A group of senior health advocates are calling on the Ministry of Health to investigate colonoscopy services in the south, but their request has been rejected.
The advocates include Southland Charity Hospital Board chairman Murray Pfeiffer, Canterbury Charity Hospital Trust chairman Philip Bagshaw and Emeritus Professor of Medicine and Gastroenterologist Gil Barbezat, among others, who all say that without knowing the number of patients being declined for colonoscopies, there is no way of knowing that every patient who needs a colonoscopy is getting one.
The group has requested data from the DHB on who has been declined, but the DHB does not report it to the Ministry of Health.
Barbezat, who previously worked as a Southern DHB gastroenterologist, argued that while wait list numbers were dropping, GPs and surgeons were still struggling to refer patients for colonoscopies – but without data, the group could not prove it.
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“We cannot see the raw data, they (DHB) won’t give it to us. We only see what they present,” he said.
A Ministry of Health spokesperson said it was not considering an inquiry and that it was satisfied with the Southern DHB’s level of data transparency.
“The number of declined colonoscopies is not reported by all DHBs and is not monitored by the Ministry for any planned care procedures. Instead, the Ministry monitors the timeliness of delivery for colonoscopy procedures once the referral has been accepted because it is a more objective measure that is comparable across DHBs,” the spokesperson said.
Dr Andrew Connolly, who chaired a group set up to improve Southern DHB colonoscopy services, said referrals from specialists were automatically accepted while those from non-GI specialists were assessed under the Ministry of Health’s direct access criteria.
“It is vital to understand that a referral is not the same as meaning the case automatically requires colonoscopy – all units must give due consideration to the request as colonoscopy is not necessarily the right test nor is it risk-free,” he said.
During a Southern DHB meeting in April, chair Pete Hodgson asked Connolly if anyone in the catchment area had been denied a colonoscopy because of the National Bowel Screening Programme (NBSP).
“I don’t believe they have,” Connolly replied. “Can I put my hand on my heart and say that? No I can’t. Can someone put their hand on their heart and say the opposite? No they can’t. Not in my view.”
Southern NBSP clinical lead Dr Jason Hill said that between September 2021 and March 2022 the DHB received 3571 colonoscopy referrals, of which 95.2% were assessed and 4.8% were not offered a colonoscopy or an alternative.
One could reasonably expect similar results in other districts, assuming national screening or surveillance guidelines and direct access criteria were used, he said.
“The outcomes for patients with declined referrals are not routinely monitored by the majority of clinical services, as this would be logistically challenging to do, but there is a process,” Hill said.
Many in the advocacy group have been fighting for better access to colonoscopies for patients showing symptoms since 2017 when clinicians began raising concerns about the number of colonoscopy referrals being declined in Southland and Otago.
What followed was a series of independent reviews that culminated in former Southern DHB board chair Dave Cull publicly apologising in October 2020 for a lack of focus, a lack of clarity, and a lack of reporting that had caused harm to patients.
Southland and Otago have among the highest rates of bowel cancer in New Zealand.
The group repeatedly called for a public inquiry into why the Ministry of Health allowed the Southern District Health Board to join the national bowel screening programme despite concerns that it did not have the resources or staff to offer screening alongside colonoscopies for symptomatic patients.
In May 2021, Minister of Health Andrew Little said he saw no need for a public inquiry, that the DHB had the capacity and capability to join the screening program, and that the Southern DHB was “more or less meeting the target times and the target volumes expected for that population” for colonoscopy services.
Bagshaw said he had called for a public inquiry several times.
“I still think there should be one, but most of the people who should have testified in 2019 have now passed on because of a delayed cancer diagnosis,” he said.
He strongly supported bowel screening, he said, but added that a screening programme should not be run at the expense of taking colonoscopies from symptomatic patients.
“Ethically, our first responsibility is to patients with symptoms.”
Now retired, Murray Pfeiffer was among the Southland Hospital surgeons who called for “decisive colonoscopy action” in 2020 over frustrations that specialists were not being given direct access to colonoscopy wait lists.
No system could reform itself from within, he said, and a public inquiry was needed “so someone fully independent can come in and make binding recommendations.”
The service would need significant investment in resources and staff to be able to keep up with need, Pfeiffer said, and while Connolly had improved the service somewhat, “there are still too many people missing out.”
The group has also sent complaints to the Medical Council of New Zealand and the Health and Disability Commission and is waiting on responses before deciding on what it will do next.
Meanwhile, the Southern DHB celebrated the fourth anniversary of the National Bowel Screening Programme, which has detected 282 cases of bowel cancer and resulted in more than 2200 participants having polyps removed in this time.