1800 patients dumped on the quiet

At least 1800 patients referred to specialists in South Auckland have been quietly rejected in the past year as they are not sick or disabled enough, even for an assessment, under the public hospital rationing system.

When they were sent back to the care of their GP - a daily occurrence for their district health board - there was none of the controversy that erupted last week when the Hawke's Bay board dumped 1800 patients all at once off its specialists' waiting lists.

The Counties Manukau board has rejected low-priority patients in this low-profile way for at least 18 months after a "tidy-up" of most waiting lists.

Some specialists say the Hawke's Bay move marks another low point in elective services and that far more money and staff are needed.

A heart specialist said cardiac surgery patients now had to be sicker to get treatment. "They are waiting longer, having heart attacks. If we had operated earlier the operations would not have been so complex and they would not have stayed as long in hospital."

But in orthopaedics, where the Government is spending up to $70 million a year extra to double the number of hip and knee replacements, one surgeon said elective surgery had improved greatly, after struggling.

Hawke's Bay's empty-out follows a Health Ministry warning to six health boards, including Auckland, Hawke's Bay and Waikato, over compliance with waiting list reporting rules.

The Opposition and groups representing senior doctors and the elderly condemned Hawke's Bay's removal of the patients, highlighting a potential false economy: Some patients could become sicker while waiting and be more expensive to treat.

The board is implementing Government policy on elective services, a system introduced by National a decade ago and developed under Labour, which aims to treat the sickest first. Those with less serious conditions are weeded out and the access bar has been raised in some areas.

The Hawke's Bay patients were judged to be of low clinical priority. Half were on the waiting list more than six months, in breach of Government policy.

Board chief executive Chris Clarke said some might be referred straight back to a specialist by their GP.

He blamed the move on an unprecedented increase in demand for assessment by a specialist, driven by a growing and ageing population and the region's higher rates of chronic illness than other areas.

The inability to meet the demand was despite increasing staff and bed numbers, performing more surgery than before and assessing hundreds more patients than provided for in the budget, he said.

"We simply can't provide care to everyone who is referred to us ... Prioritising or rationing, to ensure those in the greatest need receive care, is the reality of today's health system."

Thousands of patients in recent years have similarly been pushed off waiting lists by other health boards, to provide what bureaucrats refer to as greater "clarity" and "honesty" about who will and won't be treated.

The Counties Manukau board's surgical services manager, Chris Fleming, said it had been sending people back to GP care regularly, rather than all at once, for two years.

Asked if it had denied access to a similar number to Hawke's Bay in the past year, he said, "Yes, we have, but relative to scale. We are three to four times the size of Hawke's Bay.

"For patients on the in-patient waiting list, we probably have sent something like that sort of number back over the last 12 months."

Hawke's Bay seemed to be doing what Counties had done 18 months ago - "tidy up" its waiting list.

Some 3200 patients at the Auckland DHB, as at January, had been waiting longer than six months for a first specialist assessment - more than 1000 of whom, the board points out, were from other health districts.

Its attempts to stem this overflow include having GP liaison officers check that patients did need to see a specialist.

Plagued by a reduced number of heart-artery procedures, Auckland is planning to put some heart patients, whom surgeons say need treatment, on its "active review" list.

National says that because of inefficiency, elective surgery is in crisis, despite the $3.4 billion increase in the health budget since Labour took office.

Health Minister Pete Hodgson said it was "unacceptable" of Hawke's Bay to let its list become so big, unfairly raising patients' expectations by promising more than it could deliver.

He says elective surgery has increased by 12.6 per cent since 2000 - when counted in 2005 by patient numbers weighted for case complexity - but the actual number of patients had risen by just 1 per cent and was fewer than in some intervening years.

He also suggests more elective work is being done in outpatient clinics - hospital managers agree - but collection of national data on this will not start until July.

Senior doctors' union executive director Ian Powell said the rapid rise in referrals to Hawke's Bay specialists might, ironically, indicate the success of the Government's increased spending on primary healthcare - more patients seeing GPs, more illness detected, more referrals.

"The problem, however, is that our public hospitals are not adequately resourced to meet this increased demand."