Is the Southern District Health Board’s bowel cancer screening doomed to failure, asks Colin Aldridge.
The Southern DHB is already being criticised for excessive delays, particularly when treating cancer patients. The medical profession, and the public, are concerned about possible adverse effects from the soon-to-commenced bowel screening programme (''Bowel screening comes at a cost'', ODT 3.8.17).
The SDHB bowel screening plan for 2018-19 expects some 768 colonoscopies will be needed to follow up on positive faecal blood tests. This will be a dramatic increase in colonoscopies.
The screening workload can only be expected to increase over time as the population ages, and as tests are periodically repeated. In addition to the clinical workload of screening, there will be more operations needed to treat the cancers diagnosed.
There is already a concerning shortage of doctors to resource the screening (''Lack of resources worry doctors'', ODT 3.8.7). What is more, the CEO of the Southern DHB acknowledges the Dunedin Hospital operating theatres are already working to capacity (''Reopen wards: clinician'', ODT 7.8.17).
These resource constraints are likely to delay treatment of bowel cancer patients diagnosed during screening, compounding their distress. Patients already in the system are also likely to suffer increased delays. Even worse, more of the ill will be denied access even to a waiting list.
The traditional approach to training gastrointestinal specialists will struggle to provide the number of bowel screening personnel needed for the programme.
Is the bowel screening programme already doomed to failure?
The picture drawn is a parlous one indeed. Hand-wringing will not suffice. Bold and innovative action is needed.
I propose that the Ministry of Health be tasked with developing a training programme for gastrointestinal endoscopy (bowel screening) technicians. Training programmes should be established at NZ institutions - probably polytechnics - sufficient to meet anticipated demand. (There may be a role for ''nano-degrees'' here.)
The ministry should also be made responsible for evaluating the knowledge and competence of trainees and licensing them to undertake the procedures needed to meet the requirements of the national bowel screening programme. Remuneration would be similar to that of nurses.
Entry to the Ministry of Health endoscopy training programme should require no more than university entrance with appropriate biological science subjects. The training may well attract first year university health science students with good grades, but which are insufficient for entry to medicine.
No doubt medical professionals in general, and the Royal Australasian College of Surgeons in particular, will express concern about the incursion of technicians into their exclusive domain. They will warn of the dangers to patients of modestly qualified people taking over one of their highly trained, highly qualified roles.
However, these bowel screening technicians would not be surgeons, nor would they undertake surgical procedures, such as polypectomies, nor would they conduct, for instance, procedures on patients with bowel obstructions.
But, in view of the potential for adverse events during colonoscopies, an important part of the education of technicians would include identifying, evaluating and mitigating risks and if necessary responding to adverse events. A technician would be expected to call upon and defer to a more qualified practitioner, if needed.
Finally, the Ministry of Health should be charged with designing, building and equipping the bowel screening clinics needed to service anticipated screening requirements in each DHB region. They would not necessarily be just located in the regional hospital. Indeed, some could be mobile.
The DHBs would then be responsible for running the clinics, including employing bowel screening technicians and other staff.
What is proposed here has significant challenges. But the steady-as-she-goes, business-as-usual option is not an option.
-Colin Aldridge is a retired academic (PhD) and a former lecturer in information science at the University of Otago.
