Progress to clear overdue planned care backlogs has been slower than forecast for some services. Photo / 123rf.com
Nearly 30,000 New Zealanders are caught in delays for hospital treatment and Covid-19 recovery plans to get services back on track are lagging in some regions.
The alarming picture of the health system has emerged in a review by the Herald of recovery plans filed by all 20 DHBs, which identified dozens of services that were under severe stress even before the pandemic struck.
According to those documents, clinicians feared that those needing treatment could suffer serious consequences. One major DHB warned that delays in its ophthalmology service could result in people going blind.
The recovery plans were sent to the Ministry of Health last summer and estimated how quickly delays for planned care, including elective procedures, could be reduced.
Progress has been slower than anticipated for some services, the ministry confirmed to the Herald, but it wouldn't provide details about which services, in what areas.
Patients whose treatment was delayed during the first phase of the pandemic have since been treated, the ministry said. However, the system is so strained that new backlogs have since built up.
According to the ministry's latest figures, more than 15,700 people are currently waiting longer than four months - the maximum time someone should wait under official guidelines - for a first appointment with a specialist. Another 13,500 have been accepted for treatment, but are waiting longer than the four month target.
That's a reduction of nearly 14,000 patients (for both appointments and treatment) from when New Zealand emerged from level 2 last year. However, Jess Smaling, the ministry's associate deputy director-general, said progress had been slower than expected.
"Some services in some DHBs have not met their proposed reduction in waiting list numbers. This can be for several reasons, including increased demand, increased complexity of presentations, additional changes in Covid-19 alert levels, increased acute demand impacting planned care treatment, industrial action and workforce shortages."
Some waiting lists are expected to remain until 2023. The DHB recovery plans, lodged from August last year and released under the Official Information Act, reveal the stressed state of the health system.
Revelations include:
• People overdue for eye care reached into the thousands in some regions. Waikato DHB told the ministry its own delays "carries significant risk for patients of permanent deterioration of eyesight and potential blindness." The Herald understands most regions still have overdue patients, and wait lists are particularly bad in the Southern DHB.
• Diagnostic services including CT and MRIs couldn't match demand prior to Covid-19. Auckland DHB, for example, hasn't met targets for timely radiology care since 2017 and heart scans were "well in excess of what is clinically indicated" in greater Auckland and Northland.
• Also at Waikato, more than 770 people were waiting for longer than six months for orthopaedic surgery. And the DHB's maxillofacial surgical department, which performs procedures on the mouth, face, jaws and neck, was in a "critical" situation, prioritising acute and urgent cancer surgeries, with "very limited capability outside of this".
Sarah Dalton, executive director of the doctors' union, the Association of Salaried Medical Specialists, told the Herald the findings reflected a lack of action on long-standing problems, including staffing shortages, and the "parlous" state of hospital infrastructure.
"None of this is a quick fix. But people are paying for this with their health and wellbeing ... it is just shameful in a country like New Zealand that people might go blind for lack of timely care."
DHBs have sent patients to private hospitals to ease pressure. However, many of the recovery plans noted the private sector was busy clearing its own backlogs. Bay of Plenty DHB was concerned about the fees demanded by some private providers.
Another headache: not enough operating theatres. These were at capacity for the past 18 months, Bay of Plenty DHB warned, with urgent cases bumping planned operations down the list. Southern DHB noted it cost about twice as much to outsource patients, but "we have more surgeons than we can give theatre capacity to."
Northland DHB noted investment in infrastructure hadn't matched a big increase in its older population, with "small and cramped" buildings unable to take more patients, insufficient operating theatre capacity and "extremely outdated and limited inpatient capacity".
Recruitment of hard-to-find specialists worsened after Covid-19 shut borders.
Counties Manukau DHB said demand outstripped capacity in areas, including MRI scans, bariatric surgery, women's health - "there is a real gap for services for women with chronic conditions, prolapse, bleeding, pessaries, urodynamics and pelvic pain" - and chronic pain services, which receive double the referrals as five years ago, with no increase in clinical staff.
"Public dermatology in NZ is unsustainable on current projections," Counties' recovery plan stated. "The dermatology department needs to decline about 50 per cent (more than 1000 per year) of all outpatient referrals with the currently funded resource."
Help has been delivered or is on the way for some of the issues identified by DHBs. Budget 2020 allocated nearly $283 million over three years to specifically help address waiting lists, and 61 capital projects have been funded, including new equipment and theatre space. Billions more has been pledged for a wider upgrade of health facilities - Treasury has estimated about $14b will need to be invested over a decade.
A Waikato DHB spokesperson told the Herald measures including outsourcing, hiring more staff and using locums had reduced pressure in both ophthalmology and maxillofacial departments, and there were no recorded incidents of harm to patients. The recent cyber attack meant wait list information couldn't be provided.
At Auckland DHB, radiology wait times aren't meeting the ministry target to have 90 per cent of MRI referrals done within six weeks (about 82 per cent are), and 95 per cent of CT scans done in the same time period (81 per cent are). The wait time for an echocardiogram (heart ultrasound) is around 157 days.
A DHB spokesperson said demand had been very high, requiring more outsourcing to private providers, extra clinics and calling in casual staff. Overseas workers can't be easily hired because of closed borders, and training for some technical roles isn't available in New Zealand.
The Herald's previous reporting has exposed how Covid-19 aggravated weaknesses in the health system, including wait lists for tooth extraction surgery that left more than 1700 Auckland children living in debilitating pain, and backlogs for diabetic retinal screening in West Auckland that led to concern about people at risk of losing vision unnecessarily.
When a patient is accepted for either a first appointment with a specialist or treatment that should happen within four months. The total number of patients waiting beyond four months were:
• May 2021 (the latest figures available): more than 15,700 waiting for a first specialist appointment, and 13,500 for treatment.
• May 2020 (the month NZ moved down to alert level 2): more than 26,300 waiting for a first specialist appointment, and 16,600 for treatment.
• February 2020 (the last month not impacted by Covid-19): 14,136 waiting for a first specialist appointment, and 9,614 for treatment.
Source: Ministry of Health
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