Noel Kendrick,90, at his home in Wiri, Auckland. Kendrick waited years to get his cataract surgery through the traditional healthcare system.His luck turned around when his daughter spotted an add for the Auckland Charity Hospital Trust.

Public waiting lists are too long and charity hospitals are filling the gaps, with a new one soon to be established in Southland. Reporter LOUISA STEYL asks whether charity hospitals are really needed in New Zealand?

Noel Kendrick believes he might have gone blind if he'd continued waiting on the country's public health system.

The 90-year-old Aucklander says he'd been told he'd fallen off the waiting list due to an administration error.

He had been waiting for 12 to 18 months and never heard back from his district health board (DHB).

"If I hadn't spoken up I would not have been helped," he says.

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He then asked to be put back on the waiting list and ended up waiting another 18 months before his daughter saw an ad for the Auckland Charity Hospital Trust and made contact.

He's one of many patients seen by the Auckland Charity Hospital within weeks of his first appointment.

After his successful cataract surgery, Kendrick said the charity hospital was a great system.

New Zealand has two charity hospitals, the Auckland Charity Hospital (ARCH) Trust and Canterbury Charity Hospital in Christchurch. There are plans for a new charity hospital to be set up in Southland, which is a goal of national cancer advocate Blair Vining, along with his wife Melissa.

Kavinda Herath / Stuff The nationwide changes made as a result Blair Vining's efforts "will affect the lives of hundreds and thousands of New Zealanders for decades to come", Cancer Society medical director Dr Chris Jackson says. (First published October 2019)

Canterbury Charity Hospital founder Dr Philip Bagshaw said the fact the charity hospitals exists was evidence of a problematic health care system.

"There's a huge gap between public and private healthcare," he says.

"Lots of people are falling through it."

Under New Zealand's public healthcare system, patients who need elective surgery – or surgery that isn't urgent – are generally referred to their nearest hospital by a GP.

Patients are assessed on the seriousness of their condition and their quality of life. Fewer people are making it on to priority lists, which is why charity hospitals have had to step in.

Bagshaw says many are referred back to their doctor for "GP-managed care".

Both Bagshaw and ARCH director and administrator Denise Bailey noted that data on these patients isn't recorded, which means it can't be used to assess unmet needs.

John Kirk-Anderson/Stuff Dr Philip Bagshaw, at the Canterbury Charity Hospital.

The Canterbury Charity Hospital has handled 2855 patient visits – for everything from colonoscopies to oral surgery – in the past year.

While the majority of ARCH's patients have cataracts,"[They] fall short of the threshold to be seen in public even though some have significant life-affecting visual impairment," Bailey says.

ARCH was able to help Kendrick within weeks of his first consultation thanks to help from its partners.

"If public hospitals increased its amount of elective care to the point where it was dealing with this group of people, there would be no need for charity hospitals," Bagshaw says.

He believes there's a raft of things that needs to happen before charity hospitals can be made redundant, but most urgently, healthcare needs more government funding.

Bailey agrees: "Whilst we appreciate the public system is stretched to capacity in many areas, it is clear that there are areas which are still under resourced and in need of more funding and staff."

She believes unmet need should be better measured and quantified by the public service.

Health Minister Dr David Clark pointed out that the Government has funded just more than 5000 more procedures this year.

"Obviously there is more work to do though, to cope with a growing and aging population with increasingly complex needs – and to make up for many years of under investment in health."

Abigail Dougherty/Stuff Noel Kendrick, 90, can enjoy reading again thanks to the cataract surgery he received through the Auckland Charity Hospital Trust.

Charity hospitals are an "understandable community response to a health service that has been stretched for too long," but Clark added that he doesn't see them as a long term solution.

"We need to ensure our public health services are strong and sustainable – that is what will deliver the best health outcomes for New Zealanders," he says.

National's health spokesman, Michael Woodhouse, believes New Zealand has a very good healthcare system, but admits: "It's never been able to do everything for everyone in the timeframe that some would wish."

According to the Ministry of Health's latest annual report elective services are now referred to as Planned Care Services.

The ministry says it is working to make changes to its funding model and how it sets expectations for service providers.

The Government doesn't currently set national targets for elective procedures. Targets are negotiated with district health boards through funding agreements.

Woodhouse says DHBs needed to be more open about these targets so their constituents could hold them accountable.

The ministry's actual spend for elective services increased only $3 million during the 2018-19 financial year versus the extra $70 million pushed into primary healthcare or $10m for emergency services.

JOHN KIRK-ANDERSON/STUFF Phil Bagshaw with one of his patients at the Canterbury Charity Hospital.

The number of planned care services the Ministry of Health records has been rising during the past five years, but the growth started slowing down during the 2017-18 financial year when the number grew by only 4000 procedures.

This number had previously been growing by about 9000 procedures a year and dropped to a growth of only 5000 in the last financial year.

Woodhouse points out that the current government promised more funding and commitment to elective procedures. "They need to explain why things are getting worse on their watch, not better," he says.

New Zealand has 35 private hospitals, some – like the Southern Cross Health Society and Mercy Hospital – operate as not-for-profit organisations and many run charitable arms.

But just because they're not making a profit doesn't mean they don't need to cover their costs.

According to the Southern Cross Health Society, it costs between $2900 and $4400 to fund cataract surgery for one of its members.

Other common procedures Southern Cross deals with include colonoscopies, which come with a price tag of between $1700 and $3400 and hip replacements are $20,900 to $27,600.

ARCH director Bailey explains that charity hospitals are able to offer these treatments for free thanks to medical professionals who offer their services pro bono. Their fundraising efforts cover the cost of facilities, which are usually offered to the charity at a reduced rate, and medical supplies – although these are often donated too.

"We do things at a fraction of the price of what it would cost at a public or private hospital," Bagshaw says. One of the reasons the Canterbury Charity Hospital can keep its expenses down is because it only employs two full-time employees versus the rising staff costs hospitals have to contend with.

The Southern DHB, for example, spent $442m on its 4879 staff members in the past 2018-19 financial year.

The idea that public healthcare is a runaway expense is a myth, Bagshaw says.

Robyn Edie/Stuff Melissa Vining, left, with Professor Phil Bagshaw, from the Canterbury Charity Hospital, at a meeting to discuss the proposed Southland Charity Hospital in September.

"If you invest in elective healthcare you actually save money." You find less patients ending up with more serious issues down the line. Younger people can return to work and older people can remain independent.

Before his death in October 2019, cancer advocate Vining and his wife began the process of starting the Southland Community Charity Hospital in Invercargill with guidance from Bagshaw.

Southland has the highest rate of bowel cancer in New Zealand but the lowest number of colonoscopies and Vining was adamant that no other Kiwis should have to struggle as he did.

The new hospital will begin by offering colonoscopies with more services to be added as resources become available.

A board has been appointed and agreements have been signed with Southern Cross Hospital who have offered its facilities to the charity until a permanent site is established.

Clark made a point of paying tribute to Blair and Melissa Vining. "I know [they] championed a charity hospital for Southland," he says.

Bagshaw says he has been contacted by other communities interested in setting up a charity hospital, but it's a big undertaking that requires a lot of volunteers and resources.

"It's all about the community getting together to help themselves," he says.

Woodhouse says the charitable sector has a long history of providing support in this country. "I expect that it will continue to do so."

"If the public healthcare system continues to deteriorate there obviously isn't any other answer," Bagshaw adds.