Thousands more New Zealanders will get cataract surgery and a nationwide surgical threshold will end the “postcode lottery” that has meant access to the life-changing operation can depend on where someone lives.

Patients, optometrists and ophthalmologists have been campaigning for the change for years, and the issue has been highlighted by an ongoing Herald investigation.

Health Minister Ayesha Verrall announced the major reform at the Government’s post-Cabinet press conference this afternoon.

The regional variation in access to cataract surgery is one of the worst examples of the so-called “postcode lottery” in healthcare that has plagued the health system for decades.

The Herald has highlighted cases where people cannot easily drive or continue working but still don’t qualify for public surgery, whereas if they lived in another region like Auckland they would have had their cataracts removed many months earlier.

The change will mean all patients get the same, earlier access, and will require an initial 3500 more cataract surgeries to be done, Verrall said. Te Whatu Ora - Health New Zealand would help identify patients who are newly eligible.

Public hospitals are at or near capacity, so many of the surgeries will be outsourced to the private sector.

“Today’s announcement is a first in what we can expect to see across elective surgeries from now on - a joined-up health system working towards timely, consistent access to healthcare, regardless of where you live,” Verrall said.

Patients needing planned care (medical or surgical services that aren’t required immediately, often called electives) are frequently given a score from 0 to 100 (lowest to highest priority), according to clinical and social needs.

This is called the Clinical Priority Assessment Criteria (Cpac) score.

If the score reaches a certain threshold, the patient will be accepted for surgery, which should happen within four months (a timeframe set by the Government).

Thresholds are regularly changed to try to ensure patients who are accepted are treated within the four-month wait time.

The Cpac score needed to get cataract surgery varied widely under the old DHB system, and this regional difference continued after the 20 DHBs were replaced by the single entity, Te Whatu Ora, one year ago.

Problems including restricted operating theatre availability have meant the Cpac thresholds in the Southern region, which covers Dunedin, Queenstown and Invercargill, and Canterbury are the harshest in the country, at 61.

The lowest is 46, in Auckland and Waitematā. Counties Manukau, Hawke’s Bay and West Coast (South Island) are slightly higher at 48.

Other regions with a high threshold for surgery include Capital & Coast (Wellington), Nelson Marlborough, and Lakes, which covers Taupō and Rotorua.

Today, Verrall announced that the nationwide threshold would be set at a maximum of 46.

“A score of 46 represents mildly reduced vision. A score of 61 represents poor vision and meant that the person could no longer legally drive.”

Verrall said the Budget had allocated $118 million to tackle waiting lists, and there will be more announcements about other services.

Waitlists are at record lengths, and the enormous strain on an under-staffed health system has become a major election-year issue.

Over 56,000 New Zealanders were waiting longer than four months for a first specialist appointment at the end of April, with another 34,662 similarly overdue for treatment. (A patient is considered overdue if they wait longer than four months after being accepted for a specialist appointment or treatment.)

People unlucky enough to live in areas with high thresholds for cataract surgery - and who cannot afford the approximate $5000 cost to go private - have endured major vision loss.

A recent study analysed all 44,000 patients referred for cataract surgery from 2014-2019.

“More than one quarter of patients who were declined for surgery did not meet the visual acuity requirement for driving a private vehicle in NZ,” concluded the research, co-authored by James McKelvie, Stephen Ng, Corina Chilibeck and Jeremy Mathan.

“A small but significant number of patients [26] who were declined for public-funded surgery had such advanced visual impairment they would be eligible for registration with Blind Low Vision NZ (formerly the Blind Foundation).”

Māori and Pacific patients develop cataracts at a younger age, the research found, and “have worse visual acuity and typically severe visual impairment, compared to other ethnic groups at the time of prioritisation”.

The Royal Australian and New Zealand College of Ophthalmologists (Ranzco) has been one of the loudest voices campaigning for a nationwide surgical threshold, and had lobbied for this to be set at 46.