Patient journeys

The report on the 33 colonoscopy patients and the Otago District Health Board is a mixed bag. It gives all sorts of detail about the board service, or lack of service, but it fails to spell out answers to basic questions about these patients.

Did the board provide timely and adequate colonoscopies? And was the treatment of these patients according to board and national criteria? What the report does say is that those audited did have "prolonged journeys" through the public system.

In "report speak" that seems to be saying that the answer to the first question is no.

But the report also argues that it was limited because it only examined patient notes.

The authors do, nevertheless, also specifically acknowledge that treatment delays for six rectal cancer patients could have resulted in "poorer outcomes".

The report is hedged with qualifications.

It is at pains to point out that the 33 cases were a small and skewed example which could not be used to make conclusions about the service as a whole.

But it is obvious these cases brought to light problems.

There were issues with record keeping and seven of the patients were apparently never seen by the Colonoscopy Review Panel, which is supposed to vet all referrals.

It should be remembered that the whole issue arose because of alarm from general practitioners about the service.

Health and disability commissioner Ron Paterson last June also expressed concern the service was under pressure.

Despite a high bowel cancer rate, Otago has the lowest rate of publicly-funded colonoscopies in the country and the numbers being declined a colonoscopy have been increasing.

In fact, the number performed for each colorectal cancer diagnosis has been less than half the national average.

So either other areas are doing far too many colonoscopies, or the Otago service has fallen well short.

The Southern Cancer Network, charged with producing the audit, is one step removed from the board.

But its authors and consultants are still a direct part of the health establishment.

Perhaps there is no-one else suitable for the task.

But is the network independent enough to be able to report without fear or favour? Otago board chief executive Brian Rousseau was the network's lead chief executive and had to stand down for the duration of the audit to avoid a conflict of interest.

It is in health investigations that New Zealand has been so well served by Mr Paterson, who is standing down shortly.

In his various conclusions, he has shown the disinterest to see issues from the point of view of patients, boards and medical staff.

He has been able to communicate through the media with clear findings.

Matters are not "fudged", and his autonomy has been well established.

The audit team says it was questioned if harm was done to the patients.

It says this was not part of the scope of the audit, and, in any event, should not be answered by a patient-notes audit alone. In the absence of such answers, the natural conclusion must be that harm was likely.

Of the 33 people, 23 had cancer and the delays for treatment were lengthy and in some cases extremely long.

Rather than just experiencing "prolonged journeys", it would have to be expected that delays and failures led to some patients being worse off.

One assumes, but it cannot be known from this report, that some might have died because of the delays.

Health Minister Tony Ryall, GP Murray Tilyard, who spearheaded the concerns, and the health board and its senior executives are now wisely looking to the future.

Even if this last audit is coy about whether wider conclusions can be drawn, and even if it is uses dreadful euphemisms like "prolonged journeys", serious issues have been raised and remedial action is taking place.

The board is at present working on various measures to improve systems as well as planning to increase the number of colonoscopies undertaken.

Surely, that in itself is clear evidence of past inadequacies - failings which cannot under any circumstances be allowed to continue.