‘Aspirational’ new govt targets will improve care – Chch surgeon

A Christchurch surgeon is praising the Government’s new health targets as aspirational.

Yesterday, the Government announced five targets which promised to deliver improved childhood immunisation rates, faster cancer treatment, and shorter wait times in emergency departments (EDs), as well as for specialist appointments and elective treatments.

“Having effective targets, and reporting on them publicly, helps identify where there are problems – and how we can take action to improve them,” Health Minister Dr Shane Reti said.

Colorectal surgeon Professor Frank Frizelle said it was “superb to have aspirational goals.”

“Setting clear goals and resourcing the system to deliver will revolutionise the whole thing [health system],” he said.

The leading bowel cancer surgeon said the cancer target – which aims to have 90% of patients receiving cancer management within 31 days – was great.

The most recent data, measured between October 2022 and March 2023, showed that in Canterbury, 86% of patients were receiving care within the 31 day time frame, slightly above the national average.

Frizelle believed the answer to better cancer survival rates was faster treatment and not just modern drugs.

A New Zealand Medical Journal article, published on Friday, emphasised that our cancer care is lagging far behind comparable countries, in large part because of the delay in care.

The most recent comparison for diagnoses – between 2014 and 2018 – shows that cancer deaths in New Zealand were 11% higher than those in Australia, 17% higher in women, and 5% higher in men.

Previous National government health targets were scrapped by Labour Health Minister David Clark in 2017 who said they were “perverse incentives”.

Frizelle said removing the targets did lead to worse outcomes.

“Covid’s made it worse, but the lack of targets ... really stopped people achieving them. Now they’ve been re-established, I’m certain that the government will resource

to deliver because it would make no sense otherwise,” he said.

The four other targets announced yesterday were:

■ Improved immunisation for kids: 95% of children to be fully immunised at 24 months of age.

■ Shorter stays in emergency departments: 95% of patients to be admitted, discharged or transferred from an ED within six hours.

■ Shorter wait times for first specialist assessment: 95% of patients to wait less than four months for an FSA.

■ Shorter wait times for treatment: 95% of patients to wait less than four months for elective treatment.

In the first quarter of 2023, child immunisations across Te Whatu Ora Waitaha Canterbury were sitting just below the new target at 91.2% and above the national average of 83%.

However, the number of people being seen in an ED within six hours was well below the target at 71%, a 10% drop when compared with the same period 12 months earlier, again above the national average of 66%.

Frizelle said the current wait times at Christchurch Hospital were awful and recalled the statistics being much closer to the target numbers back in 2017 and 2018.

“It is possible, it’s just a matter of having the infrastructure to cope with the number of people,” he said.

Canterbury specific numbers for wait times for specialist appointments and elective treatments were not available, however the national data showed 66.4% and 61.5% respectively were waiting more than four months. As of March 31, 2023, more than 10,000 Canterbury patients had waited more than four months for their appointments and treatments.

Frizelle believed the targets were realistic, and hoped they could be achieved in the next 18 months to two years, funding permitting.

Labour’s health spokesperson, Ayesha Verrall, labelled the targets “half-baked” and said they ignored general practice and primary care.

People living in Australia are more likely to survive cancer than those living in New Zealand, studies show.

Lower funding, fewer staff, equipment barriers and a shorter list of funded medicines are the key reasons New Zealand is so behind Australia and other countries in cancer care, Professor Mark Elwood stated in an editorial published in the New Zealand Medical Journal yesterday.

The same day, Health Minister Dr Shane Reti unveiled five new key health targets, including faster cancer treatment – specifically, for 90% of patients to receive cancer management within 31 days of the decision to treat them.

While NZ’s cancer survival rates are getting better, our rate of improvement is slower than comparable countries.

In 2018, the number of lives lost to cancer in NZ was 9818. More than 2000 of these, or 21%, could have been avoided through public health and prevention measures and effective and timely healthcare.

The most recent comparison, for diagnoses – between 2014 and 2018 – shows cancer deaths in NZ were 11% higher than those in Australia, 17% higher in women and 5% higher in men. The excess deaths in NZ are not because there is more cancer, Elwood said.

In fact, the total incidence of cancer in NZ is slightly less. The plain fact is NZ is not as good at treating the disease.

Survival rates in NZ are lower than those in Australia for most types of cancer, Elwood said. “These differences have increased over time, as the survival rate in Australia improved more between 2000 and 2005, and 2006 and 2010.” Survival figures for NZ are even worse in the Māori population.

The difference in survival is down to the speed at which cancer is diagnosed, and people in New Zealand are diagnosed later. Delayed diagnosis makes treatment more difficult and less successful. “For most cancers, the main prognostic factor is the extent to which the cancer has spread when it is diagnosed, summarised as the stage of the cancer,” Elwood said, adding the speed of diagnosis was a primary care issue.

In NZ it is more difficult and takes more time for GPs to get diagnostic tests done or to get a specialist opinion, an international study of primary care in 12 countries or regions showed. Among NZ GPs, 45% reported that they could get a referral for a suspected cancer patient within 48 hours, compared to 57% in other countries. Average times for a colonoscopy were nine-and-a-half weeks in NZ, compared with seven weeks elsewhere.

NZ has the highest rates of cancer diagnoses as a result of an emergency admission compared with the UK, Canada, Australia, Norway and Denmark, accounting for 42.5% of diagnoses, including more than half of all lung cancers. “That is really a desperation thing. They have some serious problem that they haven’t been able to get primary care help with,” Elwood said.

Once diagnosed, treatment requires a strong work force and good resources. A worldwide work force survey Elwood refers to in his study reported 272 cancer cases per clinical oncologist in Australia and 525 in NZ.

There are also lower levels in NZ for radiotherapy equipment (28% lower) and CT scanners (35% lower), but no deficit in MRI or mammography, Elwood said.

Health Minister Shane Reti had said: “New Zealanders have increasingly had their access to effective cancer drugs reduced over time compared to our friends across the ditch.”

It does come down to money, Elwood said. Less money invested in health results in shortages in people, equipment and opportunities. Countries with greater total health expenditure per capita have higher relative cancer survival rates, he added.

In a 2019 review of 30 developed countries, Australia was ranked fifth in expenditure and second in survival; NZ was 15th in health expenditure and 22nd in survival.

“It’s politicians who decide how much money we spend on things. It’s a political choice that this is what we spend on healthcare and these are the results we get.”