You would assume Te Whatu Ora Health New Zealand’s specialist community mental health service is actually about people, so provided to places where people actually are.
Remember it’s a "community" service. But for Central Lakes people, those services are denied them, by an astonishing margin.
Call that what you like, but "post code lottery" will do, meaning the specialist health service you get varies bizarrely depending on where you live.
This past year, as expected, the population of Central Otago and Queenstown-Lakes climbed and the Dunedin population didn’t really. But the Dunedin-based management of our specialist mental health services failed to address this reality. However, with our new nationwide health system, maybe there is hope.
So how bad is it? In the 2022 figures for Dunedin district, there was one community mental health staff member for every 443 people in the district. And in Central Lakes there was one community mental health staff member for every 2884 people. That was out of kilter by more than six to one. It’s an extraordinary post code mismatch.
It’s got worse, not better. This year, the population in Central Otago and Queenstown-Lakes has jumped by 4500 people and in Dunedin by only 1500. So now more than 3000 people in Central Otago and Queenstown-Lakes have to share a single specialist worker. And Dunedin remains much the same with only 450 or so to each specialist worker.
You don’t have to be precise to see the mismatch is still outrageous. The solution is to shift 75 staff positions out of Dunedin into Central Otago and Queenstown-Lakes, taking the staff roster from about 26 now, to over 100. It doesn’t cost, it’s a rearrangement. Yes, move 75 professional staff into the region, quadruple the capacity, with similar for Clutha and Waitaki. Sounds a lot, but that is the relevant number to meet the issue.
Let’s be clear here, this is about clinical staff, the direct employees of Health New Zealand who are the serious clinical input for the most serious issues. It’s doctors, nurses and others with the capacity to diagnose and prescribe treatment. Employees of NGOs and primary care, who are in place, can provide excellent support, but from time to time need specialist clinical input to support their work.
Every story I hear from those NGO employees and the GP practices locally is that when they are worried about a situation that seems beyond them, they want to ask the specialists. But they can’t get those patients to be seen. Often there is no point to make the referral, it’s not going to happen.
This was bought to my attention long ago by a person working at a Central Otago college. They had a 14-year-old in front of them who had rope burns to the neck from a suicide attempt. The young person could not be seen by the specialist community mental health service — "not serious enough".
A GP recently explained "I have a worried mother crying in front of me about her child. I need the child to be seen, with analysis as to what is really going on. But what can I do that works?"
When the GP requires specialist input assistance and the specialist service is mostly not available, what can the GP do?
Reaction to an adequate staffing proposal has been curious. One person said to me "what would all those staff do in Central Lakes?". My reply was "so tell me what that vast number of staff do now in Dunedin?".
Health services do have professional roles and privileges creating serious internal tensions. Managing those can eclipse the actual need of the populations, as it seems to in this case. Management focus is on the tensions of the service more than the local people’s needs. Dunedin management describe a hub and spoke model, but clearly it’s all hub, minimal spoke. They acknowledge the numbers are correct but there is no sign of a proper staff reallocation.
The unwillingness to upset staff privileges means that any proposal relies on extra staff and more funding. "More funding, more funding — but don’t ask us to change anything." To solve the internal politics, nothing can be reduced, all programmes have to be extra. But that neglects managerial responsibility to provide a fair service to the taxpayers with the resources they are given.
But there are useful opportunities now. There is more awareness of post code situations. The Southern DHB is no more and the planning and funding role changed dramatically. It’s becoming part of the nationwide health service. There will be a national overview, rather than Dunedin focus and control.
A different view will develop in the next year as Health New Zealand creates "localities" and a "Locality Plan" which will be led by Iwi and the local councils. Focus will change from the providers of the service to the local people’s needs. The 2023 population of Central Otago and Queenstown-Lakes, now 78,000-plus, grows rapidly every year. It’s an ideal "locality".
It would be very strange if Health New Zealand, with it’s view over the whole country, allowed the post code lottery with a six-to-one mismatch in service level to continue. The Central Otago/Queenstown-Lakes locality will have influence. You will have a say.
Services will no longer be planned by paid professionals and funded organisations alone.
■Kerry Hand worked in Southern mental health services for many years and operated the successful Miramare agency. He had a close observation of the money flows and operations. He maintains an interest in the allocation of resources.
