Special Medical Areas
Current moves to end the special medical area status in the West Coast's Ngakawau and South Westland districts again
highlight the failure of successive governments, Ministry of Health, and local DHB corporate managers to understand the
principles upon which these areas were established around New Zealand.
It has long been recognised that the earliest possible treatment of health problems is not only beneficial to patients
but is also economically advantageous in that it often prevents more serious conditions developing which often cause
great suffering and cost far more to treat at a later stage. So the s.m.a.s were established in many low socio-economic
areas to remove the barrier of cost to people consulting their doctors at an early stage.
While some progress has been made in reducing the cost of going to a doctor this still remains a barrier to a great
number of people especially when some doctors will only discuss one medical problem per consultation when the patient
may have several problems, and when extensive travel to the doctor's surgery is involved.
It is remarkable to note, therefore, the continuing shining light which the Hokianga s.m.a. provides in terms of a
rural medical model. The Hokianga provides free services for approximately 9,600 people via the Rawene Hospital/Health
Centre and no less than nine local clinics scattered throughout the district. They also have eight community nurses,
psychiatric district nurses and support workers, home support services and basic dentistry working from five school
dental clinics. . Even prescriptions are free apart from manufacturers' premiums. (more information on their website
While there has been some dispute about the costs per head compared to the rest of New Zealand, some years ago it was
established that the cost per head in the Hokianga was actually less than the average for New Zealand overall.
It is also pertinent to mention that while successive governments have decimated the rural hospital network (over 80
local hospitals closed over the past 25 years) a Canterbury Area Health Board report in the 80s demonstrated that the
costs of up providing rural health services via local hospitals was vastly cheaper than when services are centralised.
In the early 90s small Otago rural hospitals ran on total yearly budgets of around $400,000 - the same as some DHB ceos
get as yearly salaries now.
So why are the West Coast bean counters now moving to end the two remaining s.m.a.s here? Presumably, like everything
else they do, this will be at the direction of the Ministry of Health who obviously believe that one size fits all.
During my year on the West Coast DHB board I recall talking to them about the legendary Dr. Smith who entirely on his
own launched the Hokianga health service which ultimately led to the present free service. They were not interested.
Highly relevant to the West Coast is the Buzz Burrell scheme to provide a version of the Hokianga service which, by
eliminating unnecessary management duplication and disorganisation would have saved enough money to provide free health
services to everyone in the Reefton/Inanghua district. My fellow board members weren't interested in that either.
It is an appalling indictment of the supposed community representatives on the West Coast DHB that they will undoubtedly
knuckle under to the bean counters when they are presented with the ultimatum to approve the ending of the Ngakawau and
South Westland s.m.a.s. As long as the Hokianga system survives - and I have a copy of Buzz Burrell's Reefton/Inangahua
scheme! - the sound common sense of removing all cost barriers to health care will remain a live issue.
The refusal of the authorities to apply the sound principles of the Hokianga model elsewhere can only lead to the
conclusion that eventually, and under whichever government feels the time is right, the ultimate aim of the politicians
is to entirely privatise health care.
David Tranter 46 Woodstock-Rimu Road, RD3 Hokitika.