While it is important to hold governments to account for election promises, it is even more important to hold them to account for not providing services equitably.
Early on Cr David Benson-Pope and the then-mayor of Dunedin Aaron Hawkins spent a huge effort to get the new hospital to be built in downtown Dunedin.
It was not about services, it was about the building. And the politics.
We are getting reasonable bang for our bucks compared with other countries. If it were just money, the United States would have much better health outcomes.
The reality is that even life expectancy in the US is significantly below countries who spend a lot less. All countries need to have a focus on what we are actually achieving with the money spent.
However New Zealand does not look good when judged on providing equitable access to healthcare.
The previous government decided to concentrate on inequities in provision for Māori. The solution they constructed was to create a stand-alone Maori Health Authority jam jar. This was removed by the current government on the basis that having separate racial jam jars was not likely to create more equitable healthcare.
Strangely Andrew Little knew that separate jam jars were not the most effective way of delivering services when he dismantled the geographical jam jars in the form of health boards.
Now that the government is at least paying lip service to a nation-wide healthcare system, it is more straight forward to argue that we should have our needs met in the South. Returning to reporting on what is actually being delivered by our healthcare system will also help provide a sound basis for us to argue our corner.
But we should concentrate on services, not on how the government should deliver them.
If we are concentrating on services we can have rational discussions about what we need and how the government will provide the services to Otago/Southland which are available in other places in New Zealand.
We are expecting higher proportions of older people in general in New Zealand, and more than the average in Dunedin. Areas with higher numbers of Maori have a younger population and therefore different health needs.
That leads to the likelihood of different demands on the health system in different areas. In the South we are likely to have higher needs for skin specialists, orthopaedic services and cancer treatments since these are associated with ageing. And possibly mental health services which may be more needed around our young adults.
What we actually have in Dunedin is a demand for orthopaedic services which far outstrips the supply. We are pretending some mental health services can usefully be dealt with in Christchurch. Skin specialists have retired or left town.
There is a drive to link spending with outcomes. This is useful but will not necessarily address the postcode lottery problem.
Surely the South wants to build on the idea of the health of all New Zealanders being delivered equitably.
The new hospital build will need to provide the buildings which will allow services to be provided effectively, efficiently and equitably in the South. Retired surgeon Mike Hunter has, for example, highlighted the need for a number of theatres being available and beds which allow the theatres to be fully utilised. There is clearly no point in having staff without facilities.
Neither is there any point in having facilities without funding staff.
Our bottom lines should be to harass the government to provide the same services which anyone else in New Zealand is getting. If this means particular facilities then so be it.
If the bottlenecks are staff then whatever the government needs to do to get the necessary staff it should do.
If we have higher needs for some services than other parts on New Zealand, then these should be provided for on the basis of the needs we have.
A focus on what we want will likely get us further than telling the government how they should do it.
Our civic leaders could find out what services others are getting and we should demand that we should have them too.
In the meantime anyone who has the need to attend the Emergency Department in Dunedin Hospital will likely have many hours to reflect on whether they would prefer to sit for longer in a fancy new waiting room or to be attended to and be back home in a reasonable time with an emphasis on service.
— Hilary Calvert is a former Otago regional councillor, MP and Dunedin city councillor.
