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The Southern District Health Board has taken a range of measures to address its cancer diagnosis and treatment waiting lists, which rank among the worst in New Zealand.
Those included adding extra shifts and staff to run its linear accelerator machines for longer each week and provide more treatment to desperately ill patients.
However, the Otago Daily Times understands those machines are regularly turned off early as not enough patients have had their first specialist appointments and been approved for treatment.
SDHB chief medical officer Nigel Millar confirmed that there was no issue with availability of machine time, and the delay in getting people treated by the linear accelerator was due to the number of first specialist appointments (FSAs) staff could process each week.
Documents released to the ODT after an Official Information Act request showed on average 21 FSAs were done by SDHB clinicians each week but that demand projections showed it needed to be 22 - a shortfall of 52 people annually.
However, it was generally expected in other DHBs that each full-time senior medical officer would do five appointments a week, for 42 weeks a year.
"If we can only expect five appointments ... we will fall short by 122 FSA per annum," a memo written by specialist services executive director Patrick Ng warned.
At the time the radiation oncology waiting list was 146 people and another 63 people were on the oncology waiting list.
Board chief executive Chris Fleming was told in February that 27 people were recorded on a medical oncology harm register as having had negative health effects while on the waiting list, including three people who were no longer considered treatable.
People on other cancer waiting lists have also suffered harm; on Saturday the ODT reported the case of Kathryn Harper, an Invercargill woman whose lung cancer progressed from treatable to untreatable while on the waiting list.
Ms Harper died last month, and her family plans to lodge a complaint about the care she received.
Mr Ng’s memo said if the SDHB wanted to reduce its FSA waiting list to its target of 50 people, 90 FSAs would need to be done in the next five months, an extra 19 a week.
"Outsourcing is our likely way forward if we are going to meaningfully stay on top of volume," he said.
"The need to rely on outsourcing is in turn driven by the inability to recruit a sixth radiation oncologist role."
If the SDHB was able to fill that position it should be able to keep pace with demand for FSAs, Mr Ng said.
After that memo was written, the SDHB agreed an outsourcing contract with Christchurch private hospital St George’s Hospital for cancer diagnosis and treatment of up to 200 breast and prostate cancer patients.
Dr Millar said the SDHB had now referred 47 patients for treatment at St George’s.
"The previous arrangement with St George’s was casual and we have now entered into this new agreement for four patients a week," he said.
"Southern DHB also has an agreement with another provider [Bowen Icon Cancer Centre in Wellington] for the treatment of patients on a casual basis if we need to further increase our outsourcing."