When operating theatres reopened after the 2020 Covid-19 lockdowns, surgery waitlists were prioritised in Auckland based on clinical need and ethnicity alone. A group of medical professionals who perceived that as too blunt created a new equity adjustor score, which has ethnicity as one of five criteria
During Covid-19 medical professionals in Auckland identified that Māori and Pasifika were disproportionately waiting for surgery compared with other population groups and sought to fix it when operating theatres were back up and running after the 2020 lockdowns.
All the health data pointed to ethnicity being a significant factor, so alongside clinical need – how urgently someone requires surgery – Auckland hospitals started working its way through waitlists using those two criteria for routine surgeries.
When doctors decide who should be front of the queue, everyone is first and foremost put into a clinical priority category of urgent, semi-urgent, or routine.
Duncan Bliss, Te Toka Tumai surgical services manager, is part of the team who created the algorithm for a new equity adjustor score that was rolled out in Auckland in February.
He tells Newsroom he can't stress enough that clinical need “always takes precedence and the equity adjustor doesn’t interfere with that”.
When clinical need and ethnicity were the only criteria being used in 2021 and 2022, there was some pushback from the medical profession that social deprivation and geographical location also needed to be included.
Bliss says as soon as the adjustor score was implemented to take those two additional criteria into account along with a fifth, time spent on the waitlist, those clinicians who had been critical “welcomed” the algorithm.
The four measures that come underneath the priority, clinical need, have all been given a weighting, but Bliss says it varies from service to service.
“Take neurosurgery for instance, clinical priority and days waiting absolutely take precedence over everything else,” he says.
But when it comes to low-end routine surgeries Bliss says if the proportion of Māori and Pasifika on the waitlist exceeds their population percentage then a higher weighting is given to ethnicity.
Clinical need is still the first consideration, however.
“We haven’t looked at it from race or whether it might be controversial, it was based on data.” - Te Toka Tumai surgical services manager Duncan Bliss
Medical professionals, clinical services, and Māori health teams were all part of the team that designed the equity adjustor score and weightings.
Though Bliss says the tool is effective in dealing with some of the inequities in the current system, it only does some of the work as it is too blunt to be completely relied on.
“There isn’t a blunt tool you can apply to everything, it’s more complicated than that.”
Bliss says the prioritisation gets “fine-tuned” at the service level by doctors making the decisions, who apply different factors where necessary.
Prime Minister Chris Hipkins has asked the health minister to look at the criteria after Newstalk ZB reported the new algorithm on Monday, including criticism from some in the sector who opposed ethnicity being a consideration.
Hipkins tells Newsroom there is clear evidence Māori, Pasifika, rural people, and those in low-income communities have had to wait longer for clinical care than others and have been discriminated against.
Though he says Te Whatu Ora has worked to address that, he has asked Ayesha Verrall to look at it to make sure the discrimination that already exists hasn’t been replaced by another discriminatory tool.
National and ACT are strongly opposed to ethnicity being a prioritisation and say they would remove it if in government, and ACT leader David Seymour has called out the government for treating New Zealanders differently depending on who their ancestors are.
Bliss says the equity adjustor score is designed from a health perspective, not a political one.
“We haven’t looked at it from race or whether it might be controversial, it was based on data.”
Life expectancy and mortality rates paint a bleak picture for Māori and Pasifika in New Zealand with European or other males having a life expectancy of 81 years compared with 73.4 years for Māori and 75.4 years for Pacific males.
Bliss says that is data that could potentially be used in place of ethnicity, but he hadn’t looked closely enough at it to know if it was a fair comparator.
“I think we’d have to look at it but also ask why. Why would we try and do that?
“Not using the word 'ethnicity' because it’s too political doesn’t feel like the right thing to be doing in health,” Bliss says.
“We treat patients based on need and ensure there aren’t inequities.”
Hipkins was also unwilling to use other criteria in place of ethnicity, even if they drew the same results.
“I don’t want to dress up a problem in a way that disguises the problem, and therefore it doesn’t get addressed.
“We shouldn’t try and hide that by talking around in circles about it,” he says.
