Seeking Support For National Survey Of Unmet Elective Surgical Need: Open Letter To NZ Rich List

Sir/Madam,

Our public health system is in crisis mode. Managers of the nation’s public hospitals are operating under severe financial constraints, which are centrally controlled without appropriate direction, leaving the workforce in a state of ‘learned helplessness’. Dedicated staff at the coalface are at their wits’ end. Their initiative is strangled and their morale at an all-time low.

When the people of Aotearoa New Zealand require hospital level care, they are often faced with unduly long waits for assessment and treatment, which make their conditions worse. A significant part of the reason for this is a lack of quality data on the size and nature of the unmet need for care. Without measuring something it is impossible to manage it adequately. What little data are available show that healthcare need, delivery, and survival rates are much worse for Māori and Pasifika people and for those living in poverty.

This is not a new problem. We’ve been denying hundreds of thousands of New Zealanders timely access to public hospital waiting lists since the 1990s. These patients have effectively been treated as “non-people” who are denied even first assessments, shunted back to the care of their over-burdened GPs and primary health care services, with many left undiagnosed and untreated despite suffering life-limiting and life-threatening disease. This is a national disgrace.

Where and how do we even start to fix this huge problem? And why are we directly appealing to you for help?

We, the below-signed list of experienced New Zealand senior healthcare workers and academic researchers, believe that the first step to any recovery from this dire situation lies in defining the actual nature and size of the problem at hand.

Unlike many countries in Europe, North America and even Africa, New Zealand has never actually measured or sought to define the levels and extent of unmet need in our secondary (hospital) elective (non-urgent) health system. Successive governments have made no commitment to getting this body of work done, despite repeated entreaties from expert clinicians and academics. Without these data, management of the problem is impossible, and the present cycle of poorly directed measures will continue.

Our group wishes to remedy this. We want to carry out a national population survey of unmet secondary elective healthcare need, to expose how many people are languishing on waiting lists or remaining untreated with or without constant GP care. Examples include: urgent colonoscopy to detect bowel cancer; a tubal ligation to support their reproductive rights; cataract surgery or mental healthcare to allow them to work and support their whānau.

We have put together an expert nationwide team to carry out this vital survey, based on a small pilot study we carried out in 2016, and published in the New Zealand Medical Journal.

In the years since this pilot study was published, two subsequent Ministers of Health indicated their commitment to ensuring that this nationwide unmet need would be measured. However, these requests were not followed through by officials of the Ministry of Health or the Health Research Council.

We are keen and ready to carry out this body of work and could complete the survey in a matter of months. It would canvass a baseline national sample of 10,000 participants, with an additional oversampling of 2,000 Māori and 2,000 Pasifika peoples. We have sought costing quotes from survey companies experienced in such work. One quote has come in at approximately $1.3 million dollars.

Results from this proposed national survey of unmet secondary elective healthcare need would be invaluable. They would deliver, for the first time, a strong foundation upon which a Te Whatu Ora recovery plan for our entire public secondary elective healthcare system could be soundly based.

You are among a group of around 100 prosperous New Zealanders who penned an open letter to the government a few months ago, selflessly indicating your wish to pay more tax to fund better social services for the population of this country. Please help us take this first step in fixing our broken health system, by offering your financial support to ensure this vital survey is undertaken and completed.

Nā mātou noa, nā

Phil Bagshaw CNZM, FRCS, FRACS

Chair, Canterbury Charity Hospital Trust.

Andrew Hornblow CNZM, MA, Dip.Clin.Psych, PhD, FNZPsS.

Emeritus Professor, University of Otago.

Bridget Robson BA, DPH

Associate Professor | Associate Dean Māori

University of Otago, Wellington.

Sue Bagshaw DNZM FAChSHM FRNZCGP (hon)

Adolescent Health Physician, Trustee Charity Hospital Trust.

Professor Robin Gauld

Co-Director, Centre for Health Systems and Technology; Professor, Dunedin School of Medicine and Otago Business School.

John D Potter MBBS PhD
Professor, Research Centre for Hauora and Health, Massey University, Wellington.

M Gary Nicholls MBChB FRACP FRCP (London, Glasgow, Edinburgh) FNZMA MD

Professor Emeritus, University of Otago-Christchurch.

Professor Chris Frampton BSc hons, PhD

Department of Medicine, University of Otago-Christchurch.

Professor Frank Frizelle ONZM, MBChB, MMedSci, FRACS, FACS, FASCRS, FNZMA, FRCSI(hon), FRCSEd(hon). Clinical Director of General Surgery Canterbury and West Coast, Editor in Chief NZMJ.

Dr Ben Hudson MBBS, MRCGP, FRNZCGP

Head of the Department of General Practice, University of Otago-Christchurch.

Les Toop MBChB, MD, MRCGP, DFRNZCGP

Professor Emeritus, University of Otago- Christchurch.

Dr. med. (Univ. Kiel) Frank Kueppers

Consultant Urologist, Christchurch Public Hospital, Canterbury Urology Research Trust.

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