DHBmissing targets after lockdowns

The long tail of Covid-19 could be felt for another three years in Marlborough and Nelson as the district health board works to clear backlogs caused by lockdowns.

Ministry of Health data shows that the Nelson Marlborough District Health Board has failed to meet national targets for planned health care for the past 12 months.

Nelson Marlborough Health chief executive Lexie O’Shea said this was a flow-on effect of Covid lockdowns – and it would take at least 36 Covid-free months to get the targets out of the red.

‘‘What our trajectory back to the targets would look like, I would suggest that that’s probably a work in progress for the next 36 months – and that’s if we have got no Covid in our community,’’ she said.

‘‘But we’re likely to bump around a little bit until we get settled into a pattern of the new normal.’’

The Ministry of Health sets Elective Services Patient Flow Indicators (ESPIs) to measure the performance of DHBs. These include targets that patients should be seen within four months of being referred to a specialist, and that any treatment begin within four months.

However, Nelson Marlborough Health has failed to meet either target for the 12 months to June 2021.

In June, 483, or 8.7 per cent of, patients weren’t seen within four months, and 173, or 10.1 per cent, had not started treatment. Of the previous 12 months, the worst was February, with 556 patients not seen, and 263 not treated.

O’Shea said the struggle to meet the national targets was being felt nationwide as the healthcare system worked to catch up after the Covid lockdowns.

‘‘They still remain our targets, but the volume of patients now that are outside those targets are quite significant, and that is an issue right across the country.’’

The backlog started when the country went into the first alert level 4 lockdown in 2020, and the

DHB postponed all but the most urgent procedures.

‘‘That upset the whole system quite significantly,’’ O’Shea said.

While fewer procedures were put off during the latest lockdown in August, as long as the country was higher than level 1 there was still an impact on the hospital system, she said.

The need to be prepared for contingencies, which meant keeping beds available for emergencies and complications, as well as allowing areas such as waiting rooms to be socially distanced, put limits on appointments. ‘‘It slows flow down – both for our outpatients and our inpatients.’’

The general surgery, orthopaedic, ophthalmology, ear, nose and throat, and urology departments were the areas with the greatest challenges, O’Shea said.

Those specialities involved more surgery, and also had more requirements for specialised tests and face-to-face appointments, which made solutions such as virtual consultations less effective, she said. They were also the departments with higher volumes of patients.

‘‘When you’ve got a volume situation of demand, then it certainly has a longer tail to get through.’’

The DHB was working to see where processes could be adapted, as well as hiring locums and using private hospital services to try to push through the backlog, but it would still take some time, she said. ‘‘We’ve just got to be conscious of capacity.’’

Healthcare was always adapting and changing, so the focus was on delivering a contemporary level of care, while ensuring follow-up in the community as patients were discharged, she said.

‘‘We have to make sure if we’re discharging people back into the community, we have the resources in the community to take care of those people.’’

‘‘The volume of patients now that are outside those targets are quite significant, and that is an issue right across the country.’’

Nelson Marlborough Health chief executive Lexie O’Shea