Scalpels out over elective surgery 'scores'

Denis Jury

The National Party claims that figures released by the Auckland District Health Board prove patients have to be sicker to qualify for elective surgery than five years ago.

The board disputes the claim, despite sending National a response to an official information request which shows the mean clinical priority access scores have, in most cases, risen during that time.

Its response also said: "The patients treated from the waiting list are sicker now, on average, than they were five years ago."

Board funding and planning officer Denis Jury, who signed the reply when filling in as acting chief executive, told the Herald further information explaining what the statement meant had been inadvertently left out of the letter.

The letter should have explained that the average priority scores of patients having procedures was higher only because refinements of the system had seen patients with low surgery needs weeded out of the queue.

But National health spokesman Tony Ryall, who sought the information, has dismissed the explanation as "just an excuse".

"What this is showing is that the number of points you need is getting higher and higher before you can get an operation. "When the means are going up, it means the people being operated on are getting sicker and sicker."

The figures show the mean score for adults having cardiothoracic surgery has risen from 33.5 in 2001 to 46.4 in 2005.

Mean adult general surgery scores have risen from 77.5 to 87.9 and orthopaedic scores from 75.4 to 81.2 over the same period.

There has also been a big jump in ophthalmology scores.

Dr Jury said, "The reason the average indicates a sicker level, if you like, is that proper thresholds are in place compared to five years ago and are being more rigorously enforced.

"Previously there was leakage of patients with quite a low need into elective surgery, so the overall average would have been lowered by those patients.

"Now, with thresholds and proper prioritisation procedures and ranking of patients, patients who are properly in need of surgery are now getting on to the list. So the average has increased.

"People who really need elective surgery are really getting it now, where previously they were often missing out."

Asked why "leakage" continued some years after the prioritisation thresholds were introduced, Dr Jury said the system had been consistently streamlined since 2001.

Overall the number of operations had remained "pretty much the same", he said. "Just as important as looking at elective surgery rates, the overall health of the population is really important.

"If you take a snapshot now of the health status of the Auckland District Health Board population, its health status is the highest in the country."

Mr Ryall said: "If they were making inroads into their waiting lists it would mean those points would either remain stable or be coming down.

"The [surgery] bar is going up. The money has not been going into the right areas."