Originally published by The Press – July 13, 2024
A gynaecologist has accused Health New Zealand of not valuing women’s quality of life as potentially hundreds live with debilitating health conditions with no idea when – or even if – they will get treatment.
The gynaecology unit at Christchurch Women’s Hospital has, for over two years, been unable to accept any referrals unless there is a suspicion of possible cancer due to “capacity constraints”.
Dr Richard French, Health NZ Waitaha Canterbury chief medical officer, said about 20 of the 120 referrals received every week were accepted.
“We continue to accept colposcopy referrals, in line with the National Cervical Screening guidelines, and hysteroscopy referrals for abnormal bleeding,” he said.
Health NZ was unable to provide updated numbers on the gynaecological surgical wait lists without an Official Information Act request. A year ago, 622 women were waiting.
Women’s health conditions like endometriosis, fibroids and heavy bleeding are not cancer-related but can have a severe impact on patients’ quality of life. (File photo)
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Data on Health NZ’s website show by April this year, 27.8% of gynaecology patients were waiting longer than the required time frame for their specialist assessment, while 51% of gynaecology patients had been given a commitment to treatment but weren’t treated within the required time frame.
Since January 2023, three doctors have resigned from the Christchurch Women’s Hospital’s obstetrics and gynaecology department, while other clinicians have reduced their work hours or retired.
“We currently have three vacancies for doctors and are seeking further resourcing,” French said.
Conditions like endometriosis, fibroids, prolapse and heavy bleeding are all medical issues that can have a severe impact on patients’ quality of life and can worsen if left untreated.
However, due to the capacity constraints, referrals for these and other non-cancerous conditions are being declined with no alternative for treatment in the public system.
Katie Daly lives in “excruciating pain” with suspected endometriosis, but can not even get her referral to hospital accepted. (File photo)
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A Christchurch Women’s Hospital gynaecologist, who does not want to be named, said the unmet need was likely huge but not being monitored. “They are definitely not getting on the waiting list, and so the consequences are really difficult to quantify – both medical as well as … the moral distress of clinicians who are unable to provide what we see as very necessary care.”
Katie Daly has been living with “excruciating” pain for years, but has no idea when she’ll be able to get help.
Two years ago, her son was born by c-section due to life-threatening pregnancy complications. Several adhesions were found in her uterus during the surgery. “My bladder was stuck to my uterus,” she said.
“If that was the state of the adhesions two years ago, I can only imagine that it has since gotten even worse.”
Her only option is surgery to have the adhesions removed.
Health NZ says Canterbury’s health system continues to experience a high demand for acute surgery, “which further limits the already reduced planned care capacity”. (File photo)
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Daly’s GP suspects the adhesions might be the result of endometriosis and has provided her with multiple hospital referrals, all to no avail.
Daly has complained to the Ministry of Health and Health NZ, but has been told surgical capacity at the hospital is constrained and referrals are prioritised “to ensure those with the greatest need and potential to benefit from treatment receive the highest priority”.
“I don’t think they actually looked into my specific case to provide a response to me. It was just sort of general messages saying sorry, we can’t help you.”
If she was could afford to see a private gynaecologist, she would have “done it in a heartbeat”, but financially it wasn’t an option.
According to Endometriosis New Zealand, the average delay between onset of symptoms and a diagnosis of endometriosis is over eight years, partly due to long delays to see a gynaecologist.
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“You are a citizen of this country that has a public health system, you pay your taxes, you pay for a service, but you can’t get the treatment you need.”
Tanya Cooke, Endometriosis New Zealand chief executive, said New Zealand’s health system continued to “fail those with endometriosis”.
“This is illustrated by the fact that the average delay between onset of symptoms and diagnosis is over eight years.”
“Many issues” contributed, including the long delays to see a gynaecologist. Even when patients were referred to secondary care, many faced long wait times or their referrals were declined.’
It is estimated at least 120,000 Kiwis suffer from endometriosis, and the condition costs the country an average of $30,000 per patient each year in lost productivity and healthcare costs.
One Christchurch GP, who didn’t want their name used, said while GPs had access to specialist advice on gynaecological issues, they were increasingly required to deal with more complex problems they often didn’t have the skill or experience for.
The gynaecologist said there was “deep concern” among clinicians that Health NZ was not living up to the goals set out in its Women’s Health Strategy to provide more support for women’s health conditions and reduce the inequities in the healthcare sector that affect women, especially wāhine Māori.
“If anything, I would say that those gender inequities are being widened further by the non-acceptance of routine referrals.”
Daly has sent letters to the Ministry of Health and Health NZ asking for a solution to getting access to specialist healthcare, but to no avail.
KAI SCHWOERER / THE PRESS
She said it was concerning that while Health NZ said it was looking at ways to increase surgical capacity, but there was no real plan as to how it was addressing the unmet need in women’s health.
A further concern among doctors was the risk of “deskilling” – having their surgical skills diminish because they were no longer doing surgeries that used to be routine, the gynaecologist said.
“Surgery [and] childbirth have inherent risk associated with them and we can’t afford to cut any corners or reduce anything that will impact on safety.”
Health NZ declined to answer questions about doctors’ concern of deskilling and whether the risk of increased medical complications was being monitored or mitigated.