Cautious welcome for waiting-list package

Health groups have welcomed the Government's re-commitment to extra eye, knee and hip operations, but worry that preventive treatment is missing out.

One group is also concerned that the shortage of nurses could prevent the full number of extra joint replacements being carried out.

The cataract scheme and the orthopaedics project cumulatively will cost an extra $200 million over the next three years and the increased spending will become part of district health boards' ongoing "baseline" funding.

The schemes are intended to more than double the number of hip and knee replacements by 2007-08 and to increase the number of cataract operations by half.

Health boards are permitted to contract the eye and joint work out to private hospitals if a region's public hospitals lack the space or staff to do it. A number have done so, particularly in Auckland and Tauranga.

The orthopaedic boost came after a study found that some people dumped from joint replacement surgery waiting lists were being forced into resthomes, suffering depression and/or unable to leave their homes.

Severely diseased joints are painful and can stop people doing daily activities such as going for a walk.

Cataracts - cloudy lenses - can prevent people from reading or driving. Both problems are more common among the elderly and surgery can dramatically improve quality of life. New Zealand is well below the major joint replacement levels of some other countries, but the project aims to put it in the top international bracket.

"We are delighted that more people with joint deformities will be able to have those fixed," said Arthritis New Zealand president Kate Thomson. "But more importantly, we would like it not to reach that stage."

Arthritis can be caused by wear and tear (osteo-arthritis) or by a systemic disease (including rheumatoid arthritis and gout).

Miss Thomson said that if health boards provided more early, drug-based treatment for the systemic types of arthritis, the need for many people to have joints replaced would be dramatically slowed or prevented. But this would require more specialist rheumatology doctors and a relaxation of Pharmac's drug funding rules. She said New Zealand needed one rheumatologist for every 100,000 people; it has one for every 250,000 and the ratio is worsening.

"That means increases in waiting times to see a rheumatologist. People are waiting with acute joint inflammation, which equates to permanent joint damage.

"While people are waiting ... to get appropriate treatment, they get joint deformities that need to be replaced."

College of Ophthalmologists spokesman Dr Stephen Best was concerned about "other conditions that may need to be considered as well" as cataract. But he was confident that staff numbers were sufficient.

By contrast, Orthopaedic Association president Dr Richard Nicol said that while the Government's hips and knees target was met last year, the higher targets in later years would be a greater challenge, mainly because of the shortage of nurses.

Nurses Organisation chief executive Geoff Annals said the pay rise of around 20 per cent for most public hospital registered nurses over three years and the inquiry into safe staffing levels would ensure staff numbers were sufficient.

Extra surgery

* 4665 hip and knee replacement operations in 2003-04.

* 9450 a year by 2007-08.

* 8000 cataract operations in 2004-05.

* 12,000 a year by 2007-08.