Hawkes Bay couple Ken and Lois Smith do not understand why Ken has been denied a knee-replacement, when multiple specialists have told him he needs one.

A District Health Board has rejected claims it advised GPs to refrain from referring patients for surgery, as new figures suggest the numbers being turned away are rising.

One of those patients is Napier man Ken Smith, who has almost resigned himself to life in a wheel chair before he's granted a knee replacement.

The 75-year-old has been told by several specialists his knee was now "bone-on-bone" and he needed a new one.



That meant there was no longer any cartilage acting as a cushion between the two parts of the knee joint.



He is one of apparently more than 140,000 people in the past five years that have been turned away from hospitals without seeing a specialist, according to figures obtained by Labour.



A once active retiree, Smith now fears he will lose all mobility as his other knee begins to give way under the added stress.



Smith was first turned away from a full specialist assessment three years ago, after a referral from his GP.



He was advised to go private if he could, and while he has paid for private specialist appointements, he and his wife Lois were unable to afford the around $20,000 cost of the surgery in a private hospital.



Smith got another referral and after a further 18 months was able to see someone at the Hastings Hospital. It turned out to be the same specialist Smith had paid to see privately months earlier.

MARK TAYLOR/FAIRFAX NZ Labour health spokeswoman Annette King says "rigid" national targets that threated financial penalties were acting as a disincentive to DHBs accepting more people onto surgical waiting lists.

He said to Smith "if I could do your knee tomorrow, I would, but there's just no money".



"The letter I got from the hospital said I did not meet the requirements and they'll refer me back to my GP for further treatment - in other words, keep taking painkillers," Smith said.



"Life's a bugger," said Smith, who uses a certain amount of dark humour with his GP to deal with his loss of independence.



"My GP says until I actually crawl up his driveway to his surgery, don't bother asking him again."



His wife Lois said it was not the specialists' fault.



"More than one told us that they'd like to do the operation tomorrow, but they're not allowed.



"And they've also said that the hospital advised doctors not to refer anybody for operations because they would be turned down," she said.



"I get really annoyed when I see in the paper, DHBs patting themselves on the back because their elective surgery list is almost zero. But they don't tell you about all the ones that they've knocked off."



Labour's data canvasses 19 out of 20 District Health Boards - Nelson-Marlborough DHB was yet to respond to a request for information.



In some cases, just in the orthopaedic sector, which included knee and hip operations, some DHBs had seen more than a hundred-fold increase in refusals in the past five years.



Taranaki DHB had gone from 60 in 2010, to 675 in the 2014-15 financial year.



Bay of Plenty and Canterbury had also sky-rocketed in that same period. The former leaping from 614 to 1358 patients being turned away, and Canterbury jumping from 872 to 2060.



Five DHBs had managed an overall decrease in their figures, including Capital and Coast, Counties Manukau and Hutt Valley.

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MARION VAN DIJK/FAIRFAX NZ Health Minister Jonathan Coleman.

Labour health spokeswoman Annette King said Hawkes Bay was not alone in "running a sneaky system".

"They're not putting people onto the list - the [numbers] that are getting onto the surgery list are growing, but what they've also got are people they're saying need rehabilitation and physio before they're put on the list.

"It's a way of diverting people from the waiting list."



DHB Chief Medical Officer Dr John Gommans said patients who had the greatest need and who would "benefit the most compared to other patients with similar conditions", were offered tax payer funded surgery.



"We categorically deny that HBDHB has issued an advisory to doctors... in fact the opposite has happened.



"While we recognise there is still more room for improvement we are pleased we have been able to offer more surgery to more people and believe we will only see this increase. In orthopaedics alone we have performed 122 procedures since June, seven more than planned."



Gommans also rejected the notion physio lists were being created as a diversion.



"Patients are in fact going through a musculo-skeletal assessment pathway prior to being seen by a specialist. This helps patients with movement and pain problems to understand the benefits of exercise and weight loss etc."

Health Minister Jonathan Coleman said Labour's figures were "impartial and incomplete", because there was no standardised database.

Work was underway to change that, and access to elective surgeries was a Government priority.

"That's why operations are up by 50,000. The number of patients receiving elective surgery across the country has increased by 42 per cent," Coleman said.

"Under Annette King, the official health data shows that the number of people having their surgical assessment dropped over 7,000."

King said a "rigid" national target threated financial penalties, if DHBs could not fit surgical patients in within four months.

"Having a timeframe is good, because people want to know when it will be done. But it's so rigid now the surgeons are having to send patients back, and they hate it.

"You could do lots of things in four months if you had the capacity, the staff, the money and the theatres."

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