Few people who know Cooper's Beach man Neill Bainbridge wished him a Merry Christmas.
They knew he wasn't expecting one, and that he was looking forward to a(nother) painful New Year.
Mr Bainbridge has been waiting for knee replacement surgery since 2015, and while there is some hope that his wait might soon be over — the doctor he saw at Cooper's Beach last week agreed to write to the Northland DHB's orthopaedics department, and he completed another 'scoring form' — his wife Sheryl suspects that there is a bigger picture.
She has expressed those concerns in writing to the Northland DHB management and board, the Ministers of Health and Senior Citizens, and Northland MP Matt King.
Her "limited" research showed that more than 170,000 people were waiting for joint replacements, but were not on a waiting list. Unless they could afford to go private, they too would be waiting indefinitely.
She believed her husband, who was now down to a hobble, was a victim of a "well-embedded process" used to continue the deferment of joint replacement treatment.
He had had two specialist referrals from GPs, the first in 2015, and an orthopaedic surgeon had told him that both knees were "worn out". The surgeon had written to Mr Bainbridge's GP last year, saying he had been put forward for a left knee replacement, assuring him that he would have surgery within the first four months of this year.
In December, however, he was told that he would be reassessed in six months before being considered again by a consultant.
Mrs Bainbridge said she needed to be persuaded that this was not elder abuse, or at the very least, neglect.
"Within the relationship between a patient and his or her medical provider there is an expectation of trust, trust that everything possible will be done to alleviate pain and suffering," she said.
"The needs of my husband, and others whose joints are failing following a lifetime of hard work, are not being met. Despite reaching the clinical threshold for replacement, these patients are falling outside the recommended waiting time — an arbitrary bureaucratic time frame — for joint replacements, unmet needs that have been termed a national disgrace.
"In 2015 the National government introduced an artificial target requiring that DHBs only accept patients on the waiting list for operations if they could guarantee to provide that operation within four months. It did nothing to increase capacity, and went on to say that others needed to consider private insurance or self-funding their surgery.
"Many elderly do not have the ability to pay for their surgery."
Mr Bainbridge's problem with his left knee dated back an injury suffered in the late 1990s. In late 2015 his knee collapsed twice, and his GP referred him to a specialist. For reasons that were not explained, the specialist chose not to see him.
"If at that stage he had been put on the waiting list, in an ideal world his operation could well have taken place by now," Mrs Bainbridge said.
After years of extreme pain, he saw his current GP at Cooper's Beach and was referred to an orthopaedic surgeon. The DHB's acting general manager surgical, pathology and ambulatory services, stated that he would be closely monitoring her husband's progress over the coming weeks, and recommending that he continue to see his GP, who would advise of any change in his condition that required reassessment.
"It ignores the fact that continued GP visits are a costly, time-wasting exercise in frustration for both the patient and the GP," she said. "How does that need to be reassessed?
She wanted the DHB to review its processes and priorities to ensure a separation of elective and acute surgery, more theatre capacity, more beds and more ward staff, and an assurance that the DHB was not prioritising patients who were able to pay for surgery over those who could not.
She also wanted to see the DHB work with other providers to investigate the possibility of maximising the capacity of Kaitaia Hospital to specialise in joint replacement operations, both locally and from other regions, as suggested by "eminently sensible" former DHB chairman Wayne Brown.
"Mr Brown offered funding towards kicking off a suggested model of how better high-end health care could be offered in Northland.
"His offer, and the suggestion, appear to have been ignored," she said.
She also asked that the Ministers of Health and the Elderly look at the impact of postponing surgery for those who met the clinical threshold for joint replacement.
"I want the DHB and the Ministry of Health to release statistics that accurately reflect the extent of the issue, with more emphasis on facts and less on bureaucratic key performance indicators, and the ministry to develop a strategy, with urgency, to deal with the burgeoning need for joint replacements," she said.
"The bottom line is that I want my husband's health needs met without delay, and a written assurance that private patients who can pay for operations are not disadvantaging patients who need to rely on the public health system."