Brian Rudman: If the Super City plan is so great, let's use it on the hospitals too

Good old National has wheeled out Lester Levy, the poster boy for its 1990s restructuring of the health service, to head the troubled Waitemata District Health Board.

His task in 1993 was to be the acceptable face in Counties-Manukau of the free enterprise culture being unleashed on the hospital system.

National's handbook for that series of now abandoned reforms was Act-backer Alan Gibbs' report, "Unshackling the Hospitals".

Dr Levy then retreated back to the private side of health, where he's been for the past decade. Now he's back, bringing to the public system, says Health Minister Tony Ryall, "his capacity to deal with the most complex challenges".

But he comes with one hand tied behind his back, thanks to Mr Ryall's refusal to consider combining the region's three health boards. As Dr Levy concedes, a shortage of money will always dog public health.

His recipe is "one needs to work with what one's got". That's moneywise. But why is the Government making his job so hard by persevering with the artificial division of Auckland into three different health districts?

This conservatism is particularly puzzling from a Government which is singing the Super City plan's praises for everything else.

The Royal Commission on Auckland Governance was strangely quiet on the subject, though it advocated the Super City advantages for just about every other human endeavour, including planning, transport, water, broadband, civil defence and solid waste disposal.

The Auckland District Health Board did make a submission to the commission pointing out how district health boards are elected according to existing local body boundaries and that creating one city would have "a related impact".

The board also made the point that "the natural flow or movement of communities to access publicly funded healthcare through DHBs and the health services they provide or fund is not aligned with the geographical boundaries of territorial authorities ...

"The most obvious example of this lack of alignment is the community of Otahuhu, which is part of the Auckland City terrritorial authority and thus the Auckland DHB but whose natural alignment for acute and other hospital services is with Middlemore Hospital, part of Counties-Manukau DHB".

It could have also thrown in the North Shore resident who succumbs to a heart attack in downtown Auckland and becomes a cost to the Waitemata DHB, even if he's carted off to Auckland Hospital for emergency treatment.

That person becomes a charge that Auckland DHB has to bill its North Shore neighbour for, and get rid of as soon as possible.

The Auckland DHB also provides specialist services that the other DHBs do not. So popular are its services that about half the board's total operating revenue of $600 million is obtained from services provided to people from other board areas. Indeed, on a national basis, 40 per cent of these "inter-district flows" are between the three Auckland DHBs.

Of course, arguing the toss over these inter-district flows, as each DHB tries to short-change the others, wastes countless bureaucratic hours. Emergency professionals are also concerned at the risk to patients who are ferried back to their place of origin.

In its report to the incoming Health Minister last November, the Crown Health Financing Agency worried about the rate of cost inflation in the health sector and suggested "a formal reduction of DHB 'sovereignty' in favour of regional bodies and/or central agencies will be necessary to facilitate the necessary planning improvements in service provision, asset management and human resource management".

But early in the new year, Mr Ryall said it was not Government policy to amalgamate DHBs.

"We think there are significant gains to be made through greater co-operation and sharing of back office functions."

Which begs the question that if the little amalgamations are a good thing, then how much better might full amalgamation be.

In 2004, then minister Annette King made the timid gesture of appointing Counties-Manukau chairman Ross Keenan to become deputy chairman of all three Auckland boards "to promote greater collaboration across the region at board level".

It didn't last. Small pockets of co-operation still exist. But it's just brushing the surface.

If the Government's case that we need a Super City to make Auckland prosper is valid, then how can it argue for the status quo when it comes to health?