Blog | Local Election Watch 2019: Electing the Leaders of Our Healthcare System

By Yi Xin Heng

Healthcare remains a perennial concern of New Zealanders, which is why the local elections for District Health Board (DHB) candidates should be closely watched. Candidates will be competing against a backdrop of mounting dissatisfaction expressed by both DHB employees and the public. In 2018, for instance, 30,000 nurses were involved in a pay dispute and went on strike, [1] while 3,300 junior doctors deployed the same tactics to negotiate better working conditions in January this year.,[2] Candidates will have to contend with the frustrations expressed by mental health service users, which were brought to light by the Mental Health and Addiction Inquiry in 2018,[3] as well as the measles outbreak that has led to more than 1,000 confirmed cases in Auckland. [4] These demands must be met while striking a careful balance between keeping healthcare spending in pace with inflation and prudent allocation of taxpayer dollars. One in every four dollars is already being spent by the Government on healthcare.[5] This article will provide an overview of how the DHB elections are organised, and the most frequently mentioned policies that candidates are campaigning on.

Nurses strike and rally. march down Queen St and meet at Aotea SquareFigure 1. Nurses on strike on Queen Street, Auckland[6]

How do candidates get elected to each District Health Board?

The District Health Board elections are important as board members set the DHB’s direction for health service delivery. This is especially significant as the central Government is allocating more funding towards health and mental health services from the Wellbeing Budget, and DHB Board Members will have a say in specific ways in which the funds should be used.

Anyone can run for the DHB elections, and you need not reside within the DHB that you are campaigning to be elected to. There are no specific experiences or skills required. DHB employees can also run for office, provided that they declare their potential conflict of interests. The only criteria is for the candidate to be a New Zealand citizen and be on the parliamentary electoral roll.

Figure 2. A sample voting form for an election held using the Single Transferable Voting system[7]

While the District Health Board elections are part of the local elections, they utilise a different system to count the votes and elect board members. This is known as the Single Transferable Voting System, where voters rank their preferred candidates.[8] Board members are elected by taking into account all voters’ preferences using a computer system. The Minister of Health can nominate four additional members to the board to fill any potential gaps in expertise.

In Auckland, elections are held for three District Health Boards. Waitemata DHB (WDHB) is responsible for the delivery of health services for regions in the North Shore and West Auckland, while Auckland DHB (ADHB) does the same for Central Auckland and Counties Manukau DHB (CMDHB) for South Auckland and some parts of East Auckland.[9]

Auckland Regional DHBsFigure 3. Map showing the regions that the three DHBs in Auckland cover[10]

What is the profile of the DHB candidates?

There are 23, 27 and 33 candidates campaigning to be elected for WDHB, ADHB and CMDHB respectively.  Of the 83 candidates, the largest proportion of candidates have a background in health management, followed by allied health and business. Eight candidates have a background in medicine while seven candidates have a background in nursing.

dhbcanFigure 4. Proportion of DHB candidates from each profession

Majority of DHB candidates are affiliated to an organisation, while slightly less than half are standing for election as independent candidates. The three organisations which fielded the most candidates are Communities and Residents (C&R), the Labour Party and City Vision Health in descending order. C&R only fielded candidates for the ADHB and CMDHB elections. City Vision is only contesting in the ADHB elections, leaving the field open for Labour Party candidates in the WDHB and CMDHB elections.

dhborgFigure 5. Proportion of DHB candidates who are affiliated with an organisation, or who are independent candidates

Communities and Residents (C&R), which describes itself as “a voluntary grassroots association of members” that “provide leaders for Auckland’s development”, does not appear to have a unified policy agenda listed on their C&R website[11] or Facebook page.[12] Neither do Team Health candidates,[13] nor candidates endorsed by the Labour Party, though the CMDHB Labour candidates are publicising their campaign using a single Facebook page.[14]

A pair of siblings, Apulu Reece Autagavaia, a lawyer, and Autagavaia Vaaiga Autagavaia, a doctor, cited each other as running mates among the Labour Party pool of candidates. Both propose to “focus on … whanau experience” and “prepare for future population growth” among other policy proposals. In contrast, City Vision Health and Manukau Alive and Well have clearly stated their priorities.[15]

dhbpriFigure 6. Policy priorities listed by Manukau Alive and Well (CMDHB) and City Vision Health (ADHB)

A significant number of candidates have been active users of the healthcare system. Michelle Atkinson (City Vision Health, ADHB) utilised mental health services, while Ezekiel Robson (Labour Party, CMDHB) experiences low vision and advocates for people with disabilities.

Some candidates have an impressive track record of advocating for policy changes. Spurred by his wife’s diagnosis of breast cancer, Troy Elliot (C&R, ADHB) advocated for Pharmac to increase the range of cancer drugs they funded. Similarly, Gerhard Sundbord (Independent, ADHB), established Fighting Sugar in Soft Drinks, a public health advocacy group, after he witnessed his mother’s experience of type 2 diabetes. Sandra Coney (Independent, WDHB), wrote an article for the Metro magazine which “revealed an unethical experiment at National Women’s Hospital that resulted in many women developing cervical cancer and some dying”. Her subsequent advocacy led to the creation of Office of Health and Disability Commissioner and the Code of Patients’ Rights.

What are the DHB candidates campaigning on?

Auckland City Hospital is facing 'unprecedented' demand this winter, prompting DHB health officials to ask the public to instead visit their GP unless it's a genuine emergency. Figure 6. Auckland City Hospital’s services under strain in 2018 [16]

More affordable healthcare

Monina Hernandez (Labour Party, WDHB) promises to reduce GP fees for low income patients, while three candidates (Kullasit Chutiongpisit, Independent, ADHB; Nivedita Sharma Vij, C&R, CMDHB; Catherine Abel-Pattinson, Team Health, CMDHB) are campaigning on more affordable dental treatment.

Increasing access to medication

Douglas Armstrong (World Class Health Auckland, ADHB) vows to demand appropriate Pharmac and Government funding for Auckland, while Gerhard Sundborn (Independent, ADHB) commits to the provision of better diabetes medication that will delay need for dialysis by 4-6 years. Glyn Richards (Independent, ADHB) makes it a priority to increase availability of pain medicine.

Reduced waiting times

Monique Poirier (C&R, ADHB) wants to increase the availability of after-hours services. John Bottomley (Independent, WDHB) thinks that treatments for life threatening conditions should be available 24/7 and that there should be faster access to diagnostic imaging services.

Bringing healthcare services closer to home

Glyn Richards (Independent, ADHB) wants to establish satellite emergency clinics in communities most in need to take pressure off main centres, while Geoff Smith (Team Health, CMDHB) and Apulu Reece Autagavaia (Labour Party, CMDHB) advocate for increased rural access to services. Adam Amos (ADHB, Independent) would like ADHB’s Needs Assessment and Coordination Service Coordination agency to allocate more funding and hours for home-based care support services.

Image result for drug resistant bacteria at middlemoor ehospitalFigure 7. Middlemore Hospital [17]

Rolling out preventive healthcare

Pete Williams (Independent, ADHB) promises to invest in community exercise facilities to encourage active lifestyles, while Ross Bosswell (Independent, ADHB) will invest in immunisation.

Addressing the social determinants of health

Apulu Reece Autagavaia (Labour Party, CMDHB) recounts his childhood memories of collecting cans from rubbish bins or doing paper runs for extra cash and empathises with the “fresh and raw struggles of working-class migrants” in South Auckland. Patrick Cummuskey (City Vision Health, ADHB) wants to advocate for housing code changes and support for cross-departmental projects that deliver better housing while Kerrin Leoni (City Vision Health, ADHB) would like to collaborate with social services to tackle other causes of illness, such as education and poverty.

Designing customer and whanau focused services

Zoe Brownlie (Independent, ADHB) speaks of codesigning services with the community, while Ezekiel Robson (Labour Party, CMDHB) would like to “restore the appointed community representative roles that this DHB scrapped from its advisory committees in the previous term”. Nathan Billing (Independent, WDHB) rallies for “better transport links to hospital” and to “make parking easier for patients attending appointments and family members visiting loved ones”.

Improving services for women

Kerrin Leoni (City Vision Health, ADHB) would like to make more services available to mothers and families post birth, while Dianne Glen (Independent, CMDHB) would like to establish a women’s health centre. Sandra Coney (Independent, WDHB) observes that the Special Care Baby Unit in Waitakere Hospital is currently crowded and will advocate for new primary birthing units for women and an expanded special baby unit.

 Waitematā District Health Board chief executive Dale Bramley said the situation at Mason Clinic was "severe and we request an urgent response". 
Figure 8. Mason Clinic[18]

Better mental health and disability services

Kyle MacDonald (City Vision Health, ADHB), who was a key member of the team which conducted the People’s Mental Health Inquiry, has expressed his commitment to advocate for greater access to talking therapies. Sandra Coney (Independent, WDHB) supports the rebuild of the Mason Clinic forensic mental health facility, while Bernadette Pereira (Independent, CMDHB) will enhance access pathways to suicide prevention services for adolescents. Catherine Abel-Pattinson (Team Health, CMDHB) plans to increase home care and respite care for over 65 and persons with disabilities.

Develop culturally responsive services

Zoe Brownlie (Independent, ADHB) appears to be the only candidate who specifically mentions that more robust services should be developed for the rainbow communities. Te Karere Scarborough, (Independent, ADHB) would like to introduce capacity development in Māori, Pacific and migrant staff to ensure increasing leadership diversity, while Geoff Smith (Team Health, CMDHB) thinks that an Independent Māori Health Authority should be established.

Explore alternative medicine

Adam Amos (Independent, ADHB) believes that ADHB needs to become “more liberal” and trial non-traditional forms of treatment, such as naturopathy. Tadhg Tim Stopford from The Hemp Foundation is campaigning in the ADHB elections to teach hemp medicine to medical professionals, and Tricia Cheel from STOP Trashing Our Planet thinks that WDHB should make “mega-doses of intravenous Vitamin C readily available”.

North Shore Hospital's emergency department is inundated with people with winter illnesses. Figure 9. North Shore Hospital[19]

Improved working conditions for staff

A number of candidates raised the issue of parking for hospital staff (Warren William Flaunty, Health Board Action, WDHB; Lyn Richards, Independent, ADHB), while others will increase the number of frontline medical and nursing staff (Douglas Armstrong, World Class Health Auckland, ADHB; Monina Hernandez, Labour Party, WDHB). Zoe Brownlie (Independent, ADHB) specifically mentions that she will look into better pay and development opportunities for healthcare staff.

Greater investment in research

Patrick Cummuskey (City Vision Health, ADHB) opines that gene therapy treatments should be explored, while Pete Williams (Independent, ADHB) would like to enable more people to participate in clinical trials. Parag Bhatnagar (Independent, CMDHB) emphasises the importance of improving the DHB’s digital strategy and capitalising on emerging technologies like robotics and AI.

Anticipating future demands

Jude Keys (Independent, ADHB) encourage more medical graduates into general practice in anticipation of an aging GP workforce. Chris Carter (Labour Party, WDHB), who also appears to have an intimate knowledge of the social services and cultural communities in West Auckland, will address the need for medical services in the new residential and commercial areas out West. This concern is echoed by Warren William Flaunty (Health Board Action, WDHB) who opines that WDHB should “urgently look for suitable sites for future Health Board facilities in the north”. Catherine Abel-Pattinson (Team Health, CMDHB) will establish 2 new hospitals in South Auckland to cope with rapid population growth, while Dianne Glen (Independent, CMDHB) would like to see a new spinal and rehabilitation centre being built.

Zero carbon hospitals

Lastly, two candidates addressed the issue of climate change in their DHB campaign. Pete Williams (Independent, ADHB) is determined for ADHB to achieve zero carbon emissions from its operations by 2050, while Dianne Glen (Independent, CMDHB) would like CMDHB to reduce their carbon footprint by using food waste as compost, and grow food locally with the establishment of community gardens.

Ourauckland Magazine October 2019Figure 10. Your vote matters in the local elections[20]

Vote for your DHB candidate(s)

There are only a few days left until voting closes! Place your vote it in one of the ballot boxes before 12pm on 12th October 2019, Saturday. You may locate the ballot box closest to you using this search bar. To ensure that your vote is not disqualified, only rank one candidate as number 1 in your voting slip for DHB candidates. Here’s to an improved healthcare experience for all Aucklanders.

 

[1] https://www.rnz.co.nz/news/national/361500/why-are-nurses-striking

[2] https://www.scmp.com/news/asia/australasia/article/2182180/strike-3300-junior-doctors-cripples-hospitals-new-zealand

[3] https://www.mentalhealth.inquiry.govt.nz/inquiry-report/

[4] https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12267124

[5] https://www.stuff.co.nz/national/115236249/healthcare-in-new-zealand-a-victim-of-its-own-success

[6] https://www.rnz.co.nz/news/national/361708/nurses-return-to-work-as-national-strike-ends

[7] http://www.stv.govt.nz/stv/votingform.htm

[8] http://www.stv.govt.nz/stv/index.htm

[9] https://www.health.govt.nz/new-zealand-health-system/key-health-sector-organisations-and-people/district-health-boards/location-boundaries-map

[10] http://www.safetyinpractice.co.nz/

[11] https://www.c-r.org.nz/

[12] https://www.facebook.com/CommunitiesandresidentsCMDHB/

[13] https://www.facebook.com/nzteamhealth/

[14] https://www.facebook.com/CountiesManukauDHBLabour

[15] https://cityvision.org.nz/our-candidates/introducing-the-city-vision-health-candidates-standing-for-the-auckland-dhb/

[16] https://www.stuff.co.nz/auckland/106247467/auckland-city-hospital-emergency-department-straining-under-unprecedented-winter-demand

[17] https://www.newshub.co.nz/home/lifestyle/2018/12/drug-resistant-bacteria-at-middlemore-hospital.html

[18] https://www.stuff.co.nz/auckland/107627726/health-boss-raises-significant-concerns-over-gender-mixing-at-aucklands-mason-clinic

[19] https://www.stuff.co.nz/national/health/94948665/all-auckland-hospitals-at-capacity-all-nonurgent-patients-asked-to-stay-away

[20] https://ourauckland.aucklandcouncil.govt.nz

Featured Image Credit: http://www.aucklanddoctors.co.nz/hospitals/aucklandcityhospital/

The Public Policy Club is a non-partisan club at the University of Auckland that aims to encourage, educate and involve students from all backgrounds in the education and development of political knowledge. The views and opinions expressed in this article are those of the author and do not necessarily reflect those of PPC.

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