Funding fails to treat patients

Our Hospitals, it seems, are sick. And, like rival snake-oil merchants, our politicians are lining up to peddle their peculiar brand of panacea.

The blue bottle labelled "Dr Brash's Waiting List Balm" claims it will slash the backlog of 20,000 people waiting for high-priority elective surgery by spending $100 million over three years.

In the red bottle, "Helen's Eye, Knee and Hip Linament" promises extra knee and hip replacements and cataract operations worth $200 million, and hospital upgrades worth more than $500 million.

The green jar of "Jeanette and Rod's Wellness Rub" says a free health check, applied annually, will keep more people out of hospital.

Despite the annual health system injection being $3.5 billion bigger last year than six years ago, most voters think hospitals are in a worse state now than before.

Orthopaedic surgeon Bruce Twaddle, director of orthopaedic trauma at Auckland City Hospital, explains what he thinks happened.

What is the biggest issue facing our hospitals?

The biggest issue is having enough resources to look after patients with an acceptable standard of care, and those resources include personnel as well as beds, operating rooms and structural facilities.

Are there enough resources now?

I think presently, speaking from an orthopaedic [surgery] point of view, we are struggling to get the work done with the resources we have.

So who's missing out?

The problem is there are still delays for acute patients, so they have to wait longer for their surgery, so it results in unnecessary complications and a longer stay in hospital afterwards. And the elective patients - because the hospital becomes filled with acute patients - either have their procedures cancelled or deferred or done under contract in private institutions.

An enormous amount of money has gone into health over the past six years. Why aren't hospital services better?

I think the problem is that the Government has given a lot of funding to try to improve health care but it hasn't ended up treating patients. So I think there's not enough accountability for what happens to the money.

If the money isn't reaching patients, where is it going?

From an orthopaedic point of view, I don't think the money that is designed to care for orthopaedic patients necessarily ends up there because it goes into a pool and it may be used to deal with problems elsewhere. We don't know where it goes. And I don't think there's enough focus on treating patients. There's a lot of focus on administration and managerial issues.

How bad are the waiting lists for elective surgery? Are our hospitals so overwhelmed they can no longer cope with routine cases?

No, I don't think that's the case. I think there are problems getting elective patients into hospital because the hospitals are full. Plus - in the case of joint replacement surgery at least - although the money is available to do the work, the facilities and personnel available are not sufficient to service that. You get concerned the administrators are keen to get the money but aren't necessarily going to spend it on providing all the resources you need to do the work in a timely fashion.

How do you decide who gets an operation and who doesn't?

That's something we're working through now ... [We're] trying to work out a way that accurately assesses disability so that the most disabled patients get treated early and there are now scoring tools available that better assess a patient's disability. The present scoring tool probably doesn't do that.

- HERALD ON SUNDAY