The postcode lottery most New Zealanders wouldn’t accept

Sunday, 3 August 2025

Dr Jez Leftley is a rural hospital medicine specialist based in Queenstown. He is the Queenstown representative for the Association of Salaried Medical Specialists and a clinical advisor to the Southern Lakes Health Trust. He writes here in an individual capacity.

OPINION: Imagine being two hours from the nearest base hospital, needing urgent care, and relying on a helicopter to get there. That’s the reality for thousands across Queenstown Lakes and Central Otago.

As a rural hospital medicine specialist based in Queenstown, I’ve seen first-hand the strain on a health system never designed for the population it now serves. In her July 20 article, Queenstown risks becoming the next Barcelona, Andrea Vance captured our pressure-cooker growth. Roads are choked. Infrastructure is strained. Housing is unaffordable. And beneath it all sits an overstretched, under-resourced health system — fragile and failing to meet the needs of the population it serves.

Lakes District Hospital was built in 1988 to serve just over 4500 residents. That population has grown dramatically. On an average day, the region accommodates more than 100,000 — and on a busy day, over 150,000. Yet the hospital still has only 10 Emergency Department beds and 12 inpatient beds.

While staffed by dedicated emergency and rural hospital medicine specialists, it lacks on-site critical care, surgical services, maternity and paediatric care, and specialist support — the very things that make a hospital function safely at scale. Patients needing higher-level care must be stabilised and transferred by air — weather permitting — to Dunedin or Invercargill. This is neither safe nor sustainable.

Wānaka, meanwhile, has no free-to-access urgent care and no public hospital, despite being the country’s fastest-growing town. Central Otago is served by Dunstan Hospital, which also lacks an ED. Across the entire Queenstown Lakes and Central Otago region — with more than 80,000 residents and tens of thousands of daily visitors — there is just one small rural emergency department. When roads close, flights are grounded, or weather hits — as it often does — people are left waiting, deteriorating, or being managed in facilities not equipped for complex care. That’s a postcode lottery most New Zealanders wouldn’t accept.

This mismatch between need and service availability is no longer just inconvenient — it’s unsafe. In the past year, over 3000 patients from this region received elective inpatient care outside our district. More than 300 emergency helicopter transfers were made from Queenstown — costing over $6 million — and many more urgent transfers occurred by road. That’s before we even consider planned births, half of which occur out of region, or basic diagnostics and specialist care still requiring multi-day travel. A recent Queenstown Lakes District Council survey found that 41% of residents had to leave the region for medical care in the past year. Each of those patients was removed from their community, their whānau, and often their income — just to access the care most New Zealanders can get closer to home.

Some argue that Queenstown Lakes and Central Otago are regions of privilege. But that ignores reality. The average wage here is $10,000 lower than the national average. The housing affordability index is double. Many people live in cars, vans, or crowded short-term accommodation. Combine that with a fragile health workforce — where a single unfilled roster gap can destabilise the system — and you have a slow-moving crisis.

Queenstown contributes billions to New Zealand’s GDP. But that success masks a deeper reality: our health infrastructure is dangerously behind. This isn’t just a capacity issue — it’s a design flaw. The system assumes major centres will meet the region’s needs. That assumption no longer holds. Dunedin and Invercargill hospitals are often bed-blocked. Queenstown Lakes and Central Otago patients — unable to be treated locally — only add pressure. Investing in local care would not only help our region; it would also ease strain across the entire southern system.

I welcome the Clinical Services Plan currently being developed by Health NZ. It’s long overdue. But for it to succeed, it must be grounded in the real-world experiences of patients and clinicians. It must not be a top-down document built behind closed doors. The best solutions come from those who live and work here, and who understand the consequences of delay. The plan must reflect our high visitor burden, geographic isolation, and fast-changing demographics.

We cannot afford a repeat of what happened with the Nelson Hospital review — which, as the Association of Salaried Medical Specialists has highlighted, failed to hold leadership to account or address long-standing issues. If this plan fails, it will join a long line of reports that gather dust while services continue to decline.

If we had a major civil defence event tomorrow, the current setup wouldn’t cope. Local services are not just a convenience — they’re critical to emergency response. One disaster, one delayed transfer, or one weather event could push this system from fragile to fatal.

The people of this region aren’t asking for special treatment. We’re asking for fair access to essential services. It’s time for health planning to reflect where people actually live, work and move — not just where it’s convenient to provide care. Let’s not wait for tragedy to justify action.

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