GUEST BLOG: Ian Powell – A slow moving train wreck: cancer specialist access in New Zealand

Access to oncologist treatment in Aotearoa New Zealand’s public hospitals received a harsh but necessary reminder yesterday (3 April) with to-the-point coverage by Radio New Zealand. It reported cancer support groups saying people are losing precious time, while they wait for treatment.

The specific focus was on Dunedin Hospital which had to stop key services for patients with brain tumours. This is because of the shortage of medical specialists (oncologists) who are required to do this specialised work.

The Chair of the Brain Tumour Support Trust Chris Tse was interviewed on Midday Report: Oncologist shortage a slow moving trainwreck .

Chris Tse: right on the button

Tse knows his stuff. He is also a senior adviser to the International Brain Tumour Alliance and a patient expert for both the European Medicines Agency and European Organisation for Research and Treatment of Cancer. He is also a member of the Australian Cooperative Trials Group for Neuro-Oncology.

The precision of the message

But more than just knowing his stuff, Tse knows how to deliver an important message with precision. In his interview he focussed on glioblastoma is the most common high grade primary brain tumour in adults (fortunately it rarely occurs in children).

Glioblastoma is the most aggressive and most common type of cancer that originates in the brain. It has very poor prognosis for survival (15 months which includes six weeks of radiation treatment).

In stark terms Tse described this cancer as so aggressive that over seven weeks the tumour can double in size. A six week delay in treatment reduces the estimated survival time by three months to 12.

This reduction is obviously devastating for patients. It is also devastating their families and whānau. It affects the amount of quality time patients can spend with them including, for example, grandchildren and at weddings.

For these particular patients it isn’t practical for them to go to other hospitals for the six weeks treatment. This isn’t just because of cost although it is a big enough obstacle in its own right.

In these extraordinarily circumstances they need to be close to their families and whānau. It also erroneously assumes other public hospitals are currently resourced to provide their treatment.

It is particularly appropriate therefore that Tse describing this situation as a slow moving train wreck.

Understanding specialist shortages

No one specialist branch of medicine in hospitals is an island. They are interdependent. Oncology can’t be seen in isolation. In addition to having enough of them, oncologists also depend on other parts of the hospital specialist workforce not having shortages. This includes radiologists for diagnosis and radiation and pathologists who diagnose 100% of all cancers.

Nor is it a Dunedin Hospital crisis. The country’s whole public hospital system is savaged by specialist workforce shortages with the best estimate being around 25%. Like the rest of the population, the specialist workforce is aging and retiring (in some cases earlier because of the impact of these shortages on their health).

Ideally the solution would be training more specialists domestically. But it takes around 13 years or more, including medical school, to train a specialist. Even now medical school intakes are not being adjusted to plan for this.

The failure of successive governments to address these shortages increases the fatigue of the remaining specialist workforce. This is a powerful push factor. Australia with its own shortages, shared specialist training programmes, proximity and an over 60% pay gap provides a powerful pull factor.

As a result of these factors New Zealand public hospitals need to recruit more specialists from overseas. But we can’t compete with Australia because of the pay gap and because of the critical mass advantages for staffing of a much bigger population (for example, being on after-hours call less often).

Politically cynical neglect

Until Aotearoa has a government prepared to address these shortages head-on the crisis they drive will continue. Unfortunately successive governments have been politically cynical.

In the lead-up to the 2008 general election the National Party in opposition openly said there was a specialist workforce crisis in our hospitals. When in government it subsequently deemed that the crisis was no longer a crisis.

In the lead-up to the 2017 general election the Labour Party in opposition attacked National’s handling of the specialist workforce, including in the context of excessive hospital occupancy rates. In government, through neglect and distraction, it allowed the crisis to worsen.

Instead Labour focussed on restructuring that has solved nothing and further delayed addressing the crisis. Worse still, it did this in the midst of a pandemic which further increased the stress and fatigue of specialists.

Time for Health Minister Ayesha Verrall to kick Health New Zealand into action

Te Whatu Ora to date has expressed no commitment to addressing the core issues behind the specialist workforce shortages in public hospitals. It is time for Health Minister Dr Ayesha Verrall to give it the proverbial kick in the bottom to do so.

Otherwise the slow moving train wreck will speed up.

 

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion