Hospital backlogs have worsened to nearly 67,000 people overdue for treatment or a specialist appointment - and health authorities warn, “marked improvements will take some time”.
In May last year Health Minister Andrew Little announced a “high-powered” task force and national plan to clear backlogs.
However, figures obtained by the Herald On Sunday reveal the situation has since deteriorated.
The number of people waiting longer than four months for either treatment or a first specialist appointment has reached 66,837, the latest figures to the end of November show.
That’s an increase of 4,131 from the March 2022 figures Little cited when announcing the plan to clear wait lists. Orthopaedics, ear, nose and throat, and general surgery have the biggest backlogs.
Little says recent outbreaks of Covid-19 are to blame, and the Government has told Te Whatu Ora - Health NZ that addressing the backlog “remains a top priority”.
Fionnagh Dougan, Te Whatu Ora’s national director for hospital and specialist services, said the plan to bring down wait lists was supported by nearly $283m in Budget 2020, to be used over three years.
“Marked improvements are going to take some time as new systems and processes are bedded in… Covid-19 continues to stretch capacity for our own healthcare system and we continue to experience pressure due to sustained high levels of acute demand.
“This has also impacted progress on planned care activity and disrupted the volumes of elective surgery planned. Increased staff sickness and absences, combined with continued pressure on hospitals where people needing urgent care must be prioritised has meant less planned care has been delivered since October last year.”
When surgeries and appointment targets aren’t met, including because of past lockdowns, overdue cases “tip over into the next month, creating bulges in waitlists that are occurring at a higher rate than treatment can keep pace with. This trend is expected to continue in the coming months”.
Decisions to delay care were made carefully by clinical teams, and “not taken lightly”, Dougan said, and patients needing acute and semi-urgent treatment are moved up the queue.
Little said the spread of Covid over October to November last year increased hospitalisations, including in intensive care, and this reduced the completion of planned complex surgeries and procedures.
People waiting longest were being prioritised, in particular Māori and Pasifika. The number waiting longer than 12 months for assessment had fallen by more than 1900 since last July, Little said.
“Though there was an increase of Covid cases towards the end of 2022, the health system delivered 382,814 planned care interventions over the period of July to November in 2022.”
National Party health spokesperson, Dr Shane Reti, said wait lists were the worst they had ever been, and likely to lengthen through 2023. Some regions were worse than others, he said.
“The taskforce was a ‘high-powered’ taskforce - that was the narrative - and we have been watching it every single month, and seeing no substantive change on this at all.”
He said policy decisions had made things worse, including the government in December adding not already eligible nurses, midwives and specialist doctors to the straight-to-residency pathway.
That had come far too late, Reti said, and put New Zealand well behind other countries who rolled out the welcome mat for healthcare workers, who are in even greater demand since the pandemic.
“In health, so many of the roads come back to workforce… the international nurses who may have been interested have now gone to Australia, Canada.”
Reti said he was frequently contacted by people overdue treatment - including those losing sight - and waiting too long brought anxiety, stress and often worsening health.
Particularly sad were the cases of people whose condition meant they gained weight while waiting, and then were told they were too risky for a general anesthetic.
“I get all the emails… ‘Shane, I’ve been on a waiting list for eight months for my hip. Because it was so painful I couldn’t sleep at night, and because I couldn’t walk anymore I put on weight. And because I put on weight I’m no longer a suitable anesthetic risk to get my hip done’.
“They were promised [treatment within] four months. That is the promise we make to people. And yet they slowly see their chances of ever getting a hip or knee done, disappearing.”
Sarah Dalton, executive director of the doctors and dentists union the Association of Salaried Medical Specialists (ASMS), said the country was short of thousands of healthcare workers.
That shortage comes as demand increases, because of an aging population that is also sickening with chronic conditions like diabetes.
“I am not surprised [by growing wait lists]... I think Rob Campbell [Te Whatu Ora chair] himself has said it’s going to get worse before it gets better. And he is right.”
The long wait lists will be a focus in this election year, and represent a potential headache for new Prime Minister Chris Hipkins. However, Dalton said the problem was so complex that it needed long-term, cross-party planning and action - particularly to solve the staffing crisis.
“What people are trying to do is unravel a really tightly knotted ball of string. And every time they pull a piece, they find another problem that also needs to be unravelled. Because we just haven’t looked at this properly for quite a long period of time.”
The wait list taskforce was led by surgeon and chief medical officer at Counties Manukau Health, Andrew Connolly, who Little described as a “health service fix-it man”.
Other members included Cancer Control Agency chief executive Diana Sarfati, who was subsequently named as Dr Ashley Bloomfield’s permanent replacement as director-general of health.
In his speech last May, Little said other countries like the United Kingdom experienced much worse increases in overdue patients because of pandemic disruption. However, a “business as usual” approach to clearing backlogs here could take between three to five years, he said.
“That is not in anyone’s best interest. It is my expectation that we can clear the backlog in considerably less time than that.”
The latest figures on wait lists to the end of November:
- 37,779 people waiting longer than four months for a first specialist appointment (35,942 in March 2022)
- 29,058 people waiting longer than four months for treatment (26,764 in March 2022)
Source: Te Whatu Ora, Health NZ