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Cracks in health system exposed

Opinion Piece

COVID-19 returned to our shores with a vengeance last month, and in the battle to survive it our health system is taking the hits.

Last week we saw hospitals and staff at the heart of the latest outbreak stretched beyond capacity. Auckland DHB sent out the call for additional ICU nurses, hospitals were making space to create more specialist rooms for Covid patients, and there were reports that Auckland patients awaiting surgery might be shipped to other hospitals around New Zealand in an attempt to minimise already extensive delays.

Stretching the health system like this, with diagnoses and surgeries inevitably delayed, means the health cost of Covid-19 will be much higher than the daily case numbers.

The need for a robust health system is obvious in pandemics and emergencies, but it's also essential in normal life. In fact, the pandemic is highlighting stretchmarks, like those in the mental health system and Eating Disorder Association, that have been around for much longer than Covid-19.

We need a health system that is robust enough to care well for people right through to the end of life, whether there is a pandemic, an ageing population, or the ongoing challenges of reaching a rural population. Provision of good palliative and end-of-life care in rural New Zealand is an important example of this. It's essential to ensuring neither us, nor our loved ones, endure bad deaths, yet for many New Zealanders accessing good palliative and end-of-life care is difficult.

Health policy often refers to the “postcode lottery” of healthcare provision in New Zealand. The care available in central Auckland, with its major hospitals, can look quite different from health services available in regional New Zealand.

While regional medical practitioners care deeply for their patients, the resources and specialist services available are different from those found in the major centres. In the South Island's West Coast there isn't a hospice building, rather, a trust works to “accumulate, manage and distribute funds to support families on the West Coast financially to care for their loved ones”. Those people who require specialist palliative care must travel to receive it — despite the financial or time cost, and possible increase in pain.

Sure, Covid is stretching the system, but these problems were here before and, with an ageing population, if these accessibility issues aren't rapidly addressed the stretchmarks will quickly grow.

If major health system changes announced by Andrew Little earlier this year are to be successful, it's essential that more than the immediate concerns and stressors of Covid-19 are dealt with. The change needs to ensure end-of-life isn't forgotten amongst the desire to cure, that technology like telehealth services are appropriately utilised for regional care, and that long-term issues aren't missed in the attempt to overcome the immediate challenges of Covid-19.

If the Ministry of Health doesn't utilise this opportunity to appropriately build towards a more robust health system, these pain points will long outlive lockdown and bleed into the lives of generations of New Zealanders.

■ Danielle is a senior researcher at Auckland-based think tank the Maxim Institute.

Danielle van Dalen