New Zealand is a small country of two main islands and the population of Sydney, yet we have a complicated, expensive and unresponsive health care system that works better than it should, largely thanks to lots of effort from nurses and gps, both under pressure.

A few years back some major restructuring of primary health into PHOs made significant gains in access to primary health care, but our ponderous DHB system, dominated by too much democracy of the fee-earning type and not enough of the patient care type, has led to embarrassing cost blow-outs, unfunctional IT projects, over-investment for purely parochial reasons, and left the incoming Health Minister knowing he has to do something, but quite likely to rush off in the wrong direction.

In spite of huge advances in IT, there is little in the way of common systems, coupled with poor access to specialist medical experience for all but those living in either Auckland or Christchurch.

Past Health Ministers have felt that something is wrong with New Zealand needing 23 separate health boards, with all the attendant costs, board members, management teams, communications people and so on, yet these ministers have been like possums in the headlights, scared to make any moves, knowing full well that the well-oiled self-interest groups in health will rise up in anger at any suggestion of improvements.

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There can't have been many politicians who supported the logic of combining lots of Auckland local councils into one big city, who didn't wonder why they still had three separate hospital boards for example.

Health decisions require careful analysis of the competing factions of good service delivery, endlessly rising costs, parochial nonsense and the powerful vested interests of the senior professionals who work in both the public and private sectors, a conflict of interest that they don't acknowledge and that doesn't exist in other sectors of the economy.

There is a very unhelpful misunderstanding that links the quality of buildings with the quality of service, when in fact service quality levels are most impacted by the quality of the staff providing the service, particularly in diagnosis of the patient's needs.

This results in the sort of parochial nonsense like relatively small cities like Dunedin demanding new facilities of over $1.6 billion, or three times the cost of Auckland City Hospital, to fix operational problems that will just migrate to new premises.
Similarly, the ludicrous decision to build a neurological/brain clinic in Hamilton, only 90 minutes from an excellent team in Auckland.

New Zealand can only realistically afford two centres of excellence for complex health service delivery, and there is only sufficient work to guarantee a supply of experienced professionals in these high-end services to two large teams located in Auckland and Christchurch, but there is a way of delivering these services more readily to a wider population than the current clamour for every DHB to be able to offer every service at their local hospital.

Let me use the example of how better high-end health care could be offered in Northland and compare that to the way it is done very well in Canada.

Currently Northland, a long province a bit like a small New Zealand, has a largish hospital in Whangarei, a small old one in Kawakawa and a clean, updated, small hospital in Kaitaia, which could serve as a very good nationwide model , with a bit of help.

Whangarei pretends to be a major hospital, but like others in Palmerston North, Whanganui, Gisborne, Invercargill etc, lacks scale to support teams of high-level specialists. Local identities like mayors, prominent citizens etc are always only too happy to campaign for more services locally at their largest hospital, even when it doesn't make sense (which is most of the time actually).

Patients requiring care in the Far North are currently sent to Kaitaia, where a limited core of GPs and general surgeons (a very under-appreciated segment of health workers) do their best to diagnose the patient. In complicated cases the poor patient is then sent on a gruelling journey to Whangarei, where the team is not really much more experienced than in Kaitaia, so either a misdiagnosis or mistreatment occurs (all too regularly), or the patient is then sent on an equally gruelling journey to Auckland to get the high-level examination they deserved at the start.

What if we actually made use of the fibre optics laid out across New Zealand(another good idea badly handled by the last government) and had a team of expert diagnostic and treatment specialists available in Auckland permanently online and available to Kaitaia staff (and others around New Zealand) who could correctly diagnose and advise on treatment that could be provided in a timely manner right there in Kaitaia?

This would result in better service, reduced transfers, reduced costs, reduced running costs associated with keeping one or two specialists in Whangarei (who in many cases are just building experience before they leave for Auckland anyway).

It will also produce howls of outrage from those citizens of the town with the reduced hospital, in this case Whangarei, who see the hospital as a local economic driver, plus all those fee-earning elected board members who will miss the travel payments and the attendance fees, but patients will love it.

This is how services are delivered in Canada, a country with a few large cities, like Toronto, with big hospitals full of expertise and many small Kaitaia-like towns, separated not only by distance but also by snow and bad weather. Every patient has immediate online access to the very best diagnostic and treatment advising teams, and it works well.

All we need is a visionary Health Minister and the installation of CAT scan units and good online visual connections to teams set up in our two biggest cities and we can have it. It would be paid for by stopping the sort of stupid IT expense seen in the latest fiasco at Hamilton Hospital, where a hopeless chairman failed to manage a runaway CEO.

Alternatively I am sure local areas would get behind a fundraising scheme and I would be happy to kick it off in Kaitaia with a decent donation if the country was to get behind this.

WAYNE BROWN
Mangonui

PS: I do have some experience in the sector, having chaired the Northland DHB years ago, to be the first DHB to post a surplus while increasing services and cutting none. I was appointed as Commissioner to sort out Gisborne Hospital, and that went so well that when I stood for the board at the next election i topped the poll in spite of not living there and being off on a surfing holiday during the campaign period.

I was appointed to chair the ADHB to get the new Auckland City Hospital back on time and on budget, which I did, although it has to be said that the very negative NZ Herald made things as hard as they could for reasons never fully explained.