Patients increasingly diagnosed with bowel cancer in ED, Northland doctor says
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Doctors in Northland are blaming a massive increase in wait times for colonoscopies over the last six months on Health NZ's decision to cut rates for locums.
Health NZ data has shown the number of patients waiting longer than recommended
for non-urgent colonoscopies went from fewer than 20 a month at the start of last year to 553 in April this year.
Whangārei Hospital emergency department consultant Dr Eugene Fayerberg was not a cancer specialist - but said he and his colleagues were increasingly the ones to find cancer in patients coming into the emergency department (ED).
"[We are] diagnosing rectal metastatic cancer all the time on CT scans that are just completely incidental, because these people have had belly pain for months waiting to get a scope.
"They finally come in because they've got blood coming out of their bottom, and do a CT scan and they've got a cancer, that should have been scoped months and months ago."
Dr Fayerberg, the Northland branch president for the Association of Salaried Medical Specialists, was among 240 doctors who
went on strike for 24-hours last week
over what they say is a crisis in healthcare, with one in five specialist positions vacant.
One gastroenterologist, whom RNZ agreed not to name, said Northland was previously paying locums - and staff doing extra lists - per procedure, the same rate as Auckland, Counties Manukau and Waitematā.
"The rate hadn't changed in five years, which was fine. Then Northland changed to a daily rate in November, which meant a third less pay, and locums just weren't prepared to come for that money.
"We were doing 80 percent of semi-urgent scopes within six weeks, but now it's less than 20 percent."
Some patients, who finally had colonoscopies after months of delays, had been found to have cancer - and for a few, it was no longer curable, the specialist said.
"You have to wonder if there would have been a different outcome if they could have been scoped sooner.
"We rely on locums and doing extra lists to service the population up there - it's high need, high Māori population, higher rates of bowel cancer at younger ages, higher numbers of stomach cancer. So we need to keep on top of the scoping list to diagnose early."
Gastroenterologist Dr Richard Stein, 72, who held a locum clinic in Kaitaia for almost a decade until
it was abruptly cancelled last year
, said if Health NZ was serious about fixing regional inequities, it must recognise the cost to staff.
Gastroenterologist Dr Richard Stein used to run a locum clinic in the Far North.
Photo:
Supplied
"I'm still working, just in the public system because things are just so bad. I'm working in Invercargill, Rotorua and Hawke's Bay. They're all short-staffed."
When RNZ contacted Dr Stein last week, he was reviewing patient notes and test results while recovering from back surgery.
"I cover my patients 24/7."
Health NZ's locum rate to do colonoscopies - about $2000 a day - looked like a lot of money, he said.
"They pay transport, accommodation, maybe a rental car if you push hard. But for some remote areas, it's a day of travel each side, plus you've got all your other costs.
"And if you do colonoscopies in a private clinic, you get $800 in hand and the clinic gets about as much."
One of Dr Stein's former patients, Mindy, who has the inflammatory bowel condition Crohn's Disease, said even getting a form for a blood test was difficult now.
"I did actually have to ring him [Dr Stein] last year because I couldn't get hold of anybody to help me with something, and he some how did manage to use his magic and make it happen for me. But I shouldn't have to do that."
Mindy said her condition was currently stable, but she worried for other people who were struggling to get care, or did not have the ability to advocate for themselves.
"It's unfortunate that's the way it's got to be, but you have to push and make things happen, because no-one else is going to do it for you."
In a written response to RNZ, Group Director of Operations for Health NZ Northland, Alex Pimm, acknowledged demand for gastroscopies and colonoscopies exceeded capacity earlier in the year.
"This was due to some workforce challenges (vacancies and difficulty securing locums to cover) and increased referral to the service.
"This is now mostly resolved and we're pleased to see our waiting times reduce in recent weeks."
The median wait time for non-urgent colonoscopies was now 91 days, down from 130 days in January and Health NZ was recruiting for specialists and nurse endoscopists, and doing extra lists outside when staff were available.
Health NZ's target was for non-urgent colonoscopies to be done within six weeks.
"We are committed to further reducing wait times for these procedures in Te Tai Tokerau."
Health NZ was recruiting for gastroenterologists or nurse endoscopists, utilising extra capacity and additional sessions as kaimahi were available outside of normal working hours, and constantly reviewing waiting lists to book the most urgent patients first.
Since January, it had run nine twilight and three Saturday lists, with two more planned shortly.
Te Tai Tokerau was confident its reviewed locum rates - which were above the collective agreement - were "not out of step" with other districts, Pimm said.
Patients in Kaitaia (who were previously under Dr Stein) were now covered by locum gastroenterologists along with permanent staff, "providing a level of resourcing that exceeds previous capacity".
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