What strategies could help reduce strain on health services in New Zealand?
Written by Tom Varghese
Time spent waiting for healthcare presents a potential barrier to health system access and engagement. Patients wait at multiple points of their interaction with health systems. Waiting times for elective surgery and ED care are a frequently included key performance indicator for health services.
The COVID-19 pandemic has constrained the health system’s capacity to handle normal patient loads and has reduced the numbers of patients coming to hospitals for various reasons, creating considerable unmet or latent demand. Much of this is surgical care. Various names have been given to this phenomenon, including ‘expanded waitlists’, ‘the surgical bulge’, and ‘the surgical backlog’.
In NZ, the waitlist for planned non-acute treatment had grown from 8000 in February 2020, before the pandemic, to 27,000 in May. Te Whatu Ora has requested all 20 health districts to actively tackle the long waiting list by making sure the 7500 people who had been waiting longer than 12 months were given a booking by 31 August.
It is very important to remember that the stress on healthcare workers is something we have not seen in health before. Our ability to provide a service is dictated by our workforce. The system has had staffing shortages for many years and there are vacancies we have not been unable to recruit for. Workers moving overseas for better opportunities and an ageing workforce means the situation is under severe strain. The pandemic simply added to these pressures and has also resulted in more burnout for an already exhausted workforce.
It is entirely plausible that NZ may continue to feel the COVID-19 effect for many years to come. We need to look at a long-term approach to address the current shortfalls and mitigate risks when it comes to workforce planning, succession planning, developing different models of care, and building health infrastructure.
A multi-pronged strategy should be set in place. This could include a strong focus on training domestic workers emphasising patient equity and increasing the Māori and Pasifika healthcare workforce. Collaboration with state government, private sector, non-government agencies, and specialist medical colleges could be a parallel approach.
The public hospital system should bolster its integration with private hospitals. Even with a fully staffed public hospital system, we may not have enough resources to shorten waiting times. The New Zealand Orthopaedic Association suggested adding publicly funded surgeries to private theatre lists to help ease the backlog, estimated to cost the Government up to $100m over two years.
Balancing supply and demand might include proactively matching patients with hospital resources by giving patients explicit public hospital choice would reduce waiting times. Many patients will travel to a non-local hospital for a shorter wait. More investment in hospital-in-the home programs would also free up hospital beds.