Top medical surgeons send scathing open letter to Health Minister amid deepening crisis

Some of New Zealand’s top surgeons and health professionals have written an open letter to Minister of Health Dr Ayesha Verrall regarding unmet secondary elective health need in New Zealand.

The letter, which is co-authored by respected Christchurch Dr Phillip Bagshaw said “we have, in recent months, written to the Director-General and to you regarding unmet secondary elective health need (USEHN) in Aotearoa New Zealand, asking for action in this area and for a meeting to discuss a way forward.

We have had either unhelpful responses or silence.”

The letter said “the success of any health system is determined by whether it meets the needs of the population it serves. The fact is that our group of senior academics/clinicians has been negotiating with the Minister and Ministry of Health since 2017 to include effective USEHN measures in the National Health Survey and have expressed our willingness, and eagerness, to assist with the appropriate design and planning of such an addition to the survey. These earlier approaches, like our recent ones, have proved fruitless.”

If went on to say “recent health-sector restructuring and the widespread media coverage of problems in hospital services have again brought into focus the need for proper assessment of USEHN.”

“Referral to specialist care, for diagnosis or management of health conditions, is central to best healthcare practice in all societies and regarded as a cornerstone of healthcare in OECD countries. In Aotearoa, over decades of bad policy making, we have boxed ourselves into a corner where we often do not know who is in need at an individual level and we have no understanding at all of the full burden of need across our whole population.”

The letter said “USEHN is routinely assessed in some European countries and North America, using internationally validated survey tools, but this is not true of Aotearoa New Zealand despite: i) the ready availability of these survey tools; ii) the relevant expertise to ensure that the questions are crafted in a way that is culturally appropriate; iii) a pilot study that has already been done in NZ; iv) the anticipated fiscal returns from the consequences of investment in such a survey; and v) the excellent regular NZ Health Survey that is the primary assessment tool for measuring how well our health services meet the needs of all New Zealanders. The Health Survey routinely measures primary/GP health service delivery but does not measure USEHN.”

“Right now, there is a global collaboration forming – with WHO involvement – looking at unmet need; some of our group are participants. There will also be an opportunity for our government to be actively involved in this project, which seeks to align globally the methods for assessing unmet need. One intended outcome is a resolution at the WHO meeting later this year that commits member states to support measurement of unmet need. We look forward to the active participation of Aotearoa.”

It said “because of the failure to deliver best healthcare can occur anywhere in the system, objective, data-based assessment of both met and unmet health needs in all primary, secondary and other hospital sectors, is essential for accountability of health services to government and to the people of Aotearoa. Unmet health needs result in preventable illness, disability, and death, with consequent major social and economic costs. Crucially, unmet need often impacts specific sectors of the population more severely, creating inequity in health-service delivery – and we see this particularly among Māori and Pacific communities.”

The letter said “It is critical, in an election year, that all political parties commit to USEHN assessment, as a key element in health policy development and evaluation. As part of Aotearoa’s healthcare reforms, we need full accounting of unmet secondary elective health need to inform policy making and to ensure the continued protection of the health of Aotearoa.

Minister, despite apparent reluctance by you and your predecessors to engage with us on this issue, members of our group remain keen to meet with you in person in the near future.”

The letter has been signed by:

Phil Bagshaw CNZM, FRCS, FRACS

Chair, Canterbury Charity Hospital Trust.

Andrew Hornblow CNZM, MA, Dip.Clin.Psych, PhD, FNZPsS. Emeritus Professor, University of Otago.

Bridget Robson BA, DPH

Associate Professor | Associate Dean Māori University of Otago, Wellington

Sue Bagshaw DNZM FAChSHM FRNZCGP (hon)

Adolescent Health Physician, Trustee Charity Hospital Trust.

Professor Robin Gauld

Co-Director, Centre for Health Systems and Technology; Professor, Dunedin School of Medicine and Otago Business School

John D Potter MBBS PhD

Professor, Research Centre for Hauora and Health, Massey University, Wellington.

M Gary Nicholls MbChB FRACP FRCP (London, Glasgow, Edinburgh) FNZMA MD Professor Emeritus, University of Otago-Christchurch.

Professor Chris Frampton BSc hons, PhD

Department of Medicine, University of Otago-Christchurch.

Professor Frank Frizelle ONZM, MBChB, MMedSci, FRACS, FACS, FASCRS, FNZMA, FRCSI(hon), FRCSEd(hon). Clinical Director of General Surgery Canterbury and West Coast, Editor in Chief NZMJ.

Dr Ben Hudson MBBS, MRCGP, FRNZCGP

Head of the Department of General Practice, University of Otago-Christchurch.

Les Toop MBChB, MD, MRCGP, DFRNZCGP

Professor Emeritus, University of Otago- Christchurch.