Planned care services

You can expect:

• to receive information about your assessment and treatment options and whether or not they will be available to you
• that your level of need and ability to benefit will be assessed compared with other people
• to know in 15 calendar days or less whether you will receive assessment or treatment
• to receive care at the most appropriate time to ensure improved health and minimise ill-health, discomfort and distress.

The traditional model of hospital admission is changing. Modern, safe treatment practices mean some people’s needs may now be met by day-surgery, less invasive surgery, or non-surgical techniques.

If you have a condition you think may require treatment you should first see your primary care provider such as your doctor, nurse practitioner, Māori health provider, optometrist or physiotherapist. They will assess your condition and discuss the best option with you, including whether to refer you to a specialist.

You may be referred by your GP (or other primary health provider) for specialist advice, more investigations or to be considered for specialist intervention. As part of this referral you may be asked to fill out an ‘Impact on Life Questionnaire’, to assess how much your condition affects your day-to-day life.

If your GP (or primary health provider) refers you for specialist advice, the specialist will review your referral and provide the requested advice, where appropriate.

If you are referred to a specialist at a public hospital for investigation or consideration for intervention or treatment, the local clinical staff will schedule a First Specialist Appointment (FSA). This will be prioritised against other people needing care.

If your referral meets the clinical threshold for a First Specialist Appointment (FSA), you will be assessed by a specialist. Sometimes this does not need a face-to face appointment. The hospital should inform you and your primary care provider within 15 calendar days about whether or not you will receive a First Specialist Appointment (FSA). Your primary care provider will care for you while you are waiting to see the specialist. If your condition gets worse during this time you should contact them.

A specialist will assess your condition and recommend the best care option for you.

The outcome depends on how urgent your condition is and what resources are available.

• The specialist may arrange for more tests to be done before a decision is made
• You may be prescribed a course of medical treatment (eg, drugs) after which you may need to be reviewed again
• If surgery is the best option, your priority will be determined based on how urgently you need the surgery and how much you will benefit from it compared with other people
• We will determine whether we can provide treatment, depending on your priority and the available resources
• If we can offer you the required treatment, it will be provided at a clinically appropriate time based on your level of priority. This must be within four months of the date the offer to treat you was made
• If your condition is not urgent enough to receive specialist care within 4 months, but it may get worse, you may be given the status of Active Review. This means the hospital must re-assess your condition at least every six months for up to 18 months. If your condition does not get any worse, you will be discharged to your primary care provider with advice on what to do if your condition gets worse
• in some cases a specialist may tell you that a service is not available even though you would benefit from it. This could happen if some 'planned care' services have not been prioritised for your district. If this happens, you and your primary care provider will be informed, and the best options of care will be discussed with you.

The specialist will assess your condition and recommend the best care for you.

There are several possible outcomes depending on how urgent your condition is and what resources we have available:

• The specialist may arrange for more tests to be done before a decision is made
• You may be prescribed a course of medical treatment (eg, drugs) after which you may need to be reviewed again
• If surgery is seen as the best option, your priority will be determined based on how urgently you need the surgery and how much you will benefit from it compared with other people
• We will determine whether we can provide treatment, depending on your priority and the available resources
• If we can offer you the required treatment, it will be provided at a clinically time based on your level of priority. This must be within four months of the date the offer to treat you was made
• If your condition is deemed not urgent enough to receive specialist care within four months, but it may get worse, you may be given the status of Active Review. This means the hospital must re-assess your condition at least every six months for up to 18 months. If your condition does not get any worse, you will be discharged to your primary care provider with advice on what to do should your condition get worse
• In some cases a specialist may tell you that a service is not available even though you would benefit from it. This could happen if some planned care services have not been prioritised to be provided in your district. If this happens, you and your primary care provider will be informed, and the best options of care will be discussed with you.

Two important questions guide the specialist in making this decision:

1. How severely does your condition affect your day-to-day life?
2. How much will you benefit from it compared with other people?

We use national prioritisation methods to make sure the decision is fair and clear.

If we confirm we can provide treatment, we must provide the treatment within four months of making the decision to treat you.

This could be sooner than four months, depending on your priority. If you are waiting for surgery and your condition suddenly gets worse, you may be admitted to hospital immediately (acutely) to have an operation.

If we confirm we can provide treatment, we should provide that treatment within four months.

However, if you are waiting for surgery and your condition suddenly gets worse, you may be admitted to hospital immediately (acutely) to have an operation.

If your condition gets worse you should see your GP or other primary care provider.

They will ask the specialist to reassess you, which may mean your priority for treatment changes.

New Zealand’s health system is funded by the taxpayer.

Our government decides how much tax we pay and how it is spent. This determines how much publicly funded treatment can be provided. Demand for 'planned care' services is increasing because our population is ageing and new technologies are allowing more procedures to be provided.

We have to balance our spending on planned care with other health priorities such as maternity services, cancer treatment, mental health services and accident and emergency care.

Often there aren’t enough resources to meet all of these demands.

You and your GP or other primary care provider will be told the results of any tests and what treatment options are available and most suitable for you.

If you disagree with a decision to not provide you with a publicly funded treatment, you should talk to your GP or other primary care provider.

They will explain why the decision was made and what options are available to you.

These may include referral to a private specialist for assessment or treatment, or a clinical review of your condition, either by the original specialist or by another clinician (a 'second opinion').

You have the right to ask for a clinical review, but the original decision may still stand. You should also check that all relevant information about your condition has been given to the specialist, including the impact your condition has on your life.

If you have a concern about your care, please contact our Quality, Patient and Safety Team.

Often the letter you first receive says you will be seen within four months.

This doesn’t necessarily mean you will need to wait the full four months. Specialists will decide how soon you need to be seen, based on the information provided in your referral.

You can discuss your options with your GP or other primary care provider.

They can tell you whether or not the recommended treatment is likely to be available from a public hospital or if it can be provided elsewhere such as at a GP or community clinic.

There are no additional costs to people when they are receiving publicly funded services.

There may be a range of options and services available to you, depending on your circumstances.

The specialist may discuss these with you, and your GP or other primary care provider can tell you about possible alternatives.

These could include non-surgical treatments, ongoing care, or private treatment.

Other important factors include cost, how long you are prepared to wait, whether you have private health insurance and the level of expertise required.

You won’t be transferred automatically to the waiting list at your 'new' local hospital.

This is because hospitals operate within their own districts and budgets.

One option is to stay on the waiting list where you lived before, until treatment becomes available.

We will meet our commitment to treat you even if you have moved out of our district – but you must make yourself available for appointments and follow-up procedures.

Any travel costs (before and after your operation) would be at your expense.

Another option is to get a new referral from your original specialist, or your GP (or other primary care provider) in your new location. In this case, your process will start again from the beginning.

If you have already seen a private specialist, your referral will still be treated the same way as everybody else’s.

If your priority is high enough you will receive treatment from the public system. You may have to see a specialist at the public hospital to have your priority assessed.

Under the Code of Health and Disability Services Consumers’ Rights, you have the right to be treated fairly, consistently, and to an appropriate standard.

If you feel you have been treated unfairly, or wish to make a complaint, you have rights under the Health and Disability Commissioner Act 1994.

Information about how to make a complaint is available on the Health and Disability Commissioner’s website

You also have the right to have a support person or advocate help you when you are dealing with us.

You have several obligations when seeking publicly funded treatment through us. These obligations help keep things fair for others.

You must:

• confirm whether or not you are willing to have the treatment (with all its implications), so that we can best use our resources
• carry out all instructions given to you to prepare you for treatment, so your treatment can proceed safely
• let us or your specialist know if your contact details change, so they can contact you urgently if necessary
• give us or your specialist reasonable notice if you can’t keep your appointment, so it can be made available to another patient.

Valuable time and resources are wasted when we can’t contact patients, or when patients don’t show up for appointments and treatments.

We can’t always reschedule appointments at short notice, or ask others to take your place.

This means some treatment slots are not used and contributes to waiting times.

Your GP (or primary care provider) should be the first person you talk with because they understand how the planned care system works.

For some things you will need to talk to your hospital's customer liaison representative.