Cancer patients harmed by ongoing treatment delays at Southern health board

A cancer patient given six to eight weeks to live was told he faced a 12-week wait to see a specialist.

The man’s story is part of a critical report by the country’s patient health watchdog released today, that found the Southern District Health Board’s cancer treatment delays harmed patients and breached their rights.

Health and Disability Commissioner (HDC) Morag McDowell’s investigation found “significant delays” for patients with suspected cancer to see a specialist in the Southern DHB area between 2016 and 2022.

Notably the board failed to recognise and respond to the clinical risk associated with a lack of capacity within Southern Blood and Cancer Services (SBCS).

In the first two months of 2021, 27 patients were harmed by cancer treatment delays, the Otago Daily Times reported.

Three became so sick while waiting they were unfit for treatment.

Clinicians raised the alarm in January that year, although it took until May for the DHB to approve outsourcing cancer treatment to address the “shameful” problem, the ODT reported.

The Southern District Health Board, which covered the lower South Island as far north as Waitaki and Queenstown, is now Te Whatu Ora Southern, part of the new national health agency.

McDowell started investigating after concerns were raised by a patient advocate, identified in her report only as Ms A.

Ms A told the inquiry that in 2018, her family was told to expect it would take 12 weeks for her husband to be seen by an oncologist.

This advice came after his prognosis, which was that he only had six to eight weeks to live.

“That situation had a catastrophic impact on our family,” Ms A told the inquiry.

“People have this horrendous news that they are dealing with. They know that they’ve got cancer and they can’t get care in a timely way, and they get a letter that says, ‘I’m really sorry, but we’re operating outside of the Ministry of Health’s recommendations’.”

Ms A raised concerns about delays in first specialist assessments (FSA) for non-surgical cancer services, specifically medical oncology, radiation oncology and haematology services – collectively known as the SBCS.

The inquiry report said that in 2020 and 2021, between 65 and 73 per cent of patients were receiving their first treatment within 62 days of being referred to a specialist.

The Ministry of Health target is to see 90 per cent of people within 62 days.

McDowell said the inquiry provided a “salutary reminder” of the detrimental physical and psychological outcomes for patients, and of the impacts on whānau, when the health system failed to provide timely cancer care.

She said the problems were because of poor overall clinical governance systems, including inadequacies in quality measures and indicators, and poor relationships between clinicians and executive leadership.

She said Te Whatu Ora Southern breached the Code of Health and Disability Services Consumers’ Rights.

“Timely treatment is particularly important for reducing morbidity and mortality for cancer patients and delays also have a significant psychological impact on patients and their family/whānau,” McDowell said.

“In this case, it is clear the care Te Whatu Ora Southern provided was not adequate, and patient harm was caused.”

McDowell recommended Te Whatu Ora Southern consider establishing a single point of contact for patients on the waiting list for first specialist assessments.

She also wanted the national agency to update her on work to address geographic disparities in patient access to cancer services nationally.

McDowell acknowledged that Te Whatu Ora Southern continued to face significant specialist workforce shortages, which has recently led to the district being unable to provide some cancer services and ongoing delays.

Te Whatu Ora Southern said its Southern Blood and Cancer Service acknowledged the “immense challenges” highlighted in the report, and said these continued to be significant, particularly in recruiting senior doctors.

“Southern does not underestimate the impact this has on our staff and our communities when we are unable to fill key vacancies.”

It said its small service depended on individual specialists, and this had added to the “vulnerability” of the service over the years.

“Te Whatu Ora is currently working on a national and regional recovery and support plan to improve access to oncology treatment and ensure equity of access to radiotherapy,” the agency said.

“A significant part of this recovery and support plan is looking at how we collectively work regionally and nationally on implementing pathways to access cancer treatment regardless of who you are or where you live.”