Kiwi surgeons’ wishlist

Kiwi surgeons’ wish list for the general election

A comprehensive pandemic health recovery plan, a single electronic health record for all New Zealanders, and less reinventing of wheels are on surgeons’ wish list for the October 17 general election. The sight of elderly patients being transported on stretcher beds from their rest home into Burwood Hospital during the COVID-19 lockdown in April was spine-chilling for those of us who work in health care. Was this just the beginning of a deluge? How would our hospitals cope? Fortunately our fears were not realised and New Zealand has continued, so far, to avoid the horrendous situations faced by other countries as they respond to the COVID-19 pandemic. The management of our response to COVID-19 has been extremely effective, but we are paying a huge price for that and not just economically. Thousands of people have had planned procedures delayed and, while the government has put in more funding to enable hospitals to catch up, infrastructure and staffing limitations mean that many patients are still experiencing long and painful delays. Given that the infectious cases are still coming into the country from people arriving home, there is no vaccine for COVID-19, and that epidemiologists say we should expect similar pandemics will occur every 10 years, we continue to have serious concerns about our ability to meet the challenges of this and future pandemics. Singapore, for instance, learnt many good lessons from the SARS outbreak in the early 2000s and the systems it has put in place since then have paid off during COVID-19. We would like the next government to oversee the development and implementation of a comprehensive health recovery plan that enables, for example, planned operations to continue wherever possible. We would also like the next government to take the idea of a single electronic health system out of the ‘too hard’ basket. It’s difficult to believe that in 2020, about 30 years after information technology began to be adopted in New

Zealand, we still do not have a single Electronic Health Record (EHR) system here. Currently, for example, if I want the treatment history of a patient who has moved from Auckland to Christchurch, where I practise, I will need to find out which hospital(s) my patient has been treated at, then trawl through scanned records, images and test results. Compare this with most patients who have lived in the South Island all their lives. With a click or two of a mouse I can get a comprehensive picture of their health status, consultations, medications, treatments and procedures. Having a connected electronic patient record also means that if a drug is recalled urgently, it is easy and fast to identify and inform people who are currently on that medication and arrange for an alternative. A study of Pennsylvanian hospitals, relatively early adopters of an EHR system, found that between 2005-2012 there was a 30 per cent reduction in adverse medication events, a 27 per cent decrease in aggregated adverse patient safety events, and a 25 per cent drop in complications following tests, treatments or procedures. Plans for a single EHR have been proposed and talked about in New Zealand for at least 10 years. We wish the next government would make it happen. Every dollar spent on our increasingly demanding health system is precious so it is concerning that, despite national procurement strategies and legislation to encourage District Health Boards (DHBs) to work more collaboratively, there still seem to be a lot of wheels being reinvented around the country. This was particularly evident during the national response to COVID-19 as each DHB created its own interpretation of national directives issued by the Ministry of Health. For example, the allocaton of personal protective equipment and the prioritisation of patients’ needs varied not only from DHB to DHB, but from hospital to hospital and even from ward to ward. Valuable – and expensive – time and resources are being taken away from where they are needed most. We support calls made recently by the Health and Disability System Review Panel for more collaborative DHBs, and for more consistency among them when it comes to basic operational issues that don’t need unique solutions. We hope the next government will adopt the panel’s recommendations in this regard. These are some of the challenges that we would like the next New Zealand government to tackle. The firm foundations are in place, they just need to be built on. 

Philippa Mercer FRACS Chair, RACS New Zealand National Board