Heather Roy's Diary - May 12 2006
Heather Roy's Diary - May 12 2006
This week's guest columnist is Peter McCardle. A former Associate Health Minister, Peter is a now an elected member of the Hutt District Health Board. This article was originally published in The Dominion Post.
A year ago my Doctor rang. 'Your blood tests show you have had a heart attack. We are admitting you to the Emergency Department now'.
A quintuple bypass later, fit and dangerous, I am one of many wonderfully looked after by our public health system.
Today there are around 31,000 New Zealanders in our top surgical waiting list group called "Booked/Certainty". Mostly they are in near acute need, but while many will have to wait some months, they will get the surgery they need.
My concern is the second tier waiting list group, called "Active Review", 24,000 people who will not get the elective surgery they need-unless they get more seriously ill.
Active Review is the waiting list for the waiting list. People in it need an operation, but they are not quite seriously enough ill to join the top "Booked/Certainty" group. Our Hospitals simply don't have the capacity or resources to provide their operation.
These people must wait until either their condition deteriorates enough so they go up into the "Booked/Certainty" category- or if they don't deteriorate enough- after eighteen months the Ministry of Health now says they are supposed to be removed from the Active Review list.
Now here's the very serious problem.
The number of people needing to see a Specialist, and then needing an operation, is growing strongly every year. For simplicities sake, we could say that the numbers wanting surgery grew from 100,000 cases one year, to 110,000 the next.
But our public capacity to do these operations is growing more slowly- - in this example year say to 105,000 operations- in part because the complexity of the surgery needed by those in the top "Booked/ Certainty "group is intensifying each year.
Our population is aging and growing, as are our treatment options. Each year, several thousand more people need a Specialist assessment or elective surgery than can be delivered, than the previous year.
Health Boards are instructed to try and ensure no one waits for over six months. To achieve this and to control the three lists-First Specialist Assessment, Booked/Certainty and Active Review- while facing greater numbers each year, there are three measures Boards usually have to implement.
Firstly, they lift the points threshold at which a patient gets into the "Booked/Certainty" category. Instead of needing 70 points out of 100, it may be lifted to 72. This is needed not because the hard working surgeons, nurses and staff are doing less-it's because more and more people need operations-and more serious operations on average. So each few years you effectively have to be sicker to qualify to get into the "Booked/Certainty" category.
Secondly, the Ministry now says patients should only remain in "Active Review" if they are likely to deteriorate enough within eighteen months to qualify to go into "Booked/ Certainty". Many Health Boards have not been applying this guideline, and so there are some thousands in Active Review for over eighteen months. But that will change as Boards are pressured to meet the Ministry's and Governments goals.
The third strategy to reduce waiting is to narrow down entry into the waiting lists system in the first place-where the GP refers the patient to the Hospital specialist- called the First Specialist Assessment list. Hospitals are increasingly having to limit the number of GP referrals, because Hospitals cannot meet all GP requests for Specialist Assessments, and are now limiting inflows onto the list to the number it can see within six months. Hospital staff work with GPs to limit referrals. Failure to do this led to the Hawkes Bay situation, where the numbers waiting to see the Specialist got so large the hospital carried out a huge one off removal of 1,800 low priority patients from its FSA list.
So what to conclude.
Firstly; because we are living longer and new procedures are available- every year the number of people wanting a place on elective waiting lists grows faster than capacity.
Even with the increasing exclusions and removals outlined, there are around 120,000 waiting for a Specialist Assessment, and over 55,000 needing surgery.
Secondly, the public system is at full capacity. Let no-one tell you otherwise-the Doctors and Nurses we have are part not just of a profession-but a vocation. They are great. And Government has poured hundreds of extra millions-actually billions- into the health system. To meet all waiting list demand however would require not just hundreds more millions, but billions more to build extra theatres, hire staff, and create extra capacity. We are already over taxed-it is just not a practical option.
We must come up with new ways to help the 24,000 plus patients in Active Review or who have been sent back to their GP, who need surgery.
Our hospitals generally deliver well surgically for those who are acute or very sick. But they cannot for all those needing elective surgery, including those in Active Review.
We must find new ways to help these people, for each year it will only get worse. The status quo is not a long term option. Let's give elective patients greater hope by giving Health Boards freedom to try initiatives, such as subsidies to go private.