Suppressing data is not the answer to the problem of surgery targets

by The Listener / 05 July, 2018
RelatedArticlesModule - Data suppression surgery

Health Minister David Clark. Photo/Ministry of Health

If Health Minister David Clark has an issue with reporting on surgery targets, he should know that data suppression is not the solution.

David Clark is rightly concerned with “perverse outcomes” from the way we collect data on surgical procedures. But he has bizarrely trumped that perversity by halting publication of any further figures at all until a better system is devised.

Clark’s strategy, which reportedly did not go before the coalition Cabinet as it arguably should have done, appears to be to portray the system as having become debased under the previous Government, with quick, minor procedures and major surgery, such as heart operations and hip replacements, sometimes given equal weight. If this is true – and Clark has yet to produce evidence that it is – he could fix it now by cracking down on misclassification. By suppressing all data indefinitely, he scores an own goal. He allows the appearance that he has used a possible statistical flaw as an excuse to hide the whole truth because he doesn’t expect surgery rates to improve.

Good data is essential to the formulation of good policy. Unfortunately, not all state data is accurate or well curated. But in the case of the surgery statistics, at least we now know where its flaws may lie and they’re still a useful interim measuring tool. Tellingly, the Government will continue collecting these numbers, even while keeping them secret.

The previous Labour Government introduced the reporting system in 2007 so the public could see the number of operations performed in each health district in the most vital categories, such as cancer and cardiac surgery. Knowing the targets also gave power to patients, who began to realise that if they had not received treatment within a set time, they were waiting too long.

Confusion has arisen because, Clark alleges, some hospitals have counted simple procedures such as skin-lesion excisions and eye injections for macular degeneration alongside the major operations originally intended to be counted. This may have made the numbers look better than they are. But it’s surely not beyond the wit of the bureaucracy to clarify what should and should not be counted.

To instead suppress all the data is so illogical as to raise the suspicion that the Government secretly believes surgery throughput will be poor for the foreseeable future, whatever data is collected, and has decided to hide it. Reinforcing such scepticism is its decision to release no more “patient flow” data, which tell us how many specialist referrals lead to surgery, and how many patients are declined operations they need.

Given the necessarily long time frame for the Government’s overall review of the health system, it’s possible the public will see no surgical statistics for the rest of this parliamentary term. That is unacceptable and will be politically counterproductive. Leaked snippets will inevitably fill the information vacuum with unverifiable and confusing information considerably less reliable than the current data, however skewed it may be. The odds are that the leaks will not be positive. So in refusing to allow transparency, the Government risks exactly what it seeks to avoid: being portrayed as failing patients.

Clark is hardly the first minister to suppress data at the risk of being seen as deflecting scrutiny from his own performance. National sandbagged information-gathering about foreign property ownership, a political blindfold only peeled back when the Statistics Department recently took over home transfer data from Land Information. Both administrations have squabbled over the crime statistics, which still cannot tell us whether actual crime is rising or falling, or whether people are simply reporting it more often, as could be the case with domestic violence, or less often, as is suspected with burglaries and theft.

Now, Social Development Minister Carmel Sepuloni is halting the previous Government’s work on data collection aimed at identifying at-risk families and young people, potentially hampering valuable early-intervention mentoring. She fairly worries the programme could become intrusive and objectifying. But former Prime Minister Sir Bill English’s project was aimed at empowering local iwi and other community entities, not just arms of the state, to help avert social crises. Surely a balance can be found between individual privacy and a child’s right not to be set on a path towards malnutrition, addiction, illiteracy and other life blights.

Let’s hope Clark heeds the incredulous public response to his data suppression. People know surgery is costly and is rationed accordingly. They will judge the Government less harshly for disappointing progress than for trying to hide the unpalatable truth.

Update: An earlier version of the article made reference to “eye injections for glaucoma”. This has been changed to “eye injections for macular degeneration”.

This editorial was first published in the July 14, 2018 issue of the New Zealand Listener.

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