The phantom phantom hospital waiting lists

Written By: - Date published: 12:46 pm, July 25th, 2016 - 28 comments
Categories: Annette King, health, national, same old national, spin, the praiseworthy and the pitiful, you couldn't make this shit up - Tags:

Anyone who has had to tolerate the sight of Health Minister Jonathan Coleman standing up in Parliament and parroting the twin lines that things are much better in the Health Sector now and besides it is all Labour’s fault must be getting tired of the continuous parroting of official “statistics” to show that all is well.  And as time goes by his statements appear more and more to be spin and less and less reality based.

From Radio New Zealand:

District Health Boards struggling to meet the government’s goal of a four month waiting time for treatment are being accused of hiding patients on “phantom” waiting lists.

But the government said there were no “virtual” waiting lists in the health system.

The claim comes as latest DHB figures show 45,000 patients sent to a hospital specialist were turned away in 2015 – 3000 more than the previous 12 months.

The Association of Salaried Medical Specialists said the figures did not account for those on “phantom” waiting lists – patients who meet the clinical threshold but have little hope of seeing a specialist within the official timeframe.

The official numbers also ignored those who did not visit a GP, or who did but were not referred for a specialist appointment even though they needed treatment, the association said.

Its executive director Ian Powell said under the current system DHBs were penalised financially if patients waited more than four months to see a specialist after being referred by a GP and that meant some hospitals were fudging the numbers.

“Because we haven’t got the workforce capacity to actually deliver on that in our public hospitals, there’s quite a bit of – I’ll use this term loosely – rorting going on, where some patients are actually put on what they call a virtual list or a suspended list. It’s like picking up a number of patient files and just putting them on a shelf somewhere,” he said.

Mr Powell could not say how many DHBs had phantom lists – but he said often patients were none the wiser.

“The patient knows nothing. The patient may well then appear on the list for the following four months. The patient will be unaware this is happening.”

How many are on this phantom list?  TNS prepared an analysis earlier this year that suggested the figure was 174,000.  From Stuff:

Thousands of people are being left off surgery waiting lists across the country, and Canterbury may have the highest level of unmet need.

About 174,000 New Zealanders are in need of publicy-funded surgery, but have not been placed on a waiting list, new research from global research company TNS shows.

Patients are commonly being turned away as their pain is not considered to be severe enough, or GPs are “waiting to see” how their condition progresses.

Labour’s Annette King summarised the situation in this way:

People write to me, they say their GP said they needed to be seeing a specialist, that they had an issue, they had pain, they had disability, they go in for their assessment and they’re told ‘sorry, you don’t meet the criteria’, and the criteria is overwhelmingly a financial criteria.”

And Coleman’s response?  More statistics.  Again from Radio New Zealand:

Health Minister Jonathan Coleman said the advice he had received was that there were no such phantom lists.

Mr Coleman said the government had dramatically cut waiting lists, and more and more people were getting appointments and operations.

“The key thing is we are doing more appointments every year.”

He said there were 110,000 more appointments each year and 50,000 more operations.

Mr Coleman told Morning Report that historically there had always been a proportion of people who had not been seen for treatment.

“Official figures show that only 5 percent are not getting that appointment, 87 percent are, 8 percent are being asked for further information.

“There is absolutely no phantom waiting lists in the system.’

“It’s a figment of Ian Powell’s imagination I’m afraid.”

Something does not add up.  If there are 45,000 people on a waiting list that were turned away it does not feel like 5% of total figures.  That would suggest that just under a million kiwis are waiting for surgery.  And if the total figure is 230,000 then this is completely irreconcilable with what Coleman is saying.

 

28 comments on “The phantom phantom hospital waiting lists ”

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  1. TC 1
    25 July 2016 at 1:02 pm

    A back specialist at a major hospital told me I required a life threatening condition to be taken any further in the public system and I was not allowed on any lists.

    The appointment itself took months of hassling by my GP and to paraphrase the surgeon the entire system is creaking at the seams but you arent dying so see ya around.

    • Pasupial 1.1
      25 July 2016 at 2:10 pm

      It recently took over two years for me to get an operation finally preformed and that was with the frequent chasing-up queries from my GP. To be fair, this was during the period when; the SDHB orthopaedics section lost accreditation, the SDHBoard was sacked and replaced with a commissioner, and Coleman took over from Ryall as the Health minister. However, it doesn’t really matter who was the minister at the time, this was due to the National Party’s focus on cost-cutting above health outcomes.

      I thought I was done with them at last, but just this past month I’ve had another different health issue which has seen me; kicked from the ED to a specialist department who refused a place on their waiting list (not that that told me that, it took a phone call to get that information out of them, and I still haven’t got anything in writing). So now I’m headed back to my GP (which is itself a barrier in terms of time and money) to have them chased up from his end.

      As for Coleman’s lack of commitment to health outcomes, does anyone still recall this from last decade? (as an example; I could link to his more recent deceptions in dismantling democracy at the SDHB, but I did that yesterday):

      Smokefree Coalition Director Mark Peck is calling National Party associate health spokesperson Jonathan Coleman’s presence in British American Tobacco’s (BAT’s) corporate box an unbelievable lapse in judgement…

      Mark Peck says when he met with Dr Coleman earlier this year the MP was very clear on his understanding about the harm caused by tobacco and the need for tobacco control.

      “Dr Coleman was also at a recent function at Parliament that highlighted the harms caused by using misleading descriptors such as ‘light’ and ‘mild’ on tobacco packets. I am surprised and disappointed, therefore, to find him accepting hospitality from BAT. I’m also amazed a GP who has seen the ravages of tobacco-related illnesses would smoke and subject others to his second-hand smoke.

      http://www.scoop.co.nz/stories/GE0612/S00013/health-spokesperson-in-bat-box-ill-judged.htm

      • Draco T Bastard 1.1.1
        25 July 2016 at 2:42 pm

        So now I’m headed back to my GP (which is itself a barrier in terms of time and money) to have them chased up from his end.

        Time and money being a barrier is exactly what the market system is about. The whole point of the market system is to reduce demand for limited resources. Once you realise that then you realise that the health system simply cannot be done effectively through the market. People need their health seen to NOW and not when some flunky (government or private sector) deems it meets some arbitrary threshold. That means that the health system needs to be large enough across the entire country to meet average demand at all times.

        All that means that the entire health system, from GP through to hospitals need to be state run and with good state run education in the health fields to meet the demand for nurses and doctors.

        • Pasupial 1.1.1.1
          25 July 2016 at 3:13 pm

          People need their health seen to NOW and not when some flunky (government or private sector) deems it meets some arbitrary threshold.

          But even if you disregard the human suffering caused by having patients languishing in the limbo of waiting listlessness, this entire model is flawed. Spontaneous healing does occur, however in the longterm over a large population, you will save money by intervening in health issues earlier rather than later.

          This isn’t just market economics. A company that provides a life-threatening product will end up out of business. Key’s National government seem to be running a slash and burn strategy for short term gain over long term sustainability. Creating the illusion of prosperity by burning the resources of the past, and the future. Rats secure in the knowledge that when the ship finally down, that they already have their boltholes well lined.

        • Wayne 1.1.1.2
          25 July 2016 at 3:51 pm

          Draco,

          Just so we actually set out what happens, rather than using labels (market) for political purposes.

          We don’t have a market system in public heath, which would imply if you have the money you get treatment. That is what happens in the private system, which is only about 10% of the NZ system. If you have the money (i.e. have private insurance) you get the treatment in a private hospital, essentially for elective surgery.

          In the public system, which is 90% of the NZ system, you have an allocation of public money, and a needs based allocation of patients to the extent of the money allocated. The higher the medical need, the higher on any waiting list. Of course more public money allocated would mean more operations done, but it would still be purely based on need.

          In short, in the NZ public health system there is not a market allocation of treatment, there is a needs based allocation of treatment.

          Your final paragraph implies you would ban any private health insurance, and any private hospitals, and presumably any private specialists. I don’t see any political party picking up that idea.

          • Draco T Bastard 1.1.1.2.1
            25 July 2016 at 5:03 pm

            That is what happens in the private system, which is only about 10% of the NZ system.

            The GPs have been set up as gate keepers to the public system. The GPs are private and people have to pay to see them – time and time again.

            If you have the money (i.e. have private insurance) you get the treatment in a private hospital, essentially for elective surgery.

            Or we could have an adequate public health system that got people the treatment that they need as soon as they need it. As Pasupial points out, early treatment costs less than treatment delayed.

            And insurance is a scam as we found out with Christchurch. People had insurance but the insurance companies didn’t have the money to pay out and so they worked out not to pay out at all. And yes, that applied to the EQC as well.

            In short, in the NZ public health system there is not a market allocation of treatment, there is a needs based allocation of treatment.

            But that’s an illusion because you have to go to the GP first and have them put in place an application to get you submitted to the public system. An application that can be turned down requiring you to go back to the GP. Going to the GP costs money thus we have a market system.

            Your final paragraph implies you would ban any private health insurance, and any private hospitals, and presumably any private specialists.

            Why would I ban it? An adequate public health system would make it uncompetitive and it’d die a natural death.

        • Pat 1.1.1.3
          25 July 2016 at 7:09 pm

          “Time and money being a barrier is exactly what the market system is about. The whole point of the market system is to reduce demand for limited resources. ”

          exactly….but then I thought we had a publicly funded health system.

          • Draco T Bastard 1.1.1.3.1
            25 July 2016 at 7:55 pm

            We do – but you have to go through your GP to get to it and you pay to see your GP.

            • Pat 1.1.1.3.1.1
              25 July 2016 at 7:59 pm

              and the specialist referred to…..was being facetious

              • Wayne …
                25 July 2016 at 8:28 pm

                Draco,

                A good point about GP’s as gatekeepers for the waiting list. However, it is hard to imagine any other way to deal with referrals to specialists. There is way fewer specialists than GP’s. Thus there needs to be some professional way to “control” access to specialists, who otherwise could be swamped.

                I note you acknowledge that the GP role represents a medical assessment and is not a financial (market) assessment. Although I accept numerous visits to the GP has its own financial implications. I was under the impression there were some reductions in case of high GP use, in the same way as the high use pharmaceutical card – which I think is not actually means tested.

                • Pat …
                  25 July 2016 at 8:43 pm

                  “I note you acknowledge that the GP role represents a medical assessment and is not a financial (market) assessment”

                  It is a de facto financial assessment in that the service is rationed due to the limited funding of the resource.

  2. Lanthanide 2
    25 July 2016 at 1:08 pm

    Pretty much anyone who works in this area of the health system will know what the government is doing.

    They ‘solved’ the long waiting lists by saying that everyone on a waiting list had to be seen within 6 months. DHBs are allowed to have a small number of people on that list not be seen within 6 months, eg they roll over to the next 6 month period.

    So in order to keep that rollover figure very small, DHBs simply don’t put people on the waiting list. They try to be fair about it by prioritising those with the most need first, but since this is never a truly objective measure, and more people arise with ‘high needs’ (or because they’re untreated, they go from moderate to high need, when it costs more to fix), it means those people with low to moderate needs will possibly never receive their treatment.

    To be honest, I’m not sure if it’s much worse than the old system, where you could be added to the end of a waiting list with 27 months projected until your operation date, and then 27 months later you’d still need to wait for another 15 months because of all of the higher priority people that got added ahead of you in the queue anyway.

    The only solution is more funding for health. National have taken the short-cut approach of changing the official data that is gathered, so that no-one can prove with data that there is more unmet need than ever. Everything is merely anecdote or commissioned by 3rd parties that the government can just write-off as having incorrect data or making it up (since the source data – purposefully – doesn’t exist).

    In the long run this approach is not sustainable, because as more and more of the population have friends and family who are punished by this scheme, they will become weary and distrustful of the government. Once people lose trust in you for one area, they’re less likely to trust you in all areas, and are more likely to vote for the opposition in the hopes that the situation might improve for them if someone else in charge.

    • Macro 2.1
      25 July 2016 at 8:32 pm

      And then people will say – “The Public Health system does not work” Let’s get rid of it and save our taxes and then have Private insurance.
      This is what National want to do in the end. They and their mates would love it. More money in their pockets but for those at the bottom of the economic system a travesty.

  3. adam 3
    25 July 2016 at 2:02 pm

    Good work MickeySavage

    Having been put through this mill whilst waiting for surgery, under this national government. I can categorically state that Coleman is lying. I’d also like to say that there are also another list before the wait list for surgery, making the times Lanthanide is talking about in his comment, comparable in the current system.

    Quite frankly, if I had not had the knowledge of the medical system that I do, it could have been much worse. I at least know what and how to fight for my rights. Who to write letters to, and what people I can ask to intercede on my behalf.

  4. Siobhan 4
    25 July 2016 at 2:07 pm

    Well, maybe National voters have private Health insurance. Certainly I expect Coleman does. He should be called out, don’t be in charge of a system you wouldn’t be caught dead using.
    Pun intended.

    • Pasupial 4.1
      25 July 2016 at 2:19 pm

      Siobhan says; ” don’t be in charge of a system you [, or your family,] wouldn’t be caught dead using.”
      Given the number of MPs with privately schooled children, that goes for public education as well!

  5. NZJester 5
    25 July 2016 at 2:38 pm

    The National government has become very skilled at making official figures look like their policies are working and ignoring all the other information from non-governmental organisations that shows their figures are a lie.

  6. mosa 6
    25 July 2016 at 2:49 pm

    Key and Coleman and National fiddle as NZ burns.
    Its the mushroom strategy, keep them in the dark and feed them faeces .

  7. Repateet 7
    25 July 2016 at 4:22 pm

    Simple logic: Coleman is a liar. Is that too hard to believe?

  8. Psych nurse 8
    25 July 2016 at 4:26 pm

    How about the other scam, you have an accident, you need surgery, you linger in a DHB bed for a few days, the DHB transfers you onto the elective surgery list, ACC pays for the surgery, your happy. The elective surgery figures now look even better but you have occupied an acute bed for days at x $.

  9. Keith 9
    25 July 2016 at 5:35 pm

    This from a dishonest government who has made a relaxed art form out of rigging stats. The same government that recently made several thousand unemployed simply vanish because those Unemployed dared do something crazy 21st century like look for jobs on the internet!

    Anyway who would you believe, a minster of the Key National government or a medical professional? Actually I’d believe Bernie Madoff and Charles Ponzi combined over a minister in the Key National government!

  10. righty right 10
    25 July 2016 at 7:13 pm

    this is economic vandalism anyone who undermines the government is a traitor . the john key government is trying to hold new Zealand together and all you lefties want to do is destroy the countries perception of having a rock star economy national lies because it has to. freedom of speech has limits

  11. peterlepaysan 11
    25 July 2016 at 10:41 pm

    There are no waiting lists. There have not been waiting lists for decades includung Labour governance.

    The figures have been fudged for decades.

    Patients are triaged. There is no waiting list. “clients” are prioritised on relative urgency and recovery rate. It is a movable feast.

    If one is not damaged enough, or recoverable enough forget about treatment. Bill English has not got any money for you. Bugger what the medics think.

    What would they know?

    It is statistics that matter, bugger the patients and electorate.

    What would the electorate know that politicians, economists, bankers, bureaucrats do not.

    Let the electorate eat cake!

  12. AmaKiwi 12
    25 July 2016 at 11:34 pm

    Gossman, where are you when I need you to tell me there is no problem?

  13. Erik Bloodaxe 13
    26 July 2016 at 7:20 am

    I was turned away without even a specialist consult as I did not meet the ‘criteria’. I was using morphine to manage pain and work and the dose was getting to the point where my work was compromised and driving was becoming hazardous. I developed depression subsequent to ongoing extreme pain and yet failed to meet some criteria (that was never explained). Eventually I was forced to go private. I am lucky that I was working fulltime and could afford private health insurance, but the reality for me was that something had to be done. I have since had a full knee replacement and shoulder reconstruction – not through the public system as I was turned away more than once for not meeting their ‘criteria’. I am now functioning really well and my wellbeing is better than ever – but this is no thanks to National