Diane Clyma's right hip has "completely collapsed", causing debilitating pain and compromising her quality of life. (Video first published December, 2019)

New Zealand has a world-class public health system, but for some people accessing care can be a long, painful journey. OLIVER LEWIS reports.

Morphine. Codeine. Panadol. Voltaren.

For Diane Clyma, the drug names are shorthand for pain. The 51-year-old is running through her medication regime, a regime that has gradually ramped up over the past two years to manage the debilitating pain radiating from her crumbling right hip.

"The pain medication makes it manageable, but it doesn't make it go away," Clyma says. "Without it I'm in screaming pain, I'm in on the floor crying pain. It's agony.

"It's got to the stage where I've had friends actually put me on suicide watch at times, because they know how upset I am. You can't keep taking all these drugs and be on top of the world all the time."

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Each year, thousands of New Zealanders try and fail to access hospital-level care. Their GPs refer them for specialist assessments, and for whatever reason – they don't meet the threshold, or maybe the service they need is swamped by demand – they get rejected. What that means is they wait, often for a long time, and often in pain.

STACY SQUIRES/STUFF Diane Clyma has walked with a limp for the past 18 months, and had to start using a walking stick this year due to the pain in her hip.

Clyma traces her condition back to an accident in 2013. The North Canterbury woman had a bad fall from a horse, breaking several ribs and ending up in hospital. It wasn't picked up at the time, but she believes the fall also affected her hip. In 2017, it started getting painful and she went to her GP, who prescribed pain medication and anti-inflammatory drugs.

It was the start of a long process, which included several X-rays, self-funded scans and appointments with a private specialist. Clyma says her doctor and the specialist referred her to the Canterbury District Health Board (CDHB) for a first specialist assessment multiple times from 2018, but the referrals kept being rejected.

"They're horrified. They're absolutely horrified," Clyma says. "Because they know I'm in desperate need of a hip replacement, and the only way you can get done is just to keep applying for the DHB to accept you."

For the past 18 months, Clyma has walked with a limp. Living on a lifestyle block, there have been times when she's fallen in a paddock and struggled to get up. Now she uses a walking stick. Sleeping, too, has been difficult, even with the morphine she started taking this year. "I haven't had a decent sleep in two years. There is no quality of life."

STACY SQUIRES/STUFF The 51-year-old loves horses and says she would be locked up if she let her animals suffer the way she has.

While she works part-time in an administrative job, her condition has curtailed other activities. "I've never been one to ask for help from anyone, but at the moment I just can't do things," Clyma says. Friends have helped her tend the 40-odd animals she keeps on her property; training race horses has also become far more difficult.

"I'd get locked up if I let one of my animals suffer the way I've been made to suffer," Clyma says. "The SPCA would come down on you like a tonne of bricks if you let an animal go through this."

By September, 2019, the specialist Clyma had been seeing was requesting an urgent assessment from the CDHB. In a letter seen by Stuff, the orthopaedic surgeon said Clyma was getting rapid osteoarthritis of her hip. "It has now completely collapsed. She is in quite severe pain with this and really needs help from the DHB," he wrote.

Earlier rejection letters from the health board noted the large number of people waiting, but in November Clyma finally got the news she had been waiting for. The CDHB wrote to her saying she had been accepted for an assessment and it would take place by February 21, 2020. Asked how it felt getting the news, Clyma says: "It's more than I've had in the last two years."

CDHB chief executive David Meates said 2019 had been a hugely challenging year for the planning and delivery of services. Several factors had affected planned care, he said, including re-prioritising operating theatres for acute demand – responding to the March 15 attack, for instance – flooding of the new outpatients building, industrial action and operating in constrained facilities.

Access to elective surgery is a national issue.

In 2018, Ministry of Health data shows there were 773,323 referrals for first specialist assessments across all 20 DHBs. Of these, 78,993 referrals were declined. The ministry stresses the data is under development, but still it gives some picture of the number of people missing out. Other studies have put the overall rate of unmet need much higher.

For Clyma, the rejections were disheartening and frustrating. "It's made me angry, and I don't get angry," she says.

WAITING IN PAIN, BY THE NUMBERS

- About 1 in 10 referrals for first specialist assessments are declined.

- DHBs carried out about 200,000 elective surgeries in 2018-19.

- About 1.4 million people in New Zealand have health insurance.

- 11,305 people waiting longer than four months for a first specialist assessment, September reporting shows.

- 7312 people waiting longer than four months for treatment, September reporting shows.