Bowel screening hold-ups could recur

Jason Hill
Jason Hill
Problems over access to colonoscopy in the Southern District Health Board could recur if staffing levels do not keep up with demand.

This warning is given by the board's gastroenterology clinical leader, Dr Jason Hill, in his report on the audit of patients who may have had surveillance colonoscopy denied or delayed in Otago between 2007 and 2011. (During this time, screening colonoscopies for those considered at increased risk of bowel cancer was severely curtailed because the Otago board's service was under pressure dealing with patients who had possible cancer symptoms.)

There was ''a significant future risk that this situation will recur if the service has inadequate resource to meet predicted demands for gastroenterology services'', he says in the October report, released recently under the Official Information Act.

In an interview, Dr Hill said his reference to ''resource'' referred to staff, not the facility.

If he was given ''$10 million tomorrow'' for the Dunedin facility, he would still need to attract and retain staff. The board has a full complement of staff, including six gastroenterologists, four of whom are based in Dunedin.

In the next 10 years, there would be fewer colonoscopists than needed in New Zealand and planning for this now was important, he said.

The audit found about 460 of the people who may have had their surveillance colonoscopy declined or deferred were no longer overdue. A further 145 had not reached the recommended date at the time of the audit.

Figures are not available to show the length of time the 178 people who received follow-up colonoscopies may have waited.

Dr Hill said it could probably be assumed that for a significant proportion the interval was right, but some might have waited five years over the interval time.

None of this group was found to have cancer or advanced adenomas. Twenty-eight had polyps - which may develop into cancer over time - removed.

By the time the audit took place last year, eight people had died as the result of confirmed bowel cancer or complications.

Of those eight, two had waited 12 months beyond the recommended interval for a colonoscopy and one waited four years.

At the time of the audit, two more people were found to have died from undifferentiated metastic cancer, both with a remote past history of bowel cancer.

A further three people had been diagnosed with bowel cancer before the audit. At the time of diagnosis, all had tumours which had grown into the outer lining of the bowel wall.

Dr Hill said none of those still alive were beyond the currently recommended surveillance intervals when diagnosed.

In his report, written in October, Dr Hill said the results might be interpreted that four people might have avoided surgery had they had earlier surveillance and three might have had a diagnosis of bowel cancer made at an earlier stage which might have ''impacted on the clinical outcome''.

This was ''purely speculation'' and, on the basis of this limited data, no definite conclusion could be drawn that any individual had an unexpected death or major loss of function as the result of the access restrictions.

Although some details of the audit were released in late January in response to an Official Information Act request, a statement from the board on the audit findings was not released until this month.

Dr Hill said the timing was to allow the findings to be considered by the board's hospital advisory committee. A report on the audit was considered in the committee's closed session.

Asked why it was considered in private, board executive director of patient services Lexie O'Shea said this was ''the normal pathway followed regarding operational discussion documents''.

To a further question about which reason under the Health and Disability Act was being relied on for this behind-closed-doors consideration, board communications director Steve Addison said it was to ''allow activities to be carried on without prejudice or disadvantage''.

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