6 May 2021

Southern DHB 'fails our patients at multiple stages' - oncologist

11:32 am on 6 May 2021

Cancer patients are suffering and dying because they're are missing out on vital scans such as MRIs - that's the blunt assessment of an oncologist from Southern District Health Board.

A MRI scanner room in a hospital.

File photo. Photo: 123rf.com

His scathing comments in an email to the DHB were leaked to RNZ by someone else. We have chosen not to name the specialist.

The extent of how just how stretched cancer services are in the Southern DHB has been revealed this week.

Over 150 people are waiting for their first specialist appointment for radiation oncology - more than twice what the number should be.

In the leaked email an oncologist with decades of experience outlined how a lack of access to scans - which were critical for deciding treatment - had caused delays and harm.

"This is particularly evident in oncology, where patients suffer and die due to the poor access our population has to imaging services. As an example, this week a patient was informed that their staging investigations for their cancer would take 40 weeks - the impact on this individual and the staff member he traumatised should not be underestimated," the oncologist said.

The email detailed how patients who could afford to pay for scans, either through health insurance or their own means, had faster access to care.

It's a situation he labelled disgraceful.

"As an example the majority of the population have access to PET scanning for prostate cancer, the SDHB will not approve such scans. This requires patients to self fund scans, often those in great financial hardship, to access effective publicly-funded treatment.

"A number of publicly funded interventions for prostate cancers in particular can only be accessed if the patient can self fund the necessary imaging. This disgraceful situation exacerbates the existing inequity between those who can and cannot pay for private imaging, affecting our rural, Māori and other disadvantaged groups particularly.

"In summary, despite the best efforts of the radiology service, the SDHB fails our patients at multiple stages leading to poorer outcomes for those who neither have private health insurance or the ability to pay for imaging.

"It would be unusual for me to hold a clinic in which I do not have to enquire if patients can self fund their care."

The acting chief executive of the Cancer Society's Otago-Southland division, Bob King, said patients were being let down.

Having money or insurance should not be a determining factor for surviving cancer, he said.

"People will die. And patients, that if they were able to access diagnostics or treatment earlier on there maybe a curative outcome for their cancer, potentially these delays will mean patients will die because they're unable to access diagnosis or treatment in a timely manner."

It was unclear why the problems at Southern DHB were so severe.

"You obviously hear stories from our other Cancer Society divisions around issues that they face, but none of them are to the quantum of the wall of waiting lists that we are seeing down here," King said.

'It's shameful'

Bowel Cancer New Zealand medical advisor Professor Sue Crengle said the situation confronting cancer patients in the south was shocking and getting faster access to treatment because of an ability to pay was incredibly unfair.

"So many people either don't have health insurance or don't have the personal resources to be able to do that, so we are actually building in inequities for Māori people, Pacific people, people who have less financial resources we are actually building in those inequities in a public system - it's shameful."

In a statement, Southern DHB's chief executive Chris Fleming said increasing the radiology service's capacity was a priority.

"The provision of radiology services is crucial for diagnosis of many conditions across the health spectrum. The flow-on effects of waiting for imaging services can have far reaching and serious consequences for a range of conditions," the statement said.

"We are especially conscious of the delays being experienced in our oncology service as they wait for radiology scans, and the distress this creates for patients and clinicians.

"This increase in demand from oncology is caused by a range of factors, including the earlier identification of some cancers, and more treatment options becoming available. While these are positive developments, it places additional demands on other aspects of the health system such as radiology. This is a long-term trend across our society and we need to address it.

"This is why addressing capacity in the radiology service has been a critical priority for the DHB."

Another CT scanner was expected to arrive at the end of August and the board was looking at how it can do more MRI scans, he said.

"We are also developing a ten year strategy for radiology in the Southern, recognising the complex issues of patient safety, quality, equity, efficiency and workforce considerations. Initially the focus is on radiology services at Dunedin and Southland hospitals, but longer term initiatives are proposed including enabling direct access to scanning from primary care.

"Internal consultation on radiology services continues to take place with clinical directors and services managers at Dunedin and Southland hospitals, and feedback from services including oncology has reinforced concerns around issues of equitable access to services, and waiting times particularly for complex imaging.

"We take this very seriously, and it's why we are taking action in critical areas ahead of the finalisation of the strategy.

"Formal feedback from rural hospital chief executives, WellSouth, DHB representatives and urgent doctors on the expanded strategy is to take place over the next two months."

Staffing shortages within the oncology service had contributed to delays experienced by cancer patients.

"We have recruited additional staff including an additional Clinical Nurse Specialist, junior media staff and we are continuing in our efforts to recruit additional senior medical staff including locums into the radiation oncology service. Recruitment of staff, especially locums, has been challenging with the worldwide travel restrictions for Covid-19.

"We are also seeking to reduce any further delays in their care by exploring private options.

"We recognise this is a significant challenge, with very real implications for those in our care, and we are doing everything we can to address this very difficult situation."

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