Health NZ aims to cut surgery waitlists by outsourcing to private hospitals, extending doctors' hours

Health New Zealand plans to cut its elective surgery waitlist by outsourcing thousands of simple cases to private hospitals, while asking public hospital doctors to work longer hours on the more complex cases.

Surgeons have reacted to the plan with confusion, saying they are already stretched.

Labour warned the approach would likely lead to complex patients waiting even longer.

Even if it succeeds, the plan may not keep up with a 7 percent increase in waitlist numbers, as eligibility thresholds are standardised across the country, documents released to RNZ showed.

"This increase is adding almost 15,000 people each year to the waitlist," a January briefing to Health NZ commissioner Lester Levy said.

Health NZ has a target of treating 95 percent of people waiting for elective surgery within four months. As of January, only 60 percent of people were being treated within that timeframe.

The documents showed Health NZ wanted surgeries performed to increase by 20 percent by June next year, in order to improve waiting times.

While some cases would be outsourced to private hospitals, most would be cleared by the public sector by "incentivising" clinicians to work evenings, weekends and public holidays, Levy advised health minister Simeon Brown in a February briefing paper.

Surgeons questioned who would do the work.

"Most surgeons already work long hours, including evenings and weekends," Australasian College of Surgeons' New Zealand chair Ros Pochin said.

"There are some surgeons who work purely privately, but most work privately and publicly so there isn't a cache of private surgeons sitting there twiddling their thumbs in the evenings and weekends who can suddenly call in."

In March, Brown announced nearly 10,600 surgeries would be outsourced to the private sector at a cost of $50 million.

That would lift the proportion of patients waiting less than four months to 67 percent by June this year.

Documents showed Health NZ needed to fund a further 5300 operations by August, and another 15,800 between September and June 2026.

That would lift its performance to 70 percent of patients treated within the four-mounth window, and take the total number of elective surgeries performed between March and June 2026 to 31,600.

The documents said the extra surgeries would be paid for from existing health budgets through "ongoing operational efficiency", though in an interview with RNZ, Brown said the government would also be investing new money to help pay for them.

Private hospitals would be given two- to three-year contracts guaranteeing "high volume low-complexity cases" while "high complexity work will be completed in-house".

Labour's health spokesperson Ayesha Verrall said it was concerning that the private sector would only tackle the easier cases on the waitlist under the new contracts.

"That means that people who have more complex conditions won't necessarily be the people targeted by the government initiative to bring down the waitlist, and it probably means longer waits for them."

While it was good to reduce the waitlist, the process also had to be fair, Verrall said.

Brown said waitlists had "ballooned" under the last government and working with the private sector was part of the solution to get through the backlog.

Outsourcing to private hospitals was more expensive than expanding public sector capacity, and building new or refurbishing hospitals was also needed, Health NZ executives told Brown in January.

However, it was an opportunity to make private hospitals "a central part of our planning," Health NZ South Island regional deputy chief executive Martin Keogh wrote.

Brown said he was focused on using both public and private systems so people could get treatment in a timely fashion.

The government was pumping an extra $16.7 billion into Health NZ over three budgets to increase delivery and shorten wait times, he said.

Theatre capacity was being expanded at two hospitals in Auckland, at Christchurch's Burwood Hospital, and in Hamilton and Wellington.

"It's making sure the lists are full and theatres are being used to the maximum efficiency. We're also looking across private hospitals where surgeons may have spare capacity."

He had been assured by the private sector that it had capacity, he said.

"I acknowledge that our doctors, our senior medical officers, our surgeons are working incredibly hard. They're doing an incredible job.

"The conversations I've had with the private hospitals is that there is spare capacity and that there are opportunities where there may be spaces on lists," Brown said.

However, the Health NZ papers said outsourced operations could only be delivered if there were senior clinical staff available, "whilst ensuring Health NZ remains able to safely manage the clinical workload of our public hospitals".

There was a risk that private sector capacity would be "insufficient" due to workforce availability, the papers warned.

Ros Pochin, who is also a general surgeon at Nelson Hospital, said that risk was real, as most surgeons already worked long hours, including after hours.

"There's only 800 of us in the country. We already work out-of-hours, as we all do on call. I'm about to start a week of continuous on-call myself, which I'll do 81 hours straight day and night. And so we get very little time off as it is."

The college was against outsourcing elective surgeries, she said.

"Outsourcing is essentially an admission that we have not got an adequately funded and resourced health system."

The government needed to fund the public health system properly, and recruit and retain more doctors, she said.

Waitlists growing, and growing

Meanwhile, Health NZ warned waitlists were growing by 15,000 people a year and changing eligibility criteria was likely to increase that further.

"The changing of thresholds for [First Specialist Assessments] and treatment thresholds will alter these numbers, and the costs required to achieve the objective."

First Specialist Assessments (FSAs) are the first specialist appointment a patient has after being referred by a GP.

Health NZ redacted the estimated costs of changing the thresholds, citing commercial reasons.

In a statement, the agency said there was currently variation in thresholds used by clinicians between districts and clinical specialities and it was working to "harmonise" access criteria for first specialist appointments, which was likely to lead to more people being eligible.

"This work will initially focus on Ear, Nose and Throat (ORL) and Orthopaedics, which represent around 30 percent of the FSA and elective treatment waitlists."

Association of Salaried Medical Specialists executive director Sarah Dalton said people were already missing out on referrals, because GPs doubted they would ever be seen because of growing waitlists.

"So they're not bothering to refer in the first place."

She was also concerned that public hospital doctors did not have any say over which patients should be outsourced,

"They're told that's in the hands of the private hospital provider."

Another senior doctor warned Brown in March there were risks to outsourcing more operations to the private sector, and this approach would only work if public and private worked collaboratively.

"It is vital those establishing contracts recognise there are clinical obligations and responsibilities in the public sector that must not be weakened by outsourcing. Health New Zealand must consider such risks in the contracting process," Health Workforce and System Efficiencies Committee chair Andrew Connolly wrote.

The committee advises the minister on workforce challenges.

The 15 March memo to the minister was heavily redacted, including all the risks and mitigation strategies the committee suggested.

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