Bay of Plenty: Renal patients choosing palliative care over treatment due to lack of resources

A leaked letter from Bay of Plenty District Health Board senior specialists to its chief executive said it had significant concern about resources and planned care. Photo / George Novak

Some Bay of Plenty patients are "choosing to die" instead of travelling for treatment due to a lack of facilities in the Bay, 30 medical specialists have claimed.

Bay of Plenty MP Todd Muller described the claim of patients dying as a "brutal example" of Government underfunding in the region's health system.

But Health Minister Andrew Little said the issues were a consequence of routine underfunding, including by previous National governments, and said the situation was now improving.

Te Whatu Ora - Health New Zealand's interim chief executive saw the letter this month and discussed with the Bay of Plenty team that solutions were needed across the system, with no "silver bullet".

Its planned care task force this week made 101 recommendations on cutting surgical wait times.

The letter was written by senior specialists at the then-Bay of Plenty District Health Board (DHB) to its chief executive Pete Chandler on December 16.

It was published by National Party health spokesperson Dr Shane Reti in a press release this week.

The letter was written by gastroenterology head of department Dr Alex Lampen-Smith on behalf of 29 other named senior medical and clinical staff.

It describes their "significant concern" about the state of resources for the "effective delivery of planned care" at the DHB, which ran the Tauranga and Whakatāne hospitals.

The letter was forwarded to Health New Zealand in June this year as part of a handover declaring risks at each hospital. The new entity replaced all DHBs on July 1.

The letter said: "We believe that Covid is providing an excuse for delays in access to care when the true fault is years of under-investment in resources".

It listed examples of "inadequate" services due to a lack of resources including patients being diagnosed with bowel cancer who had been on its waiting lists for months longer than recommended times, which was leading to palliative rather than curative treatments.

Renal patients were having to travel to Hamilton three times a week for haemodialysis due to a lack of facilities in the Bay.

"It is not an exaggeration to state that patients are choosing palliative care (choosing to die) rather than commence life maintaining haemodialysis due to the unacceptable burden on their quality of life from this treatment delivered from Waikato," the letter said.

Bay of Plenty MP Todd Muller. Photo / Mark Mitchell

Muller said he had heard concerns about people having to travel to Waikato for dialysis due to "inadequate provision" in Tauranga for years.

He said the number of senior specialists supporting the letter was "significant".

In his view, the claim people were dying rather than receiving curative care was a "damning indictment of where we are as a country frankly but particularly as a city".

"This city has grown hugely over the last decade in particular and the funding has simply not kept up.

"It's particularly devastating for the families for them to be able to see that in writing that actually their loved one, according to specialists in the city, could well have been still alive had they had access to the kind of services that if they lived anywhere else, they would get."

During parliamentary question time on Wednesday, Reti asked the Ministry of Health how many people with bowel cancer at Tauranga Hospital were estimated to have progressed from curative to palliative treatment plans due to being on the waiting list months longer than the recommended times.

Health Minister Andrew Little. Photo / Mark Mitchell

In response, Little said answering the question would require "a manual review of every patient's clinical notes".

"Even if a meaningful assessment could be made in each case, the member's question has no timeframe on it and is therefore not possible to answer."

Little said when the letter was sent, 88 per cent of patients in the DHB region who received treatment for upper and lower gastrointestinal tumours did so within the target of 31 days.

In the most recent reported period ending in August, 96 per cent of Bay patients received treatment within 31 days, compared to 88 per cent nationally.

"It's important to note both that the rates of bowel cancer diagnosis have been trending upwards while diagnosis in emergency departments has been declining.

"I'm advised this is almost certainly because of the success of the National Bowel Screening Programme which this Government has invested $203m into after the previous Government didn't properly fund it and which we have now rolled out nationwide."

He said the letter was "very clear" that the issues described were "the consequence of a system that was routinely underfunded for many many years, including the entirety of the previous government's period of time".

"The reasons we are making the changes we are is because we needed to see change and improve performance."

Little told the Bay of Plenty Times he first saw the letter yesterday.

In response to the concerns about Bay people not getting the same level of care as those in other areas, he said the Government's July 1 health system reforms gave it the ability to have the same standards of care in every hospital.

"The reason we changed the health system was that too many district health boards were under-performing and not providing consistent levels of care."

"While I didn't expect the system to have changed within four months, I am satisfied with progress to date."

Te Whatu Ora - Health New Zealand and its Bay of Plenty team were asked what happened after the letter was received, what had been done to address the concerns since and whether further concerns had been raised. Comment from Chandler and Lampen-Smith was also requested.

In a written statement, a spokesperson said the letter was written in December and Margie Apa did not take up the role as interim chief executive until February.

"She saw the letter when she was in the Bay of Plenty earlier this month. She wouldn't want to downplay the concern clinicians have. She discussed with the team there that solutions are across the system. No silver bullet."

The spokesperson said Te Whatu Ora planned care taskforce lead Andrew Connolly's comment would be that the letter highlighted why change was needed and why the taskforce did not focus only on elective operating.

On July 1, New Zealand's new healthcare entities - Te Whatu Ora Health New Zealand and the Māori Health Authority - came into effect, abolishing the country's 20 district health boards.