Elective Services
General information about elective services is available from the Ministry of Health’s website: www.electiveservices.govt.nz
Monthly and trend information on DHB elective services performance is available at
www.electiveservices.govt.nz/indicators.html
What are elective services?
Elective services are hospital services for patients who do not need immediate treatment. Common conditions in this category include hip joint replacement and cataract surgery. If you are very ill and require emergency treatment you will be treated acutely with minimal delay.
What can I expect?
Clarity: You should receive information about assessment and treatment options and whether or not publicly-funded options will be available to you.
Timeliness: You should know within 10 days whether you will receive access to treatment or assessment. If assessment or treatment is offered to you, you should receive it within 6 months.
Fairness: You will be assessed on the basis of your level of need relative to other people with similar conditions.
How do I get an assessment?
If you have a condition that you think may require hospital assessment or treatment you should contact your general practitioner (GP), nurse practitioner, or Maori health provider. They will assess your condition and discuss your options with you, including whether to refer you to a hospital specialist.
If you are referred and accepted by a specialist, you should be given an appointment for a first specialist assessment (FSA) within six months of acceptance. Your GP (or other primary care practitioner) will care for you while you are waiting. If your condition worsens during this time you should contact your GP.
What does the specialist do?
The specialist will make an assessment and determine the best option of care for you. He/she also will use clinical guidelines to help determine your level of priority for treatment.
If, based on your level of need, publicly-funded elective services are not available to you at this time, your GP will continue to care for you. The specialist will provide information on the outcome of your assessment to you and your GP.
Who determines when I'll receive treatment if I need it?
Staff of Timaru Hospital's Booking Office have the responsibility for scheduling you for surgery based on the specialist's determination of your need and clinical priority relative to others. If publicly-funded treatment is available, you will be advised either that you have a firm date for treatment within the next 6 months or that you will receive treatment within 6 months and the specific date will be provided closer to the time.
How long will I have to wait for assessment or treatment?
Some patients need to be seen more urgently than others. For example, people suffering severe pain would generally be seen more quickly than, say, a person with occasional discomfort. If you are offered publicly funded specialist assessment or hospital treatment, you should receive it within six months.
Why is treatment not always available?
Spending on elective services in public hospitals must be balanced with other health priorities such as maternity services, subsidised drugs and emergency care.
Public hospitals have a set amount of funding for elective treatments. Community demand for public hospital services is often greater than the ability of the hospital to meet that demand. Public hospitals need to treat those with the greatest need first. Specialists use guidelines to help decide which patients require treatment first, so that fair and consistent decisions are made within the resources available.
In practice this means that referrals for patients with lower priorities may not be accepted and those patients will remain under the care of their GP or other primary care practitioner. It also means that patients who could benefit from treatment but whose priority is insufficient to be offered treatment within six months will be place in “Active Review,” where their condition is monitored at regular intervals until such time as they may qualify for treatment within six months.
Historically, South Canterbury DHB has provided very good access to elective services. For example, despite having only 1.3% of NZ’s population, in 2005/06 we provided 2% of the nation’s elective surgery. Half of all surgery performed at Timaru Hospital was elective. And we consistently rank among the top 4 DHBs in access to 11 common surgical procedures monitored by the NZ Health Information Service.
Will my GP know the results of my visit to the specialist?
Yes. Your GP will be told the results and whether you have been offered treatment.
What other options are available to me?
There may be a range of services available to you depending on your particular circumstances. This may include returning to your GP who can advise you on suitable alternatives.
What if I (or my GP) do not agree with what has been decided?
Talk to your GP. You may ask for an explanation or a second opinion.
What if my condition worsens?
If at any time your condition worsens you should see your GP or other primary care practitioner. Your GP will seek a specialist re-assessment if they think your condition has changed. This re-assessment may include a review of your priority for treatment.
What are my rights?
Under the Code of Rights, you have the right to be treated fairly, consistently, and to a high standard under the Health and Disability Commissioner Act 1994. If you feel you have been treated unfairly, or wish to make a complaint, you have rights under the Act. For further information see the website: www.hdc.org.nz
What are ESPIs?
There are eight ESPIs – “Elective Services Patient-flow Indicators.”
ESPI 1: % of patient referrals acknowledged and processed within 10 working days.
ESPI 2: % of patients waiting longer than 6 months for their FSA (first specialist assessment).
ESPI 3: % of patients waiting without a commitment to treatment whose priorities are higher than
the actual treatment threshold (ATT).
ESPI 4: Clarity of treatment status.
ESPI 5: % of patients given a commitment of treatment but not treated within 6 months.
ESPI 6: % of patients in active review who did not receive a clinical assessment within the last 6 months.
ESPI 7: % of patients not managed according to their status who should have received treatment.
ESPI 8: % of patients who were prioritised using nationally recognised processes or tools.
The National Elective Services Booking System is intended to create transparency, certainty and consistency in the process of patient access to elective services. The system is about managing patients, not about the supply or amount of services available (which is determined by hospital funding levels, staffing and operational capacity).
The Ministry of Health monitors DHB performance across the eight ESPIs and reports that performance by way of a traffic light system: green is ‘acceptable’, amber is ‘improvement required’, and red is ‘unacceptable’. The Ministry expects all DHBs to consistently achieve green lights on all indicators.
SCDHB was among the first DHBs to achieve green light status on all eight ESPIs for surgical specialties at both an overall level and by specialty (dental, ear-nose-throat, general surgery, gynaecology, ophthalmology, and orthopaedics). No patients were arbitrarily removed or culled from waiting lists to achieve compliance with ESPI standards for surgical specialties.