Surgery wait time slammed

David Gwynne-Jones.
David Gwynne-Jones.
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 volume.

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 the population.

Party-based funding

It is so obvious that the current government is punishing regional areas with lack of services because we do not espouse to their policies.

If your region doesn't vote National here is what happens:

Don't get a hip replacement or a colonoscopy

Hillside Engineering shut down.

Invermay Research Centre moved out of the area.

Funding for essential services slowed down.

Residents get to pay for their own neurosurgery dept 

and I am sure this is just the tip of the iceberg 

Hip replacement

I recently heard of a man in Dunedin who suffered months of agony due to delays.  He reacted to the pain killers while waiting, which caused further delays and he needed extra care (and expense).  

He finally had the operation and is now pain free, mobile and independent. 

Priorities all wrong

It is obvious that there is no desire to put more money into health. The worry about the aging population for the government is that treatment will have to be rationed, not a good look! Although I suspect that is the premise of the 'points system' instituted by a very myopic Labour government and perpetuated by this bunch of incompetents. However, I note that Key, et al. are eager to throw money at a rich boys' boat race, elite sport, and makers of the most boring movies in  the world!

When will government listen?

This story is very disheartening.  The people of Otago and Southland are at significant disadvantage because of population based funding and the geography and distance to be covered by the Southern District Health Board.  What is more concerning in this article is the unseen distress and pain people requiring joint replacement have to experience because they live in this catchment.  While people are waiting for joint surgery medically they continue to deteriorate, they are in significant pain, ongoing pain and disability can lead to depression.  They require more primary health support and all of this costs them and their families quality of life.  Most people needing joint replacement are older, they have paid their taxes and should be supported by the system.

Minister Ryall, please don't use political positioning and statistics to your advantage.  I am sure the response you provided was in good faith but protecting your position and what you have funded does not find a solution for many people who are significantly disadvantaged in Otago and Southland.  In this instance it would be most beneficial for people from this DHB to have your support. Perhaps you could listen to the medical expertise of  Prof Gwynne-Jones.  After all doctors are paid to look after patients, understand their needs and prescribe necessary treatments.  It is your job to find the funding and support the people of this region as you do those in the North.  Today the issue is joint replacement but this DHB is not adequately funded to do what it needs to do.  

Medical help

What is going on with our medical system that is not servicing people who are constantly in pain?

Are you telling us that if you are old you don't get treated?  e.g. what is the requirement you have to have to get a hip or knee replacement if you are over 65yrs.

Or has the system decided that if you are old you should be in pain?  Give us the whole story thank you. 

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