Editorial: How healthy can the cutbacks be?

OPINION: The odd arrangements that surround the provision of health services in this country are demonstrated in a new report released this week.

The Nelson Marlborough District Health Board, which on most measures compares favourably with the 20 other New Zealand boards, has over-performed in the provision of "elective procedures" – operations and other medical interventions to relieve long-term suffering.

This, surely, is terrific news. With all the negative connotations of waiting lists, our board has managed to come out ahead of the game between July and September, performing 1690 procedures when it set out to do 1510. That's an extra 180 people who were helped. But instead of celebrating this achievement, the board is embarrassed by it. Its overperformance, says planning and funding manager Sharon Kletchko, is a "significant concern" and it will aim to reduce the number of procedures to the magic 1510 per quarter.

There are good reasons for this stance – if you are an accountant or a bureaucrat mired in the health system. Doing too much in one area of service provision means that less can be done in others. But tell that to the patients, who must also digest the news that the Nelson-Marlborough board intends to make money by bringing in patients from other areas or sending its specialists out of the district to carry out procedures for other boards. This, we are told, will help our board to pay off its deficits. "If we don't live within the funding we've got, it puts our ability to deliver a whole range of services at risk," Dr Kletchko says.

Nelson and Marlborough are generally extremely well served by the board and its staff, and this is reflected in a five-year run of topping the national "public satisfaction" ratings. That's something to be proud of and, if this week's report showed mixed results, it also included plenty to cheer about. In a widely-published scorecard – a first for the Health Ministry, which paid for the advertising – Nelson-Marlborough was ranked last for shorter cancer treatment waits, a position explained by delays affecting three patients. But it was third for improved access to elective surgery, fourth for shorter stays in emergency departments, and eighth for increased immunisation. These are reassuring results – and it is pleasing that the Government has seen fit to publish them.

However, there remains the issue of so-called overperformance. The point has repeatedly been made that the provision of health services involves a bottomless hole that will swallow any money poured into it, no matter how much, and that limits must be applied. This is accepted. Advances in technology, coupled with greater expectations from the public and an ageing population, mean that restraint is inevitable. But the capacity to reduce waiting lists is not only about money – it's about relieving pain and improving the quality of life. There is something wrong with the system when patients served by our board have to wait on, while outsiders are brought in to benefit from our doctors' skills.

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