HNZ warns outsourcing surgeries will hurt doctor training
Outsourcing more elective surgeries will limit training opportunities for future surgeons, the Health Minister has been warned.
Health New Zealand aimed to perform more than 30,000 elective surgeries in the 15 months to June 2026 in a bid to reduce waitlists, including by outsourcing thousands of more straightforward cases to private hospitals.
Documents obtained by RNZ under the OIA show Health Minister Simeon Brown was told in March that outsourcing more elective operations to private hospitals will worsen training opportunities.
"That's because outsourced procedures are usually of lower complexity, which often makes them suitable for training," Health NZ wrote in a briefing.
Some doctors agree with the ministry's warning.
Hawke's Bay head and neck surgeon Christopher Kennel, who worked in both the public and private sector, said his trainees were already missing out on learning, because the public sector only had the capacity to deal with the most severe cases.
Outsourcing would only make it worse, he said.
"The registrars are already having a biased training towards more complex cases. I don't know how people who go through training here are going to be prepared to function privately because they're not going to have the background to do common, but less urgent cases, because the public system is under-resourced."
To mitigate this, Health NZ was exploring more national agreements to train more doctors in private hospitals, starting with radiology and pathology. Health NZ said significant work was underway to get an agreement for obstetrics and gynaecology, while briefing papers said otorhinolaryngology (ear, nose and throat) and plastic surgery could also be targeted.
Health NZ was also considering making training a requirement of private hospitals' outsourcing contracts.
This raised ethical and practical questions, Dr Kennel said.
"If trainees are helping me earn money privately, then who's paying them?
"Is it fair for the public side to pay them to operate with me privately when registrars could be seeing public patients in clinic instead?
"The other thing is that on any given day when I'm operating privately, I might do a public contract case, and I might treat a privately insured patient. How does the registrar know how to schedule their day? Because if they're going to be with me for like 2 hours of a public contract case, what do they do when I'm operating on just a privately insured patient?"
Auckland radiologist and Auckland University Faculty of Medicine associate professor Colleen Bergin said she wants to see details and assurances on how robust training systems in private hospitals would be.
"There are systems in place in the public hospital, there's a structure. Everyone on that day is involved in teaching those students. But moving to a private system, there's no details on that kind of process."
Orthopedics was the only surgical speciality currently allowed to train doctors in private hospitals nationally, as much of its work was ACC related and done privately. Health New Zealand said it also had training agreements with some specialities at a local level.
New Zealand Orthopedics Association chief executive Andrea Pettett said the 16-month-old scheme was "working extremely well" and a "win-win".
"All parties are very happy with the system. Our trainees are employed by the public hospital and they are released for one or two private runs. They go to the private hospital often with the public surgeon. And it's entirely up to the private surgeon whether they want to train them."
She saw no issue with publicly-paid trainees working in private hospitals, as private surgeons were also giving up their time to teach.
"Obviously in a perfect environment, our public hospitals would be better placed if they could do the full suite of acute and elective surgery, but they can't. So this is a pragmatic way to ensure that New Zealanders get access to elective surgery."
Speciality Trainees of New Zealand president Jordan Tewhaiti-Smith, an obstetrics and gynaecology registrar, was involved in setting up a training agreement between private hospitals and the Royal Australasian College of Obstetrics and Gynaecology.
He expected a deal to be announced soon but there were some details that still needed to be worked through.
"It's making sure we are medico-legally protected in those spaces because public registrars aren't employed by the private sector, so that's a grey area."
Ultimately, allowing private hospitals to train public doctors was a "needs-must" situation, he said.
"These are people that are going to be the future specialists of tomorrow and the people that are operating on you in 5-6 years time. If they aren't trained to a good standard because we've dropped the ball in the public sector then it comes at a cost to everyone.
"Some people might snub their noses at the fact that we're supporting the private sector by outsourcing all these cases, but actually it's a much bigger lens that I think we should look through."
The Royal Australasian College of Surgeons said it was speaking to private hospitals about training future surgeons, but ideally all training would happen in an appropriately resourced public health care system.
In a statement, Health NZ said a pre-requisite of any agreement is that training in private hospitals would not compromise the public system.
"We are working with the private sector towards common expectations for how medico-legal, quality and financial issues are managed, as well as with professional medical colleges and unions to build consensus," Health NZ Clinical Lead Planned Care Derek Sherwood said.
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RNZ News
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Scoop
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RNZ News
a day ago
- RNZ News
Wellington Hospital birthing suite short-staffed 70% of time
Staffing for 69 percent of shifts in Wellington Hospital's birthing suite "below target" between January and June. Photo: RNZ / REECE BAKER Nearly 70 percent of shifts in Wellington Hospital's birthing suite were understaffed in the first half of the year, which midwives say is putting pressure on services, and making it a constant juggle to provide safe care to women and babies . Information obtained by RNZ under the Official Information Act, shows 69 percent of shifts in the birthing suite were "below target" between January and June. Ward 4 North Maternity (which includes antenatal and postnatal beds) was under-staffed 40 percent of the time, while other maternity services, including the community team, were down for 20 percent of shifts. A Wellington midwife, whom RNZ has agreed not to name, said it was "scary" having gaps in the birthing suite rosters for most shifts. "Lead maternity carer midwives are most days contacted via a group text to come in to work in the birthing suite, mostly with community midwifery team labour and births, sometimes to work on the floor as part of the team on shift." The birthing suite - which has space for 12 women - was often in Code Red due to lack of staff, which meant clients booked for inductions (usually because of some risk to them or their babies) were frequently bumped for emergencies coming in, she said. "I get the acuity issue in a very dynamic environment, but if there was more capacity/meat in the system, then postponement/rescheduling would be a rarity, not the norm that it is now." As of earlier this month, Wellington's maternity service had 43 vacancies for midwives. Co-leader of the midwives union, MERAS, Caroline Conroy, said between 30-40 percent of positions were vacant. "So you're not going to run a 'business as usual' service when you've got that level of vacancy. It's going to impact somewhere." In a written response to RNZ, Health NZ said "understaffing relates directly to recruitment challenges, which is an international phenomenon". "While staffing in some units isn't as high as we'd like, it is important to note that there are mitigations in place to ensure high quality clinical care for all patients." That included pulling in casual midwives, senior midwives and non-frontline staff like midwifery educators and clinical coaches to "backfill shifts". Night shifts were more challenging because those senior staff were not available to fill in, Conroy said. "So they do try and make sure the night shifts are staffed better, which often leaves the the day shifts 'light'." When those shifts got too busy, management must utilise what Health NZ referred to as "the variance response management tool and escalation standard operating procedures". Conroy said that sometimes meant postponing inductions and non-emergency caesareans, or discharging mothers and babies early. "Often the number of staff they have on the shift is not sufficient for the workload, which then pushes them into Code Red, which means workload exceeds appropriate staffing." That could happen even when a shift was fully staffed because demand could be "unpredictable". But it was less likely to happen when services were properly staffed, she said. Last month, hospital managers were forced to back down on a plan to "reallocate" maternity and gynaecology beds to make room for medical patients coming from the emergency department. Midwives and obstetricians said the maternity service was often at more than 100 percent capacity. However, in a written response to RNZ, Health NZ deputy chief executive Robyn Shearer, who heads the central region, said those particular maternity beds were still "routinely unoccupied". "As we have enough resourced maternity beds to meet demand, there are no current plans to recruit additional staff to resource these unused beds." Health NZ deputy chief executive Robyn Shearer. Photo: RNZ Insight/Karen Brown Health NZ continued to "actively recruit" to vacant midwifery roles and a small number of specialists (3.7 full-time positions) in women's health services, she said. "Rostering is dynamic and continuously adjusted to meet the demands of patient care. "While schedules may evolve in the lead-up to a shift due to staff illness or changes in circumstances, patient safety is always our highest priority, and we have effective measures in place to ensure patient safety is always maintained." Health NZ confirmed six new recruits were set to join the Wellington service by the end of the year, and it was also hoping to recruit some of the first tranche of 22 graduates from Victoria University's midwifery programme. Conroy said that promised to relieve pressure on the existing team. "As long as they can get to the end of this year, next year should be quite different for them. There's definitely light at the end of the tunnel." Conroy said one immediate way to relieve pressure on the birthing suite would be to turn those "unoccupied" beds in Ward 4 into an observation facility for pregnant women who come in with bleeding or reduced foetal movements and need to be under constant watch. Currently, they end up taking up rooms in the birthing suite, but if Wellington had an observation ward (like other tertiary hospitals), one midwife could easily manage three or four women, Conroy said. Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
