SDHB slammed over bowel screening programme

Lives were placed at risk by an inappropriate decision to start bowel cancer screening in the South, doctors say.

The Southern District Health Board joined the national bowel cancer screening programme in 2018, and more than 200 cases of cancer have been detected since then.

However, an article in the latest issue of The New Zealand Medical Journal said the SDHB was not ready to join the programme when it did and that the Ministry of Health’s approval for it to do so was badly flawed.

Article lead author Philip Bagshaw, who was scathing of the SDHB’s colonoscopy service in a review the board commissioned from him and Dr Steven Ding in 2017, said the fact the screening programme had done very well in terms of participation rates and cancers detected did not justify an inappropriate decision to begin screening before the SDHB was ready.

"It is a serious concern that the final letter from the ministry expresses the view that the high level of performance of the SDHB’s bowel screening programme suggests that the Ministry of Health’s permission for screening to begin there was correct.

"That opinion ignored or ascribed no importance to any possible adverse clinical consequence that the concomitant restrictions on colonoscopy access had for numerous symptomatic patients in the SDHB region.

"The deficiencies clearly revealed in subsequent reviews outline the serious consequences of the poor decision-making process."

Three different reviews, including the one Dr Bagshaw carried out, had shown that between 2013 and 2018, the SDHB colonoscopy service delayed or denied colonoscopies to numerous patients, with adverse outcomes for some people, Dr Bagshaw and co-authors Paula Goodman and University of Otago cancer epidemiology specialist Brian Cox said.

SDHB surgeons had raised concerns about the high number of declined colonoscopy referrals since 2016 and the ministry should have been aware of those concerns, the article said.

"It is apparent that there were significant concerns among the ministry team in the week immediately prior to granting permission for the SDHB to go live with screening in their region."

Several emails from ministry staff to SDHB employees stressed the need for a letter of assurance from their chief executive before the programme could begin.

"He [SDHB chief executive Chris Fleming] advised that surgery, medical oncology and radiation oncology staff were committed to making the programme work and he was satisfied they will be able to provide the additional volumes that the programme will generate.

"No CEO assurance was provided for colonoscopy or radiology capacity."

These and other issues meant that, in their view, ministry approval for the screening programme to start at the SDHB was inappropriate, the authors said.

"On the evidence, we conclude the process to assess SDHB capacity to assume the national bowel screening programme did not ask critical questions.

"Further, the SDHB was not required by the assessment process to disclose relevant issues, and apparently did not choose to disclose voluntarily."

Dr Bagshaw said several other DHBs were still to join the national screening programme, and it was imperative for patient safety that a "seriously flawed" ministry readiness assessment process should be revised before they did so.

"Giving premature permission to SDHB to start bowel cancer screening when it was not able to meet the needs for colonoscopy of patients with bowel symptoms meant access for this group of patients was reduced.

"As a result, some of these patients suffered worse clinical outcomes."

mike.houlahan@odt.co.nz