Patients 'forgotten' in wait for surgery

'NOT URGENT ENOUGH': Ismay Barwell’s deteriorating hip was twice deemed not urgent enough to even get her on the waiting list for surgery, despite a referral from her surgeon. 
'NOT URGENT ENOUGH': Ismay Barwell’s deteriorating hip was twice deemed not urgent enough to even get her on the waiting list for surgery, despite a referral from her surgeon. 

One in three people requiring elective surgery are being turned away from waiting lists to meet Government targets, new research suggests.

The research, published in the New Zealand Medical Journal today, shows 36 per cent of more than 1200 hip and knee patients in Northland and Hawke's Bay referred for a publicly-funded operation by their surgeon were knocked back because they did not meet the "financial threshold".

Many were suffering in severe pain, and were significantly disabled, the study says.

Researchers cautioned that the group was small, and limited to two hospitals in Hastings and Whangarei, but it supports growing claims among some doctors and surgeons that thousands of people who need surgery cannot even make the waiting list, leading to a massive hidden "unmet need".

"These people seem to have been forgotten about," said Hawke's Bay orthopaedic registrar James Blackett, one of the paper's authors.

The researchers suggested the problem could get worse as the Government tightens the waiting-time targets for elective surgery, which will drop again to four months in January.

"With the trend toward only the most severely disabled patients gaining publicly-funded surgery, we are likely to see a population of patients with unnecessary residual disability."

Canterbury Charity Hospital founder and surgeon Dr Philip Bagshaw said shorter waiting-list times touted by the Government were a red herring.

"When they said that the waiting list was coming down from six months to five months and then to four months, they didn't mean that anybody was going to be chucked off, they just meant that they would let less people on," he said.

Few people were pushed off waiting lists now, Bagshaw said, as the practice was unpopular and authorities could achieve the same end by restricting entry.

Elective surgeries were increasing every year, but not fast enough to keep up with population growth and community need, he said.

Hawke's Bay DHB chief operating officer Warrick Frater said there was no "financial threshold", and surgery was determined by patient need, capacity, and urgent demand from other patients.

"Elective surgery is offered to those patients who have the greatest need and who will benefit the most, compared to other patients with similar conditions."

The DHB was reviewing its orthopaedic and surgical theatres to make them more productive, but there were "deep-rooted issues" that would not be fixed simply by more money, he said.

"We would like to be able to offer surgery to more people, and we know to do that we need to be productive."

The Government has repeatedly increased funding for elective surgery, committing a further $110 million over four years in this year's Budget. Ministry of Health figures show patients receiving elective surgery are at a record high, up by 40,000 in the past six years.

Health Minister Jonathan Coleman said there had always been people who did not meet the threshold, but more people were being funded now than ever. "One of the main answers to increased demand is to do more operations."

Since July, the ministry has started measuring unmet surgical need for the first time, but a spokesman said the results were not yet available. Patients who did not make the waiting list were not lost or hidden, but continued to be monitored by their GPs.

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At 66, Ismay Barwell had to re-mortgage her house to pay for a hip operation, sick of painfully waiting for publicly-funded surgery.

The Wellington woman had osteoarthritis in her right hip, leaving her in almost constant pain, day and night, unable to walk up stairs, and struggling to dress herself.

In early 2013, her surgeon was concerned enough to recommend her for a publicly funded hip replacement. When she turned up at Wellington Hospital, she was told her case was not urgent enough to make the waiting list.

She tried again six months later, but was once again turned down.

Barwell did not have private insurance, so she took out a $26,000 bank loan against her house, and had the surgery privately in March this year.

She said she had no regrets about her decision, but wondered how bad her condition would have had to get before she would be eligible for surgery.

Capital & Coast DHB said it had increased its elective surgeries by 50 per cent.

The Dominion Post