Alarmed by appalling cancer treatment statistics in the South, Health and Disability Commissioner Morag McDowell last year took the rare step of initiating her own investigation.
Its findings, released today, paint a bleak and distressing image of a woefully underfunded cancer treatment service, and health system upper management which failed to recognise and respond to a crisis its doctors had repeatedly warned it about.
"The case is a salutary reminder of the detrimental physical and psychological outcomes for patients, and of the impacts on family/whānau, when the system does not provide timely cancer care," Ms McDowell said.
The report assesses how the Southern District Health Board (now Te Whatu Ora Health New Zealand Southern) delivered its non-surgical cancer treatment services from 2016-22.
Poor clinical governance systems, inadequate quality control measures and a poor relationship between doctors and management combined to create a service which in 2021 ranked last and second-last out of 20 health districts for treating cancer patients within government-prescribed targets.
Clinicians were so alarmed at how many patients were suffering due to the repeated failure to treat people within the guidelines that twice in 2021 they produced a "Harm Register" listing patients whose condition had worsened during their wait for treatment.
From January to April of that year 42 people suffered harm and a likely reduced chance of survival from common cancers.
"Descriptions of the harm to patients included ongoing weight loss, functional decline and progressive disease while awaiting investigation, limiting treatment options."
One doctor told the commissioner that specialists had clearly predicted, for many months, how many new patients they would need to treat.
"We said we need more staff to deal with this, because this is new work, and we were told ‘you have to manage within existing resource’."
Repeated business cases and repeated presentations on the waiting list failed to achieve any increase in staff, the doctor said.
"Clinical directors further stated that a sustained and sustainable intervention was not undertaken by the DHB and that the strategies employed ‘left the service in a precarious deteriorating position with the mismatch of clinical resources versus the increasing expectation and demand leading to ever longer waiting lists’," the report said.
"The average wait times for people to see medical and radiation oncologists for first specialist appointments (FSAs) at Te Whatu Ora Southern steadily increased from 2016, with a marked further increase in radiation oncology wait times since 2020 and in medical oncology since 2021.
"From early 2021 there were prolonged delays for FSAs across medical oncology and radiation oncology services."
The SDHB did recognise the problem and initiated a range of responses, which included $2million in unbudgeted funding for cancer service staff, and commissioning a report from consultancy firm EY on how to improve provision of treatment.
"However, the clinical directors told HDC that unfortunately, the very conservative recommendations within the EY report have not translated into significant action, with only a few of the recommendations being implemented." the report said.
"In my view, since at least 2016, Te Whatu Ora Southern did not recognise and respond appropriately to the degree of clinical risk to patients as a result of increasing delays in patient FSAs and treatment. Te Whatu Ora is responsible for the operation of the clinical services it provides, and is responsible for any service failures."
Te Whatu Ora regional hospital and specialist services director Dan Pallister-Coward said the organisation "apologised unreservedly" to patients and families who had been impacted.
"We are fully committed to implementing the commissioner’s recommendations and have taken immediate steps to address the highlighted concerns," he said.
The SDHB was under serious financial constraints for much of the period and the Ministry of Health was monitoring its deficit, which was one of the largest in the country.
"Te Whatu Ora Southern had a responsibility for prioritising resources to those services that were life-preserving and this did not happen," Ms McDowell said.
Cancer treatment targets
62 days: 90% of patients to receive their first treatment or management of their cancer within two months of referral. SDHB: 65-73%, July-December 2020. 19th out of 20 health regions.
31 days: 85% of patients to receive first treatment within a month of decision to treat. SDHB: 80-85%, Oct 2020-March 2021, 20th out of 20 health regions.
