A new era dawns – what do members think? A
SMS members have a wide range of views about the upcoming health reforms. Senior communications advisor Eileen Goodwin spoke to some from different parts of the country.
It’s to be hoped the revamped health system replicates the successes of the better performing District Health Boards, rather than the poorest-performing, Wellington radiologist Arun George says. He’s speaking from the perspective of radiology, and, for Dr George, Canterbury stands out, both in IT and workforce planning. “Christchurch workforce planning has been exceptional for radiology.” “They are the only ones who have a surplus [of radiologists] now to send to the rest of the country.” But looked at in purely financial terms, Canterbury District Health Board is seen as a failure. It depends how success is measured, Dr George says. “Are we aiming to be like Canterbury, or are we aiming to bring down the Canterburys to where Wellington is?” “The one centre where they showed the rest of the country how to do it, their Board was punished. “It’s almost like a complete disconnect.”
and listen to the people on the front line. Don’t start a conversation saying there are no resources”. “That just means you are coming into some kind of conversation with conditions, so it’s not going to go anywhere.”
In practice, she points out, increased access to service could mean travelling to Auckland Hospital. Many patients cannot afford petrol or parking costs.
Dr George says he has fought many times for additional resources by demonstrating need with hard data, but “it just keeps going in circles”.
“Whether patients benefit from the . . . amalgamation of services is not certain, and traditionally Auckland has tended to ‘win’ when this has happened.”
In Auckland, at Waitemata- District Health Board, Dr Jonathan Casement is also wary, saying he’s “neither for nor against” the shake-up. Dr Casement worries a populous area like the North Shore may lose out within metropolitan Auckland in a regional health authority. “Waitemata- District Health Board does well as it has a big population. When that population doesn’t matter because you’re in a region, I’m not sure how the allocation of resources across that region will take place.”
Dr George knows his view is unlikely to find favour in certain quarters, given the longrunning funding row between the Ministry of Health and the South Island board.
Dr Casement hopes the new system ushers in a transparent ranking system for prioritising hospital builds. He says while any system can be “gamed”, there is realistic potential for improvement.
“Are we aiming to be like Canterbury, or are we aiming to bring down the Canterburys to where Wellington is?”
He is sceptical of claims the system will end the postcode lottery, saying rural and sparsely populated areas will likely remain disadvantaged. He adds the shortage of doctors in rural areas persuaded him of the need for a third medical school. It’s too hard to get into medical training.
He says health care resources are simply not sufficient for the clinical demand after “many years of chronic underfunding”. Asked what he would, given the chance, tell the Health Minister: “I’d say come 8 THE SPECIALIST | JUNE 2021
She is also concerned about how the reforms will take shape.
“You don’t need people who are massively bright, you need people who are reasonably bright and work hard.” At Middlemore Hospital, Emergency Medicine Specialist Sylvia Boys says the reform’s goals, such as improving Ma-ori health, are commendable.
“The fact we’re all going to be one big happy family won’t translate into more specialist surgical services operating on the West Coast.”
“South Auckland does have a different population than elsewhere in the country, we are a substantial Pacific community, losing the DHB structure means that the local knowledge of how to provide care to our unique communities may be lost.” “I am concerned that centralisation of services, while on paper cost saving and allowing equitable access, will in fact continue or worsen inequities.” She wants to see much more emphasis on addressing the drivers of health, such as poverty, housing, and food. There are industrial implications from having a single employer which will require strong union representation to ensure staff are not forced to accept substantial changes in renumeration, conditions or location of work. “There has possibly never been a more important time to be an ASMS member,” she says. On the West Coast, there are concerns about a change in the special relationship with the larger Canterbury DHB.
