New Zealand's crumbling heath system
85,000 people (and 5,000 new patients) turned away from seeing specialists
Anecdote says that there is at least a 2 years’s waiting list to see a cardiologist in Auckland.
I was turned away earlier this year and told by the receptionist in the hospital’s Cardiology department that the best way to get attention was to bypass the GP, the specialist and go to the Emergency Department
At least 85,000 people each year turned away from seeing specialists, some dying as result
The study found women were more likely than men to be declined care. Photo: RNZ
At least 85,000 New Zealanders a year are being turned away from seeing a specialist, some of them dying as a result, a University of Otago study has found.
The researchers have described it as a national scandal.
One general practitioner (GP) told the study they had managed a heart patient "into the grave" because she could not get the care she needed.
Another talked about their fear of trying to care for teenagers with serious mental health problems, including hallucinations, who could not get into a psychiatrist's clinic.
Researchers used nationwide Health New Zealand Te Whatu Ora data to conclude it was getting harder every year for New Zealanders to access specialist doctors.
They also conducted detailed interviews with 43 GPs about the impact on their patients.
"I just managed one into the grave. Couldn't get her in [to cardiology], and she just got worse and worse, then she got liver failure and three days later she died," one said.
"You can only manage them so much, maybe they get better, maybe they don't, maybe they die. That's not dramatic, that's the issue. If you go through any GP, they'll be able to tell you they've had at least 10 versions of that every year."
Another doctor, new to the profession, told researchers they were scared they would do the wrong thing.
They had been treating teen patients who could not get in to see psychiatrists, and were advised by the community mental health team to prescribe strong psychiatric medicines.
The pressure was strong to treat outside your comfort zone, the GP said.
The study, done in collaboration with General Practice New Zealand, found 14.2 percent of people, about 85,000, were declined specialist care even though their GP referred them.
That was up from 11.4 percent in 2018, representing an increase of 17,000 people.
One of the study's authors, health systems professor Robin Gauld, said the upward trend was continuing and was a "national scandal".
It was "appallingly bad" for patients who could be in pain or disabled because their condition could not be treated, Gauld said.
"We have thousands and thousands of people around the country not living life to their full potential," he said.
The study found women were more likely than men to be declined care.
Professor Gauld predicted another 5000 people a year would be denied treatment without change on top of those who were already missing out.
He told Morning Report that with $5 billion in the Budget destined for hospital, specialist and primary care services for the government to tackle unmet needs.
"We're talking about hundreds of people a week not able to work, not able to be productively contributing to the economy."
Innovations such as those announced yesterday around radiology provided the chance to help solve some of the problems once and for all.
The postcode lottery was still evident, although most of the period covered was before Health NZ was formed to try to fix that, in July 2022.
The former Southern DHB had 2408 (54 percent) of referrals declined in 2022.
Mid-Central was next, with 6441 (26 percent), while Wairarapa was the lowest with 145 (2.9 percent) declined.
Many of the doctors surveyed talked about how hard being turned away was on patients.
One told the researchers about patients who had waited for years for shoulder treatment and could not work.
"And they're in pain, and they've got to be on strong opioids or whatever it is to get them through the day. So they've got no quality of life, they come in to see us every three months, it's costing them money, they're on a benefit, mental health, huge impact," they said.
Those who could not see a specialist had to pay for frequent GP visits and prescriptions to try to manage their condition.
Others doctor talked about working in their own time, ringing around trying to get patients help, with one saying once she had children she no longer had time.
They spoke about the "moral injury" they felt not being able to get their patients the care they needed.
Gauld said urgent action was needed now.
The initiative announced by Shane Reti where GPs could refer patients for diagnostic scans like CTs and x-rays directly without seeing a specialist was a great start, he said.
But, much more funding and ideas were needed, he said.
In a statement, Te Whatu Ora said it was committed to working closely with general practice to address the pressures and complexities they faced.
It acknowledged the multiple pressures GPs were currently experiencing, director of programmes delivery unit for Hospital and Specialist Services, Duncan Bliss, said.
Health Minister Shane Reti said he was aware that both general practice and hospital care had "been under pressure for quite some time".
The government had announced $30 million to increase access to radiology services and ensure that primary health providers could refer patients directly, rather than waiting for a specialist assessment, he said.
"This initiative will support faster diagnoses and more efficient access to specialists. Our ambition is that this will go some way towards addressing the unmet need this report refers to."
Health New Zealand also had work underway to better understand patients who did not meet criteria for a specialist assessment, Reti said.
Researchers say 5000 new patients declined specialist care each year after GP referrals
Researchers say around 5000 new patients each year are being declined specialist services like surgery when referred by their GP, with the co-author of a new report on the issue calling it a "national scandal".
The 5000 additional patients being rejected are on top of a base of around 85,000 patients being declined each year.
One doctor told researchers they had to "manage a patient into the grave" because of they couldn't get them the specialist care they needed.
Wellington woman Cherie Jeffs-Leipst has needed a new hip for two years. She has limited mobility and, as she's waited for surgery, she told Newshub the pain had become unbearable.
"Everybody deserves quality of life. It gets to the point sometimes of no return. You know, you just end up crying."
Cherie is on the official wait list for surgery, but was initially rejected after being referred by her GP.
She didn't know why she didn't get accepted for the referral but it's likely because she didn't meet specific criteria set by Health New Zealand.
The rate of rejection, and the impact on general practitioners, was the focus of research at Otago University.
Research co-author, Professor Robin Gauld, says the constant waiting and push backs for people who need specialist services has become accepted as normal in New Zealand which is wrong.
"I think it's a national scandal, I think that we have people everyday up and down the country who are not able to access necessary health care services," he told Newshub.
The research on unmet need found that between 2018 and 2022, there was a 5.2 percent increased risk of patients being declined specialist services after being referred by their GP.
That means over that period 17,500 new patients were rejected on top of normal decline rates even though referral numbers were stable.
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Professor Gauld says the number of patients being declined is continuing to go up at a significant rate.
"We would predict, also based on our research, that about 5000 new referrals will be declined each year from here out if there are not changes to the system."
However, the numbers being declined is not a figure Health New Zealand reports. It only reports numbers of those on waiting lists - not on those yet to make it to the list.
General Practice New Zealand (GPNZ) chairman Bryan Betty says that's wrong as it means critical information is hidden.
"There's a lack of transparency about the number of people who are being denied access to specialty services."
Health New Zealand acknowledged the concerns raised by GPs.
Director of Programmes Delivery Unit for Hospital and Specialist Services, Duncan Bliss, told Newshub they're working on getting more complete data.
"Health NZ is focused on improving its communication and transparency around waiting times with general practice," he said.
Bliss said a more complete data system is planned.
"We are working hard to develop a national data platform that gives us a better understanding of patients who do not meet the criteria for a specialist assessment."
When patients can't get specialty care, primary care doctors are left to manage the fallout.
Betty says that's a huge challenge.
"There is already overflowing demand for general practice. It is putting extra burden on practices and practitioners across the country."
The research says GPs are put at "significant risk" and put under pressure managing patients with unmet needs, there's "no additional payment" for extra work, and some GPs knowingly don’t refer due to the likelihood of getting declined.
One GP spoken to as part of the research said: "I just managed one patient into the grave."
He said he couldn't get her in to see a cardiologist, she deteriorated and died.
The doctor said some patients get better, some don't, and some die.
He said: "That's not dramatic, that's the issue."
Betty says he's had reports of people dying because they couldn't get care.
"Certainly, that quote from the research is a very real example of that happening," he said.
The Southern area topped the list as the area with the highest rates of rejections, following by Nelson/Marlborough and the Lakes regions.
When it comes to specialties, ear, nose and throat services had the highest overall rate of declined referrals from GPs.
But neurology, gynecology cardiology and general surgery had the sharpest increases in terms of patients being declined services.
Bliss says work is being done to clear backlogs accumulated during the pandemic.
"Since March, we have seen the first reduction in first specialist assessment waitlists which is forecast to continue," he said.
"Last year, 18,000 more people had their first specialist assessment than in 2022, so we know that our plan is working," he said.
Health Minister Shane Reti acknowledged the health system was in "crisis", and reaffirmed that work is underway to get better information about patients being rejected for specialist services.
Reti said he's aware of the challenges GPs are facing and a review of the funding model for primary and urgent care was also underway.
"I have been assured that they (Health New Zealand) are committed to working closely with general practice to address the pressures and complexities they are facing so they can continue to provide vital care to their patients and communities."
Apparently, virtual 'medicine' and 'health' tracking devices have not been the solution to mass injection of well proven unsafe and ineffective -- at least in terms of abetting health instead of illness -- experimental US Department of Defence driven and controlled genomic experiments.