KEY POINTS:
Having enough hospital beds will always be a weak spot in a publicly funded health system.
Since the Government spends one in five tax dollars on health, it cannot afford to provide more beds, nurses and doctors than are absolutely necessary. Hospital chiefs have to judge the politically
"appropriate" number of beds but in reality there will never be enough to satisfy a demand which is almost limitless.
Waitemata, Auckland and Capital & Coast district health boards have all been caught in controversies over bed numbers.
Despite Waitemata spending $120 million on redevelopment and expansion, its shortfall exploded into a winter from hell last year, leaving North Shore Hospital frequently in "gridlock", with no beds for new patients. Many had to wait on hard trolleys in corridors or in armchairs for hours or even days, putting them at increased risk of medical errors or inadequate monitoring.
When the Auckland board began its $500 million rebuilding programme early this decade, it locked in a 7 per cent reduction in bed numbers, partly by shifting some services to Waitemata and Counties Manukau, but also because it hoped to reap efficiencies from technology and doing more surgery without an overnight stay - efficiencies that have only partly been achieved.
Waitemata has suffered from changes in Government funding that did not adequately cater for its rapid population growth, and its disproportionately high number of elderly people, who consume a large portion of health services. A group of senior Waitemata doctors last week criticised the board and management over what they said was a lack of forward planning - a charge rejected by board chairwoman Kay McKelvie, who says the board has been "acutely aware of the urgent need to increase bed capacity to meet the needs of our rapidly growing population".
That "urgent need" was impressed on her - not for the first time - last July at a public meeting organised by the National Party over the pressures at North Shore Hospital. There, her chief executive, Dave Davies, said the Government had only just started paying the board its share of funding to cater for the district's population growth.
His predecessor Dwayne Crombie, now in the aged-care sector, haggled unsuccessfully for years with the Health Ministry over population growth projections.
Waitemata is also considering rearranging its North Shore emergency centre - which is just six years old - to include a mini-ward for acute admissions, in the hope this will improve the flow of patients
* Martin Johnston is the Herald's health reporter.