Health executives have occupied at least five different well-appointed suites during the 18 years they have stalled on upgrading Dunedin's gastroenterology facility, a highly critical report released this week says.
Written by a group of prominent current and former clinicians, it takes aim at lack of progress upgrading the facility at Dunedin Hospital.
''It defies belief that Dunedin has the poorest major facility charged with diagnosing colorectal cancer in New Zealand, and continues to have its well-defined needs ignored after nearly 20 years.''
The report's authors were Gastrointestinal Diseases Centre establishment board members Emeritus Prof Gil Barbezat, Prof John McCall, Associate Prof Michael Schultz, Julian Speight, Associate Prof Mark Thompson-Fawcett, Prof Andre van Rij, and Prof Rob Walker.
The report marks a year since the establishment board agreed to suspend activities while the Southern District Health Board worked to implement its initial recommendations. The report calls for greater transparency, communication, and effort from the health board.
It acknowledges improvements to the service had increased patient throughput, but had not addressed underlying issues. All the major shortcomings listed in 1995, ahead of an aborted upgrade, remained in 2013, while demand and clinical standards had increased. Progress was continually stymied by management upheavals and the loss of institutional memory.
That Dunedin was unable to attract a single appointable gastroenterology trainee in 2013 was testament to it being the ''least desired'' hospital in New Zealand for the trainees.
The Royal Australasian College of Surgeons had identified lack of access to endoscopy training as a major deficiency in general surgery training, and had accredited Dunedin Hospital for 12 months rather than the usual five years.
''Limping on indefinitely in the current facility is fraught with risk.
''The health and safety issues are not compliant with current standards; for example, despite the obvious inherently dirty state of a recently used colonoscope, the instrument sterilising space still has a common entry and exit door for dirty and clean instruments.''
Other shortcomings included lack of patient privacy, inadequate records storage, lack of space hindering teaching.
With just one endoscopy room, Dunedin's was a lesser facility than Palmerston North, which served a slightly smaller population.
''The result has been, primarily, that the public in Otago have been denied access to publicly funded facilities and services available to other New Zealanders.
''It is accepted that the administration faces many financial [restrictions] ...however, when it comes to priorities it has not gone unnoticed that over the time of this history, hospital administrators have occupied at least five different and very well appointed suites, both on and off the Dunedin Hospital site.''
The arrival of new clinical leader Dr Jason Hill last year was seen as a step forward.
Colonoscopy numbers had increased from 700 per year to about 1100 in the past two years, a ''remarkable achievement'' that still fell short of what was required.
To push the matter forward, clinicians formed the Gastrointestinal Diseases Centre whose establishment board proposed a joint initiative with the University of Otago. That plan failed, but the health board then announced, last year, it would remodel part of the paediatric pavilion. That plan was also abandoned, after another management change, as it was considered too expensive for a temporary fix, the report said.
Health board chief executive Carole Heatly said in an interview she was determined to upgrade the facility, but it had been important to make service improvements first.
The service had been streamlined to allow greater patient throughput, under the stewardship of Dr Hill. She acknowledged the ''inadequate'' facility was ''not fit for purpose''.
Asked about the management suites, Ms Heatly said managers often shifted to make way for clinical services.
In her own tenure, she had moved from Dunedin Hospital to Wakari Hospital, to make way for the new paediatric ward/neonatal intensive care unit.
She said the board would fund the facility out of its yearly capital allocation.
