Another way to ensure wait times for specialist appointments is to make it harder to get on the wait list in the first place. This is another tactic that has been used for sometime - increase to level of ill-health/disability a person must have to get into the system. Of course this presupposes a person can get into a primary care provider in the first place
Yes, I agree. It took me nearly two years to get on a wait list to see a surgeon for a issue that previously I had a 3 month wait for. I ended up on such strong painkillers that I was forced to resign my job. I looked at going private as I was so desperate, but was told it would cost me $100,000. I finally got my surgery in November 2023, so lucky as I very much doubt that it would be funded today. Now I have been unable to get further work, as my previous role - in Health and Disability - was disestablished.
I can tell that the thought of Simeon and its implications has helped spur you into a flurry of writing activity to aid the anxiety. Oh my Lordy you have provided so much vital knowledge for me today. (Which includes your interview with Bryan Bruce on his Subtrack) After reading these damn cunning manipulations I can identify with three of these having been implemented on myself and husband in the last 12 months. Why is it Doctors don’t come clean on this information like you have? I can now see why complaining can get action. It is a great thing you have done I must spread the knowledge.
During the English premiership with Dr Johnathan Coleman at the helm of health, waiting lists for elective surgery shrank....because under his directive if you weren't operated on within 4 months you simply dropped off the list and were referred back to your doctor. Cynical but very effective in keeping waiting lists down
I have seen this at my district in that same period, but not recently thankfully.
This is the consequence of setting targets as enforceable objectives, rather than using them as diagnostic measure to tell you how healthy your patient flow processes are.
Another great method of reducing ED length of stay is to classify part of the ED as a separate monitoring or observation area, and then 'stop the clock' simply by moving patients there. It doesn't matter if it's just an area in corridor, marked out as a bed space with tape on the floor; any old place you can squeeze a patient will do.
Re the switcharoo to private, do you have any idea why Dr Beaglehole's Christchurch charity hospital has been dropped from the list of those receiving the overload for "elective" surgery?
I sent this to the PM and Health Minister today, not really expecting anything more than the std form response:
"Dear Prime Minister,
Congratulations on your recent cabinet reshuffle, in particular the changes to Health.
I call on you to support your stated faith in the NZ public health system by cancelling any personal or family private health insurance, using the public system without any priority or favour not available to others, and ordering the people listed below to do the same for the duration of their current appointments.
Health Minister: Simeon Brown
Health NZ Chief Executive: Margie Apa
Commissioner: Dr Lester Levy"
Also challenged Chris Hipkins to do the same. Will see what, if anything beyond acknowledgements, comes back.
I’m worried Simeon will read this and implement your satirical suggestions as his own bright ideas. Very interesting, and worrying. As was your excellent interview with Bryan Bruce. Thank you for speaking out and giving us the cold hard reality. I have to wonder why other doctors, surgeons and GPS aren’t doing the same. Fear? My own GP stepped down early from the Board of Te Whatu Ora last year. I can only guess why.
I’m despairing actually being in this situation, having to wait for months to be seen and the health problems getting worse because of that, it’s so frustrating, and puts such an unnecessary stress on patients
Thanks Gary, this confirms what I thought when I saw those targets. Many of them have nothing to do with ensuring someone is treated well and have good health outcomes.
The ED target is laughable. Having to take my 15 yr old to Auckland ED was very scary with the waiting room full of people waiting to be triaged. There was an unmasked case of TB, another very tall and intimidating guy shouting he was about to lose it (he was high). After a 2 hour wait we went through to a 2nd waiting room which we never processed beyond. After 6.5 hours we saw a doctor and then waited. Finally we were told there was no way to have an ultrasound as it was now 8pm at night so we were discharged with a followup ultrasound promised within a week. We had started out at 8am at a local clinic who said we needed to get to hospital, so we were really surprised with the outcome. Pretty much everything you mentioned happened. I was stunned. I've spent too much time in hospitals over the years with my other child with a rare disorder and now my parents who need care. This was the worst I've ever seen it. 😭
So what can be done? Increasing funding by Labour and whatever else they did for 6 years did not work. Is it time that we bit the bullet and stopped being a mini NHS (which is also on its knees) and moved to a model like Australia? A genuine question from a family who does not have private health insurance...
IMO, increased funding for hands-on care (ie, nurses) during last govt was very impactful: those gains have lasted, and only been eroded recently with high inflation that was met with wage stagnation by this govt. (ie, wage increase proposal of 1%, less than inflation by this govt).
the NHS was the best health programme in the world (according to some independent rankings) before 14 years of Tory hacking and underfunding which destabilised it. we should absolutely aim to be a mini-NHS, when funded adequately, it was the pride of the civilised world. it just couldn’t withstand corporate profit-driven politicians for more than a decade.
australia spends a lot more per capita on health (what, about 40% more?); that alone makes it an unequal comparision. we’d do great with vastly better funding as well. but they also exploit their vast mineral wealth, while we exploit our significant (but less fiscally valuable) pastoral wealth. dissimilar in significant ways.
and with every private interaction, comes losses in the form of private profit. sucked out of the system.
I’d like to see the people who’ve skated off with the biggest untaxed gains, have to contribute their fair share, which would be more than enough to pay for adequate health, education, and retirement funding. more than 150 years of tax-free capital gains is more than 150 years of lost funding (billions and billions) that could have made this country better and stonger. time to fix the no-Capital Gains Tax loophole that virtually every other (non-tax scam nation) fixed decades ago.
In 2009 the incoming national health minister quietly stopped paying an annual inflationary adjustment to the cost of delivery calculations for public health services. This in turn meant that each year, we would being underfunded by the inflation rate, compounding annually.
Subsequent governments did not reinstate this adjustment until - surprisingly - 2023.
No funding compensations have been made to 'catch up' for the period of neglect.
This is one of the reasons why the public health sector is so badly underfunded today. A quick Google query tells me that we are now in the ballpark of 36% underfunded, which seems about right.
That's a reasonable and simple explanation which I'm sure is correct. But if 36% is correct that would mean as a country we would need $865 000 000 more each year and where will that come from (the robbing Peter to pay Paul problem)? And would we not likely need even more soon with an ageing population but with shrinking numbers of tax payers. It's hard to see a way out of this.
Yes, and that's probably why no government has been brave enough to confront this issue - because that molehill is now a mountain.
Correcting for the neglected inflationary adjustment would require the service-delivery portion of our health budget* to be permanently increased by approx. 36%, if my inflation calculations are correct. Additionally, that portion of the budged would need to continue to be adjusted by inflation each year.
It is plainly evident that we need many hundreds of millions of 'catch up' funding to urgently build those missing hospitals, reinstate abolished services, expand screening programmes to effective levels, etc.
This would go a long way towards resuscitating our health services and making NZ health an attractive industry to work in again.
*I'm not sure what percentage of the total budget the service-delivery portion is, but it is substantial.
I have always found the ED target the most amusing. ED is functionally the social service of last resort. ED waiting times couldn't be down stream from MORE other problems. From the GP availability, to ward space, to any number of public health issues, targeting ED wait times is about as meaningful a goal as 'doing things betterer'.
Maybe every Health Minister should not be allowed private medica insurance/treatment for themselves or their family while in the job - might encourage them to improve the system rather than run it down
Another way to ensure wait times for specialist appointments is to make it harder to get on the wait list in the first place. This is another tactic that has been used for sometime - increase to level of ill-health/disability a person must have to get into the system. Of course this presupposes a person can get into a primary care provider in the first place
Yes, I agree. It took me nearly two years to get on a wait list to see a surgeon for a issue that previously I had a 3 month wait for. I ended up on such strong painkillers that I was forced to resign my job. I looked at going private as I was so desperate, but was told it would cost me $100,000. I finally got my surgery in November 2023, so lucky as I very much doubt that it would be funded today. Now I have been unable to get further work, as my previous role - in Health and Disability - was disestablished.
I can tell that the thought of Simeon and its implications has helped spur you into a flurry of writing activity to aid the anxiety. Oh my Lordy you have provided so much vital knowledge for me today. (Which includes your interview with Bryan Bruce on his Subtrack) After reading these damn cunning manipulations I can identify with three of these having been implemented on myself and husband in the last 12 months. Why is it Doctors don’t come clean on this information like you have? I can now see why complaining can get action. It is a great thing you have done I must spread the knowledge.
1- they are too busy with work and life
2- they don't want to risk getting sacked
During the English premiership with Dr Johnathan Coleman at the helm of health, waiting lists for elective surgery shrank....because under his directive if you weren't operated on within 4 months you simply dropped off the list and were referred back to your doctor. Cynical but very effective in keeping waiting lists down
I have seen this at my district in that same period, but not recently thankfully.
This is the consequence of setting targets as enforceable objectives, rather than using them as diagnostic measure to tell you how healthy your patient flow processes are.
Another great method of reducing ED length of stay is to classify part of the ED as a separate monitoring or observation area, and then 'stop the clock' simply by moving patients there. It doesn't matter if it's just an area in corridor, marked out as a bed space with tape on the floor; any old place you can squeeze a patient will do.
Unfortunately all too true re the game-able KPIs.
More of a documentary than a satire.
Re the switcharoo to private, do you have any idea why Dr Beaglehole's Christchurch charity hospital has been dropped from the list of those receiving the overload for "elective" surgery?
No insight unfortunately, but I think you mean Bagshaw not Beaglehole (both admirable health whānau)
You’re right. I did mean the admirable Drs Bagshaw
I sent this to the PM and Health Minister today, not really expecting anything more than the std form response:
"Dear Prime Minister,
Congratulations on your recent cabinet reshuffle, in particular the changes to Health.
I call on you to support your stated faith in the NZ public health system by cancelling any personal or family private health insurance, using the public system without any priority or favour not available to others, and ordering the people listed below to do the same for the duration of their current appointments.
Health Minister: Simeon Brown
Health NZ Chief Executive: Margie Apa
Commissioner: Dr Lester Levy"
Also challenged Chris Hipkins to do the same. Will see what, if anything beyond acknowledgements, comes back.
I’m worried Simeon will read this and implement your satirical suggestions as his own bright ideas. Very interesting, and worrying. As was your excellent interview with Bryan Bruce. Thank you for speaking out and giving us the cold hard reality. I have to wonder why other doctors, surgeons and GPS aren’t doing the same. Fear? My own GP stepped down early from the Board of Te Whatu Ora last year. I can only guess why.
I’m despairing actually being in this situation, having to wait for months to be seen and the health problems getting worse because of that, it’s so frustrating, and puts such an unnecessary stress on patients
Simeon will literally be taking notes from this.
Thanks Gary, this confirms what I thought when I saw those targets. Many of them have nothing to do with ensuring someone is treated well and have good health outcomes.
The ED target is laughable. Having to take my 15 yr old to Auckland ED was very scary with the waiting room full of people waiting to be triaged. There was an unmasked case of TB, another very tall and intimidating guy shouting he was about to lose it (he was high). After a 2 hour wait we went through to a 2nd waiting room which we never processed beyond. After 6.5 hours we saw a doctor and then waited. Finally we were told there was no way to have an ultrasound as it was now 8pm at night so we were discharged with a followup ultrasound promised within a week. We had started out at 8am at a local clinic who said we needed to get to hospital, so we were really surprised with the outcome. Pretty much everything you mentioned happened. I was stunned. I've spent too much time in hospitals over the years with my other child with a rare disorder and now my parents who need care. This was the worst I've ever seen it. 😭
im so very sorry to hear this.
So what can be done? Increasing funding by Labour and whatever else they did for 6 years did not work. Is it time that we bit the bullet and stopped being a mini NHS (which is also on its knees) and moved to a model like Australia? A genuine question from a family who does not have private health insurance...
IMO, increased funding for hands-on care (ie, nurses) during last govt was very impactful: those gains have lasted, and only been eroded recently with high inflation that was met with wage stagnation by this govt. (ie, wage increase proposal of 1%, less than inflation by this govt).
the NHS was the best health programme in the world (according to some independent rankings) before 14 years of Tory hacking and underfunding which destabilised it. we should absolutely aim to be a mini-NHS, when funded adequately, it was the pride of the civilised world. it just couldn’t withstand corporate profit-driven politicians for more than a decade.
australia spends a lot more per capita on health (what, about 40% more?); that alone makes it an unequal comparision. we’d do great with vastly better funding as well. but they also exploit their vast mineral wealth, while we exploit our significant (but less fiscally valuable) pastoral wealth. dissimilar in significant ways.
and with every private interaction, comes losses in the form of private profit. sucked out of the system.
I’d like to see the people who’ve skated off with the biggest untaxed gains, have to contribute their fair share, which would be more than enough to pay for adequate health, education, and retirement funding. more than 150 years of tax-free capital gains is more than 150 years of lost funding (billions and billions) that could have made this country better and stonger. time to fix the no-Capital Gains Tax loophole that virtually every other (non-tax scam nation) fixed decades ago.
In 2009 the incoming national health minister quietly stopped paying an annual inflationary adjustment to the cost of delivery calculations for public health services. This in turn meant that each year, we would being underfunded by the inflation rate, compounding annually.
Subsequent governments did not reinstate this adjustment until - surprisingly - 2023.
No funding compensations have been made to 'catch up' for the period of neglect.
This is one of the reasons why the public health sector is so badly underfunded today. A quick Google query tells me that we are now in the ballpark of 36% underfunded, which seems about right.
That's a reasonable and simple explanation which I'm sure is correct. But if 36% is correct that would mean as a country we would need $865 000 000 more each year and where will that come from (the robbing Peter to pay Paul problem)? And would we not likely need even more soon with an ageing population but with shrinking numbers of tax payers. It's hard to see a way out of this.
Yes, and that's probably why no government has been brave enough to confront this issue - because that molehill is now a mountain.
Correcting for the neglected inflationary adjustment would require the service-delivery portion of our health budget* to be permanently increased by approx. 36%, if my inflation calculations are correct. Additionally, that portion of the budged would need to continue to be adjusted by inflation each year.
It is plainly evident that we need many hundreds of millions of 'catch up' funding to urgently build those missing hospitals, reinstate abolished services, expand screening programmes to effective levels, etc.
This would go a long way towards resuscitating our health services and making NZ health an attractive industry to work in again.
*I'm not sure what percentage of the total budget the service-delivery portion is, but it is substantial.
I won’t sleep tonight 😳. Like all good satire - very close to the truth unfortunately
You're so right.
I have always found the ED target the most amusing. ED is functionally the social service of last resort. ED waiting times couldn't be down stream from MORE other problems. From the GP availability, to ward space, to any number of public health issues, targeting ED wait times is about as meaningful a goal as 'doing things betterer'.
Maybe every Health Minister should not be allowed private medica insurance/treatment for themselves or their family while in the job - might encourage them to improve the system rather than run it down
It may be satire, but it is based in reality. Thank you for being a loud voice for our public health system. You always call it how it is.