Proposed changes to orthopaedic services on the West Coast

4 April, 2012

Response from West Coast District Health Board - proposed changes to orthopaedic services on the West Coast

Responding to recent media coverage about a proposed change to the way orthopaedic services will be delivered on the West Coast, West Coast DHB Chief Executive, David Meates said, “We have said for some time that we have to live within our means. While we are one of the best-funded health boards in the country we need to always ensure that the services we provide are both clinically and financially viable, easily accessible and safe.

“Some time ago we identified regional collaboration as one of our health priorities and this means working more closely with the Canterbury DHB to provide greater certainty for both planning and delivering health services. This move towards regional alliances is happening across the country, with all the DHBs in the South Island participating in the South Island Alliance. This partnership delivers shared services across the South Island and is the way of the future for ensuring affordable health services can be maintained.

“As part of our collaboration with the Canterbury DHB we established a TransAlpine Health Services working group. This group is made up of clinicians from both DHBs and is tasked with looking at models of care that will benefit our community by closer collaboration with Canterbury.

“One of the models of care that the TransAlpine group has looked at is the way orthopaedic surgery is delivered on the Coast. There has been some speculation in the media that orthopaedic services will be reduced and this will impact on quality – this is not the case.

“There are some key points I think it is important to make. Firstly, the proposed model of care for orthopaedics has been designed by experienced orthopeadic clinicians with input from senior clinicians (doctors, nurses and allied health professionals – pharmacy, physiotherapists etc) across the CDHB and WCDHB. Their focus has been to produce a safe and sustainable service. There have been many opportunities for West Coast DHB clinicians to have input into the proposed new model, including workshops in Greymouth and Christchurch. Secondly, senior orthopaedic doctors and other senior clinicians will ensure the smooth transition and implementation of the proposed model of care. During 2011, there has been 70 occasions when there has been no onsite orthopaedic cover or this service has been provided remotely from Auckland. It is important that any changes made ensure greater continuity and consistency. That is how we will achieve a sustainable and quality service for the Coast. Any model of care that could put patients’ lives at risk would not be supported by either DHB.

“The most significant change proposed under the orthopedic model of care is the change from using locums, to having skilled senior rural hospital doctors providing orthopaedic cover on weekends and evenings backed up by CDHB specialists. At present when we have remote orthopaedic cover provided by an Auckland locum orthopaedic specialist, there is only an RMO (potentially a 2nd year house surgeon) on the ground at Grey Base Hospital. The proposed new model will provide a better standard of care than is currently provided in these situations During the week we will still have two full-time orthopaedic doctors working on the West Coast.

“Currently if there is a major trauma incident on the Coast and a patient requires orthopaedic surgery, most patients will be stablised at Grey Base Hospital (which may include surgery) and then transferred to Christchurch Hospital. Over the last 12 months 15 orthopaedic patients were transferred to Christchurch due to their injuries, and under the proposed new model, a similar number would require transfer in a 12 month period. Complex orthopaedic cases are also transferred to Christchurch; both these scenarios will not change under the proposed new model of care. If there was a major trauma on a weekend and the weather was too bad to fly a patient to Christchurch we would stabilise them at Grey Base Hospital and then depending on their condition transport them to another hospital by ambulance or wait for the weather to clear. Last year, about 10% of the time that we requested air ambulance services, it was delayed either due to weather or availability of the air ambulance. This would mean that only one or two extra people a year would have their care altered by the weather in the new model of care.

“Most orthopaedic trauma is not immediately life threatening and many procedures (including some done on weekends) are better deferred and done in a planned fashion when swelling has resolved and conditions are ideal, so comments that the proposed model of care is putting lives at risk is incorrect.

“Hip fractures are ideally done within 24 hours of presentation unless there are other complicating factors which necessarily delay safe surgery , however Ministry of Health data showed no adverse outcomes within 48 hours of admission.

“From July 2010 to November 2011 the Coast has had to use locums to staff the Grey Base Hospital the equivalent of 4,080 days. This is expensive and not sustainable. It also does not provide the basis for a robust health system. There are different ways that we need to explore as to how we deliver services on the Coast.

“As part of our review we have committed to providing 24 hour onsite care for obstetrics and general surgery provided that we can recruit and retain appropriate staff. We have a full-time anesthetist starting at Grey Base Hospital in April and we are in various stages of the recruitment process with two other full-time anesthetists. A full-time surgeon joined us last year and we have a full- time obstetrics and gynecology surgeon near the end of the recruitment stage and we are in initial discussions with another one,” says David Meates.

ENDS

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