In today’s headlines, desperate Ōtara patients queue in the cold for hours, housing market heats up and coffee costs spark debate.
The cancellation of planned healthcare including elective surgeries has been analysed by Health New Zealand Te Whatu Ora at the request of Health Minister Dr Shane Reti, who is trying to work out how to clear record backlogs of people needing to see a specialist or get surgery.
Aboutone in five late cancellations of elective surgeries is caused by an acute or emergency case needing to take precedence, new analysis done for the Health Minister shows.
The late-notice cancellation of elective surgeries and other planned procedures is a major problem in the health system, which contributes to worsening treatment delays.
Health Minister Dr Shane Reti asked top-level officials to provide a briefing on the issue, which was delivered in April and has been obtained by the Herald under the Official Information Act.
Health Minister Dr Shane Reti asked for a briefing on why surgeries were cancelled at the last minute. File photo / Mark Mitchell
The number of people needing acute or unplanned care, which is urgent and usually the result of an injury or illness, is rising, as is the complexity of their condition.
This is happening “in a highly resource-constrained environment”, the Health New Zealand Te Whatu Ora officials warned in their briefing.
“Resourced beds, operating theatres, intensive care unit capacity and renal dialysis care are the core constraints on system performance. Most hospital beds are used for acute care.
“As demand grows for acute and urgent care, available capacity for planned care diminishes.”
Hospital capacity cannot easily be increased because of workforce shortages and a lack of space and equipment – most hospitals do planned and acute care in the same facility, and acute care is always prioritised.
“There is not necessarily a 1:1 relationship between an acute presentation and displacement of a planned care procedure (for example, a patient presenting to an ED [emergency department] following a car crash and requiring surgery for broken bones does not necessarily displace a planned care patient scheduled for an orthopaedic procedure),” the briefing noted.
“There are many other considerations, eg available theatre space, staff, ICU beds.”
About one in five late cancellations of elective surgeries is caused by an acute or emergency case needing to take precedence. Photo / 123rf
Nationally, about 8% of elective surgeries are cancelled within 24 hours by a hospital (this doesn’t include when patients cancel).
An analysis of 21,000 such cancellations between November 2022 and February 2024 indicates that only 19% were called off because of acute cases being swapped into the operating list. A significant number of the other cancellations were caused by resourcing problems, such as staff illness or unavailability.
The health officials identified outsourcing to private hospitals (paying a private hospital to do procedures that would otherwise be done in a public facility) as one way to tackle backlogs, although this is expensive.
“Addressing workforce vacancies is a critical lever in maintaining acute and planned delivery. As we continue to address vacancy pressure points, this will support planned care deferrals.”
Longer-term changes include working with GPs and primary care to reduce the number of people needing care within a hospital, and providing patients more care in their own home.
Reti asked officials which ED admissions are most responsible for planned care being deferred - “eg is it children with asthma?... cardiac?” – but data limitations meant they couldn’t say.
However, ambulatory sensitive hospitalisations (ASH) – acute admissions that are considered potentially avoidable had the person been treated earlier, including by a GP – were increasing.
For instance, the rate of avoidable hospitalisations for 0-4 year olds had increased for all regions, except Tairawhiti, in the year to March 2023.
Health NZ commissioner Dr Lester Levy. Photo / Dean Purcell
“Analysis of information shows that pediatric admissions are not displacing acute care. Children tend to be cleared through the ED quickly, have less serious conditions and are likely be discharged quickly.”
Key measures of health performance are worsening. There are approximately 235,000 people waiting too long for specialist help and planned care including surgeries.
The commissioner of Health New Zealand, Dr Lester Levy – who was appointed in July to overhaul the organisation after its board was abolished – has said reducing wait times is his key focus.
Levy and his deputy commissioners have vowed that, despite the drive for savings, “the clinical frontline will not be cut or reduced, and our plans are to strengthen it”. He believes the health system’s problem is overspending, not underfunding.
A recent editorial published in the New Zealand Medical Journal, written by researchers from the union the Association of Salaried Medical Specialists (ASMS), disputed this view, saying cost overruns were unlikely to be solely caused by poor management, and successive governments had underfunded health.
