Te Whatu Ora Southern has been found in breach of patients' rights after a cancer patient was told he has six to eight weeks to live but must wait 12 weeks to see a specialist.
The case prompted an investigation commissioner-led investigation by the Health and Disability Commissioner (HDC) which in a report released on Wednesday found the Southern DHB breached the Code of Health and Disability Service Consumers' Rights in its provision of non-surgical cancer services between 2016 and 2022.
Commissioner Morag McDowell found there were "significant" delays for patients with suspicion of cancer to be seen by a specialist. Notably, she said Te Whatu Ora Southern, formerly the Southern District Health Board, failed to recognise and respond to the clinical risk associated with a lack of capacity within Southern Blood and Cancer Services (SBCS) and cancer patients were harmed as a result.
In 2021, a patient advocate in the Otago/Southland region expressed concerns about delays at the Southern District Health Board's (SDHB), now Te Whatu Ora Southern, non-surgical cancer service to the HDC.
The patient advocate, identified as Ms A, told HDC in 2018 her family were given an expected timeframe of 12 weeks for her husband to be seen by an oncologist after he was told he had around six to eight weeks to live.
Ms A said the situation had a "catastrophic impact" on their family and caused a lot of harm.
"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 [Manatū Hauora] Ministry of Health's recommendations,'" she said.
The report said for the year from July 2020 to June 2021, between 65 percent and 73 percent of patients were receiving their first treatment within 62 days of being referred to a specialist. This is against a target of 90 percent.
McDowell said the case is a salutary reminder of the detrimental physical and psychological outcomes for patients, and of the impacts on families, when the system does not provide timely cancer care.
McDowell said the delays were due to poor overall clinical governance systems, including inadequacies in quality measures and indicators, and poor relationships between clinicians and executive leadership.
Te Whatu Ora Southern breached right 4(4) of the Code, which is the right of consumers to have services provided in a manner that minimises harm to them and optimises their quality of life.
The investigation followed concerns raised by a patient advocate 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.
"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.
"Providers owe a duty of care to people waiting for resource-constrained specialist procedures, particularly when the intervention is time-critical. In this case, it is clear the care Te Whatu Ora Southern provided was not adequate, and patient harm was caused."
McDowell said it was important not to lose sight of the people whose lives were affected by Te Whatu Ora's inaction, and she was also critical of the level of communication and support provided to people on the waitlist.
"In my view patients would have benefited from a more consumer-centric approach that included a single point of contact within the district to ensure they were well-informed, supported and knew what to do if their circumstances changed."
McDowell has recommended Te Whatu Ora Southern:
- Consider establishing a single point of contact for patients on the waiting list for FSA
- Report back on the implementation of recommendations from two previous external reviews on progress with the design, in particular the implementation and embedding of an accountability framework, the establishment of a clear clinical governance framework, the cancer services recovery plan, and the implementation of a three-year workforce plan.
She has also recommended Te Whatu Ora national office:
- Updates the Health and Disability Commission (HDC) on work to address geographic disparities in patient access to cancer services nationally, focusing on timely access to service, the impact of new technologies, and new medication.
McDowell further recommended that Te Aho o Te Kahu Cancer Control Agency provide HDC with an update on progress of its work with Te Whatu Ora Southern to address cancer service delays.
She acknowledged that Te Whatu Ora Southern continues to face significant specialist workforce shortages, which has recently led to the district being unable to provide some cancer services and to ongoing delays in patients receiving FSAs.
"I will be following up on the actions being taken to ensure people with cancer in the Southern region are receiving timely services."
