by mouth from 1am to 8pm. Another patient was transferred from Kaitaia to Whangarei, nil by mouth for 59 hours, then discharged and put on an urgent list for a second operation that came three weeks later. She had not been able to work, had run out of sick leave, and was not eligible for financial assistance.

A 10-year-old boy went three days nil by mouth, receiving surgery after political intervention. His mother said nurses had thanked her for complaining.

The consolation, if there is any, is that the Northland DHB is not alone in this predicament. And grumpy patients, in Northland at least, generally have no beef with hospital staff. Most hold the doctors and nurses they come into contact with in Whangarei in high regard, instead venting their spleen in the direction of the politicians who provide the funding.

It is not difficult to find people with fond memories of the wonderful service once provided at Kaitaia Hospital, although there seems to be general acceptance that the reduction in those services was inevitable. And given the political attitude of the 1990s, Kaitaia is lucky to have what it still does.

One Kaitaia woman spoke for many, however, when she claimed that funding and services had been slowly decreasing over time.

"Less service in smaller community hospitals, all major services moved to Whangarei, where we all have to wait in line. Hardly an acceptable health model, but that's what we do with the money they have, I suppose. What upsets me the most is the amazing frontline staff who have to deal with frustrated patients and their whanau when it is beyond their control."

There is another issue too. Every three years we are exhorted to vote for people to represent us on the DHB. Those who have occupied those seats over recent years are good people who do their best to serve our best interests. Or so we suppose. In fact they have not done a good job of communicating with the people who elected them. That is unfailingly left to staff.

That should change. If elected councillors are publicly accountable for failings, perceived or real, in local government, the same should apply to elected members of the DHB. We elect them, and the least we can expect is that they will talk to us.

They might well be fighting tooth and nail for the additional funding that they clearly need, but they should not be doing that behind closed doors. At the very least they should be calling upon the people who elected them as their allies.

Public opinion can have a very powerful effect on politicians, and while a good deal of public opinion might not be well-informed, this is our health service, these people are our elected representatives, and we deserve to have input beyond chipping away from the sidelines when someone complains.