Thousands of patients in Auckland face removal from specialist or surgery waiting lists as public hospitals can't keep up with referrals from GPs.
The Health Ministry has threatened the Waitemata District Health Board with punishment that could cost it $3 million a year if it does not comply with policy on elective services.
As of March, the Waitemata and central Auckland boards had over 8000 patients waiting more than six months either to see a specialist for a first assessment, or to have treatment.
The "improvement required" by the ministry is to reduce the total by more than 6000 patients, suffering from conditions including rotten teeth, heart disease and gall bladder trouble.
The Government wants patients to be on public hospital waiting lists only if they are sick or disabled enough, under the rationing system, to qualify to be seen/treated within six months.
In a March letter to the Waitemata board, obtained by the Herald under the Official Information Act, then-Director-General of Health Karen Poutasi said: "I am writing to you to express my concern at the lack of satisfactory progress ... "
The letter in effect threatens intensive financial monitoring for non-compliance. This would cost the board about $3 million annually in forgone interest payments because funding would come at the end of each month instead of the start.
It requires compliance by June 30, which is also the deadline for most services at the Auckland board in a similar letter obtained by National health spokesman Tony Ryall.
The Government acknowledged this month that 10,000 to 14,000 patients a year are removed from public specialist waiting lists and returned to the care of a GP.
Waitemata's chief executive, Dwayne Crombie, said yesterday that its response to Dr Poutasi's letter included increasing the access "bar" to elective services and getting GPs to care for some patients who did not need to be referred to a specialist.
Patients would be removed from the first-specialist-assessment list, but no "big dumps" were planned and he expected improvement towards compliance within three months.
Although Waitemata was doing more elective surgery than last year, the access bar to elective services had risen in the past five years as Government funding had not kept pace with the area's rapidly ageing population.
"The critical group that drives services is those over 65 and over 75."
"There's a tendency to accept referrals even though we know we can't see them because they ... need help; but that's not good enough ... if we take too many referrals it's hard to see the ones that need to be seen."
Mr Ryall said the letters showed the Government "is only interested in culling waiting lists instead of trying to have more patients seen or treated".
The Auckland board said the number of patients likely to be referred back to their GP had not yet been established. It expected to comply with the policy by the end of next month.
* Auckland District Health Board: 3200 patients waiting longer than six months for a first assessment by a specialist.
* Waitemata Board: 2232.
* Auckland: 2355 waiting longer than six months following a commitment they will be treated.
* Waitemata: 710.
Source: Ministry of Health latest snapshot, taken in March.By Martin Johnston Email Martin