Kerre Woodham: Outsourcing surgeries has to be a win for patients

Simeon Brown took the words right out of my mouth. I was just saying this very morning, that people living with bone-on-bone pain don't really care where their hip replacement is done or whether their knee is replaced in a private hospital or a public one. And there in the statement released from the Health Minister's Office is Simeon saying patients don't care who's delivering their surgery – they care about getting their hip, knee and cataract operations done. I think it's a common sentiment. I think most of us would feel this way.  

News this morning that Health New Zealand has been directed to give private hospitals 10-year outsourcing contracts to perform elective surgeries should come as good news for those on the waiting list. As Simeon Brown was talking to Francesca Rudkin about the 10,000 elective surgeries that had been performed, mostly in private hospitals, he gave a hint that the arrangement with private hospitals was likely to be formalised. 

“This is something that needs to continue to happen so that we can continue to reduce the number of people waiting for those surgeries. The waitlist ballooned over the last six years, that's unacceptable for patients. I'm committed to continuing to use both the public and private system to make sure we reduce that waitlist and ensure patients get seen in a timely manner.” 

And now it has. Private hospital contracts have in the past tended to be rather short term, ad hoc arrangements designed to take the spill over from the public waiting list. But Health New Zealand has been negotiating 3-year agreements with private hospitals. And that will guarantee high volumes of low complexity patients. They don't want your tricky ones, they don't want your obese smokers, they just want the people who'll be able to come in, have a routine operation, and have the aftercare needed to provide good outcomes.  

Brown has now directed Health New Zealand to seek even longer-term arrangements, which he says will improve the cost effectiveness of delivery and provide clear investment signals to the private sector. So if the private sector is thinking, do we put up a private clinic in Tauranga that can do routine operations, do you know what? Damn it, we will, if there's a 10-year pipeline of work. Do we invest in the super duper state-of-the-art high tech medical equipment that would take the operating theatre to the next level? Damn it, we will, because we have that pipeline of work.  

That has to be good news for patients. The number of people waiting more than four months for elective surgery has grown from 1000 in 2017 to more than 28,000 and 2023. Now, I totally accept that waiting lists can be manipulated. You know, over the years, over the many, many years I've been doing a talkback, we've seen successive governments manipulate the waiting list. It looks a hell of a lot better when you just take people off it – you have to be referred by your GP and start the process all over again. That's one old trick. But we also take into account that Covid meant that a lot of elective surgeries couldn't be performed and that happened the Western world over. The Covid pandemic meant that elective surgeries were a luxury, and of course, it ballooned out.  

So this has to be good news. The fact that the private hospitals will now have a contract where they will be able to deliver these operations for less than they have been charging. The New Zealand Private Surgical Hospitals Association Representative hadn't heard about the 10 years, but said obviously with that certainty that length of agreement it was not unreasonable to expect such deals would provide certainty on costs, which is doctor speak for we'll sharpen our pencil and give you a good deal.  

However, there are concerns from the medical profession, the Royal Australasian College of Surgeons says they were sold outsourcing as a short-term solution. But outsourcing is not a solution to an inadequately funded health system. They said that outsourcing elective surgery deprived surgical registrars of the training they needed, and that it was all so much more expensive. I don't see why the registrars can't pop across the road to Alleviate or Ascot and spend a day in the operating theatre in a private clinic. I mean, it's probably much more complex than that, but when they say surgical registrars won't get the training they need, whatever happened to work experience? Where you could go to a private hospital for a day or a week and help out there.  

I agree in an ideal world where you pay your taxes to contribute to the good of the community, an adequately funded public health system would be fantastic. Where in the world do you have one like that? Possibly the Nordic states do. But we're a long way from getting that and in the meantime, when you have people who do not have life threatening conditions but who have life diminishing conditions where they can't work, they can't enjoy life, they are living in constant pain, their quality of life is 0. They can't go outside the four walls of their own home. They're swallowing painkillers, which are ineffectual, but at least make them feel like something is happening.  

The difference between what is considered a relatively routine operation by the medical profession and not having that routine operation is life changing. You may not die from having bone-on-bone pain of your hip or your knee, but you feel like you want to. The difference will be huge for patients. For some of them they don't know how they can go on another hour, far less six months.  

I just I cannot see how it is a bad thing. Ideally, yes, we would have an adequately funded public health system, and it also might mean that you're not going to get your hip or your knee done privately. If you're a high needs patient, you're gonna have to wait on the public health waiting list – that should diminish given the number of elective surgeries that will be performed in the private sector. The only concern I see is that A) it's failing ideologically to have a publicly funded health system, but needs must. Why should people be collateral damage in a war of ideology? And B) the training for the doctors. But can't they do work experience over in the private sector? C) It's a win for patients, surely. 

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