Elective operation backlog optimism

Clarification of Ministry of Health funding for Covid-19 recovery surgery has given the Southern District Health Board a financial incentive to tackle its backlog of elective operations.

The board has been in limbo for some months, having initially forged ahead with a plan to greatly increase elective surgery delayed by Covid-19 lockdown but then having to tread water as it awaited confirmation from the ministry of how it would pay the SDHB for that work.

A report by SDHB chief executive Chris Fleming, to be considered by the board on Thursday, said the ministry had now confirmed surgical recovery funding — a policy announced by the Government last year — was to be split 50:50 between inpatient elective surgeries and outpatient first specialist appointment follow ups and medical imaging.

Crucially, the ministry had confirmed the inpatient funding became available after DHBs had completed their budgeted elective surgery.

The hiatus meant that the SDHB had not done enough inpatient work yet to be able to claim recovery funding, Mr Fleming said.

"This gives us a strong incentive to maximise outsourcing volumes and we will try to get as much done as we can via outsourcing, because every caseweights delivered above the elective plan will be funded from recovery funding."

While the SDHB and patients would prefer to do more electives in its hospitals, bed block — which recently caused elective surgery to be briefly postponed — and staff shortages made that a challenge, Mr Fleming said.

"We need to systematically address the nurse gaps which are causing beds to be closed and leading to a loss of surgery."

The SDHB had recently hired several new nurses who were about to be added to its roster, but that needed to be monitored closely, he said.

"We need to ensure we start to respond by filling our elective lists again to get the most out of our elective surgery."

The ministry calculated if the SDHB maintained its amount of outpatient work it achieved in the first six months of the financial year it might earn $2.6million more in recovery funding.

"To maximise what we can earn, the additional volumes we do will be funded on the volume delivered. We therefore need to get as much additional volume done as we can."

Given the delay sorting details, he would ask the ministry to extend some of this year’s recovery funding targets into next year. Orthopaedic surgery would be a particular target of the recovery effort he said.

"Although access to inpatient beds now seems to be improving, we have a significant wait list which may take us a couple of years to truly get on top of."

List patients were early candidates for outsourced operations, and the South Canterbury DHB and soon-to-open Southern Cross hospital in Queenstown were being considered for them, he said.

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