The Auckland District Health Board has come under fire from the head of the union representing senior medical staff.
Ian Powell, head of the Association Of Salaried Medical Specialists says the Waitemata and Southern DHBs are suffering the most from mismanagement and an emphasis on Government targets, but Auckland's also showing some concerning signs.
"We're finding that increasingly so, to quote a chief executive of a large DHB, 'the system is creaking at its seams'," Mr Powell told Firstline this morning.
"That's a term that we've actually picked up on… district health boards are having considerable difficulties as they are facing a combination of relatively reduced funding, increased pressure to do more through increased Government expectations, the effects of an ageing population, the flow-on effects of poverty and a lack of leadership."
Dr Powell says the Government has set targets for DHBs to reach without any overall strategy of how to achieve them.
"There's a positive about targets, and we've generally welcomed the targets that the Government has introduced. There are problems however – one is that targets are in the absence of a strategy. There is no strategic direction which provides the context for the targets.
"Secondly, targets only cover those things that can be easily counted… Thirdly, when the squeeze goes on targets – while they have the potential to sharpen the focus, and pretty much they have and that's a good thing – but when the pressure goes on financially, and when we have health leadership not coping as well as it should because it's under pressure, the targets do run the risk of having perverse outcomes."
Health Minister Tony Ryall has called the criticism "disappointing", and says it's just union pressure being applied in the middle of pay negotiations.
Dr Powell rejects that interpretation of events, saying Mr Ryall would say that "about anything we say at the moment".
"If I was to comment to you on the state of the weather, he would attribute that to our negotiations."
Also appearing on Firstline this morning, chairman of the Auckland DHB Lester Levy said Dr Powell's comments are "unjustified".
"If you take GDP per capita countries, there's not a country that will have a public health system as good as New Zealand. The downward spiral is totally unnecessary.
"There will always be some problems – it's not perfect – but the health system is in very good heart at the moment, and I don't know why he would want to undermine it."
Dr Levy points to Waitemata as an example of how much DHBs have upped their game in recent years.
"Waitemata has had the most dramatic transformation of any DHB in the last three years. Three-and-a-half years ago, 49 out of every 50 patients who came to North Shore Hospital's emergency department waited more than six hours. Some waited days on trolleys… Now it's two."
Dr Powell says the Government has increased its expectations without matching it with investment or planning.
"In a nutshell, the problem is there are increased expectations but there is not the investment in the health workforce to cope with those increased expectations," he says.
"What we need is a strategic direction for the workforce that includes investing in its capacity, investing in its numbers. That's where the approach should be, and if we had that approach, we would not be in the predicament that we are in now."
Dr Levy on the other hand says there is only a "very weak" link between strategic planning and outcomes in the health sector.
"The system isn't creaking or breaking. Never before have we had fewer vacancies and the ease of recruitment currently is unparalleled.
"I don't think it is worth raising these issues that are not real."