Will it be the new Health New Zealand Te Whatu Ora or the old crew at Dunedin? Where does the regional deal fit in? What about the property developers? And do the people get a look in?
First, the good thing: We have the new crew from nationwide Health New Zealand undertaking a review that will be delivered this year. And they are on the right track. At a recent meeting (to which I was not invited) I heard they said that it’s about hospitals, primary care, diagnostics, specialist care and maternity services, determining what future publicly funded clinical services may be required in the area, how they will be delivered and where they will be provided. Public services. First up, they are seeing what is needed — only later comes the where and how.
That sounds more than sensible. Given 70% of the New Zealanders who live more than 2 hours 30 minutes from a base hospital live here in Central Otago Queenstown Lakes, there are huge barriers to accessing services such as infusions, dialysis and cancer treatment. Everything really. And my own special interest which is mental health.
Second: The former Southern district health board based in Dunedin seriously ignored the needs of this area and that attitude persists.
One very senior medical specialist revealed the attitude. He thought it "unethical" to shift 75 mental health positions out of Dunedin into Central Otago Queenstown Lakes. It would be "unethical" to reduce any service, anywhere, anytime.
In case you were wondering, the community mental health service has a massive 335 staff in Otago (2023 figures it refuses to update) but keep most in Dunedin. To fairly allocate to our population level means 75 positions would relocate out of Dunedin to Central Otago Queenstown Lakes.
Later, I asked the same question during a meeting with the associate minister of health. Our specialist talked of staff resistance. The minister pointed out that not everything has to happen in the same way it always has. I think our specialist was told off there but did not realise it.
Third, the "regional deal": We have to give credit here for bringing attention to the appalling lack of local services. But I am not alone in finding it find it hard to pin down what the deal actually is. Infrastructure is the focus and health is part of that.
Some of the original work described a hospital in Queenstown and that location seemed driven by property people. Quite different from the careful approach of Health New Zealand. Former mayor Glyn Lewers advocated the Queenstown location. But new mayor John Glover said immediately on his election that he saw the regional deal as for the whole area.
There are suggestions of public-private arrangements but just how that works is unclear. Is it about buildings? Or about private health specialists doing work on behalf of the public services? Or private work in public facilities? Is it speaking only about private medical specialists and their elective surgery?
Given the political sensitivities and the very difficult practical issues with public/private, it remains to be seen if the "deal" is useful for our health service. How do you determine what is the priority for work? Health New Zealand’s work may overtake the deal, or at least lead it.
Fourth, property developers: There are some great things across the area. Mike Saegers proposed Wanaka Health Precinct. Southern Cross Hospital at Ladies Mile.
The Wanaka Health Precinct can fill some of the gaps in public services. Also medical specialists who need venues for their private work. And the list is wider. Maternity? Community Mental Health (when the area finally becomes properly staffed), GP practices and the essential walk-in 24-hour care.
Southern Cross has been in operation for some time. Folk I know have received great interventions as public patients in what is a private facility. A very clever arrangement.
On the other hand, location and the focus of work might suit the developers’ needs rather than the public need. A senior government person even advocated to me that the hospital had to be in Queenstown, versus Cromwell, because Queenstown was where the "investors" wanted it. Thus revealing certain investors were already involved.
Of course, there would be a queue of investors to choose from if Health New Zealand called for investors to fund and build a hospital with a 25 or 30-year lease. It’s an attractive deal and they would build it wherever Health New Zealand said.
My previous work identified Cromwell as being the centre of population in the region and, as the centre of the road network, it’s the place for a public hospital. Will Health New Zealand think the same?
Finally, the people: There are a lot of people, so the list of what is needed is "everything". Let’s just make the list "everything". And because there are so many of us, most of that should be provided locally. Our health service is a national one, so for some things Dunedin, Christchurch and Auckland, just not all the time.
It’s easy to describe a hospital but really, most of the health service is provided outside of those.
Some activities can be provided by different organisations paid for by Health New Zealand. But the people need to have a free comprehensive public service, that provides for all the difficult long-term needs rather than just the simple ones.
It remains to be seen if the "people influence" will win through.
• Kerry Hand worked in the 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 believes health services should be easy to access and ordinary to use, and to achieve that requires wiser allocation of resources. He lives in rural Bannockburn.
