Bowel screening challenges
Canterbury health authorities aim to have the national bowel screening programme (NBSP) up and running by May or June next year, but there are caveats.
Canterbury District Health Board (CDHB) chief executive David Meates has told the Ministry of Health rolling out the programme is the right thing to do, but it presented ‘‘significant challenges’’ for the health board and would increase its deficit.
A spike in the number of people referred for colonoscopies in recent years has seen the CDHB struggle to meet national wait time guidelines. Endoscopy facilities at Christchurch Hospital lack capacity to meet demand, leading to outsourcing.
‘‘The demands created by the additional colonoscopies required to be undertaken for the NBSP are going to place additional pressure on a service already operating at capacity,’’ a business case prepared by the CDHB said.
Planning work for future infrastructure at Christchurch Hospital is ongoing, meaning any increase in capacity for endoscopy is likely years away. Services may also have to move more than once before any final
CDHB business case
location is determined.
The programme, which offers free screening for people aged between 60 and 74, is sorely needed, advocacy groups say. New Zealand has one of the highest rates of bowel cancer in the world.
‘‘We’ve been waiting a long time in this country,’’ Bowel Cancer New Zealand general manager Rebekah Heal said. ‘‘Lives will be saved, it’s proven.’’
Health Minister David Clark announced this week Whanganui had become the ninth DHB to roll out the programme. Canterbury was supposed to have it in 2017, but this was pushed back to 2018, then pushed back again. The nationwide rollout is meant to be complete by the end of June 2021.
CDHB planning, funding and decision support acting executive director Ralph La Salle said the earliest proposed start date for the NBSP to begin in Canterbury was in May or June. Population estimates for 2019-20 showed there would be about 87,030 in the eligible age range.
The implementation date was subject to the roll out of an IT programme supporting the screening programme and whether the CDHB was able to meet readiness criteria given its current capacity constraints, La Salle said.
The ministry requires DHBs to pass a readiness assessment before they are approved to launch the screening programme. Health boards had to show they
Once the National Bowel Screening Programme is fully rolled out it will offer free screening to all eligible New Zealanders aged 60-74. had the required facilities and staffing and could demonstrate they were managing colonoscopy wait times, a spokeswoman said.
In the past two years the number of people accepted for a colonoscopy by the CDHB spiked, up to 2955 in 2017-18 and 2966 in 2018-19. While the CDHB was meeting wait time guidelines for urgent colonoscopies, it was failing to do so for non-urgent and surveillance colonoscopies, the latest ministry figures show.
La Salle said there had been a more than 20 per cent increase in referrals due to the national rollout and increased awareness of the NBSP.
‘‘We are currently working towards eliminating the backlog . . . The DHB is carrying out more procedures overall than the number of referrals coming onto the wait list on a weekly basis.’’
Implementing the screening programme, which involves home testing, will result in more colonoscopy referrals. In his March email to the ministry, released under the Official Information Act, Meates said the programme would increase the CDHB’s deficit.
This was largely due to additional outsourcing, which will be required to stay on top of demand. Colonoscopies delivered through the screening programme had to be done by DHBs in-house. For every four colonoscopies through the screening programme, seven others would have to be outsourced.
‘‘Further funding has not been made available to compensate for the additional work that will need to be outsourced,’’ La Salle said.
National Screening Unit manager Astrid Koornneef said all DHBs received funding to implement and operate the screening programme.
University of Otago, Christchurch professor of colorectal surgery Frank Frizelle said the May or June roll-out for the NBSP in Canterbury was feasible, ‘‘but they need to keep working and using all facilities available in the city in order to be able to manage their wait lists.’’
‘‘The demands created by the additional colonoscopies required . . . for the NBSP are going to place additional pressure on a service already operating at capacity.’’