Deborah Coddington: Use health taxes to actually treat people

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.

Then there are all the leaflets, posters, and patients' handbooks, ignored by the public but which a group of managers, overseen by a team leader, have written. Probably at a lakeside retreat, far away from the distractions of a frantic hospital, accompanied by various consultants to advise on cultural sensitivity and correct translations, not forgetting the experts from the Labour Department advising on safety and health issues.

After these booklets are quadruple checked and signed off by senior managers, they're positioned above beds so patients, should they be so desperate they actually want to read this nonsense, fall out of bed trying to reach them.

Maybe they should be handed out to the ill and injured sitting for hours in emergency departments, who've read all they never needed to know about Kylie, Britney, Nicole, Brangelina and Madonna from germ-encrusted women's mags, and are about to call a taxi to take them home. No wonder we call these people patients.

Nothing will improve until we go back to the situation whereby health professionals, those who see and treat patients, have a direct say in the administration of the health system.

Nothing will improve because every time a political party suggests our health taxes could go into actually treating people by cutting a swathe through the ministry, axing the managers, and allowing the private sector to construct and manage the buildings so public hospitals can rent them and rid themselves of expensive maintenance burdens, socialist ninnies around the country cry "privatisation".

Government departments don't own their own buildings in Wellington but Labour - as far as I know - hasn't privatised its own officials.

And isn't it also time we started punishing patients who think it's their "right" to keep smoking and eating to morbid obesity while the rest of us pay to keep them alive?

Instead of buying 230kg capacity wheelchairs (like I spotted in Rotorua), hospitals could employ Nurse Ratcheds to enforce smokefree policies. If these people can afford to buy cigarettes and crap food, then they can pay for their own care at a private hospital.