Every new government faces a demand for more health spending, particularly a Labour government. This one is no exception.
Last week Auckland's three district health boards told a select committee of Parliament the city's health services could not cope with any more demand.
Lester Levy, chairman of all three boards, said the demand for services was growing more rapidly than the population and had reached the limit.
"Last year Auckland grew by the population of Nelson and there is very little resilience, if any, in the system," he said. "The last year has taken us to the limit."
The pressure was being felt across the board, not just in hospitals but in community care and primary health services.
The head of the Counties Manukau board, Gloria Johnson, said, "Our staff were working unexpectedly long hours and became increasingly stressed about not just how hard they were having to work but about the extremely unwell people they were having to look after."
Waitemata's chief executive, Dale Bramley, said hospital emergency departments in all three districts had seen peaks of attendance that would normally occur in winter.
Johnson said they noticed the increased demand for acute surgery last summer. It failed to tail off and left services already overstretched before winter illnesses arrived. She said the demand this summer has been even greater.
Labour came to office with a promise to spend an extra $8 billion on health over the next four years. That might go no further than meeting the deficits district health boards have been reporting in recent years. A free health service is a voracious monster of public spending, capable of consuming a healthy Budget surplus all on its own.
Every government needs to be able to make the system live within reasonable rations. That usually means limiting free services to those most in need or genuinely unable to pay for them. Those with minor of non-urgent illnesses should not be seen in emergency rooms.
If they are children they can be treated by GPs or private emergency clinics at no charge. If they are elderly and can afford to pay, they should expect to pay. If this message is too harsh for the Government's comfort, it needs to suggest another way for health boards to live within their budgets.
One other way, which it will heartily endorse, is to improve the standards of rental housing and nutrition for low-income families. New regulations and subsidies should improve the ventilation and heating of those homes if tenants can afford to run the appliances. Hopefully increases in benefits and family support payments, last year and in this year's Budget, will be used for home heating and better nutrition.
Cold and damp houses put demand on the Auckland boards in winter, but they can hardly be blamed for the summer demands the board leaders have described. Health boards are in line for Budget boosts but they should also be expected to constantly find savings in their operations. If they cannot, the Government ought to review their worth.
Auckland does not need three boards, New Zealand does not need 20. Savings on district administration could meet some of that fearful increase in demand.