Source: Radio New Zealand, 26 September 2016
A pilot screening programme is still under way at Waitemata
District Health Board but, in the Budget in May, the government
gave a long-awaited green light to national screening, providing
$39.3 million dollars for a staged rollout from next July.
About 3000 New Zealanders are diagnosed with bowel cancer every
year and some 1200 die of it. Early detection is vital, and
officials say in the papers that they believe national screening
will be safe and "very cost effective".
But major progress must still be made towards rolling out
screening nationally, including the establishment of a central
laboratory or coordination centre to manage the sending out of
invitations for screening, and processing results of immunochemical
test kits ( iFOBT) from those who've accepted invitations and taken
the first step. Regional centres are also needed and a national IT
system for the programme.
Officials say $15 million of extra government funding since 2013
has enabled DHBs to make inroads into long waiting times for
colonoscopy procedures - a vital part of screening to diagnose
bowel cancer. By June this year, 92 percent of patients were
getting an urgent colonoscopy within 14 days, compared to 52
percent two years ago. Similar improvements had also been made for
non-urgent and surveillance colonoscopies.
They stress, however, that DHBs have been gearing up since mid
2015 for national screening and if there was a delay in
implementing a programme beyond early 2017 the momentum will slow
and there may be a loss of focus and expertise. "This could result
in growing waiting lists, and the gains that have been made would
be lost," the documents said.
They say every year the start of the programme is delayed will
*a whole cohort of more than 36,000 people over age 74 not being
offered screening in their lifetime
*about 77 cancers not being detected in year one of the phased
rollout for the first three DHBs (Hutt Valley, Wairarapa and
*a delay in detecting an estimated 500 to 700 cancers annually
across the whole country in the early rounds of screening
*an ongoing cost of about $6m a year to maintain the bowel
screening pilot at Waitemata DHB.
National screening will cover those aged 60 to 74, and the pilot
(covering those aged 50 to 74) will come in gradually.
The business case papers confirm that the haemoglobin threshold
of the iFOBT test - the level at which a positive result is
triggered and a colonoscopy called for - will alter. Officials say
this will better match colonoscopy capacity.
Greatest demand on colonoscopies will occur in 2019-20 when an
extra 8300 will be needed. Health Workforce New Zealand says New
Zealand can meet the demand.
Officials, however, also warn about potential for growing health
inequality, with lower take-up by Maori, Pacific and poor
communities. They say targeted actions will be needed.
As well, DHBs must meet treatment costs and will need to submit
capital bids for any extra facilities required. The Labour Party
says that will pose a risk to under-funded DHBs in terms of their
participation and the national rollout.
"This programme is hoped to be delivered but there are fears
that it will not be delivered in time." said the party's acting
health spokesperson David Clark. And I think those fears are
legitimate because the health system is creaking at the seams due
the 1.7 billion in underfunding over recent years by this
Officials say in the papers that bowel screening will be fully
implemented across New Zealand by December 2015 at the earliest,
but "flexibility to extend the final rollout date by another year
may be required for some DHBs to help mitigate the risks of
implementing the programme".
Timetable for rollout:
*July 2017: Hutt Valley DHB, Wairarapa DHB, Waitemata
*Jan 2018: (to be confirmed) Auckland, Canterbury, Capital and
Coast, Hawke's Bay, Southern, Taranaki, Waikato, West Coast,
Whanganui. Also, from January 1, 2018, Waitemata DHB will stop
inviting new participants in the 50-59 age range, in the phase-out
of the pilot
*Dec 2018: (to be confirmed) Bay of Plenty, Counties Manukau,
Lakes, MidCentral, Nelson-Marlborough, Northland, South Canterbury,
Access the key documents on the Ministry of Health's