Hospitals have until the end of the month to book a surgical slot for thousands of patients who have been waiting longer than a year.
It is one of a series of directives that gives a first glimpse of what the Planned Care Taskforce is doing behind the scenes to try to fix the huge number of people waiting for surgery.
Te Whatu Ora - Health NZ leaders sent a letter with list of requests to all 20 of its health districts (formerly DHBs) last month.
It asked them to "actively tackle" long waiting lists by making sure the 7500 people who had been waiting longer than 12 months were given a booking by 31 August.
They did not need to have had the operation by then, simply a plan for when they would get it.
The bookings were not to come at the expense of the most urgent surgeries, the letter said.
Te Whatu Ora also set a 30 September deadline for the districts to find a slot for the 4000 people who had been waiting more than a year to see a specialist.
Though those waiting the longest for planned care were often classed as needing the least urgent surgeries, many of them still struggled to lead normal lives - often living in pain, unable to work, exercise or even sleep properly.
Doctors spoken to by RNZ worried it might be difficult to fulfil the long-wait surgical bookings in practice, because there was already big demand for higher priority cases.
The letter, from taskforce head Andrew Connolly, chief executive Margie Apa and hospital services director Dale Bramley also told health districts to cut back on specialists' follow-up appointments with patients after surgery, to free up the specialists for those waiting to be seen for the first time.
Some follow-ups could be done by non-medical people if they were trained to do that, or by telehealth, the letter said.
And it called on the different districts to work together to move patients between hospitals if one had capacity where another one did not.
In response to questions from RNZ, a Te Whatu Ora spokesperson said the directives were one part of a plan being developed to ensure people who had been told they would get treatment in the public hospital system would receive it.
It said those who needed urgent surgery would still get it and after that the priority would be for those who had waited longest.
Planning was under way to increase the amount of care provided by general practitioners, nurses and allied health professionals and to look at the resources needed to do this, the spokesperson said.
Te Whatu Ora director Fepulea'i Margie Apa said they would know whether the deadlines were reasonable, and how far ahead the bookings might be, when when districts and regions reported back on what had been possible.
"As part of booking, every service should be looking at their waitlists including assessing whether people still need the appointment or the procedure.
"Where some hospitals might have more patients waiting for a specialty than others once we know that then we can support them to work regionally and look at how they can share that work across a region." That could be over some months or a year, she said.
There was a risk that appointments were made but not delivered on, because of acute demand or staff sickness. "But New Zealanders have waited for too long for appointments and part of the process sitting behind what local hospitals are doing to book is them to also understand what capacity they've got so they are realistic as to what is achievable."
Te Whatu Ora would need to look at working with the private health system and primary care services, she said.
Orthopaedic Association president John McKie said it was a laudable goal but if it was to happen it had to be resourced.
"At the moment the whole health system ... is at or beyond breaking point, so the ability simply to schedule more people to have things done I think is unlikely to be effective."
The association has proposed to the health taskforce that the 200 orthopaedic surgeons working across public and private services take 10 additional cases a year in private hospitals for two years. That would clear 4000 elective surgeries at a cost of $80 million to $100m, McKie said.
The Planned Care Taskforce was announced in May to tackle the long waits for planned surgery.
They had been a problem before the pandemic but were exacerbated by lockdowns then by winter illnesses putting pressure on hospitals, forcing them to suspend a lot of planned care.