Monday, April 17, 2006

Editorial: Waiting lists all smoke and mirrors

Is there any sadder collision between economic rationality and human need than the system of waiting lists now operating in our public hospitals? At any moment, many thousands of New Zealanders who are plainly in need of treatment and unable or unwilling to pay for private care are languishing on a labyrinth of lists. There are those waiting to see a specialist; those who meet the clinical threshold for surgery but not the financial threshold; those under "active review"; those waiting for surgery who might, just, get it; those being sent back to their GP for re-assessment. And, presumably, some of those waiting again to go from their GP back to a specialist again.

The much-documented failings of waiting lists are about as difficult a political problem as any government encounters. The state now spends around one in every five tax dollars on the health system. It is universally agreed that no government can afford to meet all of society's health needs. At its simplest, that means there must be rationing of services to those most in need, or the private sector must provide a viable alternative, or both.

Last week's news that both the Auckland and Hawkes Bay district health boards were about to tell qualifying patients that they would not soon be receiving consultations or operations may well be the start of a trend. In Auckland, some heart patients can expect the bad news of a letter telling them that they will, instead, be placed on "active review". No operation, but (in our words, not those of a bureaucrat) a six-monthly check to ensure they are still breathing. In Hawkes Bay, around 1800 people who have waited more than six months to get to first base, an assessment from a specialist, will now be sent back to their GPs. In many cases these will be the GPs who referred them for a specialist check in the first place. In virtually all cases, because they have waited so long on the public list, it can be assumed these patients do not have the money or insurance policy to pay for an operation - or even a specialist appointment - privately.

More boards can be expected to follow this path. The Ministry of Health has tired of the district health boards tolerating large lists and has written to them promising they will be placed under "intensive monitoring" if they do not clean up their books. There is an argument that it is better to be honest with the ill than to keep them waiting in hope of a visit to the theatre. There is another argument that constantly reclassifying people does not make them any less sick.

The Minister of Health, Pete Hodgson, huffs and puffs about the Hawkes Bay board having mishandled this latest round of smoke and mirrors. Yet the patients who have been on, and now off, the board's lists did not put themselves there. If what Mr Hodgson really wants is for the GPs at the start of the labyrinth to raise their tolerance level of how sick someone must be to go on to a specialist, he, and the ministry, should say so. If they want the specialists, then, to raise their standards for the clinical needs of patients to go forward for surgery, or active review, they should say so.

More importantly, if they want to improve the service that hospitals can offer the sick, they need to be open to that other factor in the health equation: private hospitals and specialists being engaged in a partnership with the state. The Labour Party is ideologically opposed to public-private solutions for hospitals but it is probably time that it got over itself and looked for practical benefits for patients. Otherwise, these patients, their families and communities will be putting the governing parties under "intensive monitoring", with the prospect of referring them back to the Opposition benches, for reassessment.

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