16 Jun 2022

Waiting lists: Wellington Hospital scanning failures lead to big spends on private providers

8:40 am on 16 June 2022

Wellington Hospital is being forced to spend millions of dollars extra sending patients to private providers for MRI and CT scans as its old scanning machines fail to cope.

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Old technology is making it worse for people waiting on urgent MRI and CT scans. Photo: 123RF

The average waiting time for outpatient scans has grown by a third since March, to four weeks for a CT and seven weeks for an MRI, with hundreds of people in the queue.

"With current waiting times there is risk of patient harm including disease progression while waiting for imaging appointments," a board paper has warned for several months, most recently last month.

Back in 2019 outsourcing care was described by one DHB leader as an "unpalatable" option for cutting long queues.

Now outsourcing is expected to hit $5m this year, 400 percent above its original $1.2m budget, and a hefty chunk above the $3.3m the board belatedly got ministry approval to spend on more access to planned care services.

But even this is not enough.

"Even at this increased rate of outsourcing we will not improve waiting times for the foreseeable future due to increased demand and imaging complexity," a May board paper said.

It forecasts a further rise to $7m worth of public patients sent private next year, just to keep wait times as they are.

It's worst for outpatients, with priority put on inpatients and ED. From August to March this year, only urgent cases got a CT scan due to Covid-19.

Waits of between eight weeks and up to four months are common. Regular ultrasound is also jammed. Often over 4000 people are on the waiting lists for MRI, CT or ultrasound.

Adding to the mix, many of the hospitals high-tech machines are 15 or so years old, and running out of software support.

In April, one MRI scanner was "out for three weeks due to major failure".

The hospital has patched its systems, such as with a new monoplane scanner recently, and is on the threshold of a $10m upgrade - though there is scepticism about that.

An informed source RNZ agreed not to name, said:

"The situation has been bad for many years.

"In its constant search for cost-neutral solutions that do not exist, the DHB often ignores cries from employees for essential machinery and workforce solutions to help them deliver safe care without compromising patient safety or their wellbeing."

Three years ago, a tender notice said: "All equipment in the Interventional [Radiology] Unit at Wellington Regional hospital is at or approaching end of life" - and is only bearing fruit now.

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Wellington Regional Hospital is facing problems associated with outmoded scanning equipment, putting the health of patient's in danger by increasing waiting times. Photo: RNZ / Dom Thomas

The biplane scanner bought back then, is being installed tomorrow. The DHB blames Covid-19 delays.

The installation comes four years after Wellington was warned it had to get a biplane scanner to be able to properly diagnose stroke victims. Auckland, Waikato and Canterbury all have had them for a long time.

As for the big $10m upgrade, that tender was awarded just a few weeks back, for four imaging systems - awarded to Philips New Zealand Commercial for two cardiac catheter labs, one pacing and electrophysiology lab and one angiography lab.

The DHB says its board would receive a recommendation next week to approve the upgrade business case.

Waiting times are slightly better than at the peak of Covid-19 in mid-2020, though fewer than half of CT and MRI scans are being completed within the optimum six weeks.

Staff shortages are also a major drag. Radiology lost a fifth of its 60 or so staff in just six months last year.

The DHB recruited from a small pool graduates in December but remains down five people, with "high vacancies especially among medical imaging technologists".

"At the same time we are seeing growing pressure from our emergency department from patients with increasingly complex needs, and a nationwide shortage of technical staff," it told RNZ.

However, it would not be reviewing its overspend on outsourcing scans, it said.

"These pandemic-related challenges were unique and are not likely to be seen again," said director of provider services, Joy Farley, in a statement.

"Similarly, the overspend referred to relates only to the Covid-19 period and we have not indicated a return to pre-Covid-19 outsourcing budgets."

Pressure on staff, machines and wait times will only grow when the radiology department at neighbouring Hutt Valley DHB is disrupted by closure of the quake-prone Heretaunga tower block.

Yet, Wellington Hospital's wait times were stretching out long before Covid-19. In late 2019, its wait times were among the worst of the 20 DHBs.

The graph, from CCDHB board papers, shows low percentages of MRI and CT scans being completed at Wellington hospital within the optimum six weeks.

The graph, from CCDHB board papers, shows low percentages of MRI and CT scans being completed at Wellington Hospital within the optimum six weeks. Photo: CCDHB/Supplied

Its own internal reports say: "Waiting times for CT and MRI remain high as a result of historical insufficient capacity to meet demand."

One memo from three years ago said: "A routine MRI request placed at the start of September 2019 has an estimated booking date of January 2020."

That same year, a radiology leader emailed the chief medical officer: "Just checking that the risk of an additional delay in routine CT by 2-3 months is fully appreciated by the organisation. There is an additional delay in reporting the scans.

"This seems to have become normalised."

The email listed the source of the problems as "CT capacity, work force but mainly $".

It said the impacts included stress on patients and workers, and extra patients having to be admitted.

Among the "upalatable" responses? "Outsource. Let the waiting list increase."

Around this time a missive went out to radiology headed 'Things to reduce/stop', suggesting fewer orthopaedic fracture assessments be done.

Also, to avoid routine "psych head CT" scans and "stop or tighten criteria for imaging for Pharmac".

As for CT colonography screening, it noted radiology was "unable to support the screening program with current resource".

"It is scary for everyone," the anonymous source said of the current pressures.

The DHB said a taskforce at Health NZ would deliver a national plan by September to help hospitals reduce waiting times.

The Ministry of Health echoed this and said the Budget put $282.5 million over three years into planned care delivery to reduce waiting lists, including scanning.

"Workforce has identified boosting the [scanning] workforce as a significant priority," it said.

Capital & Coast District Health Board declined an interview request.

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