Before many of us went off on holiday at the end of 2024 the pages of the Beacon of Friday, December 20, erupted in a cacophony of outrage over what has been portrayed by Health NZ as a temporary loss of Secondary Obstetrics and Gynaecology (SOG) service at Whakatāne Hospital.

I was given the opportunity to add my voice and did so then, and subsequently in a One News story in the New Year.

By secondary services it is meant the system that swings into action when intervention is required that is beyond that which might be provided by a midwife during an uncomplicated natural birth.

An example might be a programmed or emergency caesarean birth.

Given the sad state of decline of our health system in the past several decades, is it any wonder that there was such an outcry from our community?

Folk are rightly suspicious. Some may remember the protests to retain a hospital in Whakatāne after the ageing hospital was deemed unsafe. It was then Health Minister, Tony Ryall, who helped us win the fight to retain a hospital in our town and he officially opened the new $67 million Whakatāne Hospital on June 12, 2014.

Just before the Christmas period, I was involved in a video call with Pauline McGrath, the BOP group director of operations, Dr Kate Grimwade, Health NZ’s chief medical officer of hauora, a Toi BOP (the public health service provider in the BOP), our local MP, Dana Kirkpatrick, and the mayors of Ōpōtiki and Kawerau to be briefed on the issue.

Both Ms McGrath and Ms Grimwade assured us that our SOG service would be restored as soon as staffing issues could be sorted out. The level of distress and concern they exhibited during the call inclines me toward taking them at their word.

Were the loss, albeit it temporarily, of our SOG service to be an isolated incident, I would not be nearly as concerned.

My long-held concern is that the direction of travel of our health system doesn’t inspire confidence.

For the past several decades at least, the system seems to have been heading downhill. The fact that the system is now in a full-blown crisis will not surprise anyone who reads a newspaper or listens to the radio or TV news or has waited on a GP appointment.

As a citizen of this country, the mayor and the president of our local Grey Power association, I have been advocating for what New Zealanders were promised in the 1938 Social Security Act and which we have never had. That is, a health system that serves a society equitably and without barriers to access, which emphasises prevention rather than cure and that is not fragmented.

With 35 percent of New Zealanders having private health insurance, it is simply impossible to argue that our health system is anything but two-tiered and highly inequitable.

I have argued for some time now that our system is, in fact, class-based.

So much for a fair-go society that New Zealanders have traditionally prided themselves on being part of.

I have good evidence that chronic underfunding and privatisation of the system are largely to blame for increasingly poor performance. I strongly suspect that this is not what most New Zealanders want.

In order to have a serious discussion about a health care system, we need to be clear about what is meant by the performance of the system.

Modern health care systems are complex and have become increasingly so as technology advances.

As a result, even the act of measuring performance can be complicated. The OECD has recently published a 62-page report on health system performance and the World Health Organisation a much longer one. Here I will try to keep it simple.

One relatively crude measure of a health system’s performance might be the life expectancy at birth of a population and what it costs to achieve that.

Other metrics might include the number of hospital beds and doctors per capita, and, of course, waiting times. I have data on these and other metrics, but in the interests of keeping it brief, I will highlight only a few of these metrics.

Let’s first look at how we rank in terms of average life expectancy at birth as a function of health spending per capita (in terms of Purchasing Power Parity).

The reader can see from the figure above that New Zealand plots in about the middle of the road for OECD countries.

The standout is the United States (star) which spends more than twice what we do and has inferior average life expectancy. The US operates what is probably the most privatised systems in the world.

Back in 1970 we used to spend about 5 percent of GDP on health and today we spend about 9 percent of GDP on health.

In contrast, the highly privatised American health system accounts for about 20 percent of GDP.

Despite the cost, it is well known that about 35 million Americans have either no health insurance or are under-insured.

Therefore, based on this data (life expectance and cost) one must conclude that private does not result in better average performance but rather the opposite. I suspect that most New Zealanders do not want to go down the American health care path.

Regarding waiting times, the last time I made an appointment to see my doctor, I had to wait at least one month.

From talking to friends and family, I believe that this has now become a relatively common occurrence in Whakatāne as it appears to be in many other parts of the country.

However, I know from personal experience that the situation was not always like this. It is hard to believe these days that in the period 2010-2016 almost 80 percent of patients were able to get to see their doctors within two days.

Our ranking among countries we might validly compare ourselves with was excellent. It is now shockingly bad.

I think we all realise that the training of medical professionals in today’s modern medical system requires folk with brains, dedication and an ability to endure lots of blood, sweat and tears.

It takes probably of the order of 10 years to fully train a general practitioner and more to become a specialist.

In my day, our universities used to perform this function at no cost to the trainee (we all paid). But in the 1980s, we turned tertiary education into a business and now an aspiring doctor has not only to work like a dog but also ends up with a huge debt to repay.

Would it be any wonder, therefore, that having received and paid for their training, these professionals seek greener pastures?

Instead, we have come to rely on medical professionals trained in other countries, often developing countries that train their people gratis.

Another metric of health system performance is the number of hospital beds per 1000 people.

As the graph above shows, between the 1960s and 1970s, we used to have between 10 and 12 hospital beds per 1000 people. However, from the late 1980s to the present that number of beds has crashed to about 2.6. It is worth mentioning that in Japan today, there are still about 12 hospital beds per 1000 people.

Japan is a modern, highly advanced society with what is commonly regarded as a high performing health system.

As I mentioned previously, there are many metrics that I could trot out (and probably bore readers to death with) that constitute an indictment of our system.

Instead, let me cut to the chase. After studying our healthcare system for more than four years I believe that the following statements are justified:

1) The performance of our health system is in clear decline, maybe even in free fall.

2) Our system is becoming increasingly two-tiered, class-based and dysfunctional.

3) Underfunding and privatisation are part of the problem.

4) There should be no room for the profit motive in health.

5) Whatever we have been doing to try to fix things thus far, has not been working.

6) Things will continue to get worse if we don’t do something radically different.

With all the above in mind, over the past several months myself and Sandy Milne have been in the throes of organising a virtual health conference and round table discussion to be run out of the Whakatāne District Council chambers.

I have recruited university professors specialising in various aspects of health provision, pre-eminent economists, mayors and others to present and participate in this event. The date and time have yet to be locked in. Participation by members of the public will be most welcome.

Given the state of crisis of our health system, it is hardly a surprise that our community was going to take a hit.

Rather than reacting to such events, our health authorities should have been proactive. I just hope that it is not small communities like ours that take the full brunt of failures on the part of Government and health authorities.

As a community, we need to be vigilant and well informed, and we absolutely need to brush off apathy and fight for what we believe in.

If we hadn’t put up a fight over a decade ago, we would have no hospital in our district today. That would have been a tragedy for all of us.