An orthopaedic surgeon is speaking out in frustration
over excessive waiting times faced by Otago hip and
knee-replacement patients, and says the region is not clearing
a backlog of cases.
Associate Prof David Gwynne-Jones, of Dunedin, said he spent
more time explaining the system to patients than talking
about the operations themselves.
A backlog was not being cleared, orthopaedic surgery volumes
as a whole were increasing, but hip and knee operation
numbers remained largely static.
''It's very frustrating when you have a very straightforward
intervention that can transform people's lives, and instead
we have to mess around sending them back and forwards [to be]
re-scored... instead of just getting on and fixing them,''
Prof Gwynne-Jones said.
Many patients did not meet the threshold, and some had to be
told they might never qualify for surgery.
''Patients find that very hard to understand, and I spend
more time trying to explain the system, than I do trying to
explain the hip operation, so there's something wrong there.
''There's a backlog of cases that need to be done in order to
get to a level where we can offer patients treatment when
they're at an acceptable level of disability, as opposed to
an unacceptable level.''
Otago patients had to be more lame, and in more pain, to
obtain major joint surgery because of a number of factors,
including an older population, a high proportion of farmers
(who are susceptible to arthritis) and previous
under-provision creating a backlog.
His analysis of the situation, published in June in The
New Zealand Medical Journal, was met with a ''deafening
silence'' and the situation was deteriorating ''all the
time'', he said.
''The real question is: what is an acceptable level of need?
And I'm told every year by the registrars who come down from
Auckland that any of the patients we're rejecting would walk
into an operation in hospitals up north.''
His published analysis said there was health board funding
for about 390 Otago hip or knee replacements, and an
additional 335 were funded by ACC or privately, leaving
''unmet demand'' of at least 73 a year.
Compared with a few years ago, fewer knee and hip joint
operations were being performed.
''There have been 33 fewer major joints done in Otago in
2012-13 compared with 2006-07, a decrease of 7%,'' he said.
The national formula that determined regional funding
compensated for Otago's older population, but underestimated
its impact and should provide more compensation, he argues.
Health Minister Tony Ryall dismissed Prof Gwynne-Jones'
concerns, saying the Southern District Health Board was
performing 40% more orthopaedic operations than five years
ago, including more major joint operations.
The figure included Southland operations. He rejected
criticism of the funding formula.
''The current population-based funding formula, developed by
the Labour government, already takes age into account.''
Prof Gwynne-Jones said Mr Ryall ''conveniently'' chose
2007-08 for comparison, when fewer hips and knees were done
because of lack of hospital resources.
Mr Ryall's figures also included Southland, which last year
performed more hip and knee replacements than its expected
Had he chosen 2006-07, it would demonstrate Otago performed
more hip and knee operations then - 33 more than in 2012-13,
a 7% difference.
Those who did not qualify for surgery were shunted back to
their GP. The issues in Otago were likely to be present in
other areas, too, but not in all, depending on the make-up of