KEY POINTS:
The Auckland District Health Board is considering quitting its multimillion-dollar contract to provide heart treatment for adults from Tahiti because its waiting list for heart surgery for New Zealanders has blown out.
The blow-out occurred as a result of ongoing difficulties in hiring and retaining enough specialist nurses. The board also expects a further increase in patients under new funding.
"It's not because there's been more people coming on to the list," the board's general manager of clinical services, Kay Hyman, said yesterday. "It's because we've had difficulties in getting them off the list. Cardio-thoracic and vascular intensive care nursing staffing is restricting our production."
The Auckland City Hospital heart service's intensive care unit, which has 70 fulltime equivalent nursing positions, is short of 15, down from 22 vacancies in September.
"There's a gradual improvement, month on month, so we are expecting that gradual improvement to continue," Ms Hyman said.
In 1999, under the last National Government - and without its knowledge - the board took on the money-making contract with French Polynesian authorities. It will not disclose the current value, but in 2002 it was around $5 million a year.
In the last financial year, 79 Tahitian adults were treated: 13 had cardiology (non-surgical) care and 66 had surgery, of whom 45 were sub-contracted to the Mercy-Ascot private hospitals group.
Tahitian children are also treated, but the board is reviewing only the adult treatment. The paediatric heart service is not experiencing the same increase in patients, and treating children from the wider Pacific provides the critical mass of population needed to help keep it safe and efficient.
Ms Hyman acknowledged it might appear that the Tahitian contract had taken surgery away from New Zealanders, but said this was not the case. In fact, it had enabled the board to increase the capacity of its heart service and to fill in troughs in local demand.
But these troughs no longer occurred; the expanded waiting list meant the agreement might not be sustainable, especially with the extra money announced last month.
Then-Health Minister David Cunliffe announced a $50 million increase over four years for heart services nationally to boost the number of operations per capita - which is low compared to Britain's and Australia's - by at least 25 per cent.
New Health Minister Tony Ryall said last night his Government would continue the new funding. Mercy-Ascot chief executive Andrew Wong said the group "wouldn't rule out" picking up the adults' heart care contract if the health board opted out.
"An important reason for that is that the Tahitians have created a lot of infrastructure in Auckland to support the contract. They have got the [Tahitian] burns contract at Middlemore Hospital. There is a regular flow of people [Tahitian patients] coming through Auckland.
"They have got places they stay, people who can speak French, people who pick them up from the airport and people who help them with shopping."
THE WAIT-LIST
* 285 adult patients were waiting for heart surgery at Auckland City Hospital at the end of last month.
* Up from 228 at the end of April and 221 at the end of October last year.
* Reason for the rise: shortage of nurses in the cardiothoracic and vascular intensive care unit.
