Latest news with #Middlemore
RNZ News
04-08-2025
- Health
- RNZ News
The ‘postcode lottery' for hip and knee replacements is still strongly in force
Lynette Wall Photo: RNZ / Cole Eastham-Farrelly Lynette Wall is waiting to find out if she will get a knee replacement Reforms were supposed to eliminate the 'postcode lottery' for healthcare. But new data shows access to care for people needing a hip or knee replacement still varies massively across the country. Lynette Wall did not think her retirement would be like this. She dreamed of freedom, travel and ticking off her bucket list. "I'm too scared to go anywhere," she says. She can't tackle the bucket list or do anything much, "apart from looking through a window". Three months before she was due to retire, she discovered she had severe osteoarthritis in her knee. She now walks with a cane and takes a self-prescribed combination of panadol and ibuprofen each day to manage the pain. Her world has shrunk. The long walks she loved are now short and full of fear her knee will either lock up, or give way. Social outings to places with stairs make her apprehensive, she sticks to territory she knows. She suspects she needs a knee replacement, but has no idea when this might happen. She has not even had a first specialist appointment at Middlemore Hospital which would assess whether she can join the surgery waitlist. A letter she received tells her the average wait time for the specialist appointment at Middlemore's Super Clinic is 47 weeks. "I would like to stop things getting worse, I would like to stay out of a wheelchair if I can," Wall says. Data obtained by RNZ shows that at the end of January 2025 Middlemore Hospital had 654 people on the waitlist for knee surgery - the biggest hospital waitlist in the country - with an average waiting time of 223 days. While Wall's likely wait for surgery may seem long, she may be one of the lucky ones. She is more likely to get onto a surgery waitlist than people in places like Wairarapa, Taranaki or Southland, and her wait for surgery will likely be shorter. If Wall lived in Invercargill, her time spent gazing out a window instead of enjoying life before she could get surgery would likely be three times as long - a whopping 721 days, despite a smaller waitlist of 190 according to the same data. A few hours drive north, at Christchurch Hospital, the average wait time for the very same surgery is 107 days, the lowest in the country. New Zealanders needing hip or knee replacement surgery face a double-whammy postcode lottery. The bar to entering a waitlist differs across the country, as does the time it takes to get surgery once you are accepted to a waitlist. Based on average wait times at the end of January, Southland hospital is the worst place to be if you need a knee replacement with 721 days, followed by Grey Hospital at 443 days. Christchurch hospital (107 days) is the only hospital meeting the target of treating patients on the knee surgery waitlist within four months. Patients needing hip replacements can also face long waits. Grey Hospital on the South Island's west coast is the worst for hips. The shortest waiting time was 128 days for Hawke's Bay Hospital, but this still exceeds the target of four months. Southland's average wait for 2025 was missing from data supplied to RNZ, but in 2024 it was 454 days. Average waiting times at different hospitals has changed over time, with some hospitals, such as Dunedin, experiencing several years with long wait times before improving. While wait times tell one part of the persistent postcode lottery story for hip and knee surgery, it is not the only factor. Patients in some areas need to be in a far worse way to even make it onto a waiting list than patients in other parts of the country. By the time many patients make it to Southland hospital's operating theatre for a hip replacement, their hip ball has practically imploded, according to Invercargill surgeon Chuck Luecker. "The ball has gone from being round, to not just having spurs," Luecker says. "Sometimes cysts form in the bone and sometimes you can collapse the wall of the cyst and the ball becomes deformed." Leuker estimates 40 percent of the patients who make it to surgery fall into this category. "They're not getting surgery in less than six months." Patients in other locations get seen before they are in such a bad way. In Southland, patients have to have a score of 70 in a prioritisation tool to get surgery. In Canterbury, they only need a score of 50 and in Tairawhiti, just 20. People in Wairarapa have the toughest time making it onto a waiting list, with a score of 80 required. Luecker says this postcode lottery of surgery comes down to Southland Hospital's capacity. "According to the Ministry, you're not supposed to offer anybody surgery that you can't provide in a timely way." Health New Zealand is working to standardise the bar to waitlist entry across the country. So far, this has been completed for cataract surgery but is yet to be put in place for orthopaedics such as hip and knee replacements. A report into the inequities in planned care published by the Office of the Auditor General noted standardising some treatments would incur additional costs for districts already under pressure. Luecker believes a one-off population decline is behind the hospital's current predicament. The decline was incorrectly taken as a sign Southland's population would continue to fall and when a new hospital was built the number of beds was reduced from 198 to 166. Of those 166 beds, only 157 were fully staffed. But, instead of decreasing, the population grew from 82,000 to 135,000. The hospital opened in the middle of the ski and flu season and immediately elective surgeries were cancelled due to a lack of staffed beds, he says. "We were turning away people who were truly disabled, out of work, on a cane or a crutch, and struggling." Health New Zealand national chief medical officer Professor Dame Helen Stokes-Lampard says work is underway to standardise the score for acceptance onto waitlists across the country, but she says there are challenges to do this over 20 separate districts. "In some areas it's workforce challenges," she says. This means more staff are needed to increase the number of surgeries which can be completed and lower the acceptance score. In other districts, the number of people already on the waiting list needs to be reduced before the score can be lowered. "In some areas there's been disagreement as to what the standard should be," she says. Stokes-Lampard is unable to give a timeline for when entry criteria to surgical waitlists will be equitable no matter where someone lives. The current focus is on reducing the number of people waiting for surgery, and a funding boost to outsource procedures will tackle this, she says. In the 2024/2025 financial year, 990 hip replacements and 1061 knee replacements were outsourced to the private sector. Data at the end of January shows in total 4600 people were waiting on the public hospital lists for hip replacements and 3300 for knee replacements There is concern the push to outsourcing could have perverse results long term. "Outsourcing in the short term is undoubtedly very helpful for our waiting lists. In the longer term, you need to get the balance right of using the private sector so that you don't destabilise the public sector," she says. "That would be quite an own goal." Patient Voice Aotearoa's Malcolm Muholland Photo: Matthew Rosenberg/LDR Chair of advocacy group Patient Voice Aotearoa Malcolm Mulholland sees the sense in outsourcing elective procedures to private hospitals as a short term method to get through a backlog of surgeries, but he's against it as a long term plan. "We're basically paying twice. We pay tax, it goes into the public health system. Then the government finds they have a shortage of workers, and therefore they contract out at a higher rate to the private sector." A lack of staff is the biggest issue he sees, but says he is yet to see a workforce plan. Wages need to be increased to match other countries, such as Australia, to make New Zealand an attractive option. He is against the idea of 10-year-long contracts with the private sector. "It's a move to privatisation," he says. "We're saying that no longer do we trust or have faith in the capability within the public health system, so rather than try and fix the public health system all we're going to do is outsource to private and they will charge a higher price." Since Mulholland started advocating for patients, he says he's seen a little less of the postcode lottery, but it's not because things are improving. He believes access for people in all areas of the country is worse, with a widening divide between rural and urban access to help. Photo: RNZ / Cole Eastham-Farrelly For Lynette Wall, who may be waiting months to find out if she is eligible for surgery, daily life consists of cautious shuffling around her home. She's determined to not need a wheelchair. "I want to stay independent, not need home help, which would cost the government money." Sign up for Ngā Pitopito Kōrero , a daily newsletter curated by our editors and delivered straight to your inbox every weekday.
RNZ News
02-06-2025
- General
- RNZ News
Two doctors, one diary and a health system in crisis
Diary of a Junior Doctor follows five young doctors at the country's busiest hospital. Photo: SUPPLIED/TVNZ The reality of working in our under-pressure healthcare system is laid bare in Diary of a Junior Doctor - the new five-part docuseries which follows a group of junior doctors at the country's biggest and busiest hospital - Auckland's Middlemore. Faced with 70 hour working weeks, they must learn to balance the often high stakes demands of their medical careers with those of their personal lives. Kathryn is joined by Dr Shadie Lupo, who features in the series and health equity advocate, Dr Emma Wehipeihana, who served as a medical consultant and cultural advisor.
CBC
27-04-2025
- General
- CBC
Looking for Eliza
She was sent as a child to work in Cape Breton. Her life was largely a mystery to her family back in England — until more than 100 years later. Eliza Showell was born in 1895 in the Black Country, near Birmingham, England. She died in 1978 in Inverness, Cape Breton. Submitted by Liz Berry Lindsay Bird | CBC News Apr. 27, 2025 The Malagawatch Cemetery isn't giving up any secrets to me on the February day I arrive. The small, rural cemetery on the shores of Bras d'Or Lake is encased in cement-like snow. Locals tell me the recent combination of rain and freezing temperatures created the shell. Upright tombstones pop through the crust, but I can't find the flat plaque marking the grave of the woman I'm looking for. Her relatives fared better on the May day they visited, back in 2010. 'To find this really small, plain stone, and with her name and her dates, it just really touched my heart,' said Liz Berry, a poet from Birmingham, England. The name on the stone in question is her great-aunt's, Eliza Showell. She was born in 1895 in the Black Country, near Birmingham. She died in 1978 in Inverness, Cape Breton. 'We always knew we'd had a great-aunt that had emigrated to Canada, but I think we all imagined this was a very glamorous thing,' Berry said, recalling she'd pictured a grown woman, gripping the rails of a ship, holding her hat to the breeze. In reality, Eliza was 12 when she crossed the Atlantic Ocean, newly orphaned. Her brothers, all older, were left to fend for themselves. Birmingham at that time was both riding high on a booming coal industry and awash in poverty and pollution. Eliza ended up in the Middlemore Children's Emigration Home, a charity set up by local philanthropist John Middlemore, which funnelled eligible impoverished children from the United Kingdom over to Canada to work until they turned 18. Middlemore was just one of many charities and agencies that did so, in a child migration movement that came to be known as the Home Children. It's estimated about 100,000 of them came to Canada between 1869 and 1948. 'On paper, I can understand that dream of lifting them out, the utter crowding and smog and smut and poverty of the city, and sending them to this clean, rural, dreamy place. I can understand how that seemed like the right thing to do,' said Berry. Admittance records to the home briefly catalogue some of the children's desperate circumstances. 'Children literally starving,' reads one note. 'Father prosecuted for positive cruelty to girl,' reads another. Another reality was that Canada needed labour, particularly on farms and in domestic service, and applications for these children were flooding in, outstripping the available supply. Eliza arrived in Halifax in 1908, and ended up on a farm in Cape Breton. Her crossing, arrival and details of her work placement still exist, in the bare bones of official record-keeping that Berry was able to collect. 'We were able to see where she'd been placed and a little bit about what was happening there. Was she still attending school? Was she still working for no pay, for board?' said Berry. Somewhere along the way, Eliza's name changed to Liza, and records became harder to find. 'Really, the story goes cold,' Berry said. One of Eliza's brothers had tried to find her after the First World War, sending a letter through Middlemore and writing, 'I have lost all trace of her.' To Berry's knowledge, they never found one another. All Berry uncovered was that her great-aunt never married and worked her entire life in domestic service. Her final years were spent in a nursing home, Inverary Manor, in Inverness, where she died. Her employers paid for her burial in Malagawatch Cemetery. Writing history The outlines and blanks of Eliza's life inspired Berry to create her poetry collection, The Home Child. It takes the slim facts of her life, and imagines others, creating a life for Eliza through her migration and girlhood in Cape Breton. The book was released to acclaim in the United Kingdom, and won awards like The Writer's Prize. 'The thought that no one might speak Eliza Showell's name again, or talk about these children again, just seems so unbearable to me,' Berry said. 'So I knew that I wanted to write about her story in some way, and sort of catch it and bring it to life, so that other people could find out about her and about the Home Children.' While Berry says the Home Children story isn't particularly well known in the U.K., in Cape Breton at least, it's touched many lives. In the same area of the Island where Eliza lived were scores of other Home Children, like John William Ellis, who came over on the same ship as Eliza — but a different crossing — in 1915. His granddaughter, Charlene Ellis, scrolls through the passage records from his journey in her kitchen in Little Narrows. Eighty-three Home Children were on that crossing, some of whom were as young as six or seven years old. John himself was nine. Before he'd left Birmingham, John's father had given him a pocket watch and a photo of his mother, newly deceased. Neither of those items made it across the Atlantic to where a man from Jubilee was waiting for John, having applied for help around his farm. 'According to my grandfather, it was a very good home,' said Ellis, adding John was treated like a member of the family. One report from a Home Child inspector notes John as 'considered adopted.' John went on to get married and see eight children through to adulthood. Ellis said he was always a cheerful and open-minded man — but that he also had questions about where he'd come from, and if he had any brothers or sisters. 'I mean, he had trouble enough just trying to get a birth certificate,' Ellis said. The records she now has of his time as a Home Child were only made available long after John had died. Ellis has combed through those reports. Others, too. She's seen records of terrible homes — children beaten, abused and starved. Historians today widely acknowledge the Home Child system was rife with abuse. She realizes her grandfather had some of the most fortunate circumstances. 'That being said, it doesn't matter how good your home is when you're nine years old or you're 12 years old or you're five years old, and you're taken from your parents and you never get to see them again,' she said. 'I'm not sure how good that is, you know, for someone's mental, emotional, growth, right?' Ellis is one of many Canadian descendants pushing for an official apology. While the House of Commons did adopt a motion of apology in 2017, she wants it to come from the prime minister directly. 'I think it was wrong, and I think it would just give some validity to us, as descendants,' she said. The Prime Minister's Office did not respond to a request from CBC on the status of any such apology. Recognition In 2010, British Prime Minister Gordon Brown did apologize to Home Children and their families. Liz Berry watched it at the time, and came back to it as she was writing about Eliza. 'It made me really aware of how powerful an apology can be and a recognition,' she said. Her day in the Malagawatch Cemetery was as close as Berry got to Eliza on her Cape Breton trip. Berry traced her great-aunt's name in the stone and picked an impromptu bouquet of wildflowers for her. In the years since, she's never met anyone who knew Eliza. 'I think almost, there was a bit of me that didn't want to pry,' Berry said, feeling that tumble of emotions that can come with writing about someone else's life, and imagining onto it. But those of us who call the East Coast home know that it's a small and interconnected place. And that surely, if Eliza died at Inverary Manor in 1978, there must still be someone around who knew her. Enter Wilma Fontaine. 'We called her Liza,' Fontaine recalls. Fontaine retired from Inverary Manor in March after 51 years of service starting in 1974. Despite what she claims otherwise, her memory is as sharp as a knife. "She was one person that kind of resonated with me, because of her situation. I found her to be like a very cute little old lady, cute in her ways. And the other part of it was that she had nobody,' said Fontaine. There may have been no visitors, but Fontaine remembers Eliza as a cheerful resident, fast friends with the woman she shared a room with. But Eliza was also non-verbal, save for a one-word request — 'candy' — when she wanted a sweet. Fontaine shared these sparse details with Berry on a Zoom call one brisk March day, filling in a few of the blanks of Eliza's life. 'I was telling my little boys and they were so excited," Berry told Fontaine. "They couldn't believe it, that somebody had known the Home Child." Even decades after Eliza's death, Fontaine said she could still envision her. 'I can just still see her in my mind. And she was such a sweet little lady," she recalled. That vision of Eliza and her life on Cape Breton Island came more into focus on their hour-long call, even if so many of Berry's questions about her — like what remnants of an English accent her great-aunt may have had — went unanswered. In the end, Berry has to make peace with that unknowability. And larger questions, too, like how to think about the Home Child scheme itself. "We can't judge the past by the morals of the present. And that's something that I really sort of struggle with,' she said, noting she's spoken to descendants who condemn it as a human rights violation, while others see it as having helped children thrive. 'It really made me think like multiple things can be true at the same time…. It can both be a desperately sad story and the wrong thing to do, and it can both be a story of hope, and perhaps a saving of someone's life, and what felt like the right thing to do. Like it's so morally complex." About the Author Footer Links My Account Profile CBC Gem Newsletters Connect with CBC Facebook Twitter YouTube Instagram Mobile RSS Podcasts Contact CBC Submit Feedback Help Centre Audience Relations, CBC P.O. 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