Southland urology at 'extreme' risk as Health NZ pays locums $3000 a day

Health New Zealand's own briefings rated the risk to Southland's urology service as "extreme" and warned of the possible "collapse of the Southland service". RNZ's Katie Todd reported the briefings on 1 October from documents released under the Official Information Act.

Southland has no permanent full-time urologist. Health NZ approved locum pay of $3000 a day and later confirmed that four locums had been supporting the service, according to the RNZ report republished by 1News.

Health NZ said that by 21 June, 48 Southland patients had been transferred to other regions and 13 operations had been cancelled. By September only five of those 13 had gone ahead. The rest were rescheduled. The briefings show that cancer surgeries were among the cancelled treatments, and that patients were sent to Dunedin or Christchurch.

Dunedin is struggling too. Health bosses wrote that its urology service was "already under-recruited and struggling to meet demand".

The problems started with resignations. Health NZ first confirmed in March that two urologists had resigned, the Otago Daily Times reported. "Additional unanticipated absences" then left the region without a permanent full-time urologist. At the time, Health NZ said one urologist based mainly in Southland and a specialist who visited weekly were seeing patients. It confirmed that two urology positions in Southland were still vacant.

On 2 October, RNZ reported the Royal Australasian College of Surgeons saying the shortage was "an issue beyond just Southland". The college pointed to shortages at Tauranga and Nelson hospitals, which it said use locums regularly. Health NZ has not said how many urologist posts are vacant nationally, or when Southland's two vacancies will be filled.

Health NZ declined RNZ's interview requests. Instead it sent a statement from Southland general manager Simon Donlevy, who said the organisation was putting patients with the greatest clinical need or the longest waits first. "We know that people requiring less urgent treatment may wait longer than we would like, and we acknowledge their frustration," he said. He added that senior doctors and specialists were in demand across health systems around the world, and New Zealand was not immune to that.

Sarah Dalton, executive director of the Association of Salaried Medical Specialists, said the resignations were not normal turnover. She told RNZ that Health NZ should offer specific allowances to recruit and keep specialists in hard-to-staff regions like Invercargill. "I'm kind of gobsmacked that Health New Zealand don't just put their hands in their pockets... It's causing patient harm."

She also warned of a "domino effect" for staff. If a specialist service collapses, she said, the doctors and general surgeons left behind are forced to work beyond their normal clinical scope.

Invercargill resident Ashley Fulton's long-awaited endometriosis operation was cancelled as she walked into hospital for day surgery, because the urologist had quit, she told RNZ. She was treated in Dunedin four months later.

The ODT reported earlier on Winton man David Evans, who needs regular surgery for kidney cancer. He was booked for an operation at Southland Hospital on 14 May. It was postponed and then cancelled, and he said nobody followed up. Craig Ashton, Health NZ's group director of operations for the Southern region, apologised for the delays. He said Health NZ was looking at recruitment, locums, staff from other areas and outsourcing, both locally and elsewhere in the South Island.

Southland was already behind on cancer care before the cancellations. The ODT, citing Health NZ's latest quarterly report at the time, said Southland had the second-longest wait for cancer treatment in the country, after Canterbury. As of March, 18.9 percent of the region's cancer patients had waited more than 31 days for treatment to start.

Prostate Cancer Foundation networker Trish Wright called the situation dire. "I think they're surely absolutely panicking to offer somebody $3000," she told RNZ.

Southland Kidney Society president Nobby Clark said there was "no magic bullet" for finding urologists. Southland is short about one and a half operating theatres, he said.