The five health targets are:
- Faster cancer treatment: 90 per cent of patients to receive cancer treatment within 31 days of the decision to treat (currently 84.6 per cent, slightly up from the previous quarter’s 83.5 per cent).
- Improved childhood immunisation rates: 95 per cent of children to be fully immunised at 24 months (currently 75.7 per cent, slightly down from the previous quarter’s 76.5 per cent).
- Shorter stays in emergency departments: 95 per cent of patients to be admitted, discharged or transferred from an ED within six hours (currently 67.5 per cent compared to to 71.2 per cent the previous quarter).
- Shorter wait times for first specialist assessment: 95 per cent of patients to wait less than four months (currently 61.2 per cent compared to 61.5 per cent previously).
- Shorter wait times for elective surgery or treatment: 95 per cent of patients to wait less than four months for elective treatment (currently 62.2 per cent — an improvement on the previous quarter’s 61.4 per cent).
On taking up the role last month, Brown said his focus was “delivering” the Government’s five health targets, including that 95 per cent of emergency department (ED) patients be admitted, discharged or transferred within six hours.
At September 30, just 67.5 per cent of patients had met this target — a drop of 3.7 per cent from the previous quarter.
College of emergency nurses (CENNZ) chair Lauren Miller said there was no way EDs could reach the 95 per cent target without more hospital bed availability and the committee had written to Brown to request a meeting on the issue as soon as possible.
“It’s not an ED solution, it’s a hospital-wide solution,” she said. “If you don’t have flow out the hospital’s back end and we don’t have beds to go to, the ED targets are impacted because we can’t get patients out.”
While a six-hour maximum ED stay was a “great aim”, it needed to be resourced, she told Kaitiaki.
‘There are so many parts of the wheel that need to be resolved, for it to work.’
More aged-care beds in the community was one thing that would help free up hospital beds, she said. Other factors included difficulties accessing primary health care, so people turned up at EDs for help instead, and a lack of available specialists to review ED patients and decide whether to admit them.
In smaller regions such as Taranaki, for example, EDs were often full to capacity, facing a hospital “bed block” — with no free beds — and delays to specialist reviews, particularly overnight.
“So you have to wait till the morning till you’re reviewed — all these factors contribute to breaching the target,” Miller said.
“There are so many parts of the wheel that need to be resolved, for it to work.”
Without investing in those areas, the targets just piled more pressure on already-overstretched ED staff who were expending “huge amount of energy” trying to meet them.
‘We’re expected to do better, quicker, with less.’
“Daily there is pressure to discuss all patients’ timelines and an endless drive and focus on these targets that often are reported and reflect poorly on ED,” Miller said.
“We’re expected to do better, quicker, with less.”
At the same time, ED patient acuity and numbers were growing, as waiting times at GP practices lengthened.
Dedicated patient flow coordinators would also help — as existed when National last brought in ED short-stay targets in 2011.
Only about 40 per cent of ED patients needed admitting to hospital, she said. The remaining 60 per cent, “we manage well”.
Emergency doctors and GPs have also warned Brown the targets will not be possible without more funding. Australasian college of emergency medicine Michael Connelly told RNZ setting targets without resourcing them was pointless as patient numbers and acuity continued to grow.
CENNZ also met Brown’s predecessor, Shane Reti last year, to raise the same concerns and, before him, Ayesha Verrall who was Labour’s health minister. Both listened but took no action, Miller said.