Sarah Dalton: Association of Salaried Medical Experts Executive Director on the number of specialist referrals being declined

The Association of Salaried Medical Specialists believes fewer people are receiving care than we're being told.  

Its new report —which looks at seven districts between 2023 and 2025— shows about 20% of GP specialist referrals are being declined.  

Executive Director Sarah Dalton told Mike Hosking it's down to staff shortages across the public and private sectors. 

She says it shows Health New Zealand isn't managing unmet need, and criticises the fact our targets-focused system doesn't provide targets for the workforce. 

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Episode Transcript

Speaker 1 (00:00):
You dart. That gives a sense of some pressure points
and health. What do we got twenty percent of GP
referrals to specialists now being declined, So that's an estimate
of one hundred and twelve thousand referrals turned down. That's
up eighteen percent and three years. Sarah Dalton's the executive
director of Association of Salaried Medical Specialists and is back
with us. Sarah, good morning to you, ldom Mike. You've

(00:20):
done here. Is this a geography or a specialist area
or both?

Speaker 2 (00:28):
I'm not quite sure what you're getting at the aative like.

Speaker 1 (00:30):
A cancer referral in Otago or is it the region
that's the issue, or is it the area of specialization
of medicine.

Speaker 2 (00:38):
No, it's right across the board. It's both. It's both
location and specialty. What this is saying is in the
first place, Health New Zealand's not managing unmet need, which
is the people who miss out. And then the second place,
and the really key thing is we've got a target's
focus system that doesn't provide targets for workforce. So a
lot of the declines we believe are down to understaffing

(01:01):
in our health system.

Speaker 1 (01:02):
Okay, are these public referrals or public hand.

Speaker 2 (01:04):
Private they are They're all public. They are all referrals
being made from GPS to the public system. Some of
those referrals may be outsourced through this government system. But
what we're also finding is that the combination of targets
and outsourcing are not achieving the goals set by this government.
And what we're also hearing from our members at the moment,

(01:26):
because the thirtieth of June is a big date for
the end of year in terms of targets figures, is
that they are under ridiculous pressure to basically see as
many people as possible, irrespective of clinical need before the
end of June.

Speaker 1 (01:42):
So is the outsource Are you telling us the outsourcing
isn't working. I'm just using anecdotal evidence of members of
family and people I know. It seems to work for
the people I know. I mean, it's not ideal perhaps,
but you get to a specialist if you need to.

Speaker 2 (01:56):
Oh, it's so. For the people who get seen, it's
great right get the care they need. But what we
are seeing is there are fewer people getting access to care,
either in a public hospital or outsourced than we are
being told, and the numbers of people that are missing
out on access to that care, whose clinical need merits

(02:16):
that care, but are being declined because of workfulce shortages,
which cover both public and private sectors. That's not being
counted or measured. So yes, you'll know people who are
getting care and are very happy to get it, and
we're pleased, but in relative terms, fewer people are being seen.
The population growth is going ahead, and access to care

(02:38):
is not even keeping pace with that.

Speaker 1 (02:40):
See that's the problem. See because we're talking about population
growth at the moment, the population isn't growing not that much.
And so I'm wondering if it will one sort itself
out eventually, or I mean, what do you do about it?
Do you need to plug more people into the system
and where do they come from? Or do if I
go into Belle Kluther and I need to be refining

(03:00):
to a specialist who doesn't happen to be in bell
Cluther but they are underneedan does that count as a
rejection or not?

Speaker 2 (03:06):
No, that doesn't count as a rejection because if you're
lucky enough to live in bell Clusa, you're always going
to get referred to Dunedin for that kind of care.
But it is there are no workforce targets right, so
we've got targets. The government has set targets about health outputs,
but they have not set targets about what we need
to as you say, plug in, So we have talking
about decades of understaffing. Back in twenty ten they set

(03:29):
targets to try and get equivalent levels of senior doctor
staffing per population as Australia have. By twenty fourteen they'd
given up. We are ridiculously behind. What I would love
to be talking to you about is that we have
got New Zealand trained doctors coming home and that we
are an attractive destination for the overseas trained doctors that

(03:51):
we still desperately need. But in many many specialties, standing
vacancies remain and there is nothing being done to encourage
perle to come back, to encourage people to stay, and
that's what we need to match the equation of access
to care.

Speaker 1 (04:06):
Lets talk to you, Sarah Appreciate Sarah Dalton, who's the
executive director, Associate Salary Medical Specialist. For more from the
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