Page 86 - Regional Services Plan 2016/19

Elective surgery
The Midland Elective Services Plan describes intended actions to increase elective surgery, including regional capacity planning where this can achieve greater gains. An option that clinical networks may wish to pursue in the future is for provincial centres to do more routine elective surgery to help maintain critical mass, while the major centres take on more of the acute and complex work. However, planning will need to be cognisant of studies of the relationship between volumes and outcomes, which generally suggest that outcomes are better in larger volume centres. This may lead to the development of centres specialising in particular procedures in the region. It is also understood that an emphasis on training general surgeons to function as generalists will maintain services in the provinces.
Future trends
The future trends can be expected to affect the future provision of surgical services in Midland in the following ways:
 Population ageing can be expected to increase the demand for orthopaedics, general surgery, ophthalmology and services with greater utilisation at higher ages;
 Population growth in the Bay of Plenty may result in the ability to provide more complex interventions locally;
 Sub-specialisation (e.g. from general surgery to upper and lower gastro intestinal), combined with reduced willingness to work frequent call rosters will make it more difficult to maintain 24/7 acute surgery in Gisborne and Whakatane. Support from neighbouring hospitals will assist in managing this pressure. DHBs and the sector need to explicitly address the consequences of sub-specialisation and the reality that the marginal reduction in risk achieved may be at the expense of increased risk to the (increased) populations at a distance from services. The theoretical increased risk of generalised services may actually be less for such populations.
 Nurse endoscopy roles may reduce the extent to which general surgeons provide screening endoscopy services;
 More services may be provided at a distance using tele-health supports; and
 Larger primary care centres may take on some diagnostic work and minor surgery.
Likely changes in future levels of surgical services over the next two decades are set out below.
Table 2: Expected future summary surgical services levels
DHB
Comment
Bay of Plenty
Population growth will lead to increased subspecialty presence at Tauranga
Lakes
Current levels of subspecialty should be sustainable with regional support
Tairāwhiti
Current levels of acute surgical services will continue to require regional support
Taranaki
Current levels of surgery at Taranaki should be sustainable with regional support
Waikato
Assumes no change to future allocation of tertiary services (and higher levels) nationally – Auckland is unlikely to be able to accommodate Midland growth
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APPENDIX 3: HEALTH SERVICES – NOW AND IN THE FUTURE