Elective surgery wait-times are an obsession not only for health officials but politicians. If patients can’t get relatively straightforward surgery in good time, they lose faith in the health system and its leaders. Photo 123rf.com
Elective surgery wait-times are an obsession not only for health officials but politicians. If patients can’t get relatively straightforward surgery in good time, they lose faith in the health system and its leaders. Photo 123rf.com
Analysis by Isaac Davison
Isaac Davison is a senior reporter for the New Zealand Herald writing about Auckland Issues.
When the Health NZ - Te Whatu Ora behemoth was rolled out three years ago, one of its core purposes was that New Zealanders with the same health needs should get the same treatment, no matter where they lived.
A single, centralised health agency would end fragmentation and spreadresources evenly around the country, bringing an end to the “postcode lottery” in which patients’ care varied depending on where they lived.
Three years on, a high-level report says that remains a distant dream. And while some progress has been made, these forward steps simply underlined the scale of the task ahead.
In an investigation published this afternoon, Auditor-General John Ryan said that the way planned care was provided in New Zealand was “not equitable or timely”.
Planned care - also known as elective surgery - covers all services for people that do not need to be treated immediately, including operations to remove cataracts or tonsils, replace joints and repair hernias. It is a big chunk of the health system - at least $1 billion a year - which is why Ryan wanted to check whether Health NZ was living up to its promises.
The clearest success story in tackling the postcode lottery is the introduction of a nationally consistent threshold for cataract treatment. Previously, there were different thresholds for different regions, meaning someone who lived in Southland might miss out while a patient with the same vision loss in Auckland would get treated.
The new cataract threshold unlocked a flood of new patients needing treatment - 1800 in the Southern District suddenly became eligible and 900 in Counties Manukau.
Work is now underway to set national thresholds for orthopaedics, ear, nose and throat conditions and cardiology. That is again likely to identify significantly more demand and costs for some districts, Ryan warned. Little is known about this unmet need.
“Significant work will be required to deal with the changes in demand that will result from the introduction of nationally consistent thresholds across all specialities. However, this work must remain a priority for Health New Zealand if it is to provide the equitable access called for in the Pae Ora (Healthy Futures) Act.”
Auditor-General John Ryan.
Health NZ has also been working to cut elective wait-lists, which had been growing before the Covid-19 because of demographic and resourcing pressures but then blew out as the focus switched to acute care and preventing the spread of infection.
Ryan’s report highlights that some attempts to address wait-lists simply pushed the problem elsewhere or made equity problems worse.
In 2022, Health NZ was given $68m to tackle the list of people who had been waiting more than a year for treatment. This approach had some success - the number of patients in this group fell from more than 4000 in October 2023 to 1900 last July, before rising again.
But focusing on the longest waiters simply heaped more pressure on other parts of the elective surgery process. The number of people waiting for a first appointment with a specialist doubled to nearly 10,000 over the same period.
Elective surgery wait-times are an obsession not only for health officials but politicians. If patients can’t get relatively straightforward surgery in good time, they lose faith in the health system and its leaders.
Wait-times are also closely tied to patients’ quality of life. The Herald has previously reported cases in which patients became increasingly housebound because their surgeries kept being pushed back. One said he expected to die before he went under the knife.
Health Minister Simeon Brown has looked to the private sector to get more elective surgeries done. A new report says that could worsen inequality problems. Photo / Marika Khabazi, RNZ
Health Minister Simeon Brown is highly attuned to the optics of growing wait lists. His Government has set ambitious targets for all patients to be treated within four months. He has also partnered with private hospitals to deliver an “elective boost”.
Ryan skirted around Government policy in his report. But it sent an indirect warning to the Government about its increased outsourcing.
Sending patients to private clinics had helped to relieve wait times but similarly created new problems. Access to private hospitals was not the same around the country. And more importantly, patients selected for outsourcing usually had less complex conditions. This meant patients with complex conditions languished on public lists while others were seen more quickly in private settings.
Health NZ officials understood that outsourcing could make inequalities worse, the Auditor General said. But there was no evidence they were doing anything about it.
In short: fulfilling the original promise of Health NZ is still a fair way off.
Isaac Davison is a senior reporter who covers Auckland issues. He joined the Herald in 2008 and has previously covered the environment, politics, social issues, and healthcare.
Sign up to The Daily H, a free newsletter curated by our editors and delivered straight to your inbox every weekday.
