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No Prime Minister: The Buck Stops With You

by Selwyn Manning

Prime Minister Jenny Shipley's frustration at evidence of a worsening health status for south Auckland children is a mere red herring, a smoke-screen designed to cloud the Government's role in this order of social shame.

Mrs Shipley's rant on Newstalk ZB on Monday questioned the degree of responsibility of south Auckland parents, and lay blame for much of the ill-health found here at each family's front door.

Through free GP visits for children under six years and improved healthcare services, she said the Government has done much to improve the wellbeing of those living in the lower socio-economic expanses of south Auckland.

Jenny Shipley says it's hard to understand, given the huge effort the government's made to improve health services and ensure they're free to children. She says there comes a point when parents have to take responsibility.

The Prime Minister ‘s hand wringing display pales into insignificance when compared to that of those with whom she accuses.

Her words are hollow when heard by the children and adults who suffer the degradation of communicable diseases. And her questioning of the degree of family responsibility is so broad a swipe it belittles Mrs Shipley's intelligence and depth of experience in health matters.

It is all too convenient to wag the finger from the lofty heights of the Beehive's ninth floor. After nine year's in Government much of this blame rests firmly on the National Party's shoulders.

As a journalist reporting matters of politics and health matters in southern Auckland for some six years, I find it "frustrating" to witness the Prime Minister's apparent bewilderment at the Counties Manukau Health Council's report. And the Health Funding Authority's attack against South Auckland Health, claiming it needed to be more "robust and proactive" in tackling the region's burgeoning health problems is an example of sheer arrogance and irresponsibility. For it has been clear, in the Winter Crisis of 1997 the funding authority refused to add to Middlemore's acute budget allocation. The contract said x-amount of procedures. Never mind what the need figures are.

And it is too convenient for those of us who were raised within the confines of the southern Auckland experience to dismiss Mrs Shipley's comments as simply the bumbling of a woman of little urban experience who would be much wiser to pitch her lectures at the guardians of the Ashburton Brownies. For she is this Nation's state leader.

And both the Government and the Health Funding Authority have been fully aware of lowering health status in this region. The HFA's predecessor North Health Regional Health Authority researched and documented the higher morbidity rates suffered by those living within socio-economic areas. The research found and displayed clearly that by degrees, the poorer you were the younger you will die. It displayed ills by age and by how rich you were.

The document was handed to me by South Auckland Health chief executive David Clarke.

When reporting on the findings, I approached Bill English for comment. He was the Health Minister at the time. A spokesperson at his office was clearly angered that we were reporting on the document and actually said she wished the country's health chiefs would get busy treating people instead of handing documents like that to journalists.

At an earlier time when soliciting comment on a mental health matter from Jenny Shipley's office, who at that time was Health Minister, one of her spokespersons asked snidely if I was to be writing "another Goebels piece?"

It gets worse.

In May we published an investigation into a co-relation between overcrowded housing in south Auckland and the rising admission rates at Middlemore Hospital. Signals were clear that another health crisis was looming in south Auckland and that Middlemore Hospital was on the brink of a bleak "winter from hell".

Ref to: http://www.newsroom.co.nz/stories/HL9905/S00042.htm

In the column we displayed the experience of those in the know; ranging from a Manurewa mother of five children to the chief executive officer of South Auckland Health.

But if a reasoned response was expected from the National minority Government, it certainly was not forthcoming.

The self proclaimed voice of Pacific Islands people in Government, Mr Arthur Anae issued a media release throughout the country titled: "Doom Merchant Needs to be Honest".

Here's a snippet: "Mr Anae accuses Mr Manning of trying his hardest to give the impression that health provisions and the health of New Zealanders was on a 'downward spiral.'

"He fails to mention that spending on health has actually increased from $4.5 billion to $6.2 billion in the last five years."

Mr Anae's ability to kick while keeping his head planted firmly in the sand is admirable. His inability to grasp the condition of the south Auckland population is not.

Please feel free to view Arthur Anae, National Party List MP's response here;
Ref to: http://www.newsroom.co.nz/stories/PO9905/S00293.htm

I raise these incidents only to demonstrate the affront shown by those employed to be communicators for the respective ministers of the time. It displayed a fortress mentality which was too arrogant to be capable of listening or learning. The ideology was to build a profit-modelled public health system, and it was clear reports on the consequences of this were not welcome.

To Bill English's credit, he always appeared to have an understanding of the degrees of urban complexities, particularly where it concerned healthcare provision.

Here he is in an exclusive interview with this author in Mangere, October 1997, he said Mangere's population of around 47,000 people should have its own specialist health service.

Mr English acknowledged how Mangere people had become isolated from outpatient hospital treatment after South Auckland Health opened its Superclinic at Manurewa in October 1997. Outpatient clinics had been relocated from nearby Middlemore to the far away new premises in Manurewa. He said the health status of Mangere people demands that some type of Superclinic be set up there.

Mangere he pointed out has one of the highest rates of diabetes, rheumatic fever, meningoccocal meningitis, respiratory and heart disease. He knew this from Governmental research.

"It is clear," Bill English said "the way the superclinics have developed [in Manukau] has left a bit of a hole in Mangere. And there are significant issues rising particularly of access." ref:1 below.

Matters of health funding provision pivotal to the state of this region's health status have been well documented and reported.

Issues like "deficit funding" which placed great hardship on prudent Crown Health Enterprises like South Auckland Health by failing to reward efficient budget management with extra healthcare contracts but rather topped up those CHE's which became insolvent.

Then there is the inequality of population based funding formulae which failed to recognised the lower health status of Pacific Islands people. The percentage of Maori [who also suffer a lower health status] living within a region as compared to the general population was rightly compensated for with a formulae top up. But the percentage of Pacific Islands people were hardly taken into account.

In regions like southern Auckland with the highest population of Pacific Islands people in the world, the inequality of governmental funding is clearly a major contributor to today's "third world conditions".

These topics and the consequences discovered have been reported, have been questioned, and have been debated by all those involved in the management of the nation's public health system.

The Counties Manukau Health Council report now cites a long list of rising health problems in the southern Auckland region. They included:
* Four times the national rate of measles.
* Iron deficiency in at least a third of the children seen at Middlemore Hospital.
* Only a third of preschool children enrolled with the dental service.
* Immunisation rates of between 56 per cent and 76 per cent, compared with national rates of 83 to 87 per cent.
* Three times as many children [up to 4000 children] as five years ago needing free breakfasts and lunches at school.

And within the details of that report and others on this topic the truth of the matter is found. There within the documents, within the testimonies can be found the sufferings of these often humble people. But so often the words of these patients are spoken through the words of statistics or a manager's empassioned quest for rightful assistance. And here in a report by researcher Joy Simpson, commissioned by local Government elected representatives grouped together in one accord called Counties Manukau Health Council can be found documented proof that something has gone wrong.

Here lies proof that the Government has been kept fully in the picture. The ministers have been fully informed of south Auckland's health problems.

Prime Minister Jenny Shipley's frustration at evidence of a worsening health status for south Auckland children is a mere red herring, a smoke-screen designed to cloud the Government's role in this order of social shame.

This time it is we who grew up here in south Auckland, that wave our finger at you. Why? Because we told you so.


Ref: 1 What Mr English was prompting was a rethink on South Auckland Health's modernisation plan. The original blueprint for the region's healthcare services was to build Superclinics in Manurewa, Howick, and in Mangere. These clinics would reach into densely populated urban environs and provide these communities with ready access to highly skilled clinicians. But the Mangere plans were shelved after South Auckland Health could not obtain land of a suitable size to construct a Superclinic on.
South Auckland Health came up with a bandaid solution to shuttle-bus Mangere people way across the city to Manurewa. But experience showed sick children, often with sick parents did not travel well or would not travel the journey. As a result the "did not attend" or "DNA's" at Manurewa's Superclinic began to skyrocket in number.
Mangere Community Heath Trust's Michael Lamont said Manurewa I too far for sick people to travel. He revealed people struggle on at home rather than catch the shuttle bus.
Here's Bill English again: "The best thing is to bring the service to the people and have organisations doing it who are really committed to that community and its longterm welfare." A few months later Bill English announced a $1.6 million funding package which empowered the Mangere Community Health Trust to buy the facility off South Auckland Health and to provide community healthcare in a joint venture with the HFA .
The centre however is no Superclinic and cannot be expected to cater for Mangere's problems [which is only one part of this complex crisis].

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