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By Ruth Hill of RNZ
Heart patients in Northland have to be much sicker to even get a specialist appointment than if they lived in Auckland, which is where they get referred for surgery if they need it.
That claim – by the region’s cardiologists – appears to be backedup by Health New Zealand Te Whatu Ora data, which show huge variations in wait times between regions.
Hokianga farmer Tokowhati Piripi lives with a ticking time bomb in his chest – an aortic aneurysm (a bulge in the wall of the main artery going to his heart), high blood pressure and an irregular heartbeat.
The 69-year-old was waitlisted for surgery in November as “routine priority”.
“I started to run out of wind going up hills about two-and-a-half years ago. It’s all right, as long as I don’t try to walk up hills or do things,” he said.
His wife, Teina Piripi, said they have been told the current wait time for non-urgent operations is about nine months – “up to three times longer than it should be”.
Whangārei Hospital. Photo / RNZ
“We’re really worried that he could just cark it. He won’t be able to see his mokopuna.”
The aneurysm could rupture at any time and then he will need emergency surgery in Auckland, probably transported by helicopter – as long as there is one available at the time.
“So that’s the other way you get in front of the surgeon too,” Teina Piripi said bleakly.
She knows her husband faces “a triple whammy of health inequities”: he is Māori, male and he lives in a rural area.
“Our acute services, the care you get here, is not the same.
“He has a higher risk of actually dying than if he keeled over in Auckland.”
According to Health NZ data, seen by RNZ, 116 Northland patients (about 17%) were waiting more than the target three months for a first specialist appointment in March.
In Auckland, 120 patients – or about one in 10 – had waited too long.
Northland’s head of cardiology service, Marcus Lee, said by the time he sees patients, they are sicker than they would be if they lived in Auckland.
The first barrier to get a specialist appointment was getting a referral from a GP, and some Northland people struggle to get a GP.
“Secondly, the barriers to get a specialist review is much higher because we don’t have the resources, the thresholds are much higher.
“And if we see someone who doesn’t meet the threshold, we are depriving someone else of care.
“So it’s just this constant juggling of who you can see within the right time frame.”
Auckland City had more than 20 cardiologists for a population of half a million, while Northland has just five to serve 200,000 people, he said.
Health NZ was recruiting for another cardiologist for Northland, but he estimated it really needed eight or 10 specialists to get the same access as in Auckland.
His team has worked hard to clear the backlog of patients waiting for first appointments – but that meant pushing back some patients with “known severe cardiac disease”.
“So you live with that, right – sometimes you think: ‘Have I made the right call?’.
“And it’s quite hard because you know GPs are under significant pressure, and they’re working long hours too.”
Northland has no after-hours or weekend cardiology service, so general physicians pick up those patients.
Auckland City Hospital. Photo / Doug Sherring
Anne Wetere, 62, is also waiting for a heart procedure.
Three years ago, she collapsed at work the day after completing a half marathon.
“I said to them, ‘I think i’m just dehydrated and I’ll be fine’. But then five weeks later, I went into ED and they picked it up.”
She has had to go to Whangārei Hospital’s emergency department 14 times with atrial fibrillation, when her heart suddenly starts racing at over 160 beats a minute.
In a written response to RNZ, Health NZ’s group director operations for Te Tai Tokerau, Alex Pimm, said the agency was “committed to providing timely access to services and reducing waiting times for patients”.
“We recently implemented an inpatient cardiology service at Whangārei Hospital. During the day, patients admitted to Whangārei Hospital for cardiac-related problems are now managed directly by cardiologists. Out of hours, the general medicine specialists continue to provide high-quality care to inpatients.”
Referrals were triaged based on clinical urgency, with the most urgent patients seen first, followed by those who had waited the longest among those triaged at the same priority.
“Ensuring people don’t wait more than a year is important as part of reducing our overall waiting times as we strive to achieve the national target of no patient waiting longer than 120 days to be seen,” he said.
Te Toka Tumai Auckland provided the regional, tertiary cardiology service and performed the specialised cardiac surgeries and interventions for patients from Te Tai Tokerau.
“There is no difference in the thresholds for treatment for patients from Te Tai Tokerau. Patients and their whānau are supported to travel to Auckland for their specialist care.”
Health NZ was currently recruiting for another cardiologist.
Meanwhile, cardiologists from Auckland were travelling to Whangārei Hospital to do additional outpatient clinics, echo reporting, MRI scans and cardiac angiography.
Wait times worse in some regions
Nationally, one in three patients who need cardiothoracic surgery are waiting longer than the required timeframe, according to data from March.
More than one in four patients are waiting more than three months for a first cardiology appointment or treatment - but it’s much worse in some regions.
In Waikato, 48.2% of patients (419 people) waited longer than three months for a first specialist appointment, and 42.3% (437 people) waited too long for treatment.
In Tairāwhiti, which has no permanent cardiologist, 98% of heart patients wait longer than three months to see a specialist.
Heart Foundation medical director Gerry Devlin – who works at Gisborne Hospital one week in three – said patients who did not have access to specialist care inevitably had poorer outcomes.
“We need more specialists, we need more health professionals and we need those patients in the right places, like Northland and Tairāwhiti, to treat the patients with the worst burden of disease in our country.”
The public system also needed to work harder to retain the health workers it already had, he said.
