A new report on health services in the northern region, which includes Mahurangi and Mangawhai, paints a bleak picture of what residents can expect under current models.

The Northern Region Long Term Investment Plan, released last month, is a collaborative report prepared by four district health boards – Northland, Auckland, Waitemata and Counties Manukau.

It predicts that the demand for healthcare associated with the region’s growing, ageing and changing population will quickly outstrip any ability to deliver health services under current models of care. As a result, there will be declining services, a lack of doctors and insufficient hospital beds.

“In the past five years, the Northern Region population has grown by 9.4 per cent,” the report says.

“Over that same period, demand for both community and hospital services has increased, with all areas of service delivery nearing capacity.

“Our region has undertaken various initiatives and work over recent years to better integrate hospital and primary care services, and this work has resulted in some moderation of demand on hospital services. However, it has not reduced the overall pressure facing specialist services.

“Our projections indicate that demand for adult medical, adult surgical services, and assessment, treatment and rehabilitation, will continue to grow, leading to a deficit of nearly 400 beds within the next five years. This bed deficit will be felt across all our major hospital sites.”

In Auckland, hospitals are not only at capacity for inpatient beds, but also operating theatres, endoscopy suites and radiology services.

“If we do not invest in additional capacity within the next two to three years, many other services will reach full capacity. We expect this to negatively impact on our patients, and their health outcomes, as patients will face longer wait times for services.”

Adding to the problem is the ageing state of building facilities – it is estimated that over one-fifth of clinical services are operating from buildings which are not fit for purpose.

Waitemata DHB chair Professor Judy McGregor stands behind the report as an “impressive” body of work, which will lay the groundwork for better and more coordinated investment in the region going forward.

The report identifies the need to invest in land for a hospital in the north in the near future, but Dr McGregor says this will be a decision for the Ministry, not the DHB. She says no site has been designated and would not comment on rumours that it could be the former Rodney District Council building in Orewa.

On the question of whether public private partnerships (PPPs) could help meet the health objectives of the plan, she says that the Minster of Health David Clark has made his views clear that he wants a strong public health service.

The Minister was recently reported as saying that the Government has ruled out PPPs, adding that in the United Kingdom they had “a disastrous track record of cost blowouts and poor service”.

“I think a public service is what most New Zealanders want,” Dr McGregor says.

She says there is a need to look at options other than hospitals, and health hubs could be part of a new model. She did not rule out the possibility of Rodney’s rural alliance of general practitioners, which was setup in 2015 to focus on patient-centred care, service delivery and integration and sustainability issues, evolving into a hub.

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Level of heath care not the issue

Long delays for appointments, a lack of understanding by Auckland hospitals of traffic and transport issues, and a disconnect between doctors, specialists and surgeons are just some of the issues facing public health patients who live north of the Johnstone Hill tunnels.

Retired local government chief executive Richard Knight, who lives in Whangaripo, has nothing but praise for the recent treatment he received from doctors, nurses and staff in Auckland’s hospitals.

“They are caring, compassionate and professional,” he says. “But the health system itself is like a dysfunctional family. It’s confusing and stressful, which is exactly what you don’t need when you are facing a serious health issue. It’s like a game of snakes and ladders – you see a specialist, get tests done and feel you are making progress, and then you get a referral somewhere else, and slide right back down to the bottom of the queue again.”

Richard was first diagnosed with skin cancer on his face while resident in England. The treatment was to remove the lesions when necessary, which was done with minimal fuss. This routine continued when he and wife Janet emigrated to NZ in 2005 to join their daughter on a farm in the Waikato. But when the family moved to Whangaripo in 2014, Richard’s ability to get the treatment he needed took on a whole new level of complexity.

“I became concerned about a swelling on one side of my face in February 2014, so went to see a local doctor. He said my options were to have it blasted or he could prescribe some cream. I took the cream, but with no improvement, I went back to see him in May.

“He told me to put a plaster over the lump that was worrying me and instead focused on two other marks on my face. I was sent for a series of biopsies and all three lumps turned out to be cancerous.

“I got the news while I was in the UK visiting my mother. I was prepared to return immediately to start treatment, but was told there’d be a six to eight weeks wait so there was no point in rushing back. It was all pretty worrying.”

Richard then went through a series of delays and appointment re-scheduling, and all the time, his face was getting worse. He did consider going private and did see a specialist.

“During the 15-minute appointment, which cost me $350, the doctor said I needed urgent attention. I would have gone private, but at the same time, I received another appointment at North Shore so thought, ‘Okay, it’s going to happen so I won’t pursue the private option’. But it turned out, the appointment was just to see if I could have a general anesthetic.

“The surgeon was gobsmacked at the state of my face by the time she finally saw me in October. She said I was lucky someone had cancelled that day so she could use that appointment to clean everything up, which involved removing 10 cancerous growths in total. It was very painful, but after so many months of waiting, I was just happy to have it finally done.”

Unfortunately, the story doesn’t end there. The district nurse visited three times a week to clean the wounds and change the dressing. When she noticed an infection, she told Richard he would need to get a cream that only the doctor could prescribe.

“You’d have thought that that at least would be simple, but again, it’s like the right hand doesn’t know what the left hand is doing and getting the prescription was anything but straightforward. What I can’t understand is why the district nurses can’t carry some of these medications so they can be administered right away.”

As a precaution, Richard was given radiation, which involved driving to Auckland five days a week for three weeks.

“Depending on the traffic, it could take two hours to get there and two hours to get home for a 51 second appointment. Since all this started, I’ve received treatment at Waitakere, North Shore, Greenlane and Auckland Hospitals, and I’ve been to hospital 31 times. I’ve had to sit in waiting rooms for hours, sometimes only to be told to return on another day.  The older you get, the less able you are to cope. It is unbelievable that the hospital system can operate the way it does.”

When Mahurangi Matters spoke with Richard, he was again awaiting more test results but this time, it looked like the results had been lost and he was facing more trips to Auckland, for more tests and more appointments, as he tried again to make his way up the ladder.

“When the first test was done, the lump on my face was hardly noticeable, now it’s a big lump. The longer the process takes, the more I stew and the more upset and anxious I get.”

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Call for “new thinking”

If the aspirations contained in the Northern Region Long Term Investment Plan are to be achieved, then the Government and health boards need to think outside the square, according to Rodney Surgical Centre chief executive Marianne Davidson-Beker.

She says there are a lot of opportunities to improve health care in the north, but not under the current model.

“We know Labour isn’t in favour of public-private partnerships, but in reality, they are doing it for roads and other infrastructure so why not health?” she says.

Ms Davidson-Beker says she struggles to understand Waitemata DHB’s lack of capacity for endoscopy.

“Rodney Surgical employs two doctors who do around 50 endoscopies a month under a contract from the Northland DHB. Wouldn’t it make sense to use the Warkworth facility for patients in this area as well? They (Waitemata) say they are at capacity but are unwilling to consider Warkworth as an option.

“Cost can’t be a factor because I know for a fact it costs $1200 in the public system and we could offer the service for less.”

Ms Davidson-Beker says there is potential to offer a range of services in Warkworth from ophthalmology and oral and maxillofacial surgery to chemotherapy and plastic surgery.

“I have a meeting with the head of the Auckland DHB soon so it will be interesting to see what their appetite for this will be,” Marianne says.

“We have an ophthalmologist who does cataracts for private patients in Warkworth once a month and then rushes back to Greenlane to do a public list. He would be more than happy to spend the whole day here and see local public patients in the afternoon.

“If this happened, it would be possible to also offer a service for people who need Avastin (used to treat certain cancers) once a month.

“They currently travel to Auckland, but if a surgeon was here all day, Auckland could send the nurses to Warkworth to administer the drug under the surgeon’s supervision. But again, this would be a new model.”

Ms Davidson-Beker says that unfortunately everything that is in the report has been talked about and written about before, “but it hasn’t made one jot of difference”.

She adds, however, that it is not about pointing the finger.

“There are conflicting interests, there’s not a lot of money and there are a lot of issues there. We can’t afford to just keep building and staffing hospitals – there has to be some new thinking.”