Auckland DHB will test ways of prioritising Māori and Pacific patients to "substantively cut waiting times" for some surgeries - including with algorithms and "care navigator" roles.
Documents lift the lid on the overhaul, which comes after a review of patient feedback highlighted problems including poor communication, late rescheduling of appointments, expensive car parking and food and perceived disrespect - one parent was horrified after their 10-year-old was asked if she was pregnant.
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"As Auckland DHB restarted planned care after Covid-19 restrictions, our objective was to focus on equity. Evidence suggests that in times of resource constraint, inequities will develop as services are prioritised and redirected," senior managers wrote in a report produced this month.
"We need to fully understand the patient journey...patients currently sit on the surgical wait list of the 'suspend list' without identified actions to support them through the next step of their pathway."
Similar work is happening around the country. Capital & Coast and Hutt Valley DHBs have confirmed Māori and Pacific ethnicity will be used to help rank patients once they're already within a priority band, along with clinical urgency and wait time.
Eight other DHBs are considering or have left the door open to similar changes, to be permanent or while surgery backlogs are cleared after Covid restrictions.
Auckland DHB will set-up Māori and Pacific clinical leadership/advisory groups, hire "care navigators" to manage Māori and Pacific patients through the system and ensure their care isn't unnecessarily delayed, and test "different approaches to applying an equity adjuster to the current surgical waitlist".
"Service by service analysis by ethnicity is required to understand the whole pathway for patients. Nuanced approaches are being delivered to both identify where inequity exists and address barriers to care," the June report explains.
"The objective of the fast pathway is to substantively cut the time that Māori and Pacific patients [are] currently on the surgical wait list and learn an approach for new pathways as they are added."
The DHB wants to better understand what might delay a patient from becoming sick to having surgery, and look at more advanced options including an algorithm with an "augmented equity component". The urology service is currently looking at how this might be used.
The issue could be vexed, the report noted, and it was important to intervene at the right time. That wouldn't always be when patients are waiting for surgery - the biggest problem in cancer care was delayed diagnosis, for example.
"We must put the effort into primary care access and earlier referral, consideration of ethnicity and clinical risk of cancer at the time we grade the FSA [first specialist assessment] and at access to diagnostics at earlier time points if we are seriously going to improve cancer inequities."
Another ADHB "equity sprint" document from September looked at cardiovascular, surgical and women's health services and found evidence of disparities for Māori and Pacific patients, from first appointment to surgery.
A review of Māori and Pacific patient feedback found problems including breaching Tikanga best practice - one family was having karakia and a doctor walked in and carried on talking - and rescheduling appointments late and without notice or acknowledgement of patients having taken time off work and travelled.
In one instance a 10-year-old was asked if she could be pregnant, in front of her "horrified" parent. Another patient was upset after a doctor "just pulled up my clothes roughly and revealed me like a piece of meat to all the students".
"Mother and father of patient believe their rights were breached, there was evident racial discrimination, racial profiling - their consent wasn't given prior to their baby having an x-ray," other feedback recorded.
Language barriers and poor communication was an issue, with some patients feeling "fobbed off" or belittled.
The high cost of car parking and hospital food was raised. A single mother wished she could get a meal too, "rather than needing to leave my sick child to go across the main hospital for food and hope to get back before my baby woke and realised I wasn't there".
Auckland DHB chair Pat Snedden is strongly supportive of the equity work but a minority of elected members oppose prioritising Māori and Pacific patients. The issue will be debated at the next board meeting.
A number of studies and reports show Māori and Pacific people are less likely to be referred or accepted for treatment in the first place, and once in the system generally get less treatment.
The equity work at some DHBs comes amid controversy over the release of a "once-in-a-generation" report into the health sector, which recommended a new Māori Health Authority.
Most of the Health and Disability System Review's panellists and its Māori expert advisers said the proposed structure risked the authority being an advisory group only, and put forward an alternative plan with beefed-up powers.
Health Minister David Clark has said legislation to create the authority will be a job for the next government. This week the Royal Australasian College of Physicians (RACP) added its support for the alternative model.
"On average, Māori will die seven years earlier than Pākehā," said Dr George Laking, the college's NZ president. "If the Māori Health Authority is not established with the teeth to drive the systemic change needed, this is an admission by the Crown that this life expectancy gap is not only tolerated, it is accepted as an inevitability."