There are high hopes for the recently announced work by Health New Zealand Te Whatu Ora on a clinical services plan.
The plan, due in December, will look at the region’s current and projected health needs and help determine what publicly funded clinical services might be required in the area.
That might be the easy bit. What will not be so straightforward is the other part of the planning — how these services will be delivered across what HNZ calls the "continuum of care".
There can be no denying the current service set-up has not kept pace with the population. There have been concerns about the costs, personal and financial, of many having to travel out of the area for birthing services and some elective procedures local health advocates consider could be delivered more efficiently closer to home.
Getting to the base hospitals in Dunedin and Invercargill in emergencies can often be challenging.
As has been pointed out, the Lakes District Hospital in Queenstown was built in 1988 when the Otago Central Lakes population was 30,000. It has the only emergency department in the wider Central Lakes region which now has a population of 78,000. Additions last year raised bed numbers to 10 emergency beds and 12 inpatient ones.
The Otago Central Lakes Health Service and Assets Project, a group combining community leaders, councils, HNZ and other health providers has been working for 18 months on a health strategy for the area.
Earlier this year, the Southern Lakes Health Trust within the project came up with a regional model of care which would involve teaming up with private investment, services or infrastructure already in progress.
The trust considers taking advantage of a unique opportunity for overstretched public health providers and emerging private health services to work together would create a stronger, more sustainable and more equitable health system for all in the area.
This week the project steering group was heralding the HNZ move to prioritise the development of the clinical services plan as clearing the way for New Zealand’s first privately owned but publicly operated hospital.
Southland MP Joseph Mooney, who is a member of the project steering committee, is optimistic about a new hospital, saying there has been a shift in the discussion from "if there should be a new hospital to where and when".
The health trust does not see its push for more involvement of private providers as leading to privatisation of health services.
Its aim is to increase access to publicly funded healthcare by using private sector infrastructure or investment to support public services. Without action "we risk a two-tier system", it says, but using emerging private developments could improve public health for everyone.
The trust acknowledges workforce development will be the key to the success of the plan, but with modern facilities and a strong local support network, it aims to attract and retain skilled health professionals.
It is easy to understand the impatience of those in these areas for action to improve services, but there will be questions which will need to be addressed in the HNZ plan over whether the trust’s suggested model is the most efficient and most cost-effective in the long term.
Will there be concerns the attractions of working in this part of the country might deplete staff in stretched health services elsewhere?
Will it turn out to be cheaper than fully publicly funded infrastructure when the private providers of the buildings/equipment will want to make an ongoing profit from that provision?
What would stop a private infrastructure provider pulling out after several years in favour of a fully private operation or stopping altogether?
How disparate services in the area might be co-ordinated and how they might fit in with services elsewhere needs clarification.
We have little confidence in HNZ overseeing this from afar. Perhaps this could be the chance for the government to finally show support for some sort of local governance.
