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Elective surgery waiting lists

Written By: - Date published: 10:47 am, November 7th, 2014 - 29 comments
Categories: accountability, health - Tags: , , ,

“How can you tell when a politician is lying? His lips are moving.” It’s an old joke (and sexist to boot), but it is governments like this one that give such jokes legs.

Take waiting lists for elective surgery, in this piece from 2013:

Four times a year, Ryall releases figures showing more elective surgeries are being done than ever before and New Zealand’s district health boards (DHBs) are repeatedly hitting waiting list targets.

So he did, all the while knowing that “hitting waiting list targets” really meant fiddling the lists. From the same piece:

Christchurch specialist surgeon Dr Phil Bagshaw said the stream of success stories pumped out of Ryall’s office were “misleading, false Orwellian double-speak”.

The levels of unmet need are growing unmanageable. The increase in surgeries has not even come close to meeting the demand. Unless a patient’s pain is disabling and classified as urgent they no longer get on waiting lists. DHBs are being forced to turn down thousands of needy patients or face financial penalties for not meeting targets.

Ryall could not tell The Press how many Kiwis in need of elective surgery were being rejected from waiting lists because, he said, the ministry was not counting as it was “incredibly difficult to measure”.

(Labour was on the case about this too.)

So – according to Ryall, counting how many Kiwis in need of elective surgery were being rejected from waiting lists is incredibly difficult. How unfortunate for the Nats that research just published in the New Zealand Medical Journal does exactly that. As covered by Stuff:

Patients ‘forgotten’ in wait for surgery

One in three people requiring elective surgery are being turned away from waiting lists to meet Government targets, new research suggests.

The research, published in the New Zealand Medical Journal today, shows 36 per cent of more than 1200 hip and knee patients in Northland and Hawke’s Bay referred for a publicly-funded operation by their surgeon were knocked back because they did not meet the “financial threshold”. Many were suffering in severe pain, and were significantly disabled, the study says.

Researchers cautioned that the group was small, and limited to two hospitals in Hastings and Whangarei, but it supports growing claims among some doctors and surgeons that thousands of people who need surgery cannot even make the waiting list, leading to a massive hidden “unmet need”.

The Nats have been manufacturing “good news” stories in health by creating a system that turns away one third of the patients in need. It’s a disgrace. Dig beneath most of their good news statistics and you will no doubt find a similar manipulation – I was about to write manipulation of the figures, but that would be missing the point, it is a manipulation of people.

29 comments on “Elective surgery waiting lists”

  1. tc 1

    Add to this the culling by ACC of folk with injuries requiring surgery for various spurious reasons.

    • Michael 1.1

      ACC have been doing this for many years, including underthe last Labour government, whose members appear to suffer from an epidemic of selective amnesia. Labour’s failure to provide a fair ACC scheme is one reason why people do not trust it (there are many other reasons, of course, all unacknowledged by contestants in the Game of Thrones).

      • Tracey 1.1.1

        nats and lab both did it hence we need a new order. acc is a great social contract but the insurance companies sniffing has turned to drooling

  2. Al 2

    My knee was so severe I was unable to sleep without morphine but I was unable to even meet with a surgeon to assess my conditions and discuss options as I repeatedly received the same response that I failed to meet the criteria. When I enquired about what the actualy criteria were I was stonewalled. I finally got to see a private surgeon who advised me that I may have been able to keep my knee if I had been seen earlier. Of course earlier efforts were declined by ACC. Between ACC and DHB’s so called ‘elective’ surgery is a joke in this country – and from my perspective not a funny one.

    • BassGuy 2.1

      I can’t help but wonder if the point of all of this is to promote how good a privatised health system and privatised insurers would be compared with the “inefficiencies” of the public system.

      My partner’s father is in need of surgery, and he had his surgery date repeatedly knocked back until he was finally told that he would need to re-apply to be put back on the list. He didn’t bother re-applying for the obvious reasons – he will always be moved further down the list.

      • Lanthanide 2.1.1

        If you are put on the “urgent” or “semi-urgent” list then you will likely be seen. If you’re not on either of those lists, then you’re at the bottom of the queue, and new entrants onto the “urgent” and “semi-urgent” lists will go ahead of you. Once you’ve reached your maximum 6 months time on the list, you’ll be booted off and forced to re-apply.

        Unless you can get onto the “urgent” or “semi-urgent” list, you will effectively never get your surgery.

        Under the old system you would stay on the list for a long time, and may eventually be seen – and in doing so, you would make the wait time on that list look really bad. So in order to get the wait times looking good, they’ve effectively denied healthcare to a lot of people who don’t meet arbitrary thresholds.

        • alwyn 2.1.1.1

          I looked at the top of your contribution to see the date. The first paragraph described, fairly accurately, the situation when the last Labour Party were in power and I assumed that this had been lost in the system for 6+ years.
          When Labour were running the show everyone would be put on the waiting list. In order to pretend that no-one waited more than six months you would be thrown off the list and referred back to your GP after that time. Then you had your GP basically pleading for you to be put back on the list.This happened twice to my brother. After the second time, and having waited about 18 months he paid to get his op. done privately.
          That was when LABOUR were the Government and King was the Health Minister.
          The thing that National did was to be honest with people. If you are put on the waiting list you WILL get the operation you need. If you don’t qualify they no longer lie to you. You won’t be put on a waiting list that is meaningless.
          You then have a choice about what to do. If you can’t get by as you are you may have to pay to go privately but at least you know the honest situation.
          I was examined for a double replacement under the current National installed system. I qualified and the op. was done. I wasn’t lied to and then dumped off the list after six months to start again. If I hadn’t got a waiting list place I would have raised the money for a private op. At least I would have known immediately that I should do so and wouldn’t have had to put up with what my brother went through

          • One Anonymous Bloke 2.1.1.1.1

            Ok, so there’s an element of wisdom in that: it’s easier to adapt to something when you know what it is, and then you have to justify your preference for tax-cuts over elective surgery.

            Good luck with that.

            • alwyn 2.1.1.1.1.1

              There is, unfortunately, always going to be some rationing with regard to medical treatment. It sounds very cruel but it is impossible to actually afford all possible medical care.
              I remember listening to an economist who had researched the subject. He was speaking about 30 years ago but since then things will only have got worse. He said, and had the numbers to prove it, that if all possible care was given to people who were suffering from kidney problems it would cost more than the entire New Zealand health budget to treat them. That is just to treat kidney problems without doing anything else at all.
              If we wanted to do all possible elective surgery imagine what the bill would be? A double hip op. costs about $40,000. I was lucky and you kind tax-payers paid. However I had been getting steadily worse for years before I did anything about it. Raising taxes by the relatively trivial amount that the tax-cuts returned to tax-payers wouldn’t make a great deal of difference I’m afraid.

              • One Anonymous Bloke

                Yeah, anecdata can be very comforting when you have a lower intestinal blockage.

              • RedBaronCV

                Actually the high end tax cuts plus gst switch comes to over $2billion a year= 5000 double hips or $10000 single hips. And is the $40000 the price price or the cost which is no doubt lower.

              • Draco T Bastard

                There is, unfortunately, always going to be some rationing with regard to medical treatment.

                Well, I suppose that depends upon how well we get automated surgery going.

                I remember listening to an economist who had researched the subject.

                Sounds like he, like most economists, fails to understand economics.

                There’s probably some ideal proportion of the working population that needs to be in health and health services. I don’t know what that ideal and it will shift as demographics shift is but I’d be highly surprised if it was much above 1% of the population. As we presently have around 6% unemployment it is obvious that we can afford to reach that ideal. Just need to train them up.

                Costing things in terms of money brings about a misunderstanding of economics and thus a misallocation of resources. And 6% unemployed is a massive misallocation of resources and yet nearly all governments since the 4th Labour government have run that as normal.

                He was speaking about 30 years ago but since then things will only have got worse.

                No, things would have gotten better due to higher productivity, better techniques and better training.

                Raising taxes by the relatively trivial amount that the tax-cuts returned to tax-payers wouldn’t make a great deal of difference I’m afraid.

                It wasn’t trivial but a billion dollars per year or so.

    • Treetop 2.2

      There appears to be a fine line between failing to diagnose and treating a condition. A person has an expectation to be given an accurate diagnosis. Unless a person is seen by the right specialist or seen at all, a condition is left untreated. There is nothing proactive about hip and knee surgery either.

      • One Anonymous Bloke 2.2.1

        And when you save up enough for the surgery, you can get a holiday in the South Pacific, plus the surgery, for the same amount of money, and then you wonder why homeless people seem so judgemental.

  3. Adrian 3

    For a bad hip start a “Sleep Diary”, every time you wake in pain make a note of the time and the severity, whether you cried out our spasmed in pain. It’s not hard to do for a hip or knee because boy are you ever awake. I got up to 17 times in a bit over 6 hours, of course you are awake for quite a while after some episodes so try and identify these in the morning, then present that to your GP. It’s a big help for getting on the list.
    Here’s a hint, sleep in a pair of cyclist’s shorts, tight ones, it really helps keeping your hips together. Take the chamois seating pad out for more comfort.
    Another little trick is to select the surgeon you would like to have do the op, pay his consulancy fee ( about $150, yeah it’s a lot but worth it ) as if you are going to go private and you become ” his” on the public list if you can’t afford to go ahead wth it. You’re not ” jumping ” the list but are speeding it up a bit.

  4. Annie 4

    Michael, the issues around funding of ACC when National came into government were caused by the impact of the GFC on the fund ACC had invested to make ACC fully funded. That fund had previously been performing very well, but returns were hit by the GFC.

    The whole ‘ACC is a basket case’ thing was a complete fabrication, and an excuse to target ACC by a government that does not like social insurance schemes, and would rather it was privatised.

  5. Treetop 5

    The health system has to pick up the slack from ACC when it comes to ACC failing to treat hip and knee accidents. ACC think that no degeneration occurs from an accident.

    • A voter 5.1

      Yeah they have been pushing that angle since at least 2006 and any excuse will do to avoid paying, youve really got to be on your game if you want to win on that lottery which is pretty much where they leave you hanging when they tell you your not entitled because your condition is hereditary and not as a result of the bleeding obvious accident that nearly took of your leg completely screwing your hips as well

  6. One Anonymous Bloke 6

    “Their lips move” works equally well and isn’t gendered.

    And boy do they move!

  7. Chooky 7

    The pathetic msm …newspapers and radio and television let voters down badly by not exploring this issue of waiting lists critically and in depth before the Election….

    they repeated Nact spin however

  8. Delia 8

    Time and time again GPs refer their patients and get declined letters back. It is a disgrace. No GP refers without knowing their is a real need for that person to see a Specialist.

  9. johnm 9

    Sounds to me like rationing. “At the end of the day” It’d be much more efficient and effective to just get on with the job and do everyone instead of play games with budgets. Sounds to me they’re trying to push people into private. Disgusting! But at the end of the day National and Key don’t care: no money? then suffer!

    • One Anonymous Bloke 9.1

      Of course they care. Their empathy is stunted by right wing brain syndrome. Cf: Hodson & Busseri, Kanai et al, Piff et al.

    • johnm 9.2

      Local DOMPOST reported woman mortgaged her house for the price of a hip replacement: $26000.00. “At the end of the day” Public wouldn’t treat her leaving her in pain. Thanks all you smug bastards who voted in this bankster government. We are now paying huge interest bills for borrowed money overseas which money could quickly solve this problem.

  10. philj 10

    xox
    Thanks to commenters. This site is a great antidote to the spin of the MSM. I wondered how Ryall was doing magic, with the vanishing trick.

  11. Draco T Bastard 11

    A good article by Chris Trotter:

    As scams go, however, this is a particularly clever one, because, obviously, not all of those sufferers rendered invisible will end up undergoing emergency surgery. Most will simply go on suffering, unheard and untreated.

    The Right have to lie and scam because their ideologically driven policies always fail. They cannot admit that though as then they’d have to admit that we cannot afford the rich which they all want to be.

  12. Sable 12

    Interesting how the mainstream media run an anti government story and then promptly play it down. Here’s a fact, cancer in general is FIVE TIMES more survivable in Australia under their healthcare system than ours. That’s research from our own delightful government but good luck finding a journo who will run it.

  13. A voter 13

    Yeah and if your over 75 or younger you can kiss ES goodbye your an uneconomic unit at 25000
    +-a hip replacement
    Fascism ring a bell anyone
    Excuses, its not economic because you are an aged liability and weve got your dough anyway or youve been too smart and we cant get your money out of you
    Really strange how the govt can turn most of its business responsibilities into SOEs
    But not the health system so it can access more capital and make the health insurers do their job, but they only want the bank of ACC to be sold so that the whole US health system can be planted here and it will no longer be a govt problem
    Because as it is Ryall has completely screwed it and no one can do a thing about it
    except wait for the TTPA bomb to hit and live with the fallout

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