15 Aug 2017

'We just need to do better ... it's not good enough'

6:08 pm on 15 August 2017

Southern DHB chief executive Chris Fleming has agreed with a highly critical report into its urology department, saying patient health and wellbeing has been put at risk.

More than 3000 people work at Dunedin Hospital.

Dunedin Hospital Photo: RNZ / Ian Telfer

Last month RNZ revealed 10 prostate cancer patients at Dunedin Hospital had to wait seven months for urgent surgery, which was meant to be done within a month.

The Southern District Health Board ordered a review at the urging of urology surgeons, and has today released a 42-page report by three independent experts.

It paints a picture of a dysfunctional and "chaotic" department and recommends sweeping changes.

It said clinicians in Dunedin all expressed frustration and anger because "they feel they are not listened to and that they have been misled".

Key findings:

  • The two urology departments, in Dunedin and Invercargill, function almost completely independently, with little communication or collaboration between the two sites
  • There is a significant level of clinical risk within those patients who have waited a long time for treatment at Dunedin Hospital
  • There is a poor understanding by the DHB of the size of the patient population being treated and the demand the urology service needs to meet
  • There is no district-wide planning for urology across the DHB (the country's largest geographically)
  • There are significant differences in access to care between patients in each centre, with poorer access in Dunedin
  • There is a rift between clinicians and senior managers at Dunedin Hospital
  • Service changes cannot wait for the planned Dunedin Hospital rebuild, at least 5 to 7 years away

The report recommended Dunedin increase operating theatre lists, review the roles of all staff and standardise handling of referrals from family doctors across the DHB.

It also recommended the DHB develop an immediate plan for managing the backlog of work in Dunedin and the risk to patients, saying the level of clinical risk to those patients waiting a long time at Dunedin Hospital must be identified urgently.

While it criticised the limited knowledge of the needs for urology nursing at Dunedin, the Southland branch was praised with a recommendation to adopt its approach throughout the DHB.

More than 3000 people work at Dunedin Hospital.

Southern DHB urology services cannot wait for a planned rebuild of Dunedin Hospital, the report says. Photo: RNZ / Ian Telfer

Surveillance cystoscopy in Dunedin was almost a year overdue, and those patients have potential to develop a potentially lethal invasive cancer, the report found.

Serious clinical events had already occurred, it said, and some patients were three years overdue for follow-up with major cancer operative cases waiting six months or longer for surgery.

It said the oncology department accepted referrals from urology without a diagnosis because of "concerns about how long the chaotic urology service may take to adequately work up the patient".

Non-clinical staff at Dunedin were also having to make clinical decisions. Patients were not notified about whether they were accepted for outpatient appointments and there was no review process for patient management.

The report also said an external review of the service was promised in November last year but it did not happen until June this year. That led clinicians to refuse to do extra work until an improvement plan was in place.

"This decision has resulted in a significant decline in waiting times and ability to meet targets over the last six months at the Dunedin site".

DHB to implement all recommendations - Chief Executive

Southern DHB interim chief executive Chris Fleming.

Southern DHB chief executive Chris Fleming Photo: Supplied

Mr Fleming said the DHB had accepted all the recommendations and would implement them all as quickly as it could.

He said there was "undoubtedly risk of progression of a cancer" where a patient with a malignant condition such as prostate cancer faces delays in diagnosis and treatment.

"The mere fact that, as you know, there are 11 patients that have been waiting longer than the expected time for significant procedures in terms of the radical prostatectomies, any delays can create problems in terms of ongoing care."

"It does put patient health and wellbeing at risk and we just need to do much better."

"It's not good enough, and do I agree with it [the review]? Yes, I do."

The longest wait was for 191 days, more than six months, which Mr Fleming said was completely unacceptable.

He said he was the one who told the minister that there was a toxic culture at the DHB relating to the department.

"That is not however to be confused with individuals. We have some great urologists and some great managers working within the environment but it has created problems that have put patients at risk that cannot move forward."

Dunedin Hospital was also dealing with a shortage of intensive care beds and a backlog of thousands of patients for eye specialists.

Health Minister Jonathan Coleman has called the DHB a "cot-case" but earlier this month denied the DHB was underfunded.

Health Minister Jonathan Coleman declined to be interviewed. In a statement he said the DHB now had a path ahead to ensure its urology services were brought up to standard.

The rebuild of Dunedin Hospital could cost up to $1 billion.

A new clinical services building, holding the surgery theatres and emergency department, is planned.

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