Waitemata Health still turns away heart cases

The Waitemata District Health Board is routinely refusing to see heart patients and others deemed disabled or sick enough to need hospital care.

It blames a lack of money for elective surgery and assessments, and also blames the ageing of its population, a higher-than-expected number of acute orthopaedic patients and the lack of an operating theatre.

This lifting of the access bar is despite the board's performing 12 per cent more elective surgery so far this financial year than during the same months in 2004/05.

The Health Ministry in March threatened financial sanctions if the board failed to comply with Government policy that patients referred for assessment by a specialist are seen within six months, and that those promised treatment receive it within six months.

Chief executive Dwayne Crombie's reply, obtained by National under the Official Information Act, says - as reported previously by the Herald - that under the policy the board is raising the patient-access thresholds.

"Inevitably we are meeting some resistance because the clinical threshold is substantially below the financial threshold."

The clinical threshold is the degree of patient sickness and disability that hospital specialists consider would benefit from treatment; the financial threshold is what the board can afford.

Patients are ranked P (priority) 1 to P5 on the basis of their GP's referral letter. Only those ranked P1 or 2 are certain of getting into the system. P4 and P5 patients are returned to the care of their GP.

Some P3s get to see a specialist, some do not and are sent back to their GP if they wait longer than six months.

An example of P4 in gynaecology is women with mild incontinence. In cardiology, P3 patients' symptoms could include chest pains and having blackouts.

Points made in "worksheets" sent to the ministry with Dr Crombie's letter include:

* "Cardiologists concerned about the threshold, and the safety of not accepting patients who are P3".

* Specialists have agreed to send patients back to their GP regardless of priority if they have waited more than a year [although these patients are expected to have a low ranking].

* Several hundred general surgery patients were returned to GP care late last year.

He said it had been hoped to open a third theatre at Waitakere Hospital at an annual cost of $800,000, "but because of the need to manage within our fiscal constraints this has not been achievable".

Yesterday, Dr Crombie said the board was still considering opening that theatre.

He said the Government's bulk funding of health boards disadvantaged Waitemata because of the population factors used to adjust the amount per capita. Its funding was forced down because Waitemata's population was healthier and wealthier than the national average.

"The only reason we survive is because more of our people go private," Dr Crombie said.

The board's clinical director of medicine, Dr Hamish Hart, said: "We do not believe that we are meeting the need of our catchment at a level which is comparable to several other catchments in the country."

National's health spokesman Tony Ryall said the letter was further evidence of the Government's "waiting-list cull".