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We have a better chance of success with the Dunedin Hospital rebuild if we stop harassing the Government,  writes Hilary Calvert.

If we asked Otago people what they most want from health services it would likely be health service delivery in the province at least as good as the rest of New Zealand. For example, whatever qualifies for an operation here should be the same that qualifies those up north. The Dunedin School of Medicine is vital to us as well.

Usually the government of the day is charged with getting the best outcomes from the always limited resources, and local input involves harassing the government to get regions at least their fair share of the outputs.

Having district health boards makes it more difficult to put our case directly, as they are in place for the specific reason of taking the responsibility away from the government.

In our situation we even have to pretend we have local input and control of our destiny as regards health provision when we have commissioners.

The avoidance of responsibility provided by health boards is so valuable to the government of the day that we may not be able to get rid of them and have direct discussions with the government about services and equitable funding.

But we can get together and let this Government know, each and every day, that we want equitable services and the

Dunedin School of Medicine. Instead we bang on about all manner of disparate issues, leaving room for the government of the day to just pick up whichever is convenient during election years.

The union movement knows how to focus. From time to time someone takes to the streets and shouts ``what do we want?'' followed by a terse few words, then ``when do we want it?'' with the response of ``now!''.

It hardly makes for a pithy demand if the answer to ``what do we want?'' turns out to be ``local meals and more staff and higher pay for nurses and to replace the hospital buildings precisely here and the medical school and . . .''

Whoever we wanted to listen will have gone home for their dinner before we get to the best bit.

We are also at risk of trying to demand that the Government make choices which may not provide the best outcomes: when we have no real understanding of what they are thinking as regards the ``how'' of health delivery.

For example, what if having the hospital on the same site will cost $50 million more to keep current services going during a rebuild? That is $50 million that should be spent in our health services. What if ordering the Government to rebuild on the same site gives it an excuse to go back to the drawing board, and delays the rebuild by some years, and we can't attract good medical staff because our leaky hospital is a joke?

It seems self-evident that having the hospital stay on the same site would be better for the medical school interaction, but what if it is more efficient in the view of the Government to have some clinical services downtown and some elsewhere?

What if something we ask for puts our medical school at risk?

What if giving away the Frederick St car park land to ACC is the last straw breaking the camel's back in trying to find enough land in downtown Dunedin to rebuild? Maybe we should get to the bottom of whether the Dunedin City Council has actually promised the car park to ACC despite its inappropriate zoning, and try to withdraw any offer.

What if harassing of the Government in an imagined party political fashion just makes the Government determined to not give us what we want, since we will likely vote two local Labour people into Parliament this year?

If we concentrate on telling the Government what we most want, and stop trying to tell it how it should deliver the services, we have a much better chance of getting the best result.

Hilary Calvert is a businesswoman and former Dunedin city councillor.