Moves by Health NZ to outsource elective operations to
the private hospital sector increase the risk of a two-tier
health system and will worsen the medical workforce
shortage, a leading medical college has warned.
The
Australian and New Zealand College of Anaesthetists (ANZCA)
is one of the largest specialist medical colleges in
Australia and New Zealand and the region’s leading
authority on anaesthesia, pain medicine and perioperative
medicine.
Dr Graham Roper, chair of ANZCA’s New
Zealand National Committee, says the outsourcing plans will
negatively affect the training of anaesthetists, who are
critical for operations to proceed, and see existing
specialists move from public hospitals to the private
sector.
“Trainees’ practical
experience will be impacted, with a loss of exposure to
outsourced clinical cases, and skewed amounts of urgent and
complex work. It will take longer for trainees to get their
required experience, delaying their entry into the
workforce. Anaesthesia training will become less desirable,
threatening the ability to produce much-needed
specialists.
“Anaesthetists are a
central part of both the hospital and the surgical team –
without them, operations simply can’t go
ahead.”
Dr Roper says the changes will lead to
public system specialists facing a large amount of complex
and urgent patients, requiring the highest level of care
with extended hours of work. This would lead to specialists
choosing to move to the private sector, further increasing
the strain on the public system.
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He is also
questioning the ability of some private facilities to
provide the required level of care and training
opportunities.
“Not all private facilities are set
up to deliver the same level of clinical care as the public
system. Private providers do not take on the same complexity
of work in the same volumes as the public system, and may
not provide high-dependency care, intensive care, acute pain
services, pre-admission clinics and access to urgent
investigations. Any significant complications during or
after surgery will see the patient transferred to the public
system for ongoing care.
“Many private facilities do
not have on-site medical cover overnight and have a limited
ability to respond to medical emergencies,” Dr Roper
says.
“Our Māori and Pacific peoples, with
increased complexity of health needs, are unlikely to
benefit from this outsourcing model. In addition, our rural
and remote communities may not be well served with this
change.
“People living in rural areas are not always
close to a private provider, can have transport
difficulties, and lose family and whānau support if they
have to travel long distances for surgery.”
Dr Roper
says ANZCA is willing to be involved in finding solutions to
the unmet need of elective surgery across Aotearoa New
Zealand.
“The provision of high-quality safe and
equitable care for our community remains the core aim of our
profession and the New Zealand public should expect that
access to anaesthesia and surgery is
future-proofed.”
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