Garth George: Money's not the problem in health system shambles

COMMENT

It was one of those happy (or, rather, unhappy) coincidences that both Weekend Review & World and canvas decided at the weekend to apprise us again of the absolute shambles that is our health system.

Not that we needed reminding. Any organisation which squeezes three hospitals into one, with the loss of more than 70 beds, in a city growing by 100 people a day, has to be seriously strange.

The people who allegedly run Auckland's hospitals justify this on the grounds that "efficiencies" will take up the slack.

Which reminds me of a comment made in Tuesday's Herald by ARC transport committee chairwoman Catherine Harland, talking about the council's inability to deliver on its promises of a better train service.

Her excuse was that it had underestimated how many people would use trains and was too optimistic about the ability of the old trains to cope. Which just goes to show the quality of our bureaucracies these days: there were just two ways for the ARC to get it wrong, and it managed to score both of them.

So it will be with the district health board. You can bet that the estimates of the efficiencies will have been grossly overestimated and that they won't go anywhere near making up for the deficiencies in the number of beds.

In any case, we can almost guarantee that these mythical "efficiencies" are based on screwing more and more work out of fewer and fewer underpaid, overworked and disaffected staff, and cutting down the amount of time patients spend in hospital, irrespective of need.

So one day someone will have to admit that the board overestimated the efficiencies and underestimated the demand. Which is what has happened with maternity services, not just in Auckland City but throughout the metropolis.

Waitemata Health, for instance, accepting out-of-date forecasts no doubt prepared by some cost-cutting bureaucrat, cancelled its contract with Birthcare on the North Shore, and only months later found itself having to sign a new contract - but now new mothers have to travel all the way to Parnell to be looked after.

If this is "managing" the health service, you could have fooled me. And we won't even mention the bedlam that mental health services have become all over the metropolis but in the Waitemata board's area in particular.

The problem is not lack of money. The Government has been injecting multimillions more dollars into the health system since it was first elected.

The problem is the enormous, expensive and still burgeoning lay bureaucracy which has grown up as a result of the series of political "reforms" to the administration of the health system.

Far too much of the money that should be spent on recruiting frontline staff and paying them what they're worth, and on providing facilities and services at least adequate for the public's needs, is being squandered on executives who can't execute, managers who can't manage, team leaders who can't lead and legions of other number-crunchers, bean-counters and paper-shufflers who, dedicated and sincere as they might be, really haven't a clue what they're about.

I am reminded of a comment my late brother made years ago when he was driving Boeing 767s between here and Japan and Air New Zealand was undergoing another of its reinventions: "I could sell every aeroplane the company owns and it would take head office a fortnight to realise they weren't flying any more."

Of the three articles that appeared at the weekend, it was the canvas recitation of the devastation of maternity care that almost made me weep, and I wonder if the way women are treated straight after having their babies these days - shuffled from place to place and chucked out as quickly as possible - doesn't help to explain our national epidemic of broken homes, dysfunctional families and rebellious children.

One of my deepest regrets in life is that I didn't see my children born. Back in the 1960s birthing was strictly women's work, and if the battleaxe matron who ran the local maternity home had had her way, husbands ("partners" wouldn't even have been acknowledged) would never have been allowed within a mile of the place.

So I have never had the privilege of seeing what must surely be God's greatest gift to mankind - our ability to create in our own image. To be present at such a miraculous event as the birth of a baby must surely be one of life's most profound and rewarding experiences.

Martin Johnston's comprehensive recital of the problems arising from the attempt at state control of general practice through primary health organisations, and Cathrin Schaer's interviews with struggling and disillusioned GPs, provided further evidence, if any were needed, of the stultifying effect of political interference and the lay bureaucracy on health services.

It is long past time for supervision of the health system to be put back in the deft and highly trained hands of the medical profession. Not only would this help to ensure that we get what we pay for, it would have the benefit of providing a career path for brassed-off GPs.

* Email Garth George