By the community; for the community Health Funding Crisis Forum Canterbury Charity Hospital Trust & Unmet Need for Secondary Healthcare Services By the community; for the community Phil Bagshaw Chair, CCHT Health Funding Crisis Forum 1st July 2017

NZ Health Reforms & Healthcare Rationing Core Services Committee 1992. National Waiting Time Project 1998. By September 2006: 24,000 patients refused FSA 22,000 taken off waiting lists Result Increasing unmet need Sharon Crosbie The NZ Health Reforms of the 1990s have had many effects on our universal access, Public Health System. The National Waiting Time Project (NWTP) had one of the largest effects. Its objective was to control demand for free elective surgical services by removing patients from waiting lists, and only allowing them onto waiting lists if their operations could be done within 6 months. By September 2006, Canterbury DBH had refused 24,000 patients an initial specialist assessment for elective surgery at public hospitals; and removed 22,000 patients from the elective surgery waiting lists. Official data on the effects of the NWTP were only kept by the CDHB until September 2006. The results of the NWTP have varied around NZ, but there has undoubtedly been a large increase in the amount of unmet need for elective surgery.

Acceptance Pipeline for Public Hospital Elective Healthcare Disease Reservoir of Community Need Reservoir of Community Need Community Expectations GP Expectations ‘Health Pathways’ Clinical/Financial Priority Thresholds National Waiting Time Standards The hateful metaphor “..... altering the trajectory of demand” First Specialist Assessment Accepted for Treatment

National Studies of Unmet Need for General Hospital Healthcare Services Canada & USA Italy Thailand Sierra Leone

Apart from adults who get surgery each year:- How much unmet need for non-urgent surgery is there? Apart from adults who get surgery each year:- Another 280,000/yr told they need surgery Of these:170,000 aren’t recorded anywhere Survey criticized by Minister of Health.

STAGE 1: Pilot Study of Methods to Measure Unmet Secondary (Hospital) Healthcare Need in Adults Investigators A Prof Phil Bagshaw *† Dr Sue Bagshaw *† Prof Chris Frampton * Prof Robin Gauld ** Dr Terri Green § Prof Andrew Hornblow § Dr Ben Hudson * Dr Antony Raymont ¶ Prof Ann Richardson § Prof Les Toop * Mr Carl Shaw † * University of Otago, ChCh; ** University of Otago, Dunedin; § University of Canterbury; ¶ Auckland Independent Heath Researcher; † Canterbury Charity Hospital Trust, ChCh

Methods (n = 1,277; Q23) Christchurch & Auckland regions: 1. GP recorded cases as seen 2. Random people sampled by: Face-to-face interviews Telephone interviews Online survey

Results Primary (GP) Healthcare – because of cost: 16.5% missed GP visits 4.9% didn’t fill prescriptions 11.4% missed tests, treatments or follow-ups Secondary (Hospital) Healthcare 9.3% reported unmet need recommended by health professional (Quality about 300,000)

Types of Unmet Hospital Healthcare Needs Medical consultations Orthopaedic operations Surgical consultations General Surgery operations Dental consultations Colonoscopy Gastroscopy Psychiatric consultations Other procedures

STAGE 2: Independent National Survey of Unmet Hospital Healthcare Need Larger, even more expert panel Aim: Survey with power to measure quantity & type of unmet need by: ethnicity, income group, region, etc Question 12,000 by face-to-face or telephone questionnaire Cost $1.2m – current HRC application

Stage 3 INDEPENDENT national survey by panel of experts every 2 years To inform public on performance of hospital healthcare system To inform decisions by policy makers & planners

John Donne (1572 - 1631) Why bother John Donne (1572 - 1631) Why bother? - Devotions upon Emergent Occasions; Meditation XVII "No man is an Island, entire of itself; every man is a piece of the Continent, a part of the main; ……… any mans death diminishes me, because I am involved in Mankind; And therefore never send to know for whom the bell tolls; It tolls for thee."