Wait-list delays for some elective surgeries and first specialist appointments are among the worst in decades, with the health system yet to recover from Covid-19 disruption and struggling with workforce shortages. Nicholas Jones reports on new figures that show the extent of orthopaedic backlogs, and the case of an Aucklander who has waited years in agony for a knee replacement. 

For more than four years Bob Menzies has waited in “absolute agony” for knee surgery.  

“The other night I simply went to turn over in bed, and my knee just locked up,” the 72-year-old told the Herald.  

“It’s all bone on bone now - I walk and hear my knee clicking. If I hold my hand on my knee and move my leg backwards and forwards I feel the bones grating.”  

Menzies is caught in orthopaedic delays that have ensnared thousands nationwide, and are particularly severe in his home district of Counties Manukau, where 67 per cent of people on an orthopaedics waitlist are overdue either a first specialist appointment or treatment such as a surgery.  

Health NZ/Te Whatu Ora has acknowledged the distress current wait times may be causing, and says high levels of emergency cases and workforce shortages have restricted planned (elective) care. 

If someone’s referral to see a specialist is accepted they should get a first specialist appointment (FSA) within four months, the same timeframe that treatment such as surgery should happen if it’s needed. 

However, nationwide, more than half of the 42,500 people waiting for an orthopaedic first specialist appointment or treatment have done so for longer than four months. 

Orthopaedic wait list delays at Counties Manukau and other regions have been lengthened by workforce shortages. Photo / Michael Craig 

Years-long wait for knee surgery 

That group includes Menzies, who received a surgical “scrape” on his troublesome left knee years before moving from Auckland to Waihi Beach in August 2019. In the following months, he was assessed and placed on Bay of Plenty DHB’s waitlist for a knee replacement. 

Around August 2021, he fell while walking through an orchard, injuring the same knee. ACC refused cover because of existing arthritis, so Menzies remained on the waitlist. 

In January 2022 he suffered a stroke, had to give up work as a real estate agent and moved to Botany, South Auckland so he and his wife were closer to their daughter. 

His GP referred him to Counties Manukau Health in September 2022, and he was told it would be about 39 weeks to see a specialist. He eventually did so in April 2023, and was sent for an MRI scan. 

Menzies was put on Counties’ waitlist for a partial knee replacement on July 5, 2023. 

He asked if the time he’d already waited in Bay of Plenty could be counted, but said he was told the systems were separate, and his information couldn’t be accessed. 

“‘What’s wrong with a simple email?’ I thought that was the whole purpose of the combining of the system and getting rid of DHBs - to eliminate all that bloody red tape.” 

Menzies has been told by his GP, Peter Cameron, to use a strong dose of the anti-inflammatory Voltaren, which helps with pain, for three days on, three days off. 

“On the three days off, I’m in absolute agony.” 

His injury - for which he also receives back injections - has affected his gait. After years of hobbling, sometimes with crutches, his hips and other knee are now hurting. 

An unwieldy brace goes from his shin to the middle of his thigh, with two steel rods to prevent his knee from going sideways. 

Middlemore Hospital is battling workforce shortages. 

‘Not asking to jump the queue’ 

Menzies complained to Health NZ, the Health & Disability Commissioner and - in desperation - contacted Health Minister Dr Shane Reti, Prime Minister Christopher Luxon (his local Botany MP) and the Herald. 

“I am not asking to jump the queue or to push in front of people who have been waiting longer,” he wrote in a March 15 email to the above parties. “I am simply asking for the total time I have been waiting in the overall health system to be taken into consideration.” 

Luxon’s electorate office asked Counties for more information, and after the Herald lodged questions with Health NZ, Menzies was last month contacted for a pre-admission hospital appointment. 

He hopes to get the surgery in June, following a long-planned trip to Australia to celebrate his 50th wedding anniversary. 

Duncan Bliss, director of programmes for Health NZ’s delivery unit for hospitals and special services, said the organisation “acknowledges the distress current wait times may be having on people who are awaiting treatment across the country”. 

“Our health services continue to experience significant pressures due to sustained high levels of acute demand and workforce shortages, and this is having an impact on planned care.” 

What’s being done about hospital wait lists 

Patients who had waited the longest or were more critical were prioritised, Bliss said. Clinics and operations are being done on weekends and other cases outsourced to private hospitals, and national and international recruitment campaigns were being run. 

Bliss said Health NZ recognised the frustration of patients such as Menzies who moved locations and found their wait for surgery extended, and said there were still multiple and separate waitlists across the 20 health districts (formerly DHBs). 

“When patients move away from a district, they continue to retain their place on the waitlist at that hospital. However, we know that it is not always practical to travel back, and a person may choose to remove themselves from that waitlist and seek treatment in the location they now live in.” 

The health reforms that scrapped DHBs would take time to implement, Bliss said. 

“In the meantime, work is underway to help provide consistent direction for patients who transfer from one area to another.” 

Cameron, who works at the Health & Happiness general practice in Papatoetoe, said Middlemore workers did a heroic job, but appeared badly under-resourced, particularly in terms of their numbers. Comparably low remuneration meant New Zealand struggled to keep locally-trained workers, he said, or recruit from overseas. 

A GP in South Auckland for more than 30 years, Cameron said planned surgeries delays had never been worse. 

“People are often incapacitated and in pain. The waiting time has come up to a year, or possibly more, for a joint replacement. 

“We have to advocate for our patients by sending a string of letters to try to achieve high priority in worthy cases, by stressing the levels of impairment.” 

Joint pain 

If someone’s referral is accepted they should get a first specialist appointment (FSA) within four months, the same timeframe treatment like surgery should happen if it’s needed. Nationwide waitlist figures for March 31 show delays are severe in orthopaedics: 

* 15,459 of 29,222 people (53 per cent) had waited longer than four months for an FSA. 

* 7526 of 13,326 (56 per cent) were overdue planned orthopaedic care like surgery. 

Orthopaedic delays were worse at Counties Manukau: 

* 2228 of 3154 (71 per cent) had waited longer than four months for an FSA. 

* 620 of 1126 (55 per cent) were overdue planned orthopaedic care like surgery. 

Source: Health NZ/Te Whatu Ora 

Nicholas Jones is an investigative reporter at the Herald. He won the best individual investigation and best social issues reporter categories at the 2023 Voyager Media Awards. 

This article was originally published on the NZ Herald here.