11 Sep 2023

Cancer patients have to travel for treatment due to doctor shortage

From Checkpoint, 5:07 pm on 11 September 2023

Equitable access to cancer treatment is "broken", with some patients paying up to $7000 in accommodation and travel as doctor shortages force them to other regions, the Cancer Society says.

Patients must sometimes travel away from their homes and families for difficult treatments at hospitals in other regions. But as doctor shortages, like those at Dunedin Hospital, worsen, patients are increasingly being shunted between regions.

The Cancer Society in Christchurch says it is having to use motels to house Otago and Southland cancer patients and their whānau, because their other accommodation is full to overflowing.

All 36 rooms at Christchurch's Daffodil house and Daffodil lodge are full with patients from different districts.

About a dozen patients have had to travel to Christchurch due to a lack of medical specialists in their area - and nine families are currently in motels. 

On Friday, Te Whatu Ora Health NZ apologised to cancer patients who may face disruption due to shortages of senior doctors at Dunedin Hospital.  

The oncology unit there should have eight specialists, but was down to just three and one of those plans to leave in November, meaning the hospital is also losing its accreditation to train junior oncology doctors too. 

Te Whatu Ora has told RNZ that healthcare vacancies are a national issue, with radiation oncologists the greatest challenge in the south. It was working on recruiting more senior doctors, and part-time locums and an international locum were being used to help fill the gaps at Dunedin Hospital.

But it has also said the shortage could mean even more patients having to travel for treatment  - although it could not say how many. 

Cancer Society Canterbury, West Coast, Otago and Southland service delivery manager Craig Watson told Checkpoint's Lisa Owen the costs cancer patients had to cover to travel for treatment were substantial and needed to be looked at urgently.

"It is a hard reality to face, when you're diagnosed with cancer the first thing you need to do is leave your family behind as you go seek the treatment you need to survive or have a better quality of life," Watson said.

"That's really critical. That happens every day anyway, because our systems are regionalised, but the impact at the moment now is larger.

"What we're really worried about at the moment ... is the NTA system, the National Travel Allowance system."

If a patient is approved, the NTA helps subsidise their travel and accommodation, and offers reimbursements to a fixed amount. 

Dunedin Hospital Buildings in Dunedin

 On Friday, Te Whatu Ora Health NZ apologised to cancer patients who may face disruption due to shortages of senior doctors at Dunedin Hospital (pictured).   Photo: RNZ / Nate McKinnon

Subsidy system had one increase to funding in last 15 years - Cancer Society

However, the Cancer Society said the NTA amounts needed to be raised.

"That system has only had one increase in any kind of funding in the last 15 years, and that was a slight increase to mileage, which has gone up to a whole 28 cents per kilometre," Watson said.

"Accommodation sits at $100 per night maximum ... and as I'm sure anyone is aware, in the last 15 years, the price of a motel is no longer under or at $100. So if someone isn't able to stay with the Cancer Society, if someone is staying in a motel accommodation or a hotel accommodation, they're having to pay that extra amount. 

"That can add up over the say five, six or seven weeks worse case scenario, to thousands and thousands of dollars."

Watson said those seeking help through the NTA system might also have to wait five or six weeks before they got any reimbursements. 

"So there could be families who have had to step away from their roles, their jobs, their whānau, their life, to go away to another environment, maybe in Christchurch, Dunedin or up North.

"And they may be $5000, $6000, $8000 in debt before they get any kind of compensation, and just to remind you they don't necessarily have an income. So it's a really, really tough time. 

"The system doesn't work. It's not just about access to treatment, but about affordability and equity of access."

Watson said it was critical and achievable, for any political party to address the problem and to raise the NTA allowances "so it isn't as debilitating to somebody or to somebody's whānau". 

"Treatment in New Zealand is meant to be free, and it's far from it."

Even better, would be to put in a CPI measure, so the rates would continue to be adjusted according to inflation, he said.

"To me, one of the simplest levers right now for any party to make sure the people of New Zealand have a fair and affordable access to treatment no matter where they live is making the NTA fairer. 

"It's broken and we need to fix it." 

With more patients forced to travel for treatment in other regions, demand for help with accommodation was high, Watson said.

"We have patients staying from all across the South Island, and in fact there's one from the North Island too. Every day people have to access - especially radiotherapy, but chemotherapy as well," he said.

"At the moment, a lot of our accommodation is filling up with those from the Otago [and] Southland regions ... the shortages down there impact on their ability to deliver services."

'It's going to take a long time to backfill the system'

The Cancer Society expects the situation will get worse before it gets better.

"We're in a system that is very short of staff and it's a very, very long process to train, to retain and even to recruit. So best case scenario, it takes six to 12 months to recruit an oncologist," Watson said.

"So even if we magically found some overseas, it's going to take a long time to backfill the system and put the supports in place and that doesn't even count the registrar system finishing up next month."

The areas with shortages were causing inevitable pressure on treatment in other regions too, as those places tried to absorb the new patients sent to them.

"It's that cascading effect - nobody wants to deny anybody in New Zealand the right of access to treatment, but the reality is that when people move around the country and it puts pressure on other centres, whether it be Christchurch or Wellington, who are both supporting Otago Southland at the moment - what that does is it means it's a bit harder for someone in those areas to access treatment.

"It's not about moving pieces around a chessboard, it's recognising that the more pressure on it, the less ability there is to meet the need of the local populations too." 

The Cancer Society has produced a manifesto outlining the need for better investment in prevention, improvements to early detection and diagnosis, and better access to nearby cancer care services.