Health Minister Ayesha Verrall targets ‘postcode lottery’, defends waiting list progress

Queenstown woman Elizabeth Kerslake was unable to get vital cataract surgery through the public system. Photo / George Heard

The “postcode lottery” in healthcare, whereby patients face unfair differences in treatment based on where they live, will be tackled by new groups of expert clinicians, the Health Minister says.

In an exclusive interview with the Herald, Dr Ayesha Verrall has outlined a plan to tackle patient inequalities and also defended the progress of health reforms, nearly one year after DHBs were replaced by a single entity, Health NZ - Te Whatu Ora.

Nationwide hospital backlogs have hit record lengths after Covid-19 disruption and amid severe workforce shortages.

Fissures have appeared in services, including overloaded emergency departments and deferred cancer surgeries.

National says at the one-year mark the health reforms “are the disappointment we knew they would be”, evidenced by worsening delays and demoralised frontline workers, and the Government’s new plans are “complete fantasy”.

However, Verrall said efforts in greater Auckland and Northland showed the way forward.

“I’m convinced that they have cracked the method of how they turn around the wait lists. And Te Whatu Ora is putting support into making sure that similar processes can be supported everywhere in the country.”

Health Minister Ayesha Verrall. Photo / Mark Mitchell

Fixing our ‘postcode lottery’

Regional differences plague many services within the health system.

An ongoing Herald investigation has exposed how getting life-changing cataract surgery can depend on where someone lives, as some regions have much tougher surgical thresholds.

Elizabeth Kerslake’s cataracts clouded out her world, caused headaches and, on sunny days, made her reluctant to drive.

Despite the significant loss of vision, the Queenstown resident was just under the threshold needed to get surgery in the public system.

The southern region has one of the toughest thresholds in the country. If Kerslake, 72, lived in Auckland, she would have easily qualified for surgery.

After the Herald featured her plight in a story in April, a reader anonymously paid for her to get the surgery done privately.

Kerslake now sees clearly again, a change she described as “amazing”.

“It is just great, it is just such a difference.”

She is extremely grateful to the person who paid for the surgery, but aware others are reliant on the public system, and living with worsening vision loss.

“There just shouldn’t be that difference based on where you live.”

Queenstown woman Elizabeth Kerslake battled a postcode lottery for cataract surgery. Photo / George Heard

On the planned fix for issues like those faced by Kerslake, Verrall said frontline clinicians and health workers were now being selected from around New Zealand to represent different areas and specialties, like ophthalmology.

They will be tasked with identifying regional variations, and then recommending how these can be reduced and eliminated, as well as bringing in national standards of care that will ensure equity.

Funding would be available, she promised, although groups would also identify “areas of waste”. For instance, there was evidence some follow-up X-rays and other investigations don’t need to happen, she said.

The new groups, called national clinical networks, would be at the heart of the new health system, Verrall said, and were “about elevating the clinicians to the forefront on those key decisions about standards and how services are provided”.

Specialities already have representation through non-government groups like the College of Ophthalmologists (Ranzco), which has for years unsuccessfully lobbied for a single, nationwide surgical threshold for cataract surgery.

Asked about this, Verrall said under the old DHB system, “in order for a great idea to get traction, everyone has to agree”.

“And a single DHB who might have been disadvantaged by a change could effectively stop progress. Here, national networks will enable clinicians to get together and make judgments about what is in the right interest of the country, and how we get there.”

The networks would also have wider representation, including primary care and Māori health leaders.

They will be formed in tranches, the first covering cardiac, renal, stroke, trauma, radiation oncology, ophthalmology, infection services, and critical care. Some have existing national networks, but Verrall said for many this was “the opportunity to really get their hands much closer to the levers of how we run the health system”.

The waiting game

July 1 will mark a year since Te Whatu Ora’s formation. Verrall said the architecture of the new system was now in place, and had enabled progress seen in areas like greater Auckland and Northland, whose hospitals worked closely together.

“They have taken their longer-than-12-months waiting list down from 1800 to 800 at the time I visited [in May], and it should be down to 300 by [June 30], and cleared very soon after that.”

National Party health spokesperson Dr Shane Reti. Photo / Mark Mitchell

A patient is considered overdue if they wait longer than four months after being accepted for a specialist appointment or treatment.

National Party health spokesman Dr Shane Reti said those groups were getting bigger, and the minister talking about people waiting 12 months or longer was a shifting of the goalposts.

The so-called postcode lottery was a “convenient buzzword” to justify the reforms, Reti said, and Government policy was making regional variation worse.

“All I see is a hardworking sector that is demoralised with lack of leadership, and demoralised with a lack of certainty and direction.”

National would put targets at the forefront of its health policy, he said, to focus attention and resources on the areas most in need.