Frustrated senior doctors say millions of dollars of taxpayer money going to private hospitals to do elective operations could help many more patients, if it was invested in the ailing public system.
Health Minister Simeon Brown has directed hospitals to farm out 10,579 procedures by the end of June, at a cost of $50 million.
In Northland, 24 patients are set to get their long-awaited gynaecology operations.
But Dr David Bailey - lead obstetrician-gynaecologist for the region - said while it was good news for those patients, it would not fix the chronic underfunding and neglect of the public service over many years.
"Had that money been available over the last 12 months, we could have treated many more patients than they are going to do with this. This is a political move to make them look good."
According to Health NZ Te Whatu Ora, there were 222 patients waiting for gynaecology surgery in Northland, of whom nearly half (101) had waited longer than the target of 120 days, 64 more than six months and eight more than a year.
Bailey said the backlog had been building for several years, partly driven by population increases - Northland is one of the fastest growing regions in the country - workforce shortages, industrial action by nurses, junior doctors and anaesthetic technicians, and then finally the Covid-19 pandemic.
"We've never caught up since."
He and his team had offered to do extra surgery sessions to help clear the backlog - but Health NZ would not pay for it.
"We can't actually run weekend lists because they are nitpicking about pay for theatre nurses."
When surgery was outsourced, those most in need of treatment tended to miss out, he said.
The last time Northland referred patients to a private hospital in Auckland - about a year ago - many were declined because they were "too complex".
"So they were already selecting those who were easiest to operate on. And then patients self-selected because a large proportion of them refused to travel," he said.
"Essentially it was disproportionately advantaging relatively well-off white women, rather than those who were most in need - who are typically people who live a long way from Auckland, north of Whangārei, who are our highest needs patients and also the most complex."
Bailey said Health NZ had refused to tell him how much it was costing to send 24 of his patients to a private provider for surgery because that information was "commercially sensitive".
"We know that this is costing a very large amount of money with no transparency....whereas we would do these procedures in the public hospital, maybe as additional lists on the weekend for a fraction of the money in theatres which are sitting unused."
The push to private appeared to be "entirely ideological", he said.
"Throwing large amounts of money to do small number of procedures in private to make your figures look better, to give the impression that you are improving on health targets, is fundamentally dishonest."
Bailey said the problems were "many years in the making" and could not be cured with a "PR push".
"It won't be a quick fix. It's taken a long time to get into this situation, it will take years of sustained improved resources - but that isn't very politically attractive because they want results by 30 June. They definitely want results by the next election."
Health NZ 'committed to reducing waiting times'
In a written response to RNZ's questions, Health NZ group director of operations for Te Tai Tokerau Alex Pimm said it was committed to reducing waiting times for surgery and utilising capacity in the private sector was one way of doing this.
"We apologise to patients that are waiting longer than expected for their surgery. Our aim with using private capacity is to reduce waiting times for our longest waiting patients - either through offering treatment elsewhere or by releasing internal capacity to focus on those that need surgery in our hospitals."
The 24 gynaecology patients who were being referred to private providers in Northland and Auckland had all been waiting between 250 days and more than a year for surgery.
"Any patients travelling to Auckland to receive their surgery as part of this initiative will be supported with transport or fuel costs and accommodation for their whānau where appropriate."
Meanwhile, Health NZ was recruiting for another specialist and one trainee specialist, whom it expected would be in place by mid-year.
"We are supportive of weekend lists and have offered our kaimahi the opportunity for this, where they will receive the relevant agreed collective agreement pay rates for this work. This is available on a voluntary basis for theatre and surgical teams," he said.
Health NZ making 'savings' by not employing doctors - union
Association of Salaried Medical Specialists head Sarah Dalton said senior doctors in other regions had similar concerns about outsourcing.
Hospital services were being "directed" by the government "without clinical say-so over what should be done".
At a recent meeting with management in Northland, the union was told that most of their "savings" in the last financial year came from being unable to hire more clinicians, she said.
"So the district continues to struggle and is being told to manage its budget down at the same time this other money is magically appearing to send a lucky few patients who are healthy enough and straight forward enough to be sent for surgeries out of the area."
Health Minister Simeon Brown was not available for interview.
However, in a written statement he said the government was focussed on delivering increased elective treatment both within Health NZ and through outsourcing to private providers.
"People waiting in pain for an operation aren't worried about who is delivering the operation, they just want it done as quickly as possible," he said.
