Every few weeks, another headline alerts us to the fact that District Health Boards are struggling to get on top of their waiting lists as patient demand continues to grow.
In the last few months alone across various DHBs, we’ve had reports about rescheduled and delayed appointments due to an “enormous” increase in the number of people seeking cancer treatment; concerns about hospital capacity, patient flows and long waiting times for elective surgeries; and reports of patients waiting years for orthopaedic surgery.
Stories like these begin to paint a picture of an over-burdened healthcare system, struggling to keep up with demand.
And DHB health professionals are starting to feel the pressure. Take Lisa Rogerson, a specialist echocardiographer, based in Hamilton.
“Patients complain when they’ve been waiting a long time. Operations get put back because we can’t keep up with demand. And the situation is only going to get worse because of the population and the health problems in New Zealand.”
Clinical Nurse Specialist Jane Hawthorn agrees. Jane, who works in ophthamology, has worked across several DHBs and says the problems are widespread, with many patients having to wait longer than expected, particularly for follow-up appointments.
Many DHBs are working hard to ease the pressure, trialling different initiatives to clear waiting lists and meet their targets.
For example, the Southern DHB is trialling new initiatives to improve waiting times at its crammed emergency departments, including the introduction of a ‘Valuing Patients’ Time’ programme, ‘Fit2Sit’ sitting area, a nurse practitioner and an Older Persons’ Assessment and Liaison unit in Dunedin.
And at Counties Manukau DHB, a new MRI machine at Middlemore Hospital has helped to counter the growing demand for MRI procedures, although there were still challenges in recruiting specialist staff to operate the new machine.
Jane points to other solutions she’s witnessed.
“At the moment a lot of DHBs are using locums, which is not really that innovative and costs a lot of money,” she says.
Jane says some facilities are also training nurses to take on more responsibility. In Jane’s field, this can mean nurses doing laser treatments, intravitreal injections and seeing patients with glaucoma.
Surgeries and other aspects of care are sometimes outsourced. Jane gives the example of a scheme at Hawke’s Bay DHB in which glaucoma patients are sent to the optometrist for review, while they remain under DHB care.
“So there are things going on, but I think a lot of it is getting the time and the people who are skilled enough to do it,” she says.
This is why Jane thinks medical insourcing is the way to go. Insourcing can help public hospitals reduce waiting lists by bringing experienced specialists and teams to hold clinics after hours and on weekends.
“I’ve worked in Wellington and Manukau doing injection clinics and they’ve been really successful. In one weekend I did 103 injections. That’s a lot of people having their treatments who would have waited otherwise. A lot of these treatments are for things like macular degeneration and diabetes and are very time-dependent.”
Time is critical in healthcare.
“You make headway doing the course of injections and then if you don’t follow up you’re back to square one or worse in some cases,” says Jane.
Medical insourcing makes good sense on a number of levels. Jane says access to the facilities and equipment outside of the working week is a huge benefit.
“During the week you might get all these locums in, but the facilities you’re working in are still crammed. So while you might have enough staff, you don’t always have the facilities available to work efficiently. That adds to the stress.
“Often places only have one treatment room and that might be used for other things during the week. Even if they wanted to see more patients, and they’ve got the people there, often they can’t due to the limitation of the facilities themselves.”
Lisa Rogerson agrees.
“Equipment and facilities are all paid for and just sitting there – it seems silly not to run seven days a week now.”
Lisa works Thursday and Friday in Auckland, Saturday and Sunday in another institution and the rest of the week she “enjoys being a mum”. She says while weekend work isn’t for everyone, it works well for her.
Lisa says the patients also love the option of having their treatment on a weekend.
“A lot of patients have an elderly relative that they have to bring to the hospital, and they don’t want to take time off work to attend appointments. So from the patients I’ve dealt with and spoken to, they’re all very happy to come somewhere really quiet with no problems parking on a Sunday morning.”
Naturally there are costs involved with insourcing initiatives, a factor that might deter some DHBs.
However, Lisa is convinced the benefits outweigh the costs.
“Initiatives like working weekends does provide an extra 20 percent on top of what their staff can already provide,” she says.
SEQURE is at the forefront of providing medical insourcing and is keen to work with DHBs to help deliver solutions.
They operate a straightforward service. DHBs let SEQURE know what clinics, procedures and surgeries they need to happen, by when, and when their facilities are available. SEQURE then finds the right medical staff who are available at the right time and gets the team to the hospital, where they deliver the treatment.
Feedback from hospital manager Patrick Ng, Executive Director, Southern DHB, describes the partnership with SEQURE as “hugely valuable”.
“They’ve assisted our quest to meet Ministry of Health targets, allowing more patients to be seen in a timely manner.”
Another hospital manager reports that the atmosphere at their hospital has lifted thanks to SEQURE’s help in getting through 3000 urgent follow-up patients.
Insourcing solutions like this might be to help get a hospital through a particularly busy period, or it might be a regular fixture to keep up with patient demand, or it might be just help with filling a gap.
Jane says she was part of a multi-disciplinary team flown to Dunedin to see “lots and lots of patients” while other people were getting trained up to continue the service.
Could medical insourcing be the answer to DHBs’ challenges when it comes to grappling with waiting lists and increasing patient demand? According to a number of health professionals, hospital managers and patients, it could be the way forward.