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Orthopaedic surgeries: We're getting further behind, experts warn

The prescriptions come as the backlog of elective surgeries continues to pile pressure on the health system.

Marilyn Wehrli knows what it's like to be helpless on a public hospital waiting list.

"The pain was just unbearable. I was on four lots of pain medication a day just to really survive sitting on a couch basically."

She was one of thousands of patients in need of a hip replacement.

Her condition was deemed severe enough to make it onto Wellington Hospital's waiting list, which should have meant she was treated within four months at the latest.

However, her condition was so debilitating and painful, she says she had no option other than opting for private surgery, to the tune of $30,000.

But she considers herself one of the lucky ones.

"I've had no pain at all from the day of my surgery, it was unbelievable. Life-changing.

"I feel for the people who are on waiting lists who may not have that opportunity to pay for it themselves, I'm really feeling for those people."

READ MORE: South Auckland’s elective surgery backlog grows by 251% in a year

And there are plenty of them.

Latest numbers from the Health Ministry shows 7209 orthopaedic patients have missed the four-month treatment target, out of 28,536 patients across all specialties.

The actual number of those in need of orthopaedic surgery is far higher.

"To be fair to the public hospitals, they've been doing absolutely what's right and proper and that's prioritising acute care," said Dr John Mckie, president of the New Zealand Orthopaedic Association.

"Over recent weeks we've been winding up our elective surgery up to 60, maybe 75% of normal volumes, but that's only in recent weeks. Prior to that it was negligible surgery done."

In Christchurch, where he works on the orthopaedic front line, few patients even make it to the surgeon's table.

"Only about 30% of patients who are referred by their GPs with the arthritic joints that we see for consideration of joint replacement, are actually being seen by surgeons. The other 70% or so are being referred back for care in the community by their GPs - that's what I've described as the known unmet need."

"On top of that, we're also aware that there's a very large 'unknown' unmet need, the cases that the GPs don't even bother to refer, because they know they have no chance of being seen in the current situation."

The medical director of the Royal College of GPs says hospital and death rates are higher in those over 60 and 70.

Dr Bryan Betty, the Medical Director of the College of GPs, says it's putting additional pressure on general practices.

"Many times we refer to the hospital, and what we find is the hospital doesn't have capacity for particular operations like a hip or knee operation, and refer back to the GP," he said.

"It means the GP takes on the responsibility for that patient, who may have pain, disability, poor mobility and escalating needs in terms of support, and actually pain relief."

Often extreme pain relief in the form of opioids.

"And actually (they) are very very difficult to manage in a general practice setting. Opiates can help with the pain but unfortunately they have a lot of side effects."

Health Minister Andrew Little acknowledges the current situation is unacceptable.

"That's why we have set the targets that we've got, to get people seen and treated in a matter of months."

Andrew Little.

He instructed a new taskforce in May, chaired by Counties Manukau chief medical officer and colorectal surgeon Dr Andrew Connolly, to come up with solutions.

"They gave some interim recommendations a while ago that led to the chief executive of Te Whatu Ora, Health New Zealand (TWO HNZ) issuing a directive to all hospitals about immediate steps they had to take to manage waitlists. I'm expecting to receive a report from TWO HNZ at the end of September on the precise action plan to implement the recommendations of the taskforce."

READ MORE: Hope hospital waiting list delay taskforce will be 'really brave'

Mckie, and the orthopaedics association, are one of a number of experts to have proposed solutions to the taskforce.

He says he could commit 200 surgeons to add one public surgery a month to their private lists, for the next 10 months. That would help clear 2000 backlogged surgeries at a cost of between $80 and $100M following ACC's pricing.

"The thinking behind that, if they're doing it on existing lists that are resourced, it's not robbing Peter to pay Paul or shifting staff and resources from other areas, it's using the existing established infrastructure. So we'd see that as a very good first cab off the rank."

But Te Whatu Ora say the waiting list pressure is already easing up.

"Reassuringly, the recent decline in Covid-19 cases is already flowing through to a reduction in severely ill people with Covid-19 who might have been requiring hospital-level care. This is helping to ease pressure on the health system. Additionally, with cases of influenza and other winter respiratory illnesses also signalling encouraging signs of a downward trend, we are hoping some of this pressure on the system will also start to ease."

But addressing the current crisis of waiting lists is just one red flag issue for the association.

They're also warning of critical shortages in orthopaedic surgeons over the coming years.

Ministry of Health forecasts from 2019 show a steady increase in the number of orthopaedic cases by 2028, up 13%.

To keep pace with the increased demand, Mckie says they need 22 new orthopaedic surgeons to enter the workforce every year, a target they're falling consistently short of.

In 2020 there were nine NZ-trained orthopaedic surgeons, 12 in 2021, and 15 in 2022.

Little says this isn't unique to orthopaedics, with other specialty areas not meeting the long-term expected numbers.

"That said, we do rely a lot on overseas qualified specialists coming to work here and we'll continue to do that. I'm satisfied however that we will continue to have enough orthopaedic surgeons to do the work that is needed to make sure people get the surgeries and treatments that they need."

Roughly 40% of New Zealand's surgeons are overseas-trained.

"I see that as a huge vulnerability, because we're in a time where there's a worldwide shortage of medical practitioners. And if we're dependent on surgeons, anaesthetists, as well as all the other health workforce coming from overseas, we're competing on a world talent market which we may not be top of the queue," said McKie.

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