Giving constituents a false sense of security when you know it isn't warranted is a political crime. Yet governments do it regularly. I'd have to plead guilty to having done some of it myself in my time. In the area of health it occurs constantly. Take the pleas to maintain round-the-clock surgery at Kaitaia Hospital, and the Minister's promise to do so at election time. Does she intend it to continue? I hope not. It certainly can't be in the best interests of the people of the Far North, nor of taxpayers generally. The reality these days is that a growing number of hospitals in New Zealand are too small to provide round-the-clock surgery, or for that matter, many other health services such as sophisticated pathology or radiology. That, more than anything, lay at the core of the Gisborne inquiry and Dr Bottrill's problems. Politicians would do us all a service if they owned up to the reality, rather than responding to misguided local parochialism.


Health care is very susceptible to changing circumstances. Demographic shifts alter local needs. Areas that lose too many people inevitably see services run down; there are only so many dollars to go around, and they have to follow people. Changing age profiles can also affect demand. Soon after I became Minister of Health in 1984 I had a deputation from a small central North Island town that wanted to keep its maternity hospital open. It had once performed 175 deliveries a year. The number of births had fallen to 28. Staff were being fully paid for doing little. Not surprisingly, the local hospital board wanted to close the maternity unit and centre deliveries at the base hospital, 25 kilometres away. The lugubrious leader of the deputation mourned that people in his area "are getting older, Minister". But the local maternity unit kept hope alive for the community, like Viagara to those winding down. I heard them out, but gave them no cause for optimism. Then I asked where was their nearest nursing home. "Thanks for asking", said the spokesman, "we need one of them". To cut a long story short, the maternity unit closed and the building soon re-opened as a care facility that was more appropriate to the current age profile of the area. I heard no stories of younger people being inconvenienced by having to drive 25 kms for deliveries, and in any event, there was a fuller range of services at the base hospital.


The increasingly sophisticated equipment in modern hospitals, and the growing array of tests they can perform, also make it impossible to maintain a full range of services everywhere. The latest radiological equipment costs millions of dollars. It cannot be justified in many smaller hospitals. But for rural hospitals, the real killer - if I might use that term - is the difficulty getting staff. While the people who live in the Gisbornes, the Kaitaias and the Westports might want to stay there, they can't realistically expect that highly qualified young health professionals will be falling over themselves to join them. A shortage of adequately-trained personnel is usually the biggest single problem confronting hospitals in distant places. My last act as Minister in 1987 was to close surgery at a small hospital on the East Coast where the only surgeon locals could find was a drunkard, and a danger to patients. Locals wailed, of course. No doubt, too, they would have expected compensation if someone had died as the result of that surgeon's mistake. Health ministers often find themselves between rocks and hard places.


In the end, the mantra chanted by politicians that they will ensure "equity of access" for rural people is hot air. They can't. People must face reality: if one chooses to live in a remote spot, travel to receive modern services goes along with the package. Visiting specialists and outpatient clinics are a beneficial part of rural life. They must be maintained. But rural townsfolk - and even some small city dwellers - need to realise that for serious things like surgery it is in their own best interests to travel. If I lived in some distant part and had a serious accident or a health scare, I'd want to get to the nearest centre with top quality facilities and personnel as quickly as possible. It's wicked to kid everyone they can have first class hospital services wherever they choose. If politicians got real with the people of Kaitaia - or Gisborne for some procedures - they'd own up to that reality instead of lulling the unwary into a false sense of security, and then having to pay out when, invariably, something goes wrong. Discussion must concentrate on better transport and other forms of assistance needed to access quality care from smaller centres. The minister says she's exploring this, too. All power to her elbow.