The number of patients waiting more than 12 months for their first specialist assessment increased 17-fold over the COVID-19 pandemic, a taskforce says.
The Government established a taskforce in May to conduct a national review of health waiting lists after it was told it could take between three to five years to clear the planned-care backlog.
The taskforce's plan was released publicly on Tuesday, revealing it has made 101 recommendations to improve equity, increase access and reduce waiting lists for planned care. That includes suggesting that more care should be provided in primary care settings - like at general practitioners (GPs) - to release hospital and other specialist services "for work that only hospitals can do".
"Of the 101 recommendations received from the report, 30 will begin implementation by December this year and others will be phased in through a multiyear programme of work, led by Te Whatu Ora hospital and specialist services, in the medium and long-term," said Health NZ's chief executive Margie Apa.
The taskforce said COVID-19 has been "disruptive to hospital systems all over the world" with significant challenges persisting in providing essential health services two years on from the start of the pandemic. It noted these challenges were "exacerbated" but not "created" by the pandemic.
"A major challenge is to improve planned care delivery back to pre-pandemic levels of productivity," a summary of the plan said.
"A disciplined focus on the management of waiting lists and use of scarce resources is necessary, but at the same time, work on matters such as pathway and guideline development should proceed to enable the system to be prepared for improvements when capacity allows."
Among the taskforce's key findings is that the number of people waiting longer than 12 months for a First Specialist Assessment (FSA) - when a specialist assesses the patient's condition and recommends the best option of care - has risen 17-fold from 253 in December 2019 to 4255 in June this year.
The number of people waiting longer than four months has risen from 12,894 (11 percent of the waiting list) to 35,265 (25 percent). The number of follow-ups delivered relative to the number of FSAs delivered has increased, however.
About 6000 more referrals are accepted by the hospital and specialist services each year than are currently being seen, which is why waiting lists are growing, the taskforce said.
The taskforce also reported that between March 2022 and June 2022 there was a 6 percent increase in the number of people waiting for treatment and a 7 percent increase in the number waiting for more than four months.
At the end of June there were 5555 patients waiting for more than 12 months for treatment, an increase of 1832 over three months. A little more than half are on orthopedic and general surgery waiting lists.
"The current treatment waiting list contains (on average) 5.2 months' worth of work. If we wanted to reduce this so that we only had three months' worth of work on the waiting lists, we would need to provide approximately 30,000 additional procedures.
"There is insufficient workforce and capacity to carry out this work immediately. If it were feasible to purchase this work, it would cost approximately $254m a sum that is increasing by about $10m each month."
The taskforce also had a focus on equity. It found that 53 percent of Māori have been provided with treatment within four months of receiving certainty, compared with 58 percent of non-Māori, non-Pacific and 62 percent of Pacific. This demonstrates "inequity, especially for Māori".
There has also been a 53 percent increase in the number of Māori waiting more than 12 months for treatment, compared to a 49 percent increase for non-Māori and non-Pacific people.
The taskforce noted that a key reason for the Government's health reforms - disestablishing the many District Health Boards (DHBs) and centralising the system into Te Whatu Ora - Health NZ and the Māori Health Authority - was to help alleviate health inequities.
"Health inequities are unfair, avoidable and remediable. Health inequities in planned care include differing groups being disproportionately affected by delays or differences in advice and treatment options offered to patients. Health equity is only achieved when outcomes are equitable to that achieved for others".
Among the taskforce's 101 recommendations include providing more care in primary care settings to reduce pressure on hospitals and secondary specialist services, improving access to diagnostic imaging for clinicians in primary care, and expanding Māori and Pacific-focused provider services.
"Waiting list management must be consistent with high-priority patients treated on time and lower priority cases treated in order of entry to the waiting list. This should ensure consistent approaches to equity in waiting list."
Health NZ's Apa said effective waiting list management is key to improving care service.
"I am pleased to see progress delivering this, which will also see reduced inequity regarding excessive waiting times for Māori," she said.
She said in a statement that patients are already benefiting from the work of the taskforce.
"Good progress has been made from our start point of 5405 [people waiting longer than 365 days] on 1 July 2022, with our latest data showing that 1622 patients as at 17 October 2022 who have been waiting the longest for treatment are now scheduled."
There were 2069 waiting to be scheduled. The remaining have been treated, discharged or returned to their GP.
The taskforce will reconvene in six to 12 months' time to "provide inadequate independent assurance regarding the implementation". It was overseen by Counties Manukau's chief medical officer and colorectal surgeon Andrew Connolly.
