Tackling NZ’s growing cataract backlog

The National Party-led government remains committed to a national Clinical Priority Assessment Criteria (CPAC) score of 46 for cataract surgery, despite a growing waitlist and the outsourcing of the procedure to private practices being paused in some districts, confirmed Te Whatu Ora.

As of March 2024, the cataract procedures waitlist was 8,496 people – an increase of 696 patients since the previous Labour Government’s implementation of the national CPAC threshold 18 months’ ago following continued criticism of the country’s cataract surgery ‘postcode lottery’.

Asked how he planned to close the gap between demand and surgical capacity, former health minister Dr Shane Reti referred NZ Optics to Duncan Bliss, Te Whatu Ora’s director of health targets. Outsourcing cataract surgery was paused in some districts, pending confirmation of 2024/25 budgets, said Bliss. “But (this) has been resumed recently and outsourcing will continue to be an important part of the provision of cataract surgery in some districts.”

The long-term planning and investment strategy needs to focus on increasing theatre access and productivity to address the growing ageing population and those with diabetes requiring cataract operations, he said. “National theatre utilisation data is enabling a view of the relative productivity of different operating theatre facilities… Some public hospital services are developing ‘high volume’ cataract services aiming to replicate the productivity seen in private facilities.”

To discuss this and other issues relating to cataract surgery in New Zealand, Dr Reti met in September with Ophthalmology New Zealand (ONZ) board members Drs Sonya Bennett, Michael Merriman and Derrell Meyer, chair Dr Dean Corbett and executive officer Associate Professor Moira McInerney, as well as Alistair Papali'i-Curtin (co-lead Eye Health/Health NZ), Drs Justin Mora (clinical lead Vision 2030 Aotearoa) and Derek Sherwood (clinical lead Planned Care, Health NZ).

Dr Corbett said ONZ proposed using the UK model to increase cataract surgery provision, with specific, high-volume cataract-only services in purpose-built facilities. “Although it’s less than perfect, it has some merit to consider (as part of) an implementable plan in New Zealand,” he said.

A/Prof McInerney and Dr Corbett’s other submissions made to Dr Reti included:

Balancing public and private needs with a three-tiered cataract solution – comprising private outsourcing for immediate capacity relief, public insourcing with volume-based remuneration and purpose-built public cataract centres
Implementing eCPAC – a ‘live’, modifiable web-based version of the triage tool
Registrar funding, training and retention – including better communication between regional health hubs and registrars on employment, especially for married couples and “increasing the attractiveness of New Zealand positions (compared with) those available in Australia, via funding and conditions,” said Dr Corbett
Private health insurance considerations
Collaboration with optometry to help deliver care where there are bottlenecks in clinical service availability. “This is primarily on first specialist appointments and cataract follow-ups,” said Dr Corbett. “Collaboration will be focused on providing better service delivery in those areas where we have insufficient ophthalmic staff.”

The 2023 alignment of districts’ cataract pathways to a national pathway included clinical prioritisation and direct wait listing for surgery and use of optometrists both within hospitals and in the community for post-operative care, said Bliss. “Some districts have been able to use existing contract models to enable post-operative care in the community, while others are waiting for a national contract to be established.”