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'Better' is not good enough say surgeons

For Immediate Release: 3 May 2006

‘Better’ is not good enough say surgeons

Health Minister Pete Hodgson’s defense of the government’s system of prioritising elective surgery is a mixture of maximising the good, and minimising the bad. “It fails to honestly address the complex issues at hand,” says Chairman of the National Board of the Royal Australasian College of Surgeons (RACS) Murray Pfeifer.

Dr Pfeifer says “there are not that many good points” to maximize. “The twelve per cent increase in case-weighted elective surgery discharges, has been largely offset with something approaching eight percent of all referrals denied even a first specialist assessment.

“This may not be a crisis to the Minister or to the Government, but I can assure him it is certainly a crisis for the more than 8,000 people culled from the waiting lists over the past nine months.

“The 50% increase in health budget since 1999, has been seriously eroded by increased costs. A substantial proportion of that money has been diverted away from clinical care. Much of the increased funding has been pumped into areas other than elective surgical services, and some of the money was targeted elsewhere in advance.

“The Minister’s assertion that only 1.5 per cent of health funding is spent on bureaucrats in the Ministry of Health does not include the small army of staff in most hospitals who spend every day sitting in their offices writing, disseminating and filing required government reports.

“The result is the widening gap of unmet surgical needs,” says Murray Pfeifer.

“Better is not good enough,” he says. “Improvements in the primary health care sector; in the acute secondary services; and in the care of people who have been injured are, by and large, excellent. We cannot say the same for elective surgical services in general. Even services, which are at present considered to be satisfactory, are to some degree at risk.

“Sending people referred to surgeons or specialists back to their GPs without even an assessment after a six-month wait is clearly not a good thing, as the Minister seems to suggest. It is risky to the patient, wasteful of time and resources, puts unnecessary additional pressure on the Primary Health System, and is insulting to the General Practitioner.

“New Zealand GPs are well-trained. They refer patients to specialists based on that training and years of experience. What GP would sit on a problematic breast lump without a specialist opinion? GPs don’t send patients to specialists for trivial reasons. If a patient is sent, they deserve to be seen.

“Suggesting, as the Minister does, that inaccurate prioritisation is better than no prioritization is not sufficient. Inaccurate prioritisation may even perpetuate the problem. Research has shown that there is only limited consistency between different surgeons in the same specialty, or even between repeat assessments by the same surgeon. No effective system has been devised to compare prioritisation between surgical specialties.

“We need to get ahead of the chronic disease burden - in the Secondary Sector as well as the Primary Sector. Early surgical attention to conditions such as varicose veins, hernia repair, and tonsillitis saves time, money, resources, and future critical surgery as well as long-term suffering for the patient.

“The issues around the management of elective surgery in this country are very complex. Quite clearly, the system is failing, and indeed, in a state of crisis. Available resources are arguably under-utilised, and there is insufficient funding. It is imperative that Government moves to establish elective surgical services that more closely meet the needs of New Zealanders.

“The Royal Australasian College of Surgeons calls upon the government to urgently establish a review of elective surgical services to address these issues. It is our view that this review should have very substantial clinician input and the College would be pleased to join with the Ministry and DHBs in order to find the solutions that are so desperately needed,” says Dr Murray Pfeifer.


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