Editorial: One more option for good health

Since taking office, Labour has increased the health budget by more than $3.5 billion. It is a substantial figure, sufficient to demand evidence of a significant improvement in the delivery of healthcare. The Government, therefore, is intent on conveying the message that a splendid public health system is just round the corner. It is not about to concede that the latest flourish, $200 million for elective surgery over the next four years - intended to provide an extra 10,000 operations annually - is a sign of crisis. Or that it is a response to public wrath over the culling of thousands of patients from hospital waiting lists in line with a Government directive. No, says Health Minister Pete Hodgson, it reflects the fact that almost all district health boards now have effective booking systems.

Mr Hodgson has warmed to this theme since taking the portfolio. In May, he used his first major speech to accuse Opposition politicians and the media of creating an unsubstantiated myth that health was in critical care. There was reason to be confident in the overall state of elective surgery, he said, even if "we haven't got it right yet".

Similar sentiments peppered a Cabinet paper released this week. The Government's main worry seems to be that stories about sick people being struck off waiting lists are undermining public confidence in an otherwise "world-class" system. "Poor access to elective surgery," the paper says, "has an adverse impact on people's trust in the public health system." Nowhere is it mentioned that this is hardly surprising, as figures made public in July showed the three Auckland district health boards performed 1000 fewer elective operations in the year to April compared with the previous 12 months.

The Government's new money will be available only to boards that comply with a directive that no patient be on a waiting list for longer than six months. The Opposition suggests this is a formula for ensuring that waiting list culls will become entrenched. If so, the number of extra operations will be counterbalanced by further hits to public trust.

The health system's penchant for swallowing money with little discernible increase in efficiency means there is no certainty that more elective surgery will be done. But a more efficient booking system should help hospitals cope with the growing demand. So will targeting of operations that are in particular demand, as has been the case with hip and knee replacements. Yet the new money will go only so far, and the Government could do more. It is still refusing to contract private hospitals to help with waiting lists.

Partnerships between the state and the private sector have an inescapable logic, but even under considerable pressure, the Labour Party cannot rid itself of its ideological opposition. It says spare neighbouring health board capacity will be the first port of call. Only in an emergency will publicly funded, privately provided surgery be used, and only as a short-term measure.

This is hardly the sort of smart thinking that will avoid bad publicity and breed trust. People may grudgingly accept that some degree of rationing and prioritising is part of the modern health system. They will understand that an influx of people with illnesses related to a cold winter will put pressure on public hospitals' ability to perform elective operations.

But they will not be happy if they see that not every option is being used to ensure people get surgery when they need it. For the sake of patients, and for the Government's credibility on health, the private sector must be engaged.