Independent committee finds booking system ethical

Media Release

1 February 2007

Independent committee finds booking system is ethically appropriate overall

The Ministry of Health has welcomed a report looking at ethical issues in elective services which, it says, endorses current Government policy.

The report by the National Ethics Advisory Committee did not find any ethical issues with the overall concept of the booking system, stating it had "potential ethical advantages" but said there were some areas that needed to be worked on.

"It is pleasing to receive such positive feedback,'' says Dr Ray Naden, clinical advisor to the elective services programme.

"The report confirms the booking system as a whole is ethically appropriate as are the principles of fairness, clarity and timeliness. It supports the prioritisation of patients on nationally consistent grounds and a patient's right to know whether and when, they will be offered a publicly funded elective service. At the same time it highlights some areas where we could do better and work is already underway to make those improvements.''

Among the issues NEAC suggested for further examination were timely access to a first specialist assessment (FSA), the allocation of resources between acute and elective services and the interface between the public and private systems. The committee has called for wider sector and public input on these issues.

"There is considerable opportunity for the sector to influence the development of the elective services policy. Public input is also very valuable and when change is planned the public are able to provide input through existing mechanisms such as consultation on the District Strategic Plan.''

The Ministry is working on measures to improve the interface between primary and secondary care to improve timely access to specialist assistance. Most DHBs have GP liaison staff who work with hospital specialists and GPs in the community to streamline processes and ensure appropriate patient referrals. Many DHBs are initiating changes in how and where they run their elective services. In some cases this might involve direct referral by a GP for diagnostic tests rather than waiting to see a specialist first, in other cases it may mean GPs receive advice about their patient's care over the phone from a specialist rather than the patient waiting for a face to face consultation.

The tensions that result from the priority of acute care over elective care are also highlighted in the report.

"We recognise this is an ongoing and difficult issue. Hospital based care is dominated by dealing with emergency (acute) cases and that can mean people promised elective surgery are forced to wait longer,'' says Dr Naden.

"A number of projects are underway to work towards reducing the negative impact of acute cases on elective surgery; these include the acute demand project, the theatre efficiency project and a report by the protecting electives volume working party on how to safeguard elective surgery resources,'' says Dr Naden.

Since the report Health Minister Pete Hodgson has announced an additional $200 million for elective services to treat an additional 10,000 people each year over the next four years.

Dr Naden says the Ministry will have further discussions with NEAC about their concerns around the relationship between the public and private systems.

"It's important to remember that whether people have a public or private first specialist assessment their access to public treatment is determined in the same way.''

The NEAC report acknowledges the booking system will always operate in an environment of limited resources and states that "NEAC considers it is a health professional responsibility to determine, on nationally consistent, fair and open grounds, which patients should be given priority to be offered services.''

The Ministry has been working with relevant professional bodies to develop national prioritisation tools. The work involves critically reviewing the criteria currently being used by specialists in making their prioritisation decisions about patients with the aim of making the criteria more explicit and nationally consistent.

ENDS

Background

The Acute Demand Project aims to identify the best ways of managing demand for acute care while minimising the impact on elective services. A working group of clinicians and managers from around the country, who are involved in managing acute care, will look at what improvements could be made to reduce the impact on elective services and offer potential solutions. A report is due to the Minister mid-year.

The Theatre Efficiency Project will look at barriers contributing to theatre inefficiency and identify potential solutions. The group is chaired by Dr David Galler, the principal medical advisor, Ministry of Health. Other members include surgeons and district health board representatives with experience in theatre management, process redesign, surgery, anaesthetics and nursing. A report is due to the Minister mid-year.

The Protecting Electives Volume Working Party report completed last year outlined the process for DHBs in terms of setting baselines and targets for increased delivery of elective surgery. The findings of the working party are being used to establish the parameters for spending the extra $200 million for elective procedures announced last year.

For a copy of the NEAC report go to: _www.newhealth.govt.nz/neac/

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