The New Zealand Herald

Health system failing to cope

DHBs’ recovery plans reveal dozens of services under stress even before Covid

- Nicholas Jones

Nearly 30,000 New Zealanders are caught in delays for hospital treatment and Covid-19 recovery plans to get services back on track are lagging in some regions.

The alarming picture of the health system has emerged in a review by the Herald of recovery plans filed by all 20 DHBs, which identified dozens of services under severe stress even before the pandemic struck.

According to those documents, clinicians feared that those needing treatment could suffer serious consequenc­es. One major DHB warned that delays in its ophthalmol­ogy service could result in people going blind.

The recovery plans were sent to the Ministry of Health last summer and estimated how quickly delays for planned care, including elective procedures, could be reduced.

Progress has been slower than anticipate­d for some services, the ministry confirmed to the Herald, but it wouldn’t provide details about which services, in what areas.

Patients whose treatment was delayed during the first phase of the pandemic have since been treated, the ministry said. However, the system is so strained that new backlogs have since built up.

According to the ministry’s latest figures, more than 15,700 people are waiting longer than four months — the maximum time someone should wait under official guidelines — for a first appointmen­t with a specialist. Another 13,500 have been accepted for treatment but are waiting longer than the four month target.

That’s a reduction of nearly 14,000 patients (for appointmen­ts and treatment) from when New Zealand emerged from level 2 last year. However, Jess Smaling, the ministry’s associate deputy director-general, said progress had been slower than expected.

There were several reasons why services in some DHBs had not met their proposed reduction in waiting list numbers — including increased demand, the complexity of procedures, industrial action and workforce shortages.

Some waiting lists are expected to remain until 2023. The DHB recovery plans, lodged from August last year and released under the Official Informatio­n Act, reveal the stressed state of the health system. Revelation­s include:

People overdue for eye care reached into the thousands in some regions. Waikato DHB told the ministry its own delays carry “significan­t risk for patients of permanent deteriorat­ion of eyesight and potential blindness”. The Herald understand­s most regions still have overdue patients, and wait lists are particular­ly bad in Southern DHB.

Diagnostic services including CT and MRIs couldn’t match demand prior to Covid-19. Auckland DHB, for example, hasn’t met targets for timely radiology care since 2017 and heart scans were “well in excess of what is clinically indicated” in greater Auckland and Northland.

Sarah Dalton, executive director of the doctors’ union, the Associatio­n of Salaried Medical Specialist­s, said the findings reflected a lack of action on long-standing problems including staffing shortages, and the “parlous” state of hospital infrastruc­ture.

DHBs have sent patients to private hospitals to ease pressure. However, many of the recovery plans noted the private sector was busy clearing its own backlogs. Bay of Plenty DHB was concerned about the fees demanded by some private providers.

Another headache is not enough operating theatres. These were at capacity for the past 18 months, Bay of Plenty DHB warned, with urgent cases bumping planned operations down the list. Southern DHB noted it cost about twice as much to outsource patients, but “we have more surgeons than we can give theatre capacity to”.

Northland DHB noted investment in infrastruc­ture hadn’t matched a big increase in its older population, with “small and cramped” buildings unable to take more patients, insufficie­nt operating theatre capacity and “extremely outdated and limited inpatient capacity”.

Recruitmen­t of hard-to-find specialist­s worsened after Covid-19 shut borders. Counties Manukau DHB said demand outstrippe­d capacity in areas including MRI scans, bariatric surgery, women’s health and chronic pain services, which receive double the referrals of five years ago, with no increase in clinical staff.

Budget 2020 allocated nearly $283 million over three years to specifical­ly help address waiting lists, and 61 capital projects have been funded, including new equipment and theatre space. Billions more has been pledged for a wider upgrade of facilities.

An Auckland DHB spokespers­on said demand had been very high for MRI, CT scans and echocardio­grams, requiring more outsourcin­g to private providers, extra clinics and calling in casual staff. Overseas workers couldn’t be easily hired because of closed borders, and training for some technical roles isn’t available in NZ.

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Sarah Dalton
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