Screening delay ‘will cost lives’

The roll-out of a national screening programme for bowel cancer has been delayed by a year, with some district health boards not scheduled to start until the 2020-2021 financial year.

Cancer advocates say the delay will cost more lives.

Calls for a screening programme to detect and treat bowel cancer early began more than a decade ago. A four-year roll out got under way with the Hutt and Wairarapa DHBs last year.

Under the original plan all DHBs would start the programme by June 2020.

The timeframe was extended to ‘‘ensure delivery of a safe quality programme’’, Ministry of Health national bowel screening programme (NBSP) director Stephanie Chapman said.

‘‘The Bowel Screening Programme is taking more time than originally planned to ensure delivery of a safe quality programme, taking into account the capacity and capability pressures being experienced by DHBs, including managing colonoscopy wait times.’’

Each year 1200 New Zealanders die from bowel cancer and 3000 people are diagnosed with the disease.

‘‘The Ministry of Health’s own information suggests that 500 to

700 lives would be saved each year by a fully implemented screening programme,’’ Bowel Cancer New Zealand manager Rebekah Heal said.

‘‘It is simply not good enough that the Government and the Ministry are still, in 2018, throwing their hands up in the air – saying New Zealand DHBs still don’t have the capacity or capability.’’

Under the revised timetable, Southern and Counties Manukau DHBs will start bowel screening by June 30, 2018, followed by Nelson/Marlborough, Lakes and Hawkes Bay DHBs by November

30, 2018. Whanganui and MidCentral were to start screening by June 30, 2019.

Five more would start screening in 2019-20 and the final five DHBs by June 2021.

Hutt Valley and Wairarapa DHBs started screening in July last year and Waitemata DHB’s pilot scheme would transition to the national programme this month.

Minister of Health David Clark

‘‘. . . 500 to 700 lives would be saved each year by a fully implemented screening programme.’’

Bowel Cancer New Zealand manager Rebekah Heal

blamed the National government for the delayed rollout.

‘‘The previous Government failed to plan appropriately for the required implementation software.

In the short time I’ve been minister, I have been advised that DHBs lack the necessary capacity and infrastructure to deliver on the previous Government’s political promises.’’

National committed a total of $77.8m in funding for the programme in Budgets 2016 and 2017.

Screening would be available for 60-74 year olds, with an estimated 700,000 people to be screened every two years.

The funding was for additional colonoscopies required as a result of the screening and all set up costs including a national coordination centre and IT programme, Chapman said. ‘‘DHBs are required to cover any treatment costs out of their existing population-based funding,’’ Chapman said.

Treasury raised concerns about the capacity of DHBs to implement the programme as early as December 2015.

Ahead of Budget 2016 Treasury said ‘‘inadequate resources’’ and a lack of engagement with DHBs were key risks in a review of a business case for the programme.

Cancer Society medical director Dr Chris Jackson said the further delay was disappointing.

‘‘The National Bowel Screening Programme is an excellent idea, being implemented poorly with unclear timeframes and repeated delays and we are falling further behind the UK and Australia with bowel screening.’’

Jackson said the society raised concerns about levels of support for the programme with previous health minister Jonathan Coleman, but he turned down offers to meet with them, saying he was too busy.

News that a national screening programme for one of New Zealand’s deadliest cancers will be delayed yet again is appalling. About 3000 New Zealanders are diagnosed with bowel cancer each year and more than 1200 die from it.

Early detection is the key to successful treatment and a screening programme is the best way to diagnose the cancer early.

A national screening programme has been forecast to save as many as 500 to 700 lives. So why on earth are we still not screening?

Australia began screening in 2006 and expects to have its national programme rolled out by 2020.

Christchurch bowel cancer surgeon Frank Frizelle has been asking for a national screening programme for more than 20 years.

A pilot finally began in Waitemata, Auckland, in 2014 and in an official audit was deemed ‘‘an exceptionally cost-effective health intervention’’.

Nearly 350 cancers were detected – all cancers which may have otherwise developed without symptoms until they became lethal.

It took until 2016 for the government to pledge nearly

$40 million for a national screening programme and a similar sum in 2017.

Finally, the Hutt Valley and Wairarapa district health boards became the first to launch the national screening programme in mid-2017.

Canterbury had been scheduled to introduce screening in July this year, though asked for a delay of a few months due to the challenges of its hospital rebuild programme.

Now, it has been revealed Canterbury will not introduce screening until at least 2019, and potentially as late as 2021.

The revised timetable will see Southern and Counties Manukau DHBs start screening by July this year, with Nelson-Marlborough, Lakes and Hawkes Bay following suit by December. Whanganui and MidCentral are due to start screening by July 2019.

That leaves 10 DHBs not screening until, at the earliest, the second half of next year, and some not until

mid-2021. This delay condemns hundreds to avoidable deaths from bowel cancer.

The narrowness of the screening programme will also have an impact on survival rates. New Zealand’s free screening programme will only be offered to those aged 60 and over.

Yet bowel cancer risk increases steeply from the age of 50 and this is the age when the Australian screening programme begins.

Of course there are challenges to introducing screening.

It is expensive and difficult to resource.

There are not enough professionals in each health board area to carry out the screening nor enough to cope with the resultant increase in demand for cancer care.

But these resourcing issues have been known for many years and should by now have been resolved.

It is apparent the Government has simply not had the will to make it happen.

New Zealand has one of the highest rates of bowel cancer in the world. It kills nearly four times as many people every year as road crashes.

It seems, those who govern are content for it to remain that way for many years to come.