Health reps to focus on smoking

Emergency care has improved, but it has been at the expense of dental health, obesity and mental health, some say. Photo / Dean Purcell

Boards tasked with getting primary care up to scratch and making sure patients have help to give up cigarettes

The 21 winners of Auckland's health board elections will be required to induce GPs to check more patients' hearts and offer more help to quit smoking.

These are among the primary care health targets of the man in charge, Health Minister Tony Ryall.

While the seven candidates elected to each district health board (DHB) might think they are responsible to the voting public, the Government is clear officials answer to it.

Mr Ryall has had remarkable success in getting DHBs to focus on his seven publicly reported health targets, including hospital emergency department waiting times, elective surgery and cancer care - to the exclusion, some say, of equally important non-target areas such as dental health, obesity and mental health.

Auckland's three DHBs now all perform well on the four hospital targets and child immunisation. However, in the latest report, in June, they were well short of the required performance on one of the primary care targets - the percentage of smokers offered help to quit when they visited a general practice.

And while Counties Manukau and Auckland DHBs met the other primary care target, Waitemata DHB was 4 percentage points below the required 75 per cent of patients whose heart disease and stroke risk had been assessed in the last five years.

Some in the primary care sector believe Waitemata is disengaged with general practice. They point to the messy merging of primary health organisations (PHOs) in 2011 and the lack of GPs on the board committee concerned with primary care.

Waitemata and Auckland have merged their primary care teams and community and public health committees, and are combining their planning and funding departments.

They also have the same chairman, Government appointee Lester Levy. Dr Levy defended Waitemata DHB's primary care performance and said Auckland DHB had made great progress.

Referring to the rancour around the 2011 PHO mergers, Dr Levy said: "We've put that behind us. The landscape is looking a lot more positive now although there are people who are not happy with things."

The centrepiece of Waitemata's progress since the last board elections three years ago was the opening, in July, of its $39 million Elective Surgery Centre beside North Shore Hospital, which is expected to help boost the number of operations and reduce waiting times.

Counties Manukau chief executive Geraint Martin said it was coming to the end of a $500 million building programme, particularly at Middlemore Hospital, "and we now have the 21st century hospital South Auckland deserves".

But he said the DHB's biggest innovation of the past three years had been the "20,000 days campaign".

This had reduced hospital demand by about 5000 patients a year by providing better health services more quickly in the community and more timely and safer care in hospital.

Mr Martin said board members could be valuable in helping a chief executive know if they were on the right track.

The seven Waitemata seats are the most hotly contested, with 35 candidates, while Auckland has 27 hopefuls and Counties Manukau 19.

For more on DHB candidates click here.

DHB profiles

Auckland

2013/14 income: $2b
General hospitals/clinics: Auckland City Hospital, Starship Children's Hospital, Green Lane Clinical Centre
Population: 469,400
Ethnicity: 7.7% Maori, 11.1% Pacific, 81.2% other
Deprivation: 21% in wealthiest quintile, 19% in poorest quintile

Waitemata

2013/14 income: $1.46b
General hospitals: North Shore Hospital, Elective Surgery Centre, Waitakere Hospital
Population: 562,970
Ethnic mix: 9.7% Maori, 7.4% Pacific, 82.9% other
Deprivation: 27% in wealthiest quintile, 8% in poorest quintile
Counties Manukau
2013/14 income: $1.44 billion
General hospitals/clinics: Middlemore Hospital, Manukau Super Clinic and Surgery Centre
Population: 516,050
Ethnic mix: 16.3% Maori, 23.1% Pacific, 60.5% other
Deprivation: 19% in wealthiest quintile, 35% in poorest quintile

Note: Income includes revenue for own population, plus payments for providing services to patients from other DHBs