Elective surgery at Hawke’s Bay Hospital

Hawke’s Bay people to have more certainty over elective surgery at Hawke’s Bay Hospital

Chris Clarke, Hawke’s Bay District Health Board’s chief executive officer, said in order to give Hawke’s Bay people more certainty about whether they are likely to receive surgical treatment in the public health system, a comprehensive review has been carried out of the large number of patients waiting on the elective services booking system.

Hawke’s Bay has a legacy of long waiting times and large waiting lists, which predate the current DHB, that were not able to be fully addressed when the large amounts of funding were provided to Crown Health Enterprises around 1997/1998. This was due to the development of the regional hospital (and constraints around capacity) at this time.

“The review was conducted by specialists, general practitioners (GPs) and Hawke’s Bay Hospital staff. Two key issues were identified: patients waiting on the booking system whose assessed priority for treatment is lower than other patients waiting for similar surgery and another group of patients whose condition is not regularly monitored to determine their priority for treatment.

The demand for elective services exceeds the DHB’s resourced capacity to provide some services. This means some patients of a lower priority have no realistic possibility of receiving surgery unless their priority changes.

“For some of these patients the reality is they will not get treatment unless their condition deteriorates and their priority changes. We regret that some people will be removed from the booking system, however our aim is to ensure that patients receive an honest and clear indication from us regarding their access to surgery.”

The review also highlighted the need to regularly monitor the condition of people waiting on the booking list, where despite being given assurance of surgery they were not regularly assessed to determine their level of need. A process of active review across all surgical specialties is being implemented whereby people on the booking system will have their condition reassessed every six months.

“In this way we can better monitor their condition and priority for treatment, and ensure that those patients with the greatest need receive treatment within a reasonable time frame.”

Karen Orsborn, manager, surgical services says “The active review process already operates in a number of surgical specialities and has proved to be an effective way of monitoring patient condition and prioritising access to treatment.

“By actively monitoring people on the surgical lists we are able to ensure that they are fully informed of their status on the booking system and the treatment options available to them. We are finding that some people are given a higher priority for treatment, others continue to be monitored, and some may in time be placed in the care of their GP.”

In an environment where priorities for scarce resources are always having to be made, our aim is to provide patients with clarity of information, treat those people with the greatest need and have systems that are transparent.

“Some people have been waiting longer than is desirable in the hope that some day they may get to the top of the list. The reality is, with our current resources and requirements of the elective services booking system only those with the greatest need can receive treatment and care. We want to be honest with people, rather than have them waiting indefinitely at the bottom of a list, with little chance of ever receiving their surgery” says Chris Clarke.

Letters advising people that either they have been removed from the booking list, or confirming their status in the active review category would be sent out over the next two weeks.

Approximately 302 will be taken off the waiting list for surgery, with a further 206 people being transferred into active review.

If after receiving a letter, people believe their condition has recently deteriorated, or if they believe there are exceptional circumstances relating to their care, they should see their general practitioner. Those people taken off the booking list will be provided with a letter which they can present to their GP for a free consultation to discuss the future management of their condition.

A toll-free answer-phone has been set up for people who want more information about their status on the elective services booking list. A staff member will be available during business hours to answer any questions, a message can be left if the operator is busy or the call is out of business hours. A staff member will return their call within 48 hours, during business hours. The number to call is: 0800 150 014.

Introduction

The Ministry of Health’s goal for elective services in New Zealand is that no person will wait more than six months for a first specialist assessment (FSA) and that those that require surgery are treated within six months or have a clear plan of care.

The system aims to achieve equity of access throughout New Zealand.

The HBDHB has committed to substantially achieving the targets by June 2005. Because of the large number of people on waiting lists a comprehensive review of the elective services booking system has been carried out. The result of this is that people who do not currently meet the criteria to receive treatment and care under the public system will be advised of this situation. In the past their names have been left on the lists in the hope that one day they may get to the top of the list. Under current criteria many people currently waiting are unlikely to ever qualify for surgery in the public system.

The booking system

Many people are referred to see hospital specialists at outpatient clinics by their general practitioner (GP). A preliminary decision is made on the urgency of their condition based on the information supplied by their GP, specialist assessment and diagnostic investigation. All cases are prioritised according to need.

After this patients are advised whether they qualify for further treatment eg surgery, or will be monitored through the active review process, or are advised that they do not currently qualify and are referred back to the care of their GP for on-going monitoring and treatment.

In the past many patients seeking elective services were placed on booking lists where some remained without a plan of care, or a date at which their condition would be assessed or treatment provided. These people will now undergo an active review process whereby their condition is assessed every six months.

Today we want to provide patients with clarity of information, equity of access, transparency and honesty, in an environment where priorities for scare resources are always having to be made.

Will taking the names of around 300 people off the booking list save the HBDHB money?

No, not at all. This isn’t about money, it is about giving people certainty, clarity of information and honesty. If people are never likely to qualify for surgery we can let them know as soon as possible so they can discuss on-going care and alternative treatment / therapies with their GP.

What happens to people in the active review category?

Their condition and assessment of their priority for treatment will be made at six monthly intervals. This will mean that people on the elective services booking list will be regularly informed of their access to treatment, rather than the current situation where some people have waited for long periods not knowing when to expect treatment.

What are the factors taken into account when prioritising people for treatment?

We use tools that consider patient condition, clinical need, the impact of the condition on the patient and the patient’s ability to benefit. The overriding aim is to treat those with the greatest need first. Factors such as age and gender are not considered in making these decisions.

Why can’t money being spent elsewhere be spent on surgery?

Each year Healthcare Services, the provider arm of Hawke’s Bay District Health Board is contracted to provide a certain number of surgical procedures. The contract is based on the regions needs assessment, which looks at factors such as age, socio-economic and health status of the population.

There is a limit to the number of procedures that can be carried out each year. If we go over this limit, we are not paid for this work. Therefore it is important that people in the greatest need receive surgery first.

How much money is allocated to elective services in Hawke’s Bay each year?

$15.6 million. This includes specialist treatment in Wairoa and Central Hawke’s Bay.

How many people in Hawke’s Bay are currently on the elective services booking system? This changes on a daily basis, at the moment we have 3590 on the surgical list and a further 1632 waiting for a first specialist assessment.

How many people will be told they are being removed from the booking system? The numbers are not yet confirmed, but at this stage 302 people are being reviewed. Final decisions are subject to clinical review.

How many people will be placed into active review, where their condition is monitored to determine their priority for treatment? 206

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