Flying to the rescue

NO ONE questions the Northland Emergency Services Trust's track record for saving lives with its Northland Electricity rescue helicopters. Some have questioned, from time to time, how the trust functions, but as far as the people who benefit from the service are concerned it is enough to know that a chopper will be ready to fly when it is needed.

Nor is there any question that the service is coming under increasing demand. Last year the machines flew 735 missions, transporting 800 patients. And the further one lives from Whangarei the more likely that it will make the difference between life and death.

The only issue as far as the public are concerned is how the service is funded, and once again that has become pertinent with the Northland Regional Council's proposal to review the $600,000 contribution it makes every year. Or more accurately, the $600,000 contribution the council's ratepayers make, the NRC's role simply being that of the collection agency.

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At the moment every Northland household pays around $8 a year to help keep the choppers flying, via a targeted rate levied by the regional council. That's hardly enough to trouble the most impecunious ratepayer, but apparently the council sees it as giving NEST some sort of advantage over other emergency services that could perhaps use some of the cash. It is proposing that a new fund, contestable by all emergency services, be established.

That might not seem unreasonable - every emergency service does sterling work, and none of them are exactly flush. The problem for NEST is that it would have no idea how much funding it would receive year on year, limiting its ability to plan not only for meeting its current workload but expanding its service as demand continues to grow, as it no doubt will.

The trust believes that its share of ratepayer funding will inevitably fall short of what it needs if the money is contestable, while the power to decide how much it gets will sit with the council, rather than the people who actually provide it. It has consistently argued that the targeted rate is fair, in that it spreads that portion of the cost of providing the service equitably from one end of Northland to the other, at a level that is affordable. It also allows the trust to concentrate on providing an air ambulance service without having to constantly worry about fundraising.

The $600,000 meets about half the shortfall in government funding, the balance coming from donations and sponsorship, primarily led by the annual appeal driven by Top Energy and North Power.

How the NRC's proposal to set up a contestable fund is supposed to improve the lot of the people who actually come up with the money isn't clear, but it does, once again, beg the question as to why ratepayers should be paying anything at all. The community served by Kaitaia Hospital was once given the very clear impression that it would not have to dip into its collective pocket at all, a promise made when the future of the hospital's 24/7 surgical service capacity was resolved via an independent review, the final chapter in a long-running battle over the hospital's future.

That battle began in the 1990s when the thankfully short-lived North Health offered six options for the hospital's future. None of those options included the status quo - that was finally added, somewhat begrudgingly, as option 6A - and were designed to reduce the level of service provided by eliminating the substantial cost of around the clock surgical capacity, replacing the hospital with what was to be known as a super clinic. Change was stoutly resisted, the community universally rejecting the prospect of relying on Whangarei for anything more than the treatment of minor ailments.

The politicians won, but not without some concessions. One of those was that Kaitaia Hospital would regularly host specialists from Whangarei, another being that the Northland DHB would provide a world-class patient retrieval system, ie a rescue helicopter.

The argument was that if patients could be flown to Whangarei, or possibly further afield, quickly and safely then Kaitaia would not need a 24/7 surgical service. It would be fair to say that Kaitaia didn't like it, but didn't have much choice after an independent review, which all agreed would be binding on the community and DHB alike, found that surgical capacity could be safely reduced, providing the helicopter service was put in place.

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The DHB accepted that with alacrity, and the politicians graciously told us that we had won. That was arguable, but at least Kaitaia retained something approaching a hospital, which made it unique amongst those communities around the country that had gone through the same process and had lost big time.

The clear inference was that the helicopter service would not be dependent upon community funding, but it always has been. Northlanders - and the region's extremities benefit more from the service than the bits in the middle - have always been called upon to help meet the cost, and have done so without complaint. But the regional council's plan now, which NEST quite reasonably regards as placing it in an even more parlous financial position, should never have arisen because community funding was never part of the deal, a point not lost on Northland MP Winston Peters.

He says it is unacceptable that an essential service will be forced into relying on sausage sizzles, or going cap in hand to potential funders. That, he adds, will not be as easy in a region like Northland as it might be in large urban centres where sponsors might expect to get a better return for their largesse.

Mr Peters reckons NEST's costs should be met by the government, and that's a sound argument, not only in that that was once promised, or at least strongly inferred, but in that rescue helicopters are now an integral part of the public health system. The Northland choppers are not some desirable add-on, a medical luxury that we should pay for or do without. They are integral to the service now provided by the Northland DHB, the cost of which, in the Far North, was originally balanced by the savings made by reducing surgical capacity.

This isn't the first time that the public health service has divested itself of what was once regarded as a core role. One floor at Kaitaia Hospital was once reserved for the frail elderly, who are now entrusted, in Kaitaia's case, to a trust-run rest home. The home does receive taxpayer funding, via the DHB, but it is hardly lavish, and no doubt much cheaper for the DHB than the old system. Now we have the DHB saving money by reducing surgical services at Kaitaia Hospital, and expecting the community to pay again.

No one would disagree that public health funding has to have its limits, but the DHB's fundamental obligation is to provide the very best service it can afford. In the Far North's case that includes ensuring that a world-class patient retrieval system is available at all times.

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Northlanders will no doubt continue supporting NEST, but that should be in addition to the core funding the service needs to keep flying. That funding should not be subject to the vagaries of public generosity or a local authority's whim. There will always be room within a cash-strapped health system for local financial input, but the rescue helicopters should be exempt from that.