KEY POINTS:
The number of heart operations in Auckland has collapsed by a fifth since the nation's leading cardiac hospital shifted premises.
New Zealand's comparatively low rate of state-funded bypass and valve surgery, compared with other developed countries, contributes to what specialists have called New Zealanders' "dramatic" 35 per cent greater chance than Australians of dying within eight years of being diagnosed with cardiovascular disease.
In Auckland, including Northland, the number of state-funded bypass operations - mainly at Auckland City Hospital - fell from 641 in 2002/3, to 462 the following year. On provisional statistics, the figure stood at 454 in the last financial year, according to a leaked draft Ministry of Health report on a national review of cardiac surgery.
The report indicates the country should aim for an annual adult intervention rate for bypass and valve surgery of 74 per 100,000 population, greater than the rate in Auckland before its collapse in 2003.
An Auckland District Health Board paper for a committee meeting today attributes the fall primarily to ongoing difficulties hiring and keeping enough nurses for the cardiothoracic and vascular intensive care unit (ICU) after cardiac services shifted to the new hospital from Green Lane Hospital in December 2003
The paper also blames a temporary collapse of "surgeon confidence" at the new hospital because of initial problems with the clinical computer systems and the sterilisation of surgical instruments.
"Surgeons could not be guaranteed a consistent supply or acceptable standard of instrumentation available in the operating theatres, resulting in limited operating for several months - urgent and emergency cases only."
Because of low patient throughput, the ICU's nurses were often redeployed elsewhere, leading many of these specialised staff, in short supply internationally, to leave.
This compounded an existing shortage that had resulted from separating out head and neck patients, and children's heart surgery, and adding vascular patients, whose average hospital stays are longer.
Currently, the cardiothoracic and vascular ICU has permission to employ 70 fulltime equivalent nurses, but has 22 vacancies.
"That's forecast to improve by December with appointments coming on," the board's acting chief medical officer, Dr Margaret Wilsher, said yesterday. She agreed it was a high number of vacancies, but said it had remained stable for three years.
The board paper shows annual turnover between 34 per cent and 13 per cent since 2003.
Wellington's Capital & Coast health board is sending some patients to Australia for heart surgery, but Dr Wilsher said Auckland had decided against this as it was very disruptive for patients and their families, and it could contract out some operations to the private Mercy Hospital in Auckland.
She said Auckland City Hospital aimed to increase cardiac surgery volumes and reduce waiting times.
Health Minister David Cunliffe told the House the ministry was implementing a plan to improve cardiac surgery rates.
National's health spokesman, Tony Ryall, said that the Government was acting five years too late.
Surgical decline:
Access to state-funded adult heart surgery - coronary artery bypass graft and valve replacement:
Auckland-Northland, 2002/3: 70 operations per 100,000 population.
Projected 2007/8 rate: 55 per 100,000.
National rate, 2002/3: 63 per 100,000.
Projected national rate, 2007/8: 54 per 100,000.
Privately funded surgery is not included in the figures and is thought to account for an extra 25 per cent.
Source: draft Ministry of Health report.
