Recent media questions and response regarding colonoscopies

Deborah Woodley, Deputy Director-General Population Health and Prevention.

RECENT MEDIA QUESTIONS AND RESPONSE:

Are the colonoscopy figures available for June and July?

Please find the figures to June in table below [click here].

As you will see, in the table above, there has been a marked improvement in wait times for urgent colonoscopies and a slight improvement for non-urgent procedures to June. This is because DHBs have worked very hard to reduce the backlog caused by the realignment of services as part of the COVID-19 response.

Urgent colonoscopies continued to be performed during the COVID_19 lockdown and DHBs have priortised colonoscopy lists as we moved down the Alert Levels. Patients requiring urgent colonoscopies were treated first , followed by those with a positive test result, in the 10 DHBs offering bowel screening, then non-urgent patients followed by surveillance colonoscopies. In the DHBs that are not providing bowel screening the priority is; urgent patients, non-urgent patients and then surveillance colonoscopies.

In the wider context, demand for colonoscopy procedures has increased significantly across the country in recent years. This is attributed in part to increasing awareness about bowel cancer, probably associated with the roll-out of the National Bowel Screening Programme. Although we are delivering around 60 percent more colonoscopies than we did in 2012/13 we are still being challenged by the increasing demand. In 2012/13 we delivered 32,324 colonoscopy procedures. Seven years later, in 2019/20, we delivered 51,621 (including screening) and 47,755 excluding screening.

# Is the ministry aware of people being harmed or dying because of delayed diagnoses caused by the delays outlined in these figures? Will this likely happen because of the backlogs/pressures?

It is important to note that anyone who requires an urgent colonoscopy, because of symptoms suggestive of bowel cancer, is prioritised. Urgent colonoscopies continued to be performed during COVID-19 Alert Level 4, to ensure patients most at risk from disease were able to access treatment.

# How concerning are the percentages for non-urgent and surveillance colonoscopies?

During June 2020 more colonoscopies were performed than during any month during 2019, reflecting the commitment of DHBs to address the backlog and impact for patients waiting for these procedures. The numbers waiting longer than recommended in the non-urgent category reduced by over a 1000.

# In relation to colonoscopies, when will or should the backlogs related to the lockdown be cleared?

The backlog for bowel screening colonoscopy procedures has been cleared and it is anticipated the downward trend in the numbers waiting for colonoscopy will continue but it may be a few months before this returns to the pre-COVID-19 situation. DHBs are focused on achieving colonoscopy wait time indicators.

We also note that in comparison to NHS England and other international public health systems, New Zealand's screening services are performing well following COVID-19, and the success in managing the pandemic has enabled both elective colonoscopies and the bowel screening colonoscopies to resume.

# What is being done longer term to increase colonoscopy capacity?

In addition to the long term activities to improve workforce capacity, we are also looking at opportunities for reducing colonoscopy demand without compromising patient safety. Two pieces of work are underway in this area. One is a review of surveillance guidelines for polyp follow up. New data means that, for some groups, the interval between procedures can be extended and for others, at lower risk of bowel cancer, follow up can now be a recommendation to participate in the bowel screening programme. This has been a joint initiative between the NSU and the Cancer Control Agency (Te Aho o Te Kahu) working through the National Bowel Cancer Working Group. Development of these Guidelines has been fast-tracked and the final version is due to be released shortly.

Another joint initiative with Te Aho o Te Kahu, aimed at reducing the demand on colonoscopy services for people with symptoms, is in the early stages of consideration. The objective is to assess the potential of using a Faecal Immunochemical Test (FIT) as a triaging tool for patients referred and accepted for colonoscopy. The aim would be to identify and prioritise colonoscopy for those most at risk of having significant bowel disease, including bowel cancer.

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