A district health board has been putting patients on a "suspended" waiting list for surgery until it can fit them in within the Government's new target of four months, a senior manager's memo indicates.
The existence of Waitemata DHB's suspended list is revealed in a memo headed "An impossible situation", which has been obtained by the Weekend Herald.
Dr John Cullen, the director of the elective surgery hospital in Takapuna, told surgeons in the memo that the DHB is not adequately funded for the increasing number of patients needing elective surgery.
"Competing demands are making the management of both elective and acute surgery increasingly difficult ... ," Dr Cullen said in the memo, an overview of the issues which he later copied to chief executive Dale Bramley.
"Too many acute presentations cannot be managed without cancellation of elective surgery patients. Elective surgery patients cannot be cancelled because of ... compliance [with Ministry of Health targets]."
In January, the Government reduced the maximum waiting time to four months, from five, for patients offered elective surgery by DHBs. The ministry can penalise DHBs which repeatedly fail the targets by more than a small number of patients by withholding funding, more than $1 million a month for the larger boards.
Dr Cullen warned in his covering email to Dr Bramley of adverse publicity over plans last month to send some wait-listed patients back to the care of their GPs. He said the "threshold" for access to elective surgery - how disabled or sick people have to be to get onto a waiting list - had been increased, which increased risks for patients.
The memo said: "Currently, in addition to a raised threshold, the situation is controlled by the use of a 'suspended list' where patients who have had their FSA [first specialist assessment] and a booking form for surgery completed are held and not entered into the system until they can be managed within the four-month time frame.
"This can only be a temporary solution as if not, with time, this list will increase and management will be even more difficult."
Labour health spokeswoman Annette King said: "That is such a rort." But the DHB's acting chief executive, Andrew Brant, in a statement to the Weekend Herald yesterday, rejected the memo's "suspended list" definition.
"The 'suspend' list is not a hidden list of patients. These are people who require further diagnostic assessment, such as an MRI, before they can be confirmed and listed for surgery." At April 7, the list contained 341 patients.
Dr Brant said no patients who had been given certainty of treatment this year had been returned to the care of their GP and the DHB had met the treatment time requirements for elective surgery. At the end of March, only 14 patients - within the number permitted by the Health Ministry - had been waiting longer than four months for surgery.
"Waitemata DHB is performing more elective surgery than ever - volumes are up more than 41 per cent from 2010 to 2014."
Following the statement, Dr Cullen told the Weekend Herald he had not expressed himself accurately in the memo. He agreed with Dr Brant's statement and there was "no inappropriate use of the suspended list" at Waitemata.
What he had meant to say was that he had heard that other DHBs used the suspended list in the way he wrote.
When asked which DHBs did this, he said he did not know - it was hearsay.
Dr Cullen also said there had been no universal increase in Waitemata's access threshold, only normal fluctuations influenced by varying patient numbers.
Ms King said the the memo showed how desperate DHBs were to comply with Government targets and she believed other target-related rorts occurred.
"They will do whatever they have to, to be able to perform to the Government's measure. This [memo] is admitting that this is how they are hitting those targets."
However, Health Minister Jonathan Coleman backed the DHB's statement, saying: "There is no manipulation of the system at Waitemata DHB."
Grey Power president Terry King said the suspended list as described by the memo was "dishonest", "blatant manipulation" and contrary to the principle of transparency.
Ian Powell, of the Association of Salaried Medical Specialists, said "stopping the clock ticking" to achieve the target amounted to providing misleading data - but for understandable reasons because of the penalties.
"The Government's expectations are higher than the level of resources necessary to do the job."