Southland, Otago cancer patients still waiting too long for treatment

Ruth Hill for RNZ

Some cancer patients in Southland and Otago are still waiting too long for treatment due to workforce shortages, 10 months after a highly critical report by the Health and Disability Commissioner.

That investigation - launched in response to multiple complaints - found wait times at Southern District Health Board (now Te Whatu Ora Southern) were so bad that some cancer patients were likely to die before seeing a specialist.

In a follow-up report just released, doctors say the situation in some departments had got worse since the initial investigation last April.

Health and Disability Commissioner Morag McDowell said Te Whatu Ora Southern, Health New Zealand Te Whatu Ora and Te Aho o Te Kahu Cancer Control Agency had done "considerable work" to improve the service in response to her recommendations 10 months ago.

"However, it is evident that progress is greatly hindered by the difficulties in recruitment of the workforce, and the service has faced significant challenges since the publication of my report."

One radiation oncologist - only identified as "Dr E" - told the Commission the department was "sorely understaffed" in terms of senior doctors, and the service was "more at risk now than it was when the [original] report was written".

Another specialist, Dr B, said "the Medical Oncology service remains understaffed and therefore wait times remain unsatisfactory, and this creates a significant burden on the staff".

As a result, patient outcomes were "potentially compromised".

McDowell said until oncology workforces were brought up to a viable level and stabilised, there was "no guarantee that patients will be seen and treated within appropriate timeframes and therefore there is no guarantee there will not be ongoing patient harm".

She acknowledged the "great efforts" by Te Whatu Ora Southern in trying to attract specialists, and commended Te Whatu Ora's focus on local and national recruitment efforts.

"I am sympathetic to the disappointing outcomes of significant efforts to recruit radiation oncologists... there are workforce challenges across the country. It's a complex issue and it will take some time to address."

The problems in Southern district's oncology service - particularly the workforce shortages in radiation oncology - were not unique to the region, she said.

"The issues faced by services in the Southern district are not isolated with cancer services across the motu facing similar challenges and I am encouraged by Te Whatu Ora's commitment to instituting clear pathways for escalation of clinical risk nationally.

"It remains critically important that progress continues to be made and that patient safety remains the focus of actions taken."

Patient advocate Melissa Vining, whose husband Blair died of bowel cancer in 2019, said Te Whatu Ora needed to get serious about recruiting specialists and paying them what they were worth.

"So no, I don't think they're doing enough at a national level with Health New Zealand and the Ministry of Health.

"The report outlines the doctors are doing more hours to try and help, and they've covering with locums, but that's not a sustainable solution and they're not able to see a number of patients in a timely way."

When Blair Vining was diagnosed, he was given 6-8 weeks to live, but told he could be waiting up to 12 weeks for his first specialist appointment.

He was able to get private treatment and spent the last year of his life campaigning for better services for the southern region.

His widow has continued his advocacy work, including pushing for the establishment of the Southland Charity Hospital, which is shortly to open.

"For people in our region this has been going on for a long time, and I just don't think people should die because of where they live. It's just so wrong."

Cancer Society medical director Kate Gregory agreed the public system needed more investment to stop specialists leaving for higher pay in Australia or the private sector - and prevent burnout among those left behind.

"The more under-resourced in terms of bodies a service becomes then people are working hard, people are under stress, it just doesn't look attractive for people to go into that service, into those jobs because they know they're going into a system that's under-resourced."

Te Whatu Ora national director of hospital and specialist services Fionnagh Dougan said Health New Zealand remained committed to providing timely and accessible cancer services to the Southern community.

Te Whatu Ora said it was recruiting for permanent radiation oncologists, but locums were currently filling the gaps.

The waiting list for first appointments last week was 56, down from 113 last February.

Both medical oncology and haematology were "fully recruited to budget".

"Health New Zealand acknowledges that all three specialities continue to be vulnerable to an increasing demand and workforce pressures."

Some patients requiring lower complexity treatment were still having to travel for treatment, she said.

"We acknowledge the distress that this can cause. Health New Zealand continues to support all patients and their whānau through their treatment journey."

All patients referred are linked in with Patient Navigators - a team of specialist registered nurses who can check in on patients and provide advice and updates on wait times, and "signpost" patients to other support services such as their GP, the Cancer Psychosocial Team, and the Cancer Society.

The National Radiology Group - which has been in place since mid-2023 - was assisting with additional radiation oncology trainees, standardising some pathways, and supporting the movement of patients to reduce treatment waiting times.