Postcode healthcare a troubling problem

We say

Once again a troubling story has emerged from the public health system. Our report today of cancer services being affected by conflict between managers and surgeons, and among senior doctors themselves, provides little comfort to patients in the system. They have every right to expect the treatment that they get in Auckland and Northland to be broadly comparable to services delivered in, say, Canterbury.

But that does not appear to be the case. It seems that the point where a patient enters the system can have a bearing on the outcome. The unsatisfactory state of affairs has been given a name — “postcode healthcare”. In other words your address, which largely determines the location of treatment, can make a difference to the quality of care you receive.

Clearly a public health system such as we have in New Zealand cannot be expected to deliver perfection, or provide seamlessly equal services. But it is not unreasonable to expect the system to be managed efficiently, to deliver broadly similar levels of care, and for those working in it to put their personal agendas aside.

It is disturbing then to discover that a review of head and neck cancer treatment found that the quality of care across the upper North Island has been affected by years of “internal and inter-DHB politics”.

While these disputes were waged, some patients suffered to the extent that their illness progressed. Upsetting stories of battling cancer and a health system impervious for access to essential treatment were relayed by patients surveyed for the review.

Cancers affecting these New Zealanders can have distressing results. Patients can lose the ability to talk, eat, swallow, laugh, smile and kiss. It is not just a handful of patients affected. Every year some 500 New Zealanders learn they have head or neck cancer, and often must prepare for invasive and discomforting surgery.

As our report found, more than one patient who had their tongue and voicebox removed in surgery were later told they didn’t meet the criteria for speech therapy. That is despite such support being critical to their ability to talk and avoid being tubefed for the rest of their life.

Other cancer survivors are being forced to pay $5000 a year for devices to help them breathe, and which would be entirely funded if they lived in a neighbouring DHB. These are not the signs of a functioning, responsive system.

New Zealand’s public health system is big, costly to run and in some places stretched to the limit. When shortcomings surface the impacts can be significant.

Reports which health boards would prefer to bury have a habit of surfacing.

The Waikato District Health Board has been distracted for months because its board failed to do its job and rein in a powerful chief executive. The Counties Manukau District Health Board is grappling with leaks, rot and mould at new Middlemore hospital buildings. Now we discover cancer care problems having a direct impact on equity of health outcomes.

A feature of the recent series of failings in the health system has been the initial impulse of the institutions to try to prevent disclosure. The futility of this approach should be obvious as the public information agencies which promote disclosure tend to prefer openness and transparency.

The lesson is that reports which health boards would prefer to bury have a habit of surfacing.

New Zealanders know their health service is not impeccable, but they expect it to serve the people who pay for it. The challenge for health boards — and those who work for them — is to show they are meeting these expectations.