That might not be just because a larger proportion of its poulation cannot afford private surgery. Counties Manukau's clinical head of ophthalmology, Simon Dean, told us its cataract threshold reflects higher rates of smoking, obesity, diabetes and other risk factors for eye problems. Whatever the reason, it seems unfair that someone on the south side of the boundary through Otahuhu should have to wait much longer than someone in the same condition on the other side.
Waiting lists are no longer a guide to real need. Governments used to be embarrassed by waiting lists because people languished on some of them for years. So 20 years ago they were abolished and replaced with waiting times. Now DHBs are required to ensure nobody waits longer than four months, so they set a threshold of acceptance for surgery that will keep the numbers down at a level they can treat within that time.
It is a system that works well for politicians, less well for people in need. It used to be that they waited to get into hospital, now they wait to get on a waiting list. And they wait invisibly, not recorded, known only to their optometrist who can do nothing more for them.
In Counties Manukau, Jones reports, people whose cataracts are so bad optometrists have told them not to drive, are being refused surgery.
One Auckland ophthalmologist, Dr Trevor Gray, who provides a free operation once a week to someone in dire need, but below their DHB threshold, says, "When you realise how low cost a cataract operation is, and how high impact it is — it transforms things overnight and painlessly — there is no other operation in the Western world that has as positive an impact on an individual and an extended family."
It's provision should not depend on your postcode, ophthalmology should make cataract surgery affordable for all DHBs for all in need.