Second Anniversary for Southern DHB Bowel Screening Programme

Two years after its inception, the Southern DHB’s National Bowel Screening Programme has already detected 177 cases of bowel cancer across the district. A further 1267 people have had polyps removed, many of which could have developed into cancer over time.

“These numbers reflect significant, real-life impacts,” says the Programme’s Clinical Leader, Dr Jason Hill. “They are reflective of lives saved and families spared losing loved ones. This programme will have long-term positive effects – by detecting and treating cancers early, we will reduce the future bowel cancer burden in our community.”

The Southern DHB programme’s second anniversary passed in late April, a milestone unmarked at the time due to the Covid-19 lockdown. To date, about 55,000 test kits have been sent out to Southern residents, and approximately 37,500 of those have been returned.

Participation rates remain high in the South at 73% overall, compared with 61% nationally. Notably, Māori participation is at 75% in the South – considerably higher than the national rate of 55%.

The National Bowel Screening Programme– which is free for those aged 60-74 who are eligible for publicly-funded health care – was paused during the COVID-19 response, but is now resuming regular activity.

“We’re advising those who received test kits in the mail before or during lockdown, to complete and return their kits as soon as possible,” says Southern DHB Programme Manager, Emma Bell, whose role was recently made permanent. “The test kits have a six month expiry date, so it’s important they’re sent back soon.”

Despite the pause in the distribution of invitations and test kits, results were still processed throughout the lockdown, and those who returned positive results are now being offered colonoscopies. Of those with positive tests, approximately 8% will have cancer.

“We’re working hard to clear the post-lockdown backlog so we can offer timely colonoscopies to everybody who returns a positive test result,” says Dr Jason Hill. “Currently, 94% of those people are receiving theirs within national target time-frame of 45 days, with a median wait time of 23 days.”

The National Bowel Screening Programme is an excellent way to detect bowel cancer earlier.

“We know sometimes people put off doing the test because they are scared of getting a positive result, but early diagnosis increases the chances of having straightforward and successful treatment,” says Dr Hill.

According to the Ministry of Health, those who receive early treatment have a 90% chance of long-term survival.

Visit timetoscreen.nz for more information about the National Bowel Screening Programme.

Grieving Family Feeling Let Down After Losing Mother

Almost a month after they lost their mother during Level 4 lockdown, Jodi and Mike Conway still want answers, after feeling let down by the health system.

They believe no strategies were put in place for non Covid-19 palliative care scenarios in the hospital, or other traumatic events.

When Covid hit New Zealand, hospitals were concentrating on keeping patients safe by closing their doors, but the Conways felt this was disproportionate compared to the actual risk.

The Southern District Health Board had a zero visitor blanket policy implemented.

“The whole hospital was shut down to cater for the pandemic risk situation, but what about non Covid situations?” Mike said.

Instead they sat outside a window at the hospital watching Josephine in the rehab ward, eventually holding a Zoom family Tangi with her five children – two of which were overseas.

The mokopuna were still getting to grips with the fact they couldn’t say goodbye to their grandmother.

“It was the most challenging time for our whanau, and our thoughts are with the many other families throughout New Zealand who were placed in the same situation,” Jodi said.

They had no choice but to cremate their mother with nowhere to hold a service, and felt that their human rights had been taken away from her and them.

Mike and Jodi said if there was ever a review into Covid-19 and the health system, they would like to be sitting around that table, to make sure someone was accountable – and to have a voice.

“We have lost that time with mum where she could communicate, because we were too busy battling just to get in to be with her.”
Petition of Linda Manning: Accountability and Compensation for families bereaved during Lockdown Sign the petition here 

 

DHBs Need to Prioritise Cancer Treatment – Cancer Society

Up to 400 people could die from cancer if hospitals don’t catch up quickly enough after the lockdown, the Cancer Society says.

It was basing its analysis on new British research into the impact a three-month delay in cancer diagnosis and treatment there because of the pandemic.

The study, by The Institute of Cancer Research and the Royal Marsden Hospital, showed fewer cancers were detected in the lockdown because people were not seeing their GPs or there were not as many diagnostic scans like colonoscopies or CT scans.

Cancer Society medical director Chris Jackson said New Zealand could avoid additional deaths if cancer services were resumed quickly.

DHBs needed to prioritise cancer treatment over some other conditions to try to avoid that collateral damage.

“The thing with cancer is it gets bigger and it spreads faster in a short space of time and we are very clear about what the impacts of delays are in terms of lives lost,” he said.

Under the lockdown, urgent treatment had continued along with some diagnoses, but there had been fewer operations, scans and diagnostic tests.

Those now needed to resume, and there needed to be extra work to catch up, Dr Jackson said.

That should include more surgery, weekend clinics and using private hospitals and facilities to help clear the backlog, he said.

People should not delay seeing their GPs, he said.

The Cancer Control Agency was set up last year to oversee cancer care and reduce inequities.

Its chief executive Diana Sarfati said it was working with senior doctors on how to get more services up and running.

“The Cancer Agency has been providing very clear guidance to DHBs about the expectation around both cancer diagnosis and cancer treatment at this time which would ensure that people who need care are getting it,” she said.

Screening programmes for breast, cervical and bowel cancers would start next month, she said.

Director-General of Health Dr Ashley Bloomfield said getting normal hospital services back up and running could not be done at the expense of Covid-19 preparedness.

Hospitals still needed to be ready to respond quickly if the disease flared up again.

Source: rnz.co.nz Republished by arrangement.

Site investigation for Bluff Playground

Work to understand the possible impacts from historic fuel tanks which were once located on a Bluff playground will begin early next month. 

The land, now home to the Slaney Street Playground, was leased from the Bluff Borough Council by Europa (now BP) until 1987, and was the site of a significant fuel storage facility. 

In 1993, the site was planted out and a playground built. 

Council Interim Parks and Recreation Manager Michele Frey became aware of a potential contamination issue on the site as a result of its former life as a fuel storage location, and detailed site investigations are about to begin. 

Ms Frey said the investigation involves soil testing, with some excavation works happening on the site. 

“Experts have told us that it’s possible there may be some contamination of the soil as a result of heavy metals having been present from the fuel storage,” Ms Frey said. 

“We want to ensure that there has been no impact on groundwater, or the coastal marine area nearby.” 

Ms Frey said work will begin mid-March, and site testing would take about two days. 

Council expected to receive the results from testing within about a month, she said. 

The playground area will be closed to the public while soil samples are gathered, in order to avoid any risks associated with heavy machinery present. 

“Once we have the results of testing, we should be able to identify if there has been any contamination. From there, we can investigate whether any remedial work will be required.”

Life Expectancy Cut in ‘Unacceptable’ Southern DHB Urology Treatment

A Southland man is facing terminal cancer after major delays in treatment at Southern District Health Board.

The DHB has been forced to apologise to four urology patients for falling short in their treatment and care, after a scathing report from the Health and Disability Commissioner.

The report says the DHB’s urology service was “unacceptable,” after 38 complaints were made since the beginning of 2016.

“Many patients waited with no treatment and no information about when they would be treated,” the report says.

One of the four patients, Stephen Hoffman, was referred to the Southern DHB in September 2016, with a high suspicion that he had prostate cancer.

He told Checkpoint he should have been seen in weeks. Instead it took months.

“It got close to Christmas and I said to my wife, ‘I’m not going to be seen this year.’ It rolled into next year, on February 20 we had this appointment.

“Basically the hospital says after I got triaged, I got lost in the system. Five months had gone by. I should have been seen and done in 61 days.

“The surgeon, he said to me if he’d known about it, ‘you would have been seen and all done in 61 days’.

“That probably would’ve meant that I wouldn’t have needed any radiation, chemo… And I would have been ready for work at the start of 2017, and I would have been out in the workforce, making money for the country as a taxpayer.

“As it is, I’ll never work again.”

During his 10-month wait, Mr Hoffman says he struggled with having to take different pills to help him urinate.

His prostate was removed on July 6, 2017. During this time he could not work, his holiday leave and savings dried up.

At the time, Southern DHB chief executive Chris Fleming confirmed to Checkpoint that Mr Hoffman was one of at least six men whose cancer had spread while they were waiting for treatment.

An external review in 2017 slammed the urology service, and recommended changes. The then-government and DHB said changes were happening.

Two years later, Mr Hoffman’s cancer has spread to his lungs, and the latest report from the Health and Disability Commissioner says the service is still unacceptable.

“The government, they skite about a $7.5 billion surplus, hell that’s great, damn great but we’ve got a hospital, health system falling to bits. Fix it up.”

Mr Hoffman received a letter in September from Mr Fleming, saying the level of care he received was unacceptable, “and we unreservedly apologise that we could not provide you with the reasonable and timely care that you required”.

Mr Fleming told Checkpoint his team developed the apology letter to Mr Hoffman, and he stands by its words.

“The organisation and the health system have let these four patients down… We’ve let people down in varying states and we need to be held to account in terms of what we have done in order to improve the services moving forward.”

Mr Fleming says the DHB is accountable for patients waiting months longer than they should have been.

Currently, he says “for those patients who have been seen and identified as needing surgery, there are about 100 patients waiting longer than the four months.

“However none of those patients, with the exception of a small number of people who have been delayed for personal reasons or valid clinical reasons – none of the patients waiting longer than four months for surgery are cancer patients.”

The Health and Disability Commissioner has made a list recommendations for changes at Southern DHB, with a three-month time period to report back.

Mr Fleming says improvements are underway with increased staffing levels and more streamlining of biopsies, and the DHB will be able to achieve the recommended changes.

Health Minister David Clark said in a statement he is well-aware of the distress and “health loss” that can result when people wait too long for appropriate treatment.

Mr Clark says he expects the Southern DHB will address the issues identified in the report as a matter of priority.

He says he’s been told the DHB has made good progress reducing wait times for urology first specialist assessments but has more work to do to ensure all patients who need surgery receive it in a timely fashion.

Source: rnz.co.nz Republished by arrangement.

Charity Hospital Floated For Southland

A plan to develop a charity hospital in Southland is being launched tonight.

The plan was first floated by Southland farmer Blair Vining, and his wife Melissa.

Mr Vining, 39, has campaigned for better cancer care since being diagnosed with terminal bowel cancer last October.

The plan will be launched at a meeting with potential investors and interested parties at the Findex Building in Invercargill at 6pm.

Mrs Vining said since her husband was diagnosed with cancer the couple had hundreds of people contact them about being denied services by the Southern District Health Board.

“If we can put an end to the suffering of others by establishing a local charity hospital service to provide timely diagnosis and treatment, then Blair’s suffering will not have been in vain,” she said.

Also attending the meeting will be Christchurch surgeon and founder of the Canterbury Charity Hospital Philip Bagshaw and his wife Dame Sue Bagshaw.

“We’re delighted to be able to help by giving them advice on how to proceed,” Dr Bagshaw said.

“It’s regrettable that entities such as charity hospitals need to be considered at all, but while health resources are underfunded nationwide in general, it’s clear that people in the regions, like Southland, are suffering badly,” he said.

Source: rnz.co.nz Republished by arrangement.

Report On Bowel Cancer Diagnosis Delays Finds Southland ‘inter-service warfare’

Bowel cancer patients in Southland have suffered unacceptable waits of months – and even years in some cases – to get diagnosed because of major failures at Southern District Health Board.

A damning independent report released today describes a state of “inter-service warfare” between bowel specialists in Dunedin and Southland hospitals, which meant patients in Southland got a poorer services than those in Dunedin.

By the time some patients got colonoscopies to diagnose their cancers, they were already dying and could only be offered palliative care.

The report’s co-author, Christchurch surgeon Phil Bagshaw, says Southern DHB has one of the highest incidences of colorectal cancer in the New Zealand, one of the highest rates of cancer that has spread beyond the bowel, one of the highest rates of emergency surgery for bowel cancer, but one of the lowest colonoscopy rates.

“Those facts in themselves show they have lost the battle against bowel cancer.

“Senior people in the DHB have known about those issues for a long time and they have not addressed those issues.”

The DHB did not appear to be delivering on its promises to implement the reports recommendations to put more resources into colonoscopy services and deal with toxic working relationships, he said.

He was horrified to see how many bowel cancer patients at Southern DHB had been admitted for emergency surgery for fistulas, which he had rarely seen in his clinical practice for the last 40 years.

The report, commissioned by the Southern District Health Board, looked at 20 cases and found delays in diagnosing 10.

One patient waited over three years for a colonoscopy that showed he had cancer – partly due to the fact he got bumped off because he had already waited so long it was thought “sinister pathology was unlikely”.

Another patient whose diagnosis was delayed a year (due to the referral letter from his GP getting lost) and four others who were delayed by up to 10 months, had to be referred to palliative care.

Others were only diagnosed once their cancers had spread.

The report describes a state of “inter-service warfare” between bowel specialists in Dunedin and Southland hospitals.

Tougher guidelines for colonoscopy referrals, which were brought in to deal with “out of control” waiting lists, were now being used “as a rationing tool”, the report said.

In some cases, Southland patients were refused colonoscopies or suffered major delays, even when they met the criteria.

“Certain access criteria appear to have been applied too rigourously and to have denied access to colonoscopy or CT colonography for cases that might well have been accepted on the grounds of specialist clinical judgement.”

A survey of other DHBs – carried out as part of the review – suggested some were also using the national guidelines to manage “a scarce resource”, which was not their intention.

“The chance in policy raises national clinical, ethical and medico-legal issues, as the national guidelines were never formally validated in their effects on health outcomes or in their intrinsic utilities.”

Patients refused a colonoscopy on the basis they did not meet the local guidelines should be able to seek a specialist appointment if their doctors considered it to be “clinically indicated”, and specialists should have the discretion to order the tests they need to do their job, the report said.

“This approach restores one option for patients who cannot afford private healthcare, and would otherwise go without investigation; it also allows GI specialist physicians and surgeons to exercise the clinical judgement and endoscopic expertise, for which they were trained and employed.”

The auditors also noted most of the doctors interviewed “showed signs of distress and some were on the verge of tears” and they concluded they could not be “working to their full potential”.

“There is a state of ‘inter-service warfare’….

“Furthermore the lack of trust and poor relationships cause delays to treatment.”

Surgeons feared the service could lose its training board accreditation for registrars in colonoscopy due to lack of training opportunities.

The endoscopy service was under massive pressure due to a number of factors, including shortages of staff and equipment.

Access to colonoscopy services had declined since the National Bowel Screening Programme started, the report noted.

LB] Of the 20 cases covered by this audit:
Eleven cases met the local guidelines for colonoscopy.
Six cases met the guidelines but were refused colonoscopy.
Four cases did not meet the guidelines.
Ten cases had an unacceptable delay in reaching a diagnosis.
After referral for colonoscopy, six cases were sent for an initial first specialist appointments, which resulted in diagnostic delays for some of them.
One case was assigned a lower waiting list priority than they should have got.[LI ]In one case documentation was insufficient to conclude the appropriate level of priority.

Southern DHB has one of the highest incidences of colorectal cancer in the New Zealand, one of the highest rates of cancer that has spread beyond the bowel at the time of initial treatment, one of the highest rates of emergency surgery for bowel cancer, and one of the lowest colonoscopy rates.

The chief medical officer Nigel Millar said since the report was completed in May, the Southern DHB had been working to ensure patients in Southland received the same treatment as those in Dunedin.
Further review on others cases

A further review will look at a further 102 cases, where there are questions over how they were handled.

Dr Millar said it was important to remember these cases were just a minority among many thousands of colonoscopies performed over a number of years.

“Any case of delayed care needs to be taken seriously. However, it is recognised that bowel symptoms, such as pain and bloating, are non-specific and in many people are not the result of gastrointestinal tumours.”

It was “impractical” to investigate everyone with these symptoms, which was why it was necessary to consider other factors, including how long the problem had been going on, unexplained bleeding and the age of the patient.

Widening access would cause waiting lists to blow out and have the unintended consequences of delaying access for patients who were more likely to have cancer, Dr Millar said.

“Unfortunately, there is always a possibility this misses some cases in people who are referred, but not accepted, for publicly funded colonoscopy.

“This is a challenging balance to strike, and we appreciate the sincere concern all clinicians experience, and have shared with us, in managing this.”

Southern DHB had joined the national bowel screening programme, and Dr Millar noted the participation rates in the South were among the highest in the country, particularly for Māori.

The programme had so far detected 80 cancers that would not otherwise have been detected, and polyps (precancerous lesions) in over 700 patients.

“This a critical step to reducing late-presentation cancers and gives us an important foundation to move forward from.”

Source: rnz.co.nz republished by arrangement.

Southern DHB Playing ‘Russian Roulette’ With Lives – Midwife

A baby was born in a car park outside Lumsden Maternity Centre last night, sparking fresh calls for better maternity services in the area.

Former midwife Nicky Pealing said a midwife helped the woman alone, about 1am on a “wet and windy” night, because no backup was available.

Midwives have made repeated calls for Southern District Health Board to reinstate 24/7 midwifery at Lumsden Maternity Centre, which was downgraded from a primary birthing unit in April, Ms Pealing said.

It was not safe for a midwife to be alone at a birth, with no support, she said.

“I’m a bit dismayed they still haven’t put in place an adequate backup for these two midwives who are left holding the baby literally,” Ms Pealing said.

“They are playing Russian roulette and I don’t think that’s very satisfactory in this day and age.”

Southern District Health Board chief executive Chris Fleming said the overall service in the region had been improved and more was being spent on maternity services.

It was “simply not realistic” to have a backup midwife available at all times at the Lumsden centre, because less than one birth a week took place there on average, he said.

Ms Pealing said she had worked as a midwife for 35 years, but stopped because of the lack of backup available.

Lumsden maternity hub was now unstaffed and local midwives lived significant distances away, she said.

“It’s too scary – there is nobody who’s got your back any more. The DHB has taken every bit of support we had away,” she said.

“In my professional opinion, it’s totally unacceptable to have so few midwives available in a large area without the ability to have somebody on call and available in a reasonable time.”

Clutha-Southland MP Hamish Walker has been petitioning the government to reinstate the Lumsden Maternity Centre as a primary birthing unit.

Three babies had been delivered outside primary birthing units in the area since the Lumsden centre was downgraded, despite strong community opposition, he said.

“The hub model that was introduced a couple of months ago is not fit for purpose,” Mr Walker said.

“I’m pleading yet again to the prime minister – is it going to take the preventable, needless death of a baby before they reinstate full services at the Lumsden Maternity Centre?”

However, Mr Fleming said Southern District Health Board was confident maternity services across the whole district had been improved after its recent changes.

New birthing hubs had been created in Te Anau and Wanaka, making the service better overall, he said.

“Maternity services in remote places are always challenging to provide,” Mr Fleming said.

“We’ve enhanced the services across the entire district, so we’ve minimised the risk overall.”

There will be a review to check on the implementation of the new service arrangement.

“We’re still wanting to work with the midwives in the Lumsden-Te Anau area around ensuring that there’s an appropriate backup arrangement,” he said.

Source: rnz.co.nz republished by arrangement.

Lumsden Maternity Centre Downgrade: Committee Delays Decision On Investigation

The Health Select Committee has delayed a decision on whether to investigate the downgrade of the former Lumsden Maternity Centre.

The Southern District Health Board announced in August the centre would be downgraded, with babies delivered only in an emergency.

In November, Clutha/Southland National MP Hamish Walker submitted a petition to the committee calling for the decision to be reversed.

The committee was expected to announce whether to investigate the Southern DHB’s decision today.

But Mr Walker has confirmed the decision was put on hold until next week.

In his petition, Mr Walker said downgrading the Lumsden centre puts rural women and babies at risk.

The Southern District Health Board last year defended the downgrade, with chief executive Chris Fleming saying the DHB had made a well-informed decision using figures as well as seeking advice from independent midwives and consulting the company’s directors.

Source: rnz.co.nz republished by arrangement.

Decision To Not Front Lumsden Meeting ’embarrassing’, MP says

The Ministry of Health and Southern District Health Board decision not to meet with Southland midwives today has been described as a slap in the face.

The meeting was called to help midwives practice safely in the area after the former Lumsden Maternity Centre was downgraded.

It was cancelled after both organisations decided not to front up to midwives this afternoon.

National’s Clutha-Southland MP Hamish Walker said it was embarrassing that neither were prepared to meet with midwives for the good of the rural communities.

“Its trust directors were just doing the right thing, trying to organise a meeting with the DHB, with the Ministry of Health to give the midwives that are left some safety operating environment,” Mr Walker said.

“The fact they didn’t turn up is an absolute slap in the face. The Health Minister needs to instruct his officials to actually meet with the local trust to ensure we give some safety to the midwives operating.”

In an email, senior Southern District Health Board official Lisa Gestro said a group meeting would “become confrontational” and make it “difficult to explore solutions”.

“We don’t think this approach is helpful and for now we plan to concentrate on the establishment of the hub and on the sustainability of midwifery services for the district,” she said.

One mother gave birth in an ambulance on the way to Lumsden less than a fortnight ago, and another woman gave birth at the hub last week.

Source: radionz.co.nz republished by arrangement