Hospital bosses are planning to clear huge backlogs of Kiwis needing elective procedures within 18 months of coronavirus restrictions easing.
The Ministry of Health recently wrote to the chairs and chief executives of the country's 20 DHBs about how private hospitals will help with that mammoth task.
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Electives are medical or surgical services that aren't required immediately. Some patients needing electives that can't be postponed for weeks, including for cancer and trauma injuries, are being sent private, but the majority - including hip replacements, cataract removal and endometriosis surgery - have been postponed.
Some public hospitals are at half capacity or less, and preparing for any surge in Covid-19 patients. Private hospitals have also cancelled electives to free-up resources, and some have shut the doors because the lockdown has meant business-as-usual cannot continue.
That's put them under great financial strain. Agreements between DHBs and private hospitals will include payment for each elective done, and also funding to ensure enough capacity and staff are available, in case the Covid-19 situation worsens. Such contracts aim for a "no profit, no loss" basis.
Whenever the restrictions ease, the ministry has told DHBs the private sector will be critical in helping treat the thousands of Kiwis who have had treatments deferred. The aim is to clear backlogs in an 18-month recovery period, that would take full effect once the country returns to level 2, level 1 and normal status.
Richard Whitney, president of the Private Surgical Hospitals Association, which represents 39 hospitals, said that would keep both public and private sectors extremely busy, "but we need to get back to pre-Covid times as quickly as we can".
Before the emergence of coronavirus, more than half the country's electives were done in private facilities.
"There will be a backlog from the public system, but also from the private system, given all elective private surgery has effectively stopped as well," Whitney said.
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"The majority of us are idle, other than some specific services like cancer therapies .. .we are in a holding pattern. And it is an experience that we have never had before."
The 18-month recovery phase could be interrupted if the alert levels go up and down, and some areas could face tougher restrictions for longer, depending on outbreaks.
Whitney, also chief executive of Mercy Hospital Dunedin, was involved in the agreement with Southern DHB, but hasn't seen those covering other areas.
"There will be variation. But I have no particular concern at this time that there will be any [funding] shortfalls."
The postponement of procedures can distress patients, some of whom are living in pain. Fertility treatments have been paused, and one cancer patient had a scan to check the size of tumours cancelled, and only rebooked after she complained.
Dr Chris Jackson, the Cancer Society's medical director, said DHBs, clinicians and the new cancer control agency were working through what can be done during the different alert levels. Patients could call the society's information line on 0800 226 237 for help and advice.
"More and more hospital work is now available. Treatments like chemotherapy and radiation were prioritised initially. Other essential work, including scans, are being rescheduled and reinstated," Jackson said.
"Patients up and down the country have been affected by these disruptions and have been incredibly understanding and patient while this work has been done."
The lockdown has hit other areas of the health system. Some GP clinics have stopped using locums or reduced their hours, because many patients are seen over an audio or video call.
The Royal New Zealand College of General Practitioners has been meeting with the ministry about support and expects a response this week. Some clinics have received lump sum payments to cover coronavirus-related costs, such as equipment for remote consultations, putting up protective screens around reception areas - even portacabins to do testing in.
Yesterday the Pharmacy Guild of NZ warned some pharmacies could close without Government assistance, because of reduced dispensing and retail sales.