Three years on from the creation of Health New Zealand and a points system which sets different thresholds for care across the country remains largely unchanged. This is the first in a 1News series looking at healthcare in the regions.
Some people are being denied elective surgeries that they would qualify for if they lived in a different region. It’s one of the starkest examples of the postcode lottery which many say persists despite the axing of District Health Boards.
Watch the 1News investigation on TVNZ+.
Health New Zealand says it’s looking at access to care and whether the tools currently being used are working well enough. The current system is a hangover from the DHB days where regions could set their own rules according to how much capacity they had.
One patient who was denied a knee surgery that would be easier to get almost anywhere else in New Zealand told 1News: “We all pay the same taxes… one town’s hospital shouldn’t be any less important than another hospital around the country.”
What determines if people get on a wait list?
A system called the Clinical Priority Assessment Criteria (CPAC) is used to determine whether patients get automatically put on the wait list for elective operations. But the scores are different in each region and the higher the score, the harder it is to get on the wait list.
Dr Sharon English of the Royal Australasian College of Surgeons says the scoring is done in two sections.
“Part of the scoring is how the patient perceives their problem. The amount of pain they say they are in. The amount of impact it has on their day-to-day living.
“And also a part that the doctor does assessing the impact on the patient, how likely it is to get worse, and how much they’d benefit from the operation.”
1News has obtained the latest points required across the country under the Official Information Act.
For orthopaedic elective surgery the easiest place to get on the wait list is Tairāwhiti where patients need 20 points. The hardest is the Wairarapa where they need 80 points.
For gyneacology, 10 points are needed in Tairāwhiti and the West Coast, whereas 75 points are needed in Taranaki and Southern.
Third time lucky for Palmerston North patient
Sixty-nine-year-old Sharleen Strawbridge was used to being active until she dislocated her knee five years ago.
“It was painful. I couldn’t step on it properly… and from there it just all went downhill,” she said.
She was referred to Palmerston North Hospital and assessed for a knee replacement by a nurse practitioner.
“She got me to walk up a hallway and she also felt around the knee a little bit and then just said to me that I’d missed out by one point.”
This was the first Strawbridge had heard of the CPAC points system. She went back a second time but again didn’t qualify for the waiting list.
Under the current CPAC points, it would be easier almost anywhere else in the country for her to get a knee operation as MidCentral, where she lives, requires 73 points.
She’s now having issues with her hip, is taking painkillers and has been referred for knee surgery for the third time. “My right knee is actually bone-on-bone grinding,” she said after a recent scan.
Health New Zealand says: “Health New Zealand MidCentral is committed to providing timely, equitable access to care for all patients, and it’s regrettable that Ms Strawbridge feels she has not received this.”
‘Not a level playing field’
The Office of the Auditor-General recent released a report on access to planned care in New Zealand.
A spokesperson for the report, Richard Towers said: “At the moment, there’s not really a level playing field. So, where you live dictates to a large extent whether you can qualify for care or not.
“That’s the only way New Zealanders are going to know that their access to planned care treatment isn’t going to be affected by the place they choose to live.”
The office recommended that Health New Zealand come up with a timeline for when the national thresholds will be in place for all specialties.
“That’s the only way New Zealanders are going to know that their access to planned care treatment isn’t going to be affected by the place they choose to live,” Towers said.
Two years ago, a standard score was set for cataracts surgery with orthopaedics and ear, nose and throat being looked at next.
Dr Derek Sherwood from Health New Zealand agrees there are varying availability of care across the country. He says there is work underway.
“I think the first thing we’re going to do is look at whether the CPAC tools are working. It may be that there’s another way of prioritising patients that’s more reliable.”
Dr Sherwood said it’s not as easy as updating the scores.
“The difficulty if you change the scores right now is in areas where you perhaps have poor capacity you’d see much bigger waiting lists. So, you really need to make sure as you’re doing that that you’re investing.”
