Kenwright said the pathology workforce is \u201cat a cliff edge\u201d with an ageing workforce, and not enough staff to process the surging number of cases that need investigating.<\/p>\n
Kenwright said while cases where cancer is suspected are prioritised, there will still be \u201cundiscovered cancers\u201d that sit in piles of slides in a \u201ctraffic jam\u201d waiting to be diagnosed.<\/p>\n
Even urgent cases, which should be processed in 48 hours, take up to two weeks at the moment, she said. <\/p>\n
Slides containing tissues sit in piles waiting to be examined and diagnosed.<\/p>\n
This Wednesday, the age for free bowel screening will be lowered to 56, and in March next year an additional 786,000 women will be eligible for free cervical screening<\/a>.<\/p>\n When a procedure like a colonoscopy is performed, that procedure alone doesn\u2019t determine if a patient has cancer. Any suspicious tissue is sent to an anatomical pathologist who studies the sample, decides whether it\u2019s cancerous, and reports the result.<\/p>\n The samples are cut into paper-thin strips and examined on slides under microscopes.<\/p>\n Health Minister Simeon Brown said this month the Government had \u201cexceeded\u201d targets with 89,039 procedures delivered across radiology, colonoscopy, cardiac and colposcopy services as a result of a $65 million boost in funding<\/a> for such tests last year.<\/p>\n But Kenwright said pathologists have received no additional funding or resources to diagnose results faster.<\/p>\n \u201cIt\u2019s just moving the waitlist. Funding extra procedures translates to more biopsies arriving at the laboratory bench, but nobody funded people at the bench,\u201d she said.<\/p>\n Kenwright supported expanding screening, including moves to lower the age of free bowel screening, but said \u201cnot one dollar\u201d was set aside for the pathologists who are already 30 specialists short.<\/p>\n She said the predicament for pathologists was \u201cdistressing\u201d because they didn\u2019t want patients facing uncertainty, or added complications, because of delayed results.<\/p>\n Asked what the worst-case scenario could look like, Kenwright said there are situations overseas where patients wait up to three months for results.<\/p>\n \u201cIt would be disastrous to get to that stage.\u201d<\/p>\n The RCPA said the minister needs to fund 23 pathology training positions \u201cnow\u201d \u2013 which would cost $3.7m annually \u2013 to support the Government\u2019s screening initiatives.<\/p>\n \u201cIt\u2019s a relatively small investment to ensure that the diagnostic engine of our health service actually works,\u201d Kenwright said.<\/p>\n The Herald sent a series of questions to Brown \u2013 most of which he did not answer directly.<\/p>\n He acknowledged pathologists play an \u201cessential role\u201d, and that lowering the bowel screening age and making cervical screening free will add to demands on labs.<\/p>\n Asked why specific funding for pathology had not been set aside, he said Health New Zealand (HNZ) was talking with pathologists to \u201cunderstand and confirm\u201d funding requirements.<\/p>\n \u201cI expect HNZ to keep working closely with the sector, so patients receive their results as quickly as possible, and I encourage the college to continue that engagement.\u201d<\/p>\n However, the RCPA\u2019s policy and advocacy manager, Frances Cox-Wright, told the Herald the group\u2019s costed pitch for extra staff was sent to HNZ almost a year ago.<\/p>\n She said the RCPA was subsequently told cash to expand pathology immediately wasn\u2019t available, which is why it urged the minister to act.<\/p>\n She said Brown regularly funded new initiatives that rely on pathology but wouldn\u2019t fund pathology itself.<\/p>\n \u201cIt\u2019s within the minister\u2019s power to allocate the modest $3.7m a year needed to train more pathologists and begin to secure the future diagnostic workforce for New Zealanders waiting on a diagnosis,\u201d she said. <\/p>\n Brown did not say why he could not commit to the plan put forward by the RCPA. <\/p>\n No response to \u2018urgent\u2019 concerns<\/p>\n Kenwright, who\u2019s a gynaecological pathologist, wrote to Brown on September 4 to seek \u201curgent\u201d clarity on the Government\u2019s \u201ccervical cancer elimination plan\u201d.<\/p>\n The plan, which includes making cervical screening free in March, involves setting targets for vaccination<\/a>, screening and treatment with the aim of cutting cervical cancer rates to fewer than four cases per 100,000 women annually by 2040.<\/p>\n On average, 179 women are diagnosed with cervical cancer annually and 52 die from the disease each year.<\/p>\n In its strategy document, Health New Zealand said increasing screening would increase demand on cytology, colonoscopies and anatomical pathology.<\/p>\n The document said the pathology service and capability \u201cwill need to be monitored\u201d.<\/p>\n The word pathology features six times in the 46-page plan, but at no stage does it refer to expanding or funding the pathology workforce or infrastructure.<\/p>\n In Kenwright\u2019s letter to Brown, written on behalf of the RCPA, she questioned how the elimination plan would succeed.<\/p>\n \u201cA programme that depends on pathology at several points cannot deliver on its targets if pathology capacity is left unplanned for,\u201d she said in the letter.<\/p>\n Brown is yet to respond to Kenwright\u2019s September 4 letter.<\/p>\n Patient advocate Malcolm Mulholland, who is chair of Patient Voice Aotearoa, said a commitment to boost the pathology workforce should\u2019ve happened months ago.<\/p>\n \u201cIt should have been front of mind before they extended the screening programme because we already knew that sector was under the pump in a big way,\u201d he said.<\/p>\nPathologists warn the five-week wait for biopsy results will increase without additional resources.<\/p>\n
Health Minister Simeon Brown has acknowledged that pathologists play an \u201cessential role\u201d. <\/p>\n
Diane Kenwright says pathologists want Simeon Brown to action their request to fund more pathology training positions.<\/p>\n
Patient advocate Malcolm Mulholland says the pathology sector is extremely stretched and should have been given funding before the Government’s screening plan announcement. Photo \/ Mark Mitchell<\/p>\n