Just days out from our official polling day, confirmation at least six prostate cancer patients have shorter life expectancies after spending more than six months waiting for treatment at Dunedin Hospital has drawn sympathy from the current Health Minister – but no real acknowledgement of responsibility.

“This is an unacceptable situation and it is a tragedy,” Jonathan Coleman told RNZ this week.

“These guys are the human face of the operational problems that have been down there in Southern DHB.”

When quizzed by Guyon Espiner on his responsibility in the situation, Coleman immediately referred to “systemic problems” with the DHB’s urology department.

“And that has been a massive factor in what has happened to these poor men.”

Poor men. Tragedy. Unacceptable.

Now, all too familiar-sounding terms when it comes to healthcare in New Zealand.

So what will fix it?

Coleman claims it’s not an issue of underfunding. Labour, and many of our 20 DHBs – including Southern, Canterbury, Northland and Auckland’s trio – are adamant it is.

At the University of Auckland’s Politics of Health Forum this week, four health sector insiders – ranging from a GP to a journalist – gave their own take on what was needed.

In an almost novel twist, all four agreed that spending more was not the answer.

“It wasn’t whether you kept tipping in more money or not – the inequities were still there.”

– Rawiri Jansen

Richard Edlin, senior lecturer in health economics, used Labour’s promise of cheaper GP visits for all as an example of why broad funding proposals didn’t always work.

“Labour has stated that they’re going to be reducing the fees for the non-VLCA [Very Low Cost Access] practices by $10.

“We’re providing that broadly to the people that are not in the VLCA practices … and there’s a very valid question to be asked that if there is this extra amount of money, why is that money not going into the VLCA practices better.”

Continuing to nods from his fellow panellists – New Zealand Doctor editor Barbara Fountain, National Hauora Coalition clinical director Dr Rawiri Jansen and adolescent mental health professor Sally Merry – Edlin highlighted the fundamental problem in Labour’s GP visits’ policy:

“It seems to me that money isn’t necessarily going to improve access amongst the groups that are going to need it most, but it is possibly going to make people more broadly happy – and I’m not sure that making people more broadly happy is necessarily what we should be aiming for.”

Jansen, who practises in South Auckland and was instrumental in rolling out the rheumatic fever campaign in the Counties Manukau area, highlighted his own frustrations with bureaucratic funding processes.

“We led a programme that has reduced acute rheumatic fever by 76 percent in the population that we service in South Auckland,” he said.

Following his programme’s success, Jansen was discouraged to learn that while funding for an Auckland-wide programme would be provided, no guidelines or constraints had been placed on the primary health organisations [PHOs] that received that money.

To ensure funding was spent effectively in those types of situations, PHOs – at the very least –  needed to implement programmes that had a proven success-rate, Jansen said.

“It wasn’t whether you kept tipping in more money or not – the inequities were still there.”

Much to the crowd’s amusement, Jansen said it was one of two occasions the National Hauora Coalition returned funding to the purse-holders because it disagreed with the free range being given to PHOs over rheumatic fever campaign programmes in Auckland.

“They carved it up, and all we had to do was tell them what we were going to do with the money,” he said in disbelief.

“I said ‘No, this is dumb, have the money back – it’s unethical’.”

Fountain also provided pertinent context on the current conditions DHBs were grappling with.

“Under National for the last nine years, the public has been left ignorant really with the DHBs and their funding. In the last two months, we’ve seen Northland and even [Auckland-wide DHB chief executive] Lester Levy himself, and Canterbury coming out.”

While a bigger health spend was desirable, she cautioned against taking such a narrow focus.

“To be honest, when I heard Labour was going to put $8 billion into health, my first thought was: ‘No, don’t put it into what we have now, we need something new and something that is going to be fit for purpose of going into the future’.”

Ultimately, a review into the sustainability and need for 20 DHBs in a country as small as New Zealand had to take place, she added.

While all parties have promised to inject more into the health budget, some have made specific policies addressing changes to the overall system.

Both Labour and the Greens have promised a review of the primary care system, while NZ First says it plans to review funding of PHOs, the total number of DHBs, as well as Pharmac’s funding policy.

ACT has promised the most definitive changes, with a restructure of the overall health system by merging 20 DHBs into five regional bodies – administered by Ministry- appointed officials.

National and the Māori Party have not addressed plans for major structural reviews in their respective policies.

So, as those who are yet to vote, continue to weigh up options – consider the key message from the health panel:

Do we choose according to what seems to be the easiest, and most appealing in the short-term, or is it time to finally look ahead, and consider a comprehensive restructure of a system that is letting more and more people nosedive through the cracks?

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