Knee, hip plan a step forward for health care

VICTORIA - There’s much to praise in the government’s plans to reduce the wait for knee and hip surgery.
The problem has been terrible. Every time I write about the issue, I hear from people with stories of suffering, economic hardship and physical deterioration as they wait for surgery that keeps getting pushed farther and farther away.
Now the government has announced a plan that should make a significant long-term difference.
And at the same time it offers a model that can be used to deal with other, similar problems.
The plan has five elements.
At the centre is a new Centre for Surgical Innovation at UBC, with two operating rooms dedicated to knee and hip work. The centre will be able to do about 1,600 operations a year. That alone should take care of the wait problem for the next few years.
The problem, on one level, is simple. Wait lists grow because the government won’t pay for treatment for people who need it. The health care system has received enough funding to allow about 7,000 knee and hip procedures a year. About 7,300 people require the operation each year, so wait times grow. The extra capacity at the new centre should reverse the trend.
That’s not the only advantage. The new centre is a kind of ‘Hips and Knees R Us.’ That’s all the centre will do, so it will become very good at prepping people, operating on them and sending them on their way with a good rehab plan. As it learns better ways of sticking in a new hip and helping people recover, it will pass them on to hospitals around the province.
It makes imminent sense. Mr. Muffler finds efficiency in doing one thing; so can hospitals.
The government has also come up with $5.5 million more for the Research Centre for Hip Health at Vancouver General Hospital, the first institute in the world that’s looking at ways of avoiding hip problems and improving outcomes.
And another $5 million will be spent to set up a proper waiting list, or ‘provincial surgical patient registry.’
It’s discouraging that only now is government starting to try get a handle on the basic task of managing the wait for treatment. Only by 2007 will patients be ranked by urgency, and given some idea of how long they can expect to wait. Only then will the health authorities have basic wait list data. It’s a confession of mismanagement, but at least the problem is being addressed.
Finally, there’s $25 million to be split among the health authorities to fund extra operations in an effort to cut into waiting lists.
Again, one could argue - I certainly would - that the province could and should have provided that funding years earlier. Fixing knees and hips, relieving peoples’ suffering, getting them back into life seem both a good investment and a moral imperative. But at least it is now happening.
The other encouraging element is the way this whole initiative was developed.
The idea of a knee and hip centre was tested at Richmond Hospital by the Vancouver Coastal Health Authority. By running two operating rooms and other measures, the pilot project was able to double the number of operations surgical teams could do in a day, from three to six. It knocked a day off the average four to five-day hospital stay, and cut waiting lists. (The UBC centre is now supposed to take those lessons across the province.)
The chance to learn from small, regional experiments - on wait times, and addictions and employment training - is too rarely seized.
It’s amazing how unmanaged our health care system really is. Despite an extraordinary number of bright people looking at the issues there is almost no useful data for making decisions and setting priorities.
The knee and hip project is a step towards smarter, better managed, more effective public health care.
Footnote: Give some credit to the departing Paul Martin for this effort. The First Ministers' agreement to address wait times in five critical areas in return for more money helped drive this initiative. B.C. does well in cardiac, cancer and cataract care, but was spurred to deal with orthopedic wait problem by agreement.