KEY POINTS:
Whenever the shortcomings of the health system are discussed, it is not long before waiting times in hospital emergency departments are mentioned. Many people have bad memories of seemingly endless waits in overcrowded facilities before they are seen by a doctor or allotted a bed. This picture has been confirmed by Health Ministry data which suggests that, while the majority of patients are seen within several hours, up to 20 per cent at one of three surveyed hospitals spent more than eight hours in the emergency department. This hardly suggests the "world-class system" referred to frequently by the former Government.
It is also all the more reason to welcome Health Minister Tony Ryall's plan to impose maximum patient waiting times on emergency departments, and to hold district health boards and their management accountable for meeting them. His initiative is sure to attract criticism. Such targets are always something of a crude measure, if only because they fail to give sufficient recognition to quality of care, which should, ideally, be hospitals' paramount concern.
But Mr Ryall can be excused for starting at this point. There is a sense that, while the Labour Government increased the health budget by more than $3.5 billion, too much of this was swallowed with little discernible increase in efficiency. There were neither quantitative nor qualitative improvements. At the very least, targets incorporated into performance agreements will lay the foundation for better results by increasing accountability in emergency department operations.
The practice appears already to have been successful in Britain. There, said Mr Ryall, a targeted maximum wait, set in 2004, of no more than four hours from arrival to admission, transfer or discharge, had resulted in the proportion of patients waiting longer than that time falling from 23 per cent to 3 per cent. Before that target was introduced, people had been waiting longer even though the number of doctors working in emergency departments had gone up and billions of pounds had been poured into the health service by Tony Blair's Government.
The likelihood here is that the maximum time will be six hours and that no patient will be left waiting in an emergency department corridor. Mr Ryall has yet to finalise details, but he told the Australasian College for Emergency Medicine that he would consult clinicians in setting the targets and ensuring district health boards made it possible to meet them without compromising care. This means, presumably, that adequate resourcing will be discussed and implemented, thereby eliminating excuses for not meeting targets.
A key to reducing waiting times must be the presence of more senior staff in emergency departments. This would have the added benefit of improving the quality of care and saving money. In a sometimes harrowing environment, senior doctors are able to work faster and with greater accuracy.
But such staff improvements would, of course, mean added funding. In that respect, emergency departments must compete with other areas of health. They do, however, have the advantage of being a major cause of public concern and of being a part of the service that takes a particular strain when the system overloads.
Mr Ryall faces a challenge not only to improve health delivery but to cater for an ageing population, rising expectations for healthy lives, and for expensive new drugs and technologies. Heavy spending is inescapable. But if there are to be real gains, this expenditure must be accompanied by changes in how the system is run.
The type of accountability envisaged by the new minister is a good start.
