The govt has no national health target for elective surgery – perhaps David Clark should tell his ministry

The Ministry of Health website and the Minister of Health are out of synch, when it comes to elective surgery.

On a page last updated on August 10 last year, readers will find a section headed Health targets: Improved access to elective surgery.

This says the Government has directed the ministry to develop a new set of performance measures to improve health outcomes for New Zealanders.

While work is underway to develop these new measures DHBs will continue to report to the Ministry against the current set of health targets, as well as against a previously established suite of wider measures.

Readers are referred to the Health targets page for more information on the development of new measures.

On the specific matter of improved access to elective surgery, a sub-heading asks:  What is the target?

The answer (drum roll, please) is: 

The volume of elective surgery will be increased by an average of 4000 discharges per year.

DHBs have negotiated local targets taking into consideration the health needs of their communities. Collectively these targets contribute to a national increase in elective surgery discharges.

Since 2015/16 the target has included elective and arranged in-patient surgical discharges, regardless of whether they are discharged from a surgical or non-surgical specialty (excluding maternity).

In Parliament yesterday, however, Health Minister David Clark said the government has no national health target for elective procedures.

 At Question Time, National’s Michael Woodhouse asked him:

What national health target, if any, does the Government have for elective surgical procedures for the financial year ending 30 June 2019, and will it meet that target?

The reply is recorded in Hansard:

Hon Dr DAVID CLARK (Minister of Health): The Government does not have a national health target for elective surgical procedures. That said, district health boards (DHBs) have been contracted to deliver 200,895 elective surgical procedures in the current financial year. I’m advised that as at the end of March, DHBs were reported to be at 98 percent of planned levels.

Hon Michael Woodhouse: Well, why then does the Ministry of Health’s own website, in a page entitled “Health targets:”, say, “What is the target? The volume of elective surgery will be increased by an average of 4,000 discharges per year.”?

Hon Dr DAVID CLARK: I don’t have access to that particular page. It may be cached on his computer or it may be one that’s live that needs updating…

Clark then shamelessly proceeded to fudge the targets issue by bringing industrial action into considerations:

 … But what I can say is that we’re striving to address the contracted volumes because we acknowledge that some procedures have been postponed or otherwise moved due to the industrial action that was under way.

I’m happy to report that there’s been a great deal of progress on industrial action, which is, of course, addressing years of underfunding by the previous Government. In the example of the nurses, their settlement was worth more than all three done under the previous Government combined.

We’re addressing a historic underfunding in the sector and, even still, hoping to get to a point where we deliver on those contracted volumes. Indeed, DHBs have plans in place to improve their elective performance.

Woodhouse followed up by asking if the Minister agreed with ministry figures that show the 105,378 elective procedures completed by DHBs as at the end of March are almost 6,500 fewer than required even to get to last year’s activity level and 9,500 fewer required to meet the extra 4,000 target?

The Minister glibly disagreed.

Hon Dr DAVID CLARK: I don’t accept the member’s numbers.

Hon Michael Woodhouse: Which part of the question does he not accept?

Hon Dr DAVID CLARK: The numbers I’ve seen the member’s opposite use are ones that don’t align with the historic reporting of elective targets under the previous Government. They are not comparing apples with apples. Statistics are to be used in a way that illuminates rather than misleads, and I believe there are better ways of presenting the material that actually gives a clearer picture of what’s happening.

Michael Wood: So is the Minister saying to patients waiting for cardiothoracic surgery that there won’t be 300 fewer of those cases performed in this financial year and to those waiting for orthopaedic surgery that there won’t be 1,500 fewer of those operations performed this year?

Clark wriggled off this hook by further talking of statistical anomalies and blaming the previous government’s “neglect“.

Hon Dr DAVID CLARK: What I would say is that DHBs are working hard to ensure that contracted volumes are delivered. There are some anomalies with the data.

The system that we inherited is certainly not perfect by any stretch of the imagination. The investment in health infrastructure was also neglected under the previous Government.

But I am encouraged to see an increase in non-admitted procedures, which are up by 2 percent compared with the previous year. Procedures are now being done in an environment often more convenient for the patient and actually more cost-effective for the sector.

So we’re getting away from the distorted incentives that were in there previously that had Avastin injections and skin lesion removals often done in more expensive settings just to pump up Government statistics.

This is a Government that’s committed to ensuring New Zealanders get the care they need and deserve rather than pumping up the statistics for political gain.

The Ministry of Health website says health targets 

 … are a set of national performance measures specifically designed to improve the performance of health services that reflect significant public and government priorities. 

An update on the status of national health targets and the development of new measures is provided.

The Government has directed the Ministry of Health to develop a new set of performance measures to improve health outcomes for New Zealanders.

The new focus will be on population health outcomes and will ensure that health resources are used optimally. The objective is to give confidence the best decisions are being made to improve the health of New Zealanders.

In developing these new measures the Ministry has been asked to consider the following criteria:

  • a mix of health system and population health improvement measures
  • alignment with government priorities, for example, child wellbeing and mental health
  • be quantified and timed
  • availability of data to monitor progress
  • sector engagement and support
  • focus on health issues with alignment to socio-economic determinants.

Once new measures are announced and finalised, they will be regularly reported on to the public. 

So what’s the timeframe?

The Ministry will develop these new measures over the next six months and will aim to have the new measures in place early 2019. We will keep this page updated as this work progresses. 

We look forward to the update. 

Oh – and with regard to the target for elective surgery, the section which tells us the volume of elective surgery will be increased by an average of 4000 discharges per year includes a sub-heading which asks:  Why is this target area important? 

In reply, we are told:   

The government wants the public health system to deliver better, sooner, more convenient health care for all New Zealanders. 

Elective surgery operations improve quality of life for patients suffering from significant medical conditions but that can be delayed because surgery is not required immediately. For example, a hip replacement can reduce pain and increase function, allowing a person to get back to participating in physical work or other important activities. A cataract operation may ensure someone is able to see well enough to read or to drive their car, while a grommet operation might restore proper hearing to a young person with ‘glue ear’.  

In the past, the growth in elective surgical discharges did not keep up with population  growth. The rate of growth of elective surgery needs to increase, which in turn, will increase patients’ access to this important service, and should achieve genuine reductions in waiting times for patients.

We look forward to the Minister announcing the measures that will achieve this and other health targets.  Perhaps good news is in store in The Wellbeing Budget.

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