New Zealand will always have more patients than our publicly funded non-urgent medical and surgical services (scheduled/elective services) can cope with at any one time. Common scheduled services include treating cataracts; inserting grommets to fight recurring ear infections; replacing hip and knee joints; repairing hernias; and unblocking damaged blood vessels or arteries. New Zealand is not alone with this challenge, as public health systems throughout the world continue to struggle to prioritise patients' needs and to balance the demand for scheduled services with available resources.
So, how does the health system decide who should be seen and treated, and when?
In 2000, our public health system changed from using waiting lists to a new strategy. The strategy aimed to ensure that patients are seen and treated within six months. These days, about 90% of patients (about 61,200 people) are getting scheduled services within this six-month limit. In the last five years, more patients have been getting services because of increased funding. However, about 6800 people do not receive required services in the six-month time frame and some have waited up to two years.
There is also no certainty that the "right" patients are always seen or treated in the appropriate order. Prioritisation matters because patients should not suffer unreasonable distress, ill health, or incapacity while they are waiting their turn or miss out on treatment. Equity is also important. Patients and their families should be confident that access to scheduled services is the same regardless of where they live.
Despite the encouraging improvements made in the last 10 years, we do not yet have a system for scheduled services that can demonstrate national consistency and equitable treatment for all. Our audit suggests that such a system is achievable. There are useful steps being taken, such as the introduction of a new tool to prioritise patients for cardiac surgery. I encourage the Ministry of Health, district health boards, and medical specialists to identify any disincentives and focus on putting in place systems and tools to make sure that the right patients get access to services at the right time.
This is a complex topic and deserves detailed consideration. Readers with limited time may prefer to read only our summary of progress against the strategy's main objectives. I thank all those who shared information about scheduled services with my staff.
Lyn Provost
Controller and Auditor-General
7 June 2011