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 outsourcin

Episode Transcript

Speaker 1 (00:06):
You're listening to the Carrywood and Morning's podcast from News Talks,
he'd be.

Speaker 2 (00:12):
Well, Simmy and 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

(00:33):
office as Simmy and 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 ten year outsourcing contracts to perform elective surgeries

(00:56):
should come as good news for those on the waiting list.
Simmy and Brown was talking to Francesca on her Sunday
show about the ten thousand elective surgeries that have been
performed mostly in private hospitals, and on the show he
gave a hint that the arrangement with private hospitals was
likely to be formalized.

Speaker 3 (01:17):
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 weight lists are ballooned over
the last six years. That's unacceptable for patients and I'm
committed to continuing to use both the public and private
system to make sure we reduce that weight list and
ensure patients get seen in a timely manner.

Speaker 2 (01:38):
And now it has Private hospital contracts have in the
pass tended to be rather short term ad hoc arrangements
designed to take the spillover from the public waiting list,
but Health New Zealand has been negotiating three year agreements
with private hospitals and that will guarantee high volumes of
low complexity patients. They don't want your tricky ones, they

(02:02):
don't want your obeese smokers. They just want the people
who'll be able to to come in, have a routine
operation and have the after care 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 investments signals to the

(02:25):
private sector. So if the private sector is thinking, do
we put up a private clinic in Totonger that can
do routine operations. Do you know what, damn it, we will.
If there's a ten year pipeline of work, do we
invest in the super duper state of the art high

(02:47):
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 one thousand and

(03:07):
twenty seventeen to more than twenty eight thousand and twenty
twenty three. Now, I totally accept that waiting lists can
be manipulated. Over the years, over the many many years
I've been doing talkback, we've seen successive governments manipulate the

(03:28):
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. So you drop off the wait list and
start 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.

(03:52):
Over the COVID pandemic meant that elective surgeries were a luxury,
and of course it ballooned out. This has to be
good news, the fact that the private hospitals will now
have a contract where they will be able to deliver

(04:13):
these operations for less than they have been charging. The
private hospitals representative hadn't heard about the ten years, but
said obviously with that certainty, that length of agreement, it
was not unreasonable, said the New Zealand Private Surgical Hospitals

(04:35):
Association rep It was not unreasonable to expect such deals
would provide certainty on costs, which is doctor speak with
will 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

(04:57):
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 also much more expensive. Well, I don't
see why the registrars can't pop across the road to
Mercy or ascot and what's called now Allevium not mercy,

(05:23):
isn't it got a new name. But I don't see
why they can't pop across the road for a day
to spend a day in the operating theater in a
private 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

(05:43):
go to a private hospital for a day or a
week and help out there. I agree. And an ideal
world where you pay your taxes to contribute to the
good of the community, a public health system and adequately
funded public health system would be fantastic. Or in the

(06:06):
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

(06:31):
are living in constant pain. Their quality of life is zero.
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

(06:55):
and not having that routine operation is life changing. You
may not die from having on bone pain of your
hip or your knee, but you feel like you want to.
The difference will be huge for patients like for them,

(07:17):
for some of them, they don't know how they can
go on another hour, far less six months. So I
would very very much like to hear from those of
you who have an opinion on this one. I just
I cannot see how it is a bad thing. Ideally, yes,
we would have an adequately funded public health system, and

(07:41):
it also might mean that you're not going to get
your hip or your need done privately. If you're a
high needs patient, you're going to 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. So the only concern I see is that

(08:02):
a it's failing ideologically to have it publicly funded health system,
but needs must Why should people be collateral damage and
a war of ideology and be the training for the doctors,
But can't they do work experience over in the private
sector see It's a win for patients Surely.

Speaker 1 (08:26):
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