Reflection, not deflection, needed

News this week record numbers of Southern District Health Board patients are waiting for radiation oncology highlights again the inadequate planning and resourcing which plague our health system.

Lyndell Kelly
Lyndell Kelly
Oncologist and SDHB member Lyndell Kelly says the board has some of the worst cancer treatment waiting list figures in the country.

There will be high hopes recently announced sweeping health reforms will deliver the promised removal of winners and losers in healthcare depending on where you live, but if it happens, it is not going to happen overnight.

We are a long way from knowing yet if the resourcing will be sufficient to achieve this and we have some concern about the Ministry of Health’s ability to deliver as the primary source of strategy and policy for the system, given aspects of its current performance.

Last week, the New Zealand Medical Journal published an article by Phil Bagshaw, Paula Goodman and Brian Cox outlining their efforts to investigate the ministry’s process to assess the readiness of the Southern District Health Board to join the National Bowel Screening Programme in 2018.

After analysing what was divulged through a protracted Official Information Act process, which Mr Bagshaw described in an RNZ interview as the ministry trying ‘‘every trick in the book to avoid answering our questions’’, the authors concluded the process was flawed.

They said uncovering the true level of unmet need in symptomatic SDHB patients would have allowed an opportunity to ensure safeguarded access for those patients to colonoscopy as clinically indicated.

Instead, as successive reviews of the colonoscopy service found, including the first from Mr Bagshaw and gastroenterologist Dr Steven Ding, colonoscopy access for some symptomatic patients between 2013 and 2018 was denied with resulting adverse outcomes for some.

It is disquieting to read that although ministry staff asked board personnel several times for reassurance symptomatic patients would not be disadvantaged, documents provided did not include a response to that.

The DHB and ministry responses to the article have been to deflect attention from any shortcomings in the process to emphasise the value of the screening programme — numbers of cancers detected early and pre-cancerous growths removed.

Nobody would deny the impact an effective bowel screening programme can have on both early detection of cancer and prevention of it developing. But every part of it must be high quality and efficient and not at the expense of people already exhibiting symptoms of bowel cancer or other diseases.

The nation’s endoscopy services are still insufficient despite planners knowing for decades what workforce would be needed for a screening programme.

Indeed, Canterbury, which only joined the screening programme late last year, is already finding the numbers waiting too long as non-urgent or surveillance colonoscopies have more than doubled.

It is unfortunate the ministry continues to take a defensive and obfuscatory approach to any criticism of this programme rather than seriously reflecting on its performance. The way the ministry dealt with the OIA request from Mr Bagshaw et al is not reassuring. Eventually, after the involvement of the ombudsman, the ministry provided 3516 pages of information, which ignored some questions and included much irrelevant information.

Attempts to get the information electronically were ignored and the format of the pages with their OIA watermark posed technical challenges in order for them to be fully searchable documents.

We agree with the authors that OIA requests to the ministry and similar organisations are too easily ‘‘deferred, derailed or declined’’ and that the law needs revision.

However, that review has been postponed to some unspecified time. In the meantime, a renewed commitment to the letter and spirit of the existing law by the Ministry of Health is long overdue.


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