Surgery targets hit in healthy recovery

GOOD RECOVERY: Peter Bramley, service director, medical surgical services, outside Nelson Hospital.
GOOD RECOVERY: Peter Bramley, service director, medical surgical services, outside Nelson Hospital.

Elective surgery is one of the Government's key health targets. Sarah Dunn reports on how the Nelson Marlborough District Health Board has recovered from a slow start to meet its surgery numbers in the last financial year.

By the end of next month more than 6100 Nelson and Marlborough patients are expected to have had life-changing elective surgery over the past year.

That will meet the target set by the Ministry of Health for the Nelson Marlborough District Health Board, a target that seemed a long way off at the end of last year.

In fact the projected total of 6115 operations by the end of June will be 86 more than the original target set for 2013-14.

Like its patients, the board itself has staged a recovery after falling well behind in elective surgeries in the last six months of last year.

Then a combination of factors saw Nelson Marlborough ranked second to last of the 20 district health boards for meeting elective surgery volumes between July and September, and last in the October-December quarter, when it met 92 per cent of its target.

For that quarter all but four boards achieved 100 per cent, and most delivered above the target.

To address its under-delivery of elective operations, the board introduced an action plan including daily monitoring, more services at Blenheim's Wairau Hospital and additional surgery sessions on Saturday mornings when staff were available.

It has also outsourced 200 operations to private providers at Manuka St Hospital and Rutherford Health Care.

The board's most recent update shows a big turnaround, reaching 99.7 per cent of the elective target by the end of April, and it is on track to complete the revised 6115 surgeries by the end of next month. It is also meeting its targets measuring the complexity of the surgery performed.

Peter Bramley, service director of the board's medical surgical services, said several factors had come together to slow Nelson Marlborough's elective surgery schedule down over November and December.

He said there were only four specialists in the ear, nose and throat department. This meant that when one went on maternity leave, another broke their hand and a locum cancelled their contract at the last minute, only one specialist was available to work for several months.

An unwell anaesthetist compounded those issues.

At the same time, the hospital had also been encouraging staff to use up their annual leave as part of the cost-saving strategies to turn around its budget deficit.

"I think one of the practical realities is that when we started experiencing difficulties with things like sickness, other staff like an ENT unable to pick up the theatre sessions we had available [and having] other staff on leave, we didn't have capacity to fill some of those sessions that we would normally do."

Bramley denied the board's struggle with debt last year had influenced its slipping behind surgery targets.

He suspected most health boards found themselves challenged to deliver their elective targets and waiting time targets by the end of each financial year.

The recovery has seen the use of private providers for public procedures, an option termed a "last resort" by board chief executive Chris Fleming last year because it would "reduce the incentive to optimise" the board's resources. After the challenges at the end of last year the board decided to take the private option, including for the extra 86 surgeries funded by the ministry.

Fleming said the numbers subcontracted out make up only 1.8 per cent of the total elective surgeries, and planning for 2014-15 shows that the board can deliver the surgeries in-house.

The board's recovery is timely because by January 1, 2015, every health board will have to make sure each patient waiting for elective surgery waits no longer than four months instead of five to see a specialist or be treated.

Fleming signalled the board's approach to the reduced waiting times in a report in March.

"There is a lot of misinformation about the shifting from five months to four months, like there was when moving from six months to five months," Fleming said.

"Often the suggestion is that tightening the target will reduce access. Indeed, the transition of moving from five months to four months poses two options: increase production to clear the hump that is generated to reduce the waiting times, or tighten access for a period of time to allow the hump to be addressed.

"The reality is our approach will be a mix of both."

In response to an inquiry submitted under the Official Information Act by Labour's health spokeswoman Annette King, Fleming has admitted that the board's threshold for hip and knee elective surgery had risen since June 2012.

That year patients needed to score 74 points or more to go on to receive their procedures. In that November, the threshold was raised to 83 points and remains at that level

Asked about the level of unmet need in the Nelson and Marlborough community for people who fall short of the criteria for surgery, Bramley said the board was phasing out its active review list.

The list measures patients who are sitting just below the threshold for surgery, but many boards are moving away from keeping this record.

Bramley said the list was no longer necessary as all patients likely to end up there were now being treated in a timely fashion.

"The reason why the active review list came about was, rather than required to see them again, you would sit them on an active review list, expecting that they were likely to deteriorate over time and therefore you'd bring them into a wait list scenario."

The Nelson Mail