15 July 2022

Emma Vitz
Via email: [FYI request #19607 email]

Tēnā koe Emma,

Your Official Information Act request - Outsourced elective procedures and surgeries

Thank you for your Official Information Act request transferred to us on 15 June by the Ministry of Health
seeking information from the former Waitematā District Health Board (DHB) about outsourced procedures
and surgeries.

"I would like to request the following information for each of the DHBs in New Zealand, split
by DHB.
1. The total number of procedures outsourced by year (including the year-to-date) for the
past five years.
2. For each year, provide a breakdown of the type of procedure.
3. For each year, provide the total spend on outsourced elective surgeries.
4. For each year, provide the amount that these surgeries would have cost the DHBs if they
had not been outsourced."

On 16 June we sought clarifications to your request and on 19 June you clarified as follows:

1.  Are you seeking (either as included or separated) the procedures we have sent to private providers
and the patient does not attend their appointment (these are reported as ‘Private Provider DNA’).
Your response: No.

2.  Are you seeking (either included or separated) the procedures where a private provider either
stated the exam is no longer required or the form was returned to us as the patient was not
contactable (reported as ‘Private Provider Cancelled’).
Your response: No.

3.  Elective procedures includes radiology and endoscopy, for example. Do you want details on these
types of procedures also or just elective surgeries?
4.  Your response: Yes, I would like details on these types of procedures also, please.

Before responding to your specific questions, it may be useful to provide some context about our services.

Waitematā is the largest and one of the most rapidly growing health districts in the country, serving a
population of around 650,000 across the North Shore, Waitakere and Rodney areas. We are the largest
employer in the district, employing more than 8,900 people across more than 80 locations.

In addition to providing care to our own resident population, we are the Northern Region provider of
forensic mental health services and child rehabilitation services, plus the metro Auckland provider of child
community dental services and community alcohol and drug services.

In response to your request, we are able to provide the following information:

1.  The total number of procedures outsourced by year (including the year-to-date) for the past five
years.
2.  For each year, provide a breakdown of the type of procedure.
3.  For each year, provide the total spend on outsourced elective surgeries.
4.  For each year, provide the amount that these surgeries would have cost the DHBs if they had not
been outsourced

We are providing a combined response for questions 1 to 4. Please refer Attachment 1.

Please note there were no outsourced otorhinolaryngology (ORL) or orthopaedic procedures after 2018
due to the opening of the Elective Surgical Centre on the North Shore Hospital campus, which increased our
in-house surgical capacity.

As indicated in the attachment notes, casemix between outsourced and in-house procedures can be vastly
different, with more complex procedures being performed in-house than those that are outsourced.

I trust that this information is helpful.

Waitematā DHB supports the open disclosure of information to assist community understanding of how we
are delivering publicly funded healthcare. This includes the proactive publication of anonymised Official
Information Act responses on our website from 10 working days after they have been released.

If you consider there are good reasons why this response should not be made publicly available, we will be
happy to consider your views.

Yours sincerely

Mark Shepherd
Executive Director Hospital Services
Te Whatu Ora Health New Zealand Waitematā

TeWhatuOra.govt.nz
Private Bag 93-503, North Shore 0740
Waea: +64 9 489 0527

Outsourced procedures
Attachment 1
Skin Lesion removals
Gastroenterology scopes
ENT surgical procedures (1)
Orthopaedics surgical procedures (1)
Endocrinology bone scans
Outsourced  Estimated
Outsourced
Estimated
Outsourced
Outsourced
Estimated
Financial year
Events
cost
cost (3)
Events
cost
Estimated cost Events
Outsourced cost
cost
Events
cost
Estimated cost
Events
cost
cost (5)
2018
2672     85
  0,049
5,551

,136
1166   1,505

,558
   2,758

,863
  104

88
  1,014
  41
  2,242
2      10
  ,588
  15
  ,060
2422     14
  0,051
35
    9,662
2019
3104   1,035

,464
7,976

,904
2493   2,645

,032
   2,713

,323
ENT and orthopaedics not outsourced after 2018
2702     15
  6,289
41
    3,224
2020
3419   1,369

,619
9,655

,039
3134   4,046

,753
   4,160

,653
3382     20
  8,034
49
    3,477
2021
3672   1,424

,959
9,233

,803
3775   4,813

,021
   5,062

,736
3252     19
  8,885
50
    7,808
2022 YTD April
2505     73
  4,301
4,686

,161
2205   2,921

,761
   3,342

,285
2350     15
  3,778
43
    6,661
Radiology procedures
Ultrasounds
MRI
CT scans
PET scans
General Radiology
Interventional Radiology
Outsourced  Estimated
Outsourced  Estimated cost
Estimated
Outsourced  Estimated cost
Outsourced
Estimated
Outsourced  Estimated
Financial year
Events
cost
cost (4)
Events
cost
(4)
Events
Outsourced cost
cost (4)
Events
cost
(5)
Events
cost (2)
cost (4)
Events
cost
cost (4)
2018
8,228

1,268

,782
1,877

,057
  1,041

  87
  0,094
34
    3,053
   1,447

  1,290

,283
  36
  8,032
346

  58
  7,020
78
    0,231
2019
7,349

1,043

,638
1,798

,338
  2,745

2,112

,937
   1,015

,302
   1,596

  1,310

,625
  44
  3,429
321

  60
  2,489
74
    5,471
2020      10
  ,348
1,633

,373
2,803

,956
  2,414

2,065

,326
93
    1,594
  908

82
  8,779
  28
  8,839
421

  77
  1,445
96
    4,627
  299

Not costed
  111

  58
  4,287
  25
  6,851
2021
9,828

2,269

,253
2,757

,341
  2,444

1,309

,893
99
    9,397
   2,297

  1,313

,400
  63
  9,322
481

  89
  6,134
   1,169

,588
4,112

  35
  3,563
46
    9,696
2022 YTD April
9,351

2,169

,188
3,134

,984
  3,197

1,816

,749
   1,594

,332
   4,847

  2,938

,507
1,604

,277
431

  67
  3,870
   1,082

,504
4,355

  39
  7,027
64
    8,853
Notes:
(1)  There were no surgical procedures outsourced after the 2017/18 year. The added theatre capacity in the Elective Surgical Centre (ESC) enabled further in-house capacity.
> Estimated cost of surgical procedures is based on in-house patients with similar procedures.
(2) Outsourced general radiology was not costed in the first year of provision so costs are not available.
(3)  Skin lesion estimated cost is based on the skin lesions that are done in Waitemata's theatres with the following caveats:
>  Skin lesion removals done in-house are the more complex cases that require a theatre setting and therefore will be significantly higher cost.
> Any simple cases are outsourced to GPs where they are carried out in a more appropriate clinic setting and cost much less.
(4) The costs of outsourced radiology procedures are based on averages so the split between modalities is approximate.
> The estimated radiology costs are based on in-house average cost by modality. The mix of in-house radiology procedures within each modality may be quite different to outsourced so estimated costs are also approximate.
(5) As PET scans and Endocrinology bone scans are not done in-house, the estimated cost is based on the purchase unit price which in turn is based on national average costs.
Abbreviations
MRI - magnetic resonance imaging
CT - computed tomography
PET - positron emission tomography

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