Jonathan Simon: Just how sick do you have to be to get a hospital bed?

An advantage of doing locum work is that you get snapshots of health-care services around the country. Over the past six months, that work has taken to me to several places.

This is a tale of two of those cities; two very different places, both of which affirm the quality of the privately supplied general practice services and both of which bring into question the quality and access to secondary care services.

In Auckland some months ago, I saw a man with an acute leukaemia. The blood test was taken at 9am. A consultant haematologist from a private laboratory phoned me by noon.

What happened from then on was like an episode from Monty Python's Flying Circus. It took five phone calls to two major hospitals and four hours of waiting and holding before I eventually ignored the advice that I had been given - not to admit him, but to have him reviewed in outpatients two days later - and had him admitted directly to hospital.

That evening, he had a major bleed. Had it occurred at home, he would have died there.

Apart from the obfuscation, prevarication, procrastination and side-stepping on admitting the man into an acute bed, I was on hold for so long on the phone to the various hospitals that I had to listen to the entire repertoire of Herb Alpert and the Tijuana Brass.

The experience taught me that in Auckland, where there are three major hospitals, there is greater opportunity for each to avoid taking admissions and to try to pass them to other hospitals.

I had always assumed that despite increasing rationing, we had a system that could accommodate the really sick. By the end of my locum, I had my doubts.

The second locum was in Gisborne. There, the Tairawhiti District Health Board rejected referral letters concerning the problems of 591 patients and sent them back to their GPs without allowing the patients to have a specialist assessment.

This action suggested the hospital system was so overwhelmed that it could no longer deal with routine cases, and that only urgent and semi-urgent referrals would be assessed.

If this is the case, what happens to people with problems that are significant in terms of their daily lives? Does this mean that hernias, varicose veins, endometriosis or significant nasal septal deviation requiring surgery will no longer be treated in the public system?

How will people have their problems addressed? In the private sector? Not in Gisborne. Most people there cannot afford it.

Are they left to suffer until the bureaucracy finally believes they are sick and disabled enough for access to the public system?

What damage will have been done to them by their having to wait on the new national "non-waiting" waiting list? An experience that is becoming more Waiting for Godot.

My tale of two cities would suggest the public sector responds inappropriately to acute problems and to significant but non-urgent ones.

When we look at the significant investment in the health sector over the past four years, it is devastating to see how little effect it has had.

Pouring more money into the system without significant functional change is like pouring water into a coarse sieve.

I have wondered for the past 20 years when common sense will triumph so that the health sector serves the population and ceases to be self-serving and inefficient.
* Dr Jonathan Simon is a GP from Devonport.