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HBDHB welcomes MOH involvement in electives

13 April 2006

HBDHB welcomes Ministry of Health involvement in electives

Hawke's Bay District Health Board chief executive, Chris Clarke, said he welcomed the involvement of Ministry of Health staff who would be working with the DHB to review its systems around elective services.

He said the DHB's Board took the issue of elective services very seriously. "Yesterday's Board decision to refer 1,800 people with lower clinical priority conditions back to their GPs, was a very difficult decision. Most of these people have already been waiting over six months, and we know this news will be a huge disappointment to them.

Chris Clarke said management of elective (non urgent) services was a complex issue. "It seems the more we do, and the better we are at providing care, the more referrals we get coming in," he said. "In a way we are victims of our own success. The public have high expectations of their public health system.

"Our staff continue to work incredibly hard to ensure as many Hawke's Bay people as possible who are referred to see a hospital specialist actually get to have an outpatient appointment.

"Anyone who has an urgent, or semi-urgent need is being seen in good time. It's the large proportion of people who are clinically prioritised as "routine' that we can't see at outpatients.

"At the heart of the problem is the fact we are getting more referrals in than we have the capacity to treat. On average we have been receiving 170 more new referrals each month from GPs wanting First Specialist Assessments for their patients, than we have the resources to treat. We simply can't provide care to everyone who is referred to us, and being on a waiting list is no guarantee of treatment.

Mr Clarke said a report released last year demonstrated that when compared to the rest of New Zealand, the HB population did not enjoy good health.

"We know our people have higher rates of chronic illness, than other New Zealanders, and this is one of the factors that has contributed to the high rates of referrals to specialists. We also have an ageing population, and older people tend to have higher health needs.

"In order to address the issue of ever-increasing demand and limited capacity, we have done a number of things to help clear the backlog and reduce the inflow of new referrals. These have been taking place over the past two years.

- additional outpatient clinics, both nurse-led and using locums

- booking and scheduling processes have been reviewed and updated to ensure efficient utilisation of outpatient resources

- HBDHB has worked with two GP liaison staff to ensure local GPs are aware of the referral guidelines and keep them up to date with which conditions are likely to be seen in the public system

- A central "triage' centre is being established to ensure consistency of prioritising referrals

"As a result of these initiatives 700 more Hawke's Bay people have had an appointment with a specialist than we had budgeted for," Chris Clarke said.

"In terms of people waiting for surgery, we have also make huge inroads in changing the way we work. Our clinicians, in particular have been outstanding. We have carried out more surgery than every before and our surgeons are changing the way they work to ensure we are as efficient as possible and the system ensures those in the greatest need receive treatment and care.

"We have a fantastic bunch of clinicians and managers, and I am very proud of the value set they operate from.

"In Hawke's Bay we have five orthopaedic surgeons, who up till now had all been assessing patients independently and "scoring' patients differently. They have recently agreed to a new process, whereby a physiotherapist will review all their patients, and re-score them to ensure those in the greatest need are seen first, and those whose need isn't so great are kept informed of their status. Being open to peer review and supportive of this new process is a huge step forward.

"It's these sorts of changes to work practices, and being honest with people and telling them what the public health system can and can't provide, that are vital to ensure we meet the Ministry of Health guidelines of treating people within a six-month time frame.

"Prioritising or rationing, to ensure those is the greatest need receive care is the reality of today's health system," Chris Clarke said


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