Health system struggling with hip, knee ops

Many DHBs are struggling to hold the line to provide hip and knee replacements. Photo: File

New research shows rate of operations has stalled while population increases.

A rising number of Kiwi patients could be missing out on life-altering surgeries as rates of publicly-funded knee and hip replacements stall, new research has found.

It comes as the population surges and raises urgent questions over whether the health system can continue to cope.

Major findings published today indicate many district health boards (DHBs) are battling to hold the line, with those left lingering on waiting lists often unable to work, and suffering pain so severe that simple tasks like bathing and dressing are struggles.

In their study, appearing in the New Zealand Medical Journal, Otago University researchers analysed rates of elective knee total joint replacement (TJR) procedures between 2006 and 2013.

They found that national rates of the procedureshad not increased since 2007, and pointed out marked differences in performance between DHBs.

Those covering larger populations were faring worse.

While there had been an increase in the number of procedures carried out in the public system between 2007 and 2013, these were hardly keeping pace with the growing population.

Even though procedures increased by 6 per cent over this period, patient numbers meant the surgery rate per head of population actually decreased by 0.6 percent.

The highest rate of publicly-funded joint replacement procedures was for those aged between 75 and 84 years, followed by 65 to 74 year olds.

Study author Dr Helen Harcombe said nearly one third of Kiwis aged over 65 were diagnosed with osteoarthritis - the most common reason for joint replacement surgery.

Around 14 per cent of the population currently fell into this age group, but by 2063, this was projected to nearly double to 27 per cent.

"This means demand for TJR surgeries is likely to increase markedly in coming years, and the public health system will need to be adequately resourced to meet future demand."

Arthritis New Zealand, which funded the study, was also concerned at the findings.

"While we acknowledge recent funding increases for elective surgery have resulted in an increase in hip and knee replacements for people with arthritis, the demand continues to outstrip the capacity of the DHBs," chief executive Sandra Kirby said.

"It seems like each week the media carries another person's experience of living with the crippling pain of arthritis having being turned down for publicly funded surgery."

An accompanying editorial in the NZMJ noted that attracting funding for the "life-changing" surgery had been difficult, given the prioritisation of healthcare spending on specialities involving "cancer, cardiac or kids".

Labour's acting health spokesman, David Clark, argued the rates were a consequence of $1.7 billion in underfunding of the health system , forcing DHBs to make cuts as populations grew.

Clark said health cuts were hitting hard those seeking joint replacement in the big cities, with those servicing Auckland, Wellington and Christchurch providing the poorest access to publicly funded joint replacement, and Dunedin and Hamilton not far ahead.

"If the Government continues to underfund health, things will get worse before they get better."

Health Minister Jonathan Coleman was yesterday on leave and could not be reached for comment.

But Ministry of Health clinical leader prioritisation Dr Chris McEwan said the rate of provision of total joint replacement had been "maintained", and the total number of procedures had increased from 8439 in 2007/8 to 9792 in 2012/13 and 11,012 in 2015/16.

He acknowledged the variation between DHBs, but added the difference had reduced .

"The significance of the finding of lower intervention rates in some DHBs will be in part addressed by a new national orthopaedic clinical prioritisation tool, introduced by all DHBs this year, which will put us in a better position to address this."

Providing a year-on-year increase to elective surgery remained a priority for the Government, McEwan said, and an additional $50 million had been invested for orthopaedic and general surgery between 2015/16 and 2017/18.

Off the knee, on the list

Tauranga woman Raewyn Andrews spent a year on the public waiting list after her knee collapsed. Photo: File

Raewyn Andrews knows what it's like to be stuck on a waiting list with the agony of a bad knee.

Not long after she and her husband cancelled their health insurance because of rising premiums , the Tauranga resident found herself in urgent need of a knee replacement.

"My knee had been sore, then suddenly, it just absolutely collapsed and gave out on me."

She had to give up most activities and exercise - and many of the things she used to do around her home, where a stair lift has had to be installed.

"It's been very hard - my husband actually has to do the vacuuming now, I can't do it, and I can't do heavy housework or gardening, because I can't bend much."

She spent a year on the waiting list, but others she met were facing much longer waits.
"I've heard of other people saying they are almost crawling around the floor with pain."

She acknowledged the pressure DHBs were under to meet demand.

"They only get a certain amount of money, don't they, and that's got to be eked out between all of the people who are on the list.

"And I suppose people are living longer, so there's more need for operations."

While still recovering from her procedure and successive work on one knee, her other one is beginning to give out.

But she's refusing to go back on the list.

"I just can't face that and go through it all again."