Waikato Hospital Photo: Supplied/ Waikato Hospital
The number of patients waiting for a First Specialist Assessment (FSA) with an orthopaedic or plastic surgeon at Waikato Hospital has increased markedly since last year.
That's despite a reduction in the overall total of patients waiting across 29 specialities, from almost 19,000 to 16,375.
The government's target is for patients who are referred to a public hospital specialist by their GP to be seen within four months.
Information released to RNZ under the Official Information Act shows 3112 patients waiting for their first appointment with an orthopaedic doctor in February this year, compared with 2351 for the same month last year.
In the plastic surgery department, which did not include burns, there were 3001 patients waiting in February this year, compared with 2349 a year earlier.
By contrast gynaecology had reduced from a peak in August of 1777 waiting patients to 445 six months later.
Paediatric patients (children) waiting for an FSA had also dropped from 1161 last February to 500 a year later.
There were also high numbers waiting each month across general surgery; 2224 in July to 2110 this February.
Ear, Nose and Throat ballooned from 1492 last January to 2078 in July and down to 1829 in February.
RNZ asked for the figures earlier this year but their release was delayed until last month.
The figures do not show how long patients had been waiting.
In total there was 18,901 patients waiting last February across 29 specialties including respiratory medicine, neurology, ophthalmology and urology.
Only specialist paediatric oncology had either no patients waiting for a first assessment, or just one in January and February last year.
From January last year up to and including February this year, 3052 referrals for an FSA were declined by orthopaedic surgery.
Plastic surgery declined 1355 referrals, gynaecology (2285), general surgery (2024), ENT (1922) and paediatrics (1745).
The number of referrals declined increased from 1602 across all specialities in February 2024 to 1773 this February.
Health New Zealand Waikato hospital and specialist services group director of operations, Stephanie Doe, said there were multiple reasons why a referral might be declined. These included:
- The patient did not meet the threshold for assessment;
- Did not live in the district's catchment;
- Was already in the service;
- The referral had been sent to the wrong speciality;
- Insufficient information from the referrer;
- Specialist review was not necessary and the patient was returned to the referrer with advice.
While there had been progress in reducing waiting lists for FSAs across most specialities, Doe admitted demand for plastics and orthopaedics remained high.
She said there were several initiatives underway to address the increased number of patients waiting for both. These included:
- A review of the patient waiting lists by a senior nurse to ensure all patients waiting still required an appointment;
- Increasing capacity through additional clinics;
- Implementing patient initiated follow-ups for a defined group of patients in orthopaedics to free up resource for FSAs, rather than routinely scheduling appointments for patients who didn't necessarily require a follow-up.
In 2016, 13 orthopaedic surgeons at Waikato Hospital accused managers at the then Waikato District Health Board of stopping them from making follow-up checks on patients after surgery, so they could assess new patients instead, to meet the national health targets.
There was no target for follow-up appointments.
DHB bosses rejected the claims saying the order to stop patient follow-ups was a miscommunication.
The Association of Salaried Medical Specialists executive director Sarah Dalton said she was concerned hospitals might be managing waiting lists by increasing the threshold for surgery.
"It doesn't look like they've made much of a dent in the FSA waiting list in the course of the year."
The figures showed a lot of people waiting for care, Dalton said.
"There's also been advice given from the (Health NZ) Commissioner this year to suggest that one way of managing down the waiting list is to tighten the criteria," she said.
"So it would be really interesting to know at Waikato if there were people not being able to get on lists or be seen, not because they shouldn't be seen but because they're beyond the capacity of the service to manage."
She had no doubt clinicians were having to make tough calls.
"Whether that's getting more difficult for them - if they're having to decline more people just due to service pressures - rather than what on the surface would appear to be a condition that needs to be seen by a specialist."
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