It has been in the news in Otago and Southland for years, and for some people it has had life-limiting consequences as a result of late diagnosis of colorectal cancers.
However, this week’s reporting by RNZ highlighted the ongoing problem across the country. It showed nationally in May 20,450 people were waiting for colonoscopies, with almost 60% waiting longer than recommended times.
While 82% of urgent colonoscopies were meeting the target time (90% undertaken within two weeks of referral), the percentages meeting the longer waiting times for semi-urgent or surveillance colonoscopies were much lower.
Figures for Southern were not included in the district-by-district breakdown in the RNZ article because there is an ongoing issue with the district’s national data reporting,
Figures released through a tortuous Official Information Act process show in the year to the end of March, Southern did not come near meeting target times for urgent, semi-urgent or surveillance procedures.
The low point for that year for urgent colonoscopies in Southern was this March, when only 14 out of 48 people on the waiting list got the procedure in time, a mere 29.17%. The best compliance in any one month was June last year when 71.4% of those waiting for urgent procedures received them within the target time.
There are larger numbers seeking non-urgent (also referred to as semi-urgent) colonoscopies. These would be for people with symptoms which could be bowel cancer or other bowel conditions but not considered severe enough for an urgent procedure.
The target time for these is six weeks. In Southern, the monthly percentages meeting that time ranged from 38% in January to 88% in April last year.
The situation for those waiting for surveillance colonoscopies was also grim — in March, a little more than a third of the 947 Southern people waiting for these received them within the 12-week target period.
We have known for years there is a shortage of colonoscopy capacity.
Increasingly, people who can scrape up the money for a private procedure do so, and the public system is also using private providers, with about 30% of its 67,5000 colonoscopies in 2023 outsourced.
It seems unlikely increasing reliance on the private sector would be the cheapest or the most equitable option in the long run, but we have not seen proper examination of that.
The lack of capacity is a major reason our national bowel screening programme was slow to start and has never matched the pilot programme starting age of 50 rather than 60 years. It also uses a less sensitive screening test than the pilot.
These decisions lowered the number of colonoscopies for a national programme, but also meant fewer cancers would be detected, something not shouted from the rooftops at the time.
Within the bowel screening programme, the target is that 90% of those who return a positive screening test should receive a colonoscopy within 60 days.
Figures for the year to the end of last November, show most districts, including Southern were exceeding this target and across the country 6610 procedures were completed.
Will the system be able to deliver timely colonoscopies in the screening programme when the beginning age lowers to 58, something expected to result in an extra 5000 colonoscopies over four years? How will it ever cope with an even lower starting age, and manage demand from symptomatic patients?
What has happened to the plans to use faecal immunochemical tests (FITs), like those used for the screening programme, to assist with deciding who should be referred for a non-urgent colonoscopy?
We were told in March this was expected to begin in five districts in July, but requests for information on this have yet to produce anything.
Nobody would suggest sorting out all of this is easy, but successive governments have been playing whack-a-mole with this issue to get it out of the headlines rather than comprehensively planning improvements. That needs to change.
