Orthopaedic Programme Stalls Due to Lack of Funding

A groundbreaking physiotherapy-led initiative, designed to alleviate the burden on orthopaedic specialists and reduce patient wait times, is being held back by a lack of national funding. Despite its proven success in pilot programs, the initiative has yet to be rolled out across the country.

The program, which involves physiotherapists triaging and treating patients on the waiting list for orthopaedic surgery, was first agreed upon a year ago by Health NZ, Physiotherapy NZ, and the Orthopaedic Association. However, no budget has been allocated for a national rollout, leaving many patients stuck in long waitlists.

Jenny*, a Waikato resident, has been waiting seven months for a specialist appointment to address severe neck pain. She expects to wait another four months, and the brief 15-minute physiotherapy appointment she recently received left her feeling uncertain about the exercises she was shown. 'I'm a bit worried in case I'm doing them wrong,' she said.

Despite these challenges, the pilot program, launched in 2023, demonstrated significant potential. Over five months, more than 1,200 patients across six regions were assessed, and only about 30% were found to require surgery. The rest benefited from non-surgical treatment, such as exercise programs, education, and self-management strategies like weight loss.

Dr. Sarah Mitchell, a clinician involved in the Musculoskeletal Pathway program, emphasized the benefits of pre-habilitation physiotherapy in preparing patients for surgery. 'These patients are often in a functional decline cycle because they can't move much,' she said. 'Pre-habilitation optimizes their function to the best they can do.'

However, despite these successes, the program remains limited to certain regions. An internal presentation to Health NZ revealed that while the initiative is still working well in areas like the Bay of Plenty, there is no funding to expand it nationwide. Physiotherapy New Zealand President Kirsten Davie argued that the physiotherapy workforce could help more than 35,000 orthopaedic patients currently waiting for specialist appointments if adequate funding was available.

Health Minister Simeon Brown has expressed support for the program, which aligns with the government's goal of reducing wait times. However, the program's potential is being stifled by the current funding constraints. With over 670,000 New Zealanders affected by osteoarthritis, the economic impact—both in healthcare costs and lost productivity—is significant.

Arthritis NZ CEO Phil Kearney noted that the current system fails many patients, as many do not meet the threshold for specialist referrals. 'There's very little option for the GP to assist,' he said. He emphasized the need for a change in approach, citing the program's success in other countries.

Health NZ has not yet responded to questions about national funding for the program. However, a spokesperson stated that the national hospital-based Musculoskeletal Pathway was 'made available to all districts for deployment from August 2024,' and uptake has increased over time. So far, more than 2,000 patients have been seen through the pathway, with another 1,000 expected to receive their first specialist appointment in the coming weeks.

While the program shows promise, its national implementation remains uncertain. For patients like Jenny, the delay in accessing care is a daily struggle. As the system continues to grapple with funding and implementation, the need for a more sustainable and patient-centered approach has never been more urgent.