In Sickness and In Health

Let's be honest - did you really know who you were voting for when you rated the candidates standing for the Northland District Health Board? Chances are you'd heard of one or two but not all seven. Yet the NDHB is one of the largest businesses north of Auckland's harbour bridge.We know it runs hospitals and related 'things' but, what else?

The public health spend in New Zealand is $14 billion per year and of that four percent, or $520 million, of tax payer money is allocated to the NDHB. That's around $3,000 per person per year in Northland. The NDHB employs 2,300 people and admits 50,000 people a year into our hospitals, 35,000 of whom present to emergency departments. That's one person every 12 minutes day and night. Given the rise in Northland's population according to recent census figures, those statistics will have gone up in the last couple of years.

The board provides primary care and operates five hospitals of which the most important is Whangarei in terms of activity, capacity and breadth of services. The other hospitals are Bay Of Islands, Kaitaia, Dargaville and Rawene but not all those hospitals provide all services. Rawene, for instance, provides pre and post natal services but no birthing facility because, quite simply, there aren't two trained midwives living there and it's a mandatory requirement to have a minimum of two at a birth.

There are 2,500 births a year in Northland and the board budgets for that many babies to be born. If there was a sudden upwards spike in birth rates in the Hokianga and if a trained midwife was available the board would examine the practicalities of a birthing centre at Rawene. Skilled staffing, though, is the limiting factor in rural hospitals around the country generally.

Chairman of the NDHB is Anthony (Tony) Norman, a man who arrived back in New Zealand a dozen years ago after holding a variety of financial positions in several different countries. He's an avid sailor and a dedicated fan of Captain James Cook.

In 2008 he became Chairman of Far North Holdings Limited which owns and operates aviation and maritime assets in the region but left FNHL after, shall we say politely, a difference of philosophical opinion with then Mayor, Wayne Brown. Now as Chairman of the health board he's had to get used to acronyms, he laughs, as he flourishes a booklet that lists more than one hundred of the critters.

The territory served by the NDHB is from Wellsford north to Cape Reinga which is the second-largest area in New Zealand (next to Auckland) of all the 20 health board in the country. But it doesn't deliver all services. The more specialised services (like radiation treatment) are undertaken in Auckland because with technology being so expensive and technicians so highly trained, both are a scarce resource that needs to be located within a larger population base to give value for money.

Whether we like it or not, it's the commercial model - and tertiary care like cancer treatment or cardiac care is purchased from Auckland making health, or more accurately sickness, a commodity known as a 'monetary consequence'.

Put another way, if Auckland provides a service for Northland patients, the NDHB has to pay for it. Conversely, if an Aucklander on holiday in our region has an accident and ends up in hospital then Auckland has to pay the NDHB for that. That's called interdistrict flows or, yes, IDFs. Northland pays around $60 million a year for Auckland's services and receives around $8 million a year for services provided here.

Of current concern to the NDHB are three major health challenges.The first is what Tony Norman calls a 'tsunami' of diabetes driven by the escalation in obesity and poor lifestyle choices.The second is an ageing population where statistics show the 'driver' for hospital costs occurs in the last two years of an ageing life. Then there is concern over the increasing problems associated with addictions, particularly among the young, and creating the domino effect of mental health problems and an increase in social disorder.

Maori present to hospitals more often than other ethnic groups in Northland and die on average around 14 years earlier than non-Maori. There has been an increase of eight percent of Maori hospital admissions over the past three years which Tony Norman says is disproportionate and linked to two factors, both of which are known as 'price takers' in health board parlance.

"ACC got tough on claims so someone who can't afford to go to a GP, and some GPs who are owed money will refuse to see a patient until the bill is paid, the patient goes to the hospital emergency department.

Tony Norman's tenure as Chairman comes up for renewal this month. His appointment is at the discretion of the Minister of Health and not subject to electoral vote. For the record, in case you don't know, the current elected board consists of two new members among the two medical doctors, five commercial people with administrative experience and four appointed by the Minister of Health. For the next three years at least, it's a fairly healthy mix.