Urgent attention needed to resolve elective surgery crisis

The New Zealand Orthopaedic Association (NZOA) is calling for urgent action to address New Zealand’s large elective surgery backlog, saying New Zealanders are waiting in pain too long before having surgery.

NZOA president Peter Robertson says there has been an increase in urgent or emergency orthopaedic surgery in recent years for a number of reasons – including an ageing population and more complex cases. This has resulted in public hospitals having less capacity for elective orthopaedic surgery.

“Public hospitals prioritise urgent and emergency surgery ahead of elective surgery, which results in elective surgery often getting ‘bumped’ for emergency cases. The COVID-19 pandemic has further increased the backlog of orthopaedic and other elective surgery throughout the country”.

“We welcome the announcement of additional funding to catchup on elective surgery but we don’t believe this will greatly improve elective surgery rates”.

“The number of orthopaedic elective surgery cases able to be carried out over the next two decades will continue to decline, unless there is a much improved service model that addresses multiple factors”.

“The workforce assessments indicate current elective outputs will reduce unless there is significant increase in the number of Orthopaedic Surgeons that are trained, but this is only one factor”.

He says the recent report into the state of our hospital facilities highlighted the need for considerable investment in public hospitals to increase their capacity.

The NZOA is encouraged by the recognition in the Health and Disability System Review of the role private hospitals play in providing extra capacity for planned care, he says. Private hospitals almost solely provide elective procedures, so planned elective surgery is much more likely to go ahead.

“However, we need to act now. We have been urging action on the decline of capacity to do elective surgery for several years, but getting very little traction. We can’t wait for years for changes to take place. Partnership with the private sector utilising spare operating theatre capacity provides immediate additional capacity for elective orthopaedic and other surgery for public patients currently on waiting lists”.

The NZOA is calling for a national framework, mandated by Government, that facilitates partnerships between district health boards and private hospitals, and for this to be put in place throughout the country.

“Voluntary partnerships are not enough and will just increase inequitable access to elective surgery.

“Increasing capacity in the public sector over the long term, and optimising relationships with the private sectors in the immediate term will result in optimal productivity when managing public patients waiting for elective orthopaedic surgery”.

Background

• There is a lack of reliable national data on the number of acute and elective orthopaedic surgeries carried out, and treatment provided. This means we don’t know the extent of the problem.
• Many DHBs count planned acutes as electives which misrepresents the situation.
• It is increasingly difficult to get onto a DHB waiting list for elective surgery meaning the unmet need in the community is growing.
• A study released in 2016 suggested about 350,000 adult New Zealanders had some form of elective surgery each year.
• A further 280,000 were told they needed surgery, but only 110,000 were placed on the public waiting list.
• The average time it took a person to get from their GP to surgery was 177 days in the public health system, and just 76 days in private.