Cardiac surgery delays got so bad that officials mulled sending some patients to Australia for surgery. Photo / 123rf.com
Heart surgery delays were so severe that officials prepared to brief the Health Minister about sending sick patients to Australia.
The extraordinary possibility was raised in January, documents and emails obtained by the Herald reveal, but Te Whatu Ora dropped plans to brief the minister about the option after opposition from clinicians.
Authorities say progress has been made since then, but warn “there is no quick fix to the problem”, with issues including a shortage of staffed recovery beds. More than 60 cardiac patients are overdue at one hospital.
Te Whatu Ora late last year formed a group of clinical leaders from across the country to monitor wait times and shift patients between the hospitals able to do cardiac surgery: Auckland, Waikato, Wellington, Christchurch and Dunedin.
In January Sean Galvin, a Wellington-based surgeon, emailed members outlining plans to help Waikato Hospital, which has had the worst delays.
“It was suggested today at a meeting that I was at with [a Te Whatu Ora adviser] that outsourcing to Australia has been mentioned, and that [the adviser] is currently preparing a briefing paper for the minister,” Galvin wrote, in an email released under the Official Information Act (OIA).
“This is a very disruptive option and I think we should exhaust all local options for opening capacity in public and private before we consider that.”
It could be more appropriate to consider short-term contracts for specialists and nurses from Australia or other countries, Galvin suggested in the email.
Flying patients to Australia would have echoed past crises, including in the 2000s when a shortage of radiation therapists led to dozens of cancer patients being sent across the Tasman.
However, the briefing was never produced.
“It was agreed by clinical and senior leaders that the most appropriate way to manage wait lists was through services within New Zealand. Subsequently, no further consideration was made to having New Zealand cardiac patients treated overseas,” a Te Whatu Ora spokesperson said.
Current wait list information for each hospital could not be provided within the Herald’s week-long deadline. However, the spokesperson said delays were being addressed by sending some patients to private providers, and having the five public hospitals work together.
“We continue to monitor waiting lists and maintain contact with patients to ensure, if necessary, their condition is reprioritised or if there is a change in urgency. Patients requiring critical and urgent cardiac treatment can be assured they will be prioritised in accordance with their acuity.”
Health Minister Dr Ayesha Verrall said significant progress is being made across the health system to clear wait lists that hit record levels after Covid-19 lockdowns and disruption.
“We are on track to have zero people waiting more than a year for non-orthopaedic surgeries and by July 2024 it will be down to no one waiting for more than four months.”
However, National health spokesman Dr Shane Reti said he had been contacted by concerned hospital workers, and in the past 12 months there had been a big rise in people waiting too long for a first appointment with a specialist, particularly for cardiology.
In March a front-page Herald story revealed Waikato Hospital was sending patients to Auckland because nearly 80 people on its cardiac surgery wait lists were overdue, including those too sick to leave hospital.
The hospital was also investigating an “unexpected death”, after a patient died while on the cardiac surgical wait list in October last year. They should have had surgery within 90 days, but had been waiting 115 days.
After that reporting, the Herald on March 27 lodged an OIA for related documents.
Generally, public sector agencies must respond in 20 working days, although extensions are usual. Te Whatu Ora released the information only this month - after 109 working days and a Herald threat to complain to the Ombudsman.
In a cover letter, it said an ageing population, “pressures exacerbated by Covid-19″ and workforce shortages “has led to many patients waiting longer than they should”.
“All options are on the table and being investigated including using any available private cardiac surgery capacity and collaborating across the cardiac network.”
There is no “quick fix”, Te Whatu Ora wrote, because cardiothoracic surgery often requires patients to recover in an intensive care unit, and beds are limited.
“We know there is a problem and people who need this kind of surgery have a greater risk of deteriorating while they wait, which is why we are exploring all the options we can to improve access for these patients.”
People accepted for heart surgery are put in “urgency bands”.
The most urgent should be treated within 72 hours, “Band 2″ within 10 days, “Band 3″ between 11-30 days, and the least urgent, “Band 4″, within 90 days.
Te Whatu Ora provided the latest figures for Waikato, as at September 3. Almost 78 per cent of people in Bands 2-4 were overdue (66 patients).
Twenty-one out of a total of 25 patients in Band 2 were delayed beyond the target of 10 days.
Seventeen out of 21 patients in Band 3 were overdue, as were 28 of 39 of people in Band 4.
Inpatient numbers (the sickest patients) at Waikato have halved since December, Te Whatu Ora said.
“Wait lists begin from time of patient acceptance by a specialist, rather than the point where a patient is considered ready for procedure, eg all workups completed, scans done and reported on, pre-surgery health checks completed and any concerns addressed.”
Minutes from the national cardiac working group reveal other hospitals have been under significant pressure.
“The national push to do cardiac and thoracic cases of lower priority is at odds with the day-to-day reality. When access to beds in the hospital let alone ICU is a struggle, do stable cardiac cases trump ENT [ear, nose and throat], general, gynaecology patients?” Canterbury’s representative asked in December.
In February, Canterbury reported being “under extreme pressure”, with shortages of ICU and hospital beds, and anaesthetic technicians.
Waikato in December told the national working group that efforts were under way to check on waiting heart patients, although it was “currently relying on patients to contact [the] district if condition changes.”
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Nicholas Jones is an investigative reporter at the New Zealand Herald. He won the best individual investigation and best social issues reporter categories at the 2023 Voyager Media Awards.
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