National bowel screening year late

David Clark
David Clark
The introduction of the national bowel screening programme will take a year longer than previously planned, Health Minister  David Clark says.

In response to questions on bowel screening, Dr Clark announced a revised timetable for the programme, which will see the last, as yet unnamed,  five DHBs enter it by the end of June 2021.

He cited inadequate planning for the "required implementation software" and a lack of necessary capacity and infrastructure for boards to deliver the programme according to the previously announced timetable.

"I’m told the delay is needed to provide more surety of delivering a safe, quality programme, taking into account the capability pressures being experienced by DHBs, including managing colonoscopy wait times."

He described the situation as "very disappointing".

The new timetable details for 10 DHBs have not been spelled out and the minister’s office and the Ministry of Health were unable to  end  any confusion around this before the Christmas break.

The minister’s office said  the changes did not  signal any delay for  Southern District Health Board, which  has been gearing up to  start  offering the programme to 60- to 74-year-olds  from  April 1  next year. 

The revised programme for Southern and Counties Manukau stated they would start screening by June 30 next year which does not appear to differ from the programme previously published on the Ministry of Health website.

Southern DHB was unaware of any changes to the national timetable when contacted last week and has not responded to questions on this.

Dr Clark said Southern and Counties Manukau would be followed by Nelson/Marlborough, Lakes and Hawkes Bay DHBs by  November  30, 2018.  The original plan shows this is an earlier start for Lakes DHB which was previously to be in the last tranche, then planned for the 2019-20 year. Two further District Health Boards, "proposed to be Whanganui and Mid-Central", will start screening by June 30, 2019.

Dr Clark said bowel screening would be rolled out for five more DHBs in 2019-20 with the final five joining the programme the following year.

In the previous plan Northland, Auckland, Waikato, Capital and Coast, Canterbury and South Canterbury would also  have been due to start in 2018-19.

  Lakes, Tairawhiti, Bay of Plenty, Tairawhiti, and West Coast  would have been the last off the block in  2019-20.

(Hutt Valley and Wairarapa District Health Boards began bowel screening in July 2017 and Waitemata DHB’s pilot scheme will transition to the national programme in January 2018.)

National’s health spokesman, Dr Jonathan Coleman, has questioned the need for changes to the roll-out timetable.

"This is people’s lives we are talking about, so I’m hoping he’s not letting politics interfere with the roll-out."

There was a clear and achievable timetable for the roll-out including a clear plan around information technology.

"It’s notable that the first tranche of DHBs have all rolled out the programme successfully so what exactly is the IT problem?"

Colonoscopy wait times were also not a reason for delay.  The previous government had spent a lot of money to improve those wait times.

Nationalbowelscreeningyear late1Dr Coleman said when he was minister  concerns were not raised with him around  the timing of the ‘‘extremely complex’’ plan.  There was no suggestion it could not be delivered on time.

Concern about mhow boards would achieve and fund the extra surgery which would be required as a result of the programme was a separate issue and would be no reason for delaying the programme’s introduction.

Dr Clark’s statement said he recognised additional support was required to deliver the screening programme, but when pressed on this did not outline what form such support might take. One of the issues raised publicly by some in the health sector has been  that boards are expected to fund extra surgery and treatments resulting from the programme from within existing pressured budgets, which risks affecting the timeliness of treatment.

Dr Coleman said he felt Dr Clark had been searching for reasons to justify his "shoot from the hip" comment about problems with the programme raised in Parliament.

In  question time in mid-November, in response to queries from Dr Coleman, Dr Clark said he had been advised the programme as laid out by the previous government was unlikely to be able to be delivered.  He described that as "shocking news".

"I think New Zealanders will be disgusted to learn that they were promising something that looks very difficult to deliver on."

He said he intended to review the matter "very closely".

Later, in response to Dr Coleman’s written questions, Dr Clark said he had received advice from a range of clinicians who had raised concerns with him about the deliverability of the programme.

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