Dialogue: Gov't shuns remedies as cancer waiting lists grow

By PAUL HUTCHISON*

In July 1999, 70 per cent of cancer patients waiting for radiation therapy in Auckland were treated within the recommended time. By last November less than 41 per cent were treated on time.

The statistics are only marginally better around New Zealand. International guidelines recommend radiation therapy within six weeks from decision to treat.

In New Zealand some patients have had to wait up to 20 weeks. Some women with breast cancer have chosen to have a radical mastectomy rather than wait to have radiation therapy at an unspecified time.

The Government has failed to fix a basic health requirement of providing timely treatment for patients with cancer.

Many patients and their families have expressed fear and frustration with the uncertainty of not knowing where, when or how they might be treated.

The shortage of radiation therapists is a major problem which is being addressed but the seriousness of the situation calls for other remedies.

Senior oncologists and surgeons in public and private practice, radiation therapists and industry negotiators have indicated that, given the will, all cancer patients could be treated in a timely way in New Zealand, but that the Government and the Ministry of Health have failed to do what is necessary.

Mechanisms that the Government could use to make this happen include:

* Allowing public radiation therapy facilities to be used for contracting out to alternative providers during hours they are not being used.

* Re-establishing contract teams of Australian radiation therapists to treat New Zealand patients in New Zealand centres. (This happened successfully in Auckland in 1996, 1997 and 1998).

* Fast-track a private radiation therapy facility in Auckland (possibly a joint venture).

* Establish an Auckland radiation therapist training programme.

* If the situation becomes worse, consider radiation therapists to be an essential occupation. There are provisions for this in the Employment Relations Act.

It is clear from the ministry's report Improving Non-Surgical Treatment Services in New Zealand that medium and long-term planning for infrastructure and staffing is central to a sustainable and successful system.

Government action has been far too slow and hesitant. The Health Minister has simply not responded adequately to a crisis that senior oncologists around the country describe as dire for patients with cancer.

Annette King has kept denying cancer therapy is a resourcing issue and yet it took tremendous pressure to persuade the Government that flying patients to Australia could be used as an interim, if somewhat unsatisfactory, measure.

While patients are grateful to receive treatment, it seems madness to pay for them to go to Australia if it is possible to treat them here.

The Government has been ideologically against the practice of contracting out public facilities to private providers. But this has happened successfully in many parts of the country, such as National Women's (obstetric facilities), Masterton (surgical facilities) and Taranaki (radiology and opthalmology).

In Auckland radiation therapy does not occur after 9.30 pm or in the weekends, except in acute or emergency cases. There are technical problems associated with the physicists needed to run the linear accelerators and the radiation therapists' award is a problem for weekends but, given the go-ahead by the Government, most believe there is capacity within Auckland to make greater use of the existing infrastructure.

Those working outside ordinary hours would have to be well paid. The Government could contract out the facility to either public or private providers. Equity of access to all patients must be maintained and quality of care is paramount.

Once a year, in 1996, 1997 and 1998, teams of Melbourne radiation therapists came to Auckland Oncology Service and treated patients to reduce waiting times. The initiative was successful. The Australian teams saw their five or seven-week stints in New Zealand as a working holiday.

Although Australia is experiencing its own shortage of radiation therapists, such a system could be reinstated and would be good for networking and improving standards of care on both sides of the Tasman.

The establishment of a private radiation facility in Auckland would provide choice for the first time in New Zealand. When choice is available, there are signals for private and public services to compare and improve their quality and efficiency.

The Government has recently moved to double the number of radiation therapists trained in New Zealand and has shifted the course from the Central Institute of Technology to the University of Otago campus at Wellington. Although it is important this arrangement is given a chance to work, there is strong argument for a programme to be established in Auckland.

Nearly half of all New Zealand radiation therapists FTE positions are at Auckland and Waikato oncology services. Further, potential students from the upper half of the North Island must travel to Wellington and this excludes many mature students who have home responsibilities and who are likely to stay in New Zealand once qualified.

The University of Auckland and Unitec have each expressed interest in providing a training programme for radiation therapists. Unitec has a successful medical imaging training programme and believes it could provide an excellent complementary radiation therapy programme. The Associate Minister of Tertiary Education, Steve Maharey, has vetoed the idea. Yet an alternative provider would help to solve our serious training and retention problem.

* Dr Paul Hutchison is National's associate health spokesman.

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