Wait times for surgical procedures have worsened during Covid disruption.Photo / 123Rf
Nearly half a million Kiwis are believed to be receiving hospital care below the national standard due to a staggering backlog of planned care.
Thousands of patients in Auckland are waiting longer than the Ministry of Health's required four-month timeframe for specialist appointments and treatment, District Health Board (DHB) data from June and July shows.
The growing "unacceptable" wait times across the country are sparking fears that patients are being put at further risk, and the problem has become significantly worse due to Covid-19.
The longer patients waited for treatment, the worse their outcome would likely be and it could mean they end up needing urgent care, Association of Salaried Medical Specialists (ASMS) national president Murray Barclay said.
One Lower Hutt mum spoken to by the Herald has been waiting almost all year for surgery to treat her severely dislocated right wrist and mesh-infected left wrist.
"I'm in chronic pain, I can't work, I can't drive, I can't go horse-riding or dancing like I used to and it's like no one cares," Lisa Sullivan, 49, told the Herald. "I've just been put in the too hard basket.
"I'm scared, I'm struggling to cope. There's thousands of people like me waiting for care and it's just not right, it's not New Zealand."
The Ministry of Health's expectation is that no patients wait longer than four months for a first specialist appointment (FSA) and no one is left untreated after four months.
Health Minister Chris Hipkins acknowledged wait times for planned surgical procedures, specialist appointments and radiology scans were "not where we want them to be" and had worsened due to Covid-19 disruption.
But he remained confident in DHBs' ability to reduce the backlog.
Barclay - who is also a practising clinical pharmacologist and gastroenterologist - said the backlog was a "huge concern", especially after a 2019 ASMS reportrevealed there were 430,000 New Zealanders with an unmet need for hospital care. This included people getting rejected for hospital treatment, despite being assessed by a medical specialist as needing it.
Now, ASMS estimate this number has risen to about half a million thanks to the pandemic.
Barclay said the key issues were:
• Auckland hospitals were operating above maximum capacity to try to "catch up", meaning patients were being discharged quicker and staff were overworked.
• Serious lack of staff and operating rooms available were making it difficult to keep up, let alone catch up.
• The longer patients waited for a FSA, which was often when they are diagnosed, and then for treatment, the worse their outcome would be.
• Growing wait times for planned care was putting increased pressure on urgent care services as some patients were becoming urgently ill after experiencing long waits.
Waitemata DHB had the worst wait time rates for planned care within the Auckland region.
Data from June showed nearly half of all patients (42 per cent or 1726 people) were waiting longer than four months for treatment. That's compared to 4.7 per cent (211 patients) in June last year. The national target is zero per cent.
At Auckland DHB, 26.7 per cent of patients were waiting longer than four months for treatment. Last year's June data was not available, nor was the total number of patients waiting longer than four months.
Counties Manukau DHB reported 9.5 per cent of patients waiting longer than four months for treatment in June.
At all three DHBs, about 15 per cent of patients were waiting longer than the four-month goal for a FSA.
Figures improved slightly in July but Hipkins said rates had worsened again given the resurgence of Covid-19 in Auckland.
The Ministry of Health says DHBs have been operating at 107 per cent for inpatient surgical dischargesto catch up.
ASMS chief executive Sarah Dalton said hospitals were designed to run at maximum capacity when they were 70 to 80 per cent occupancy.
"As soon as you hit that 95 to 100 per cent-plus, you are in a horrible space - it's not good for staff, it's not good for patients.
"It's a situation where you are likely to be looking at earlier discharges and it's it's very difficult to give best care for patients because you have got really busy people trying to manage over subscribed wards."
Barclay said hospital's urgent care services were experiencing at least double the demand compared to ten years ago, and much of that was due to the growing wait times for planned care.
Hipkins said Budget 2020 allocated an increase in ongoing Planned Care funding of $31.35m a year and a one-off boost of $282.5m over the next three years.
It would increase the delivery of planned care and reduce wait times.
The one-off $282.5m investment would fund an estimated 150,000 surgeries, procedures, radiology scans, and specialist appointments, Hipkins said.
The Government was also developing a range of strategies to boost planned care delivery to immediately address the number of patients waiting too long for services, and improve equity, timely access and quality, including new capital expenditure.
Hipkins said the ministry had received and was currently reviewing these plans.
The Ministry of Health was working with each DHB on plans to reduce waiting lists and additional funding for services, as well as longer term strategies to support changes.
A Northern Region Health Coordination Centre (NRHCC) spokesperson said the three Auckland DHBs were dedicated to ensuring patients received the treatment they needed, when they needed it.
"We are working closely with the Ministry of Health to reduce wait times and have made some improvement which is continuing into September. An example of this is in general surgery at Waitematā DHB, where they have reduced the number of people waiting over four months for their first assessment from 38 per cent in June to 11 per cent."
To help reduce wait time, prevent spreading Covid-19 and to make it easier for patients to attend appointments, the DHBs were using new technology such as telehealth and video appointments.
"All hospital Emergency Departments in metropolitan Auckland have remained open to provide urgent care those who need it."
Lisa Sullivan has waited nearly all year for surgery to fix her severely dislocated right wrist and mesh-infected left wrist.
The 49-year-old Lower Hutt mum lives with a rare genetic condition called Ehlers-Danlos syndrome which affects her connective tissue and makes her prone to chronic dislocations, often needing surgery to repair them.
In the last decade, she has dislocated nearly every bone in her body, had 20 surgeries and ended up in an intensive care unit fighting for her life more than a dozen times.
The former nurse was staying with a friend in Taranaki in early February when she dropped a paper bag at the supermarket and dislocated her right wrist.
"At first I didn't think it was that bad, it happens all the time so I just popped it back in and carried on."
That night, the pain became unbearable and her friend rushed her to hospital. She was seen by a specialist who said she needed surgery but there would be a wait.
Then in June, she received a letter from Taranaki DHB which said she would need to wait at least another four months for a FSA, which she says she'd already had.
"They said that's just the way things were."
Taranaki DHB's chief operating officer Gillian Campbell told the Herald the DHB didn't discuss individual patient cases with the media regardless of a patient privacy waiver but said referrals were prioritised by its specialists based on patients' health needs.
"We are very concerned about the impact Covid-19 has had on our current wait lists as these were already under pressure for a number of reasons, including increased population demand, vacancies in several specialities and our overall staffing and facility capacity."
Sullivan also has a mesh-infected left wrist which was a result of a complication during an operation at Capital and Coast DHB, which she received an ACC treatment injury claim for.
In May, she received a letter from the DHB saying: "the specialist recommended that you would benefit from surgery however your current condition falls below the level of need at which we are able to offer you surgical treatment at this time."
She was referred back to her GP and advised to get private care.
Capital and Coast DHB director of provider services Joy Farley said like all DHBs, it prioritise patients for surgery by using national prioritisation criteria to assess their level of clinical need.
"Each patient receives a 'priority score' that sets out their level of need and ability to benefit from treatment compared to other people. Ms Sullivan did not meet the threshold at which we can offer surgery at this time. She was referred back to her GP and, as with all such patients, we advised her to consider a private provider," Farley said.
"Like other DHBs, we have experienced delays in carrying out FSAs. This has been caused by the need to limit face-to-face clinical appointments during March and April due to Covid-19. Our services are working to address these delays and to carry out FSAs in a timely manner."
