Editorial: Health targets can miss their mark

Doctors at Waikato Hospital have raised disturbing allegations about the way the district health board makes its decisions. Photo / Christine Cornege

Editorial

Doctors at Waikato Hospital have raised disturbing allegations about the way the district health board makes its decisions. A group of 13 orthopaedic surgeons complained in an email to management that they had been blocked from doing follow-ups on patients, because the hospital needed to see more new cases instead. If it failed to do so, it would lose millions of dollars by missing a Government target, which requires patients to be seen by a specialist within four months of being referred by their GP.

The surgeons described the decision as "immoral, unethical and dangerous" and a cynical denial of patients' rights. They claimed it put their patients at risk and could even raise grounds for legal action against them as surgeons.

A later email from former surgical services business manager Chris Clarke - who has now
resigned in protest - claimed that the drive to see new patients meant that a 22-year-old woman had her surgery postponed three times, despite her surgeon warning that she could end up paralysed. The district health board acknowledges the woman's surgery was delayed twice but says the second time was as a result of the junior doctors' strike and she suffered no adverse consequences.

The board has also strongly denied that it was manipulating waiting lists to meet the Government-set target. It has described the instruction to stop follow-ups as a miscommunication, which surgeons took too literally.

However its own internal emails indicate that hitting the target was a top priority. In a series of revealing exchanges over its plans to cancel elective surgery to free up surgeons' time for appointments with new patients, the executive director of services, Brett Paradine, admits frankly to clinical director Stewart Hardy; "We'll still need to examine every possible option for different ways to get this month's outstanding FSAs (First Specialist Assessments) done... Where we are today is that for want of around three days of FSA clinics we risk losing a minimum of $2.723 million of revenue. We just have to find a way to avoid that."

Further emails from Clarke claim this was not an isolated incident. In his resignation letter to chief executive Nigel Murray, he says he has reluctantly put about 60 patients who met the threshold for surgery back on the waiting list and pushed 30 new FSA patients who were "sitting in the non reported waitlist of diagnostic review" forward onto the waiting list.

Clarke raises a host of other issues - including inadequate lighting and dangerously poor air conditioning in operating theatres - which should be taken seriously. It would be easy to portray his complaints as coming from a disgruntled ex-employee but the surgeons' email and several others show wider dissatisfaction with the hospital's decision-making process..

More importantly, they raise questions over the Government's widespread use of national targets, which may look valid but have perverse consequences. Just as the drive for higher NCEA pass rates has sidelined some students into worthless credits which lead nowhere, the well-intentioned goal of assessing more patients earlier could deprive those who need help most.