Health Minister Dr Shane Reti says he’s not concerned but can’t guarantee his five targets for the health system won’t be gamed by under-pressure health staff as his Government strives for better healthcare services. 

Reti is today set to speak further about his targets, announced in March, and is expected to explain what tools the health system will use to achieve them. 

He’ll also field questions about the potential for data informing the targets to be manipulated or gamed, which has occurred in the past particularly concerning efforts to reduce emergency department wait times. 

Since establishing the targets, Reti has been briefed by health officials on how they might be gamed and advised on potential mitigations, as well as the possible risks posed by the target regime. 

It comes as improvements to ED wait times came under scrutiny this week following reports of a woman dying at Rotorua Hospital after waiting in its ED for three hours. 

In March, Reti set out five targets he hoped to achieve within six years: 

- 90% of patients to receive cancer management within 31 days of the decision to treat. 

- 95% of children to be fully immunised at 24 months of age. 

- 95% of patients to be admitted, discharged or transferred from an emergency department within six hours. 

- 95% of patients to wait less than four months for a first specialist appointment. 

- 95% of patients to wait less than four months for elective treatment. 

Health Minister Dr Shane Reti says he's not concerned about the potential for his targets to be gamed. Photo / NZME 

In May, Ministry of Health officials briefed Reti on managing the “potential for gaming and unintended consequences of health targets”. 

It cited previous research on ED wait time targets that found gaming - deliberately making performance appear better than it was - had occurred and sometimes facilitated by senior management given the “perception of high stakes”. 

In their analysis of potential gaming techniques, officials listed “stopping the clock” or removing patients from the ED information system while they were still in the department as a possible tactic. 

Another was patients being re-designated to “under observation”, without being moved to an observation unit. 

Officials suggested improved acute care pathways and faster discharge processes could help mitigate the potential for the target to be gamed. 

The target concerning cancer management posed the risk of patients being queued before treatment decisions were made. The first specialist appointment target was threatened by the potential for variable interpretations of patient referral dates. 

Officials believed the consistent application of “business rules” could prevent gaming attempts in those areas. 

Achieving shorter wait times for elective treatment could be manipulated through “inappropriate suspension”, officials warned. They recommended investigating the volume of patients being removed from a wait list for reasons other than treatment. 

Unlike the others, there was “little evidence” the immunisation target could be gamed, with officials theorising it was because the target was set by the national immunisation register. 

Reti yesterday said he was aware of how gaming had occurred in the past and while he wasn’t concerned it would impact his targets, he couldn’t rule it out. 

“Well, there could be new mechanisms that come into place, but we’re watching and monitoring for that,” Reti said. 

“They’ll appear as they appear, but we learned from the past, and it’s been well-documented as to how gaming occurred.” 

He said there had been no new measures implemented to watch out for gaming as yet, aside from an increased focus on monitoring. 

While he’d been a staunch defender of the need for targets, Reti’s May briefing also highlighted the potential consequences of the regime. 

Health Minister Dr Shane Reti was confident monitoring of gaming would be high. Photo / Michael Cunningham 

Officials warned the targets addressing planned care, first appointments and ED wait times could be “in conflict with each other, or at least competing for resources, making it difficult for management to know what to prioritise”. 

The targets could also divert attention from other goals surrounding patient and workforce satisfaction, increase inequity through a stronger focus on bigger populations that were more likely to impact target success and compromise longer-term goals. 

The briefing recommended reporting on progress by location, socio-economic status and ethnicity to “ensure service access and outcomes are experienced equitably”. 

It also reinforced the importance of independent auditing, suggesting routine checks by Audit NZ and regular reviews by the Health Quality & Safety Commission. 

Speaking to Newstalk ZB’s Mike Hosking this morning, College of GPs Medical Director Luke Bradford said Reti’s targets were achievable but a “long way off”. 

”I think it’s that without the tools to actually deliver them and make them achievable, people look at other options.” 

Bradford said there needed to be more emphasis on what to do with patients once they leave the hospital and how to prevent them from returning to the ED. 

Adam Pearse is a political reporter in the NZ Herald Press Gallery team, based at Parliament. He has worked for NZME since 2018, covering sport and health for the Northern Advocate in Whangārei before moving to the NZ Herald in Auckland, covering Covid-19 and crime.