There is growing concern over surgery waiting times - and the patients who are kept off the waiting list through gate-keeping. In the south, much of the frustration centres on long waits for orthopaedic surgery. Health reporter Eileen Goodwin looks into the issue.
Most people keep quiet once they have secured a surgical procedure after rattling a few cages.
But not Russell Lippert.
The 72-year-old Dunedin man went public with his experience only after being put back on the assured-surgery list for a hip replacement.
Irate letters to a National Party MP and the Southern District Health Board commissioner seemed to move things along: Six days later a health board manager was in touch with good news.
Spurred by the "guilt factor'' of potentially jumping ahead of other patients, Mr Lippert wanted to help others, and he took keen interest in people who contacted him after the February 27 article appeared in the Otago Daily Times.
"I can't believe the reactions from people around the community.
"I have had numerous phone calls from folks who have looked up our number in the book.
"I'm starting to record names and contacts to build on the case,'' he told the ODT.
Despite being in "dreadful pain'', many would keep quiet for fear of having less chance of making "the list'', Mr Lippert said.
Some of those who are not afraid to speak up appear today in the panel accompanying this article.
The polite term for patients living in "dreadful pain'' who are unable to make "the list'' is "unmet need''.
At long last, the Government responded to calls to measure the "unmet need''.
That took the form of new figures, released this week, showing the number of patients refused hospital specialist appointments in a three-month period.
Official surgery waiting times count only the people who are guaranteed an operation within four months.
This changed the concept of a "waiting list'' and, while it kept a lid on the issue for a few years, "unmet need'' was a growing thorn in the Government's side.
To counter critics who charge the system ignores people who do not make the list, health boards started to collect "unmet need'' figures.
But if Health Minister Dr Jonathan Coleman hoped they would silence the critics, he would have been disappointed.
The Government's main antagonist on surgery waiting times, Christchurch surgeon Phil Bagshaw - with the backing of the senior doctors' union - was quick to say the figures could not be trusted.
Four percent of referrals to a specialist were turned away as they did not meet the "threshold'' but the true number was probably as high as 15%, the document released this week by Dr Coleman's office says.
Whatever the Government says, the true figure will be higher, Southern District Health Board surgical directorate medical director Stephen Packer says.
Many people, if they could not afford private care, missed out.
"There's a lot of unfairness out there.
"There's a lot of people who have given much to the community, have gone through a lot in their life and who have not asked for much, and yet when they have a need, we're unable to deal with that need.
"Each number reflects a person and that person has their own story, their own disability.''
The blunt criticism of the Government is unusual these days for a manager at the Southern District Health Board, which perhaps accounts for why Mr Packer, a retired surgeon, is viewed favourably by doctors.
However, Mr Packer is not sympathetic towards the argument pushed by Dunedin's orthopaedic surgeons for the past several years.
The surgeons argue the southern board is particularly ill-served when it comes to hip and knee operations because the headcount funding model disadvantages the area.
They have lobbied for more operations and Associate Prof David Gwynne-Jones, an orthopaedic surgeon, carried out research, published in the New Zealand Medical Journal in 2013, to prove the point that ‘‘unmet need'' is significant in the south.
But Mr Packer believes the system overall is simply underfunded; he is disdainful of what he sees as "squabbling over crumbs''.
There was not enough data to say whether Southern was faring worse than other boards and no health board was properly resourced, he argues.
The ODT asked to speak to Prof Gwynne-Jones but the health board communications manager declined the request.
The communications manager had asked the newspaper to supply a list of questions for an interview with Prof Gwynne-Jones, which was declined.
But his colleague, Michael Chin, who happened to be in touch with the newspaper to promote a sponsored walk for orthopaedic research, says southern patients are "very disabled'' by the time they qualify.
"It's very frustrating.''
Mr Chin said the funding system favoured health boards with high levels of deprivation, Maori and Pacific Island populations.
"We've got a lot of older people down here ... and also I think in the south there's fewer people with health insurance.''
Mr Chin rejects a suggestion that surgeons who dip into both sectors - as many do - lack the incentive to make the public hospital system more efficient.
"Most of us feel an obligation to the public sector and we are acutely aware of the fact that some people just don't have those options.
"To be honest, there's so much work available that it wouldn't make that much difference ...
"The reality is that we're trying very hard to make it work well.''
Orthopaedic surgeon John Matheson, who has retired from Dunedin Hospital but still does private work, expresses similar sentiments.
"It's terrible; it's the worst thing about seeing someone who's in need, is telling them they won't have enough points to get on the system. Visiting registrars had expressed surprise at the level of disability required in southern patients before qualifying.
"They find it very difficult to understand why patients who would get an operation in, say, Middlemore, in Auckland, would not get an operation here.
"They tell us there is a huge discrepancy,'' Mr Matheson said.
