Adult cancer treatment services have been left in crisis by the shift in services to Fiona Stanley Hospital, with patient safety and clinical outcomes “significantly compromised”, a taskforce has found.
The 20-member taskforce headed by West Australian surgeon Professor Christobel Saunders was commissioned in April to scrutinise issues confronting adult cancer services in WA.
The taskforce was blunt in its assessment of the impact of dramatic changes in cancer services on the level of care and the outcomes for patients.
“These issues include the degradation of provision of adult cancer care, which is in part due to the move of large sections of cancer services provision from Fremantle and Royal Perth hospitals to Fiona Stanley Hospital in February 2015,” the report said.
“This has tipped an already stressed cancer care system into a position where patient safety and outcomes are now significantly compromised.”
The taskforce included surgeons, oncologists, pathologists and other medical specialists.
Its report was completed on June 16 but has never been made public by the State Government.
In particular, the closure of Royal Perth Hospital medical oncology services, whilst still retaining high volume cancer surgery at the hospital, has resulted in fragmentation of care, delays in treatment and compromised patient safety.
Taskforce report
Health Minister Kim Hames has denied he buried the taskforce’s report.
Dr Hames said transitioning services to a new hospital is always a difficult task.
“We’ve got a brand new $2 billion hospital that is a state-of-the-art hospital,” he said.
“But you’ve got to get to it in the first place — you’ve got to move patients, you’ve got to move equipment, you’ve got to train staff — all of those things take time and they’re not without their complications, as we’ve seen.”
Dr Hames said wait times for cancer patients were coming down and Fiona Stanley Hospital had appropriate staffing levels.
“The trend is down, the waitlist numbers are coming down, and the wait times are getting shorter,” he said.
“We’ve got lots of staff, in fact we have overstaffed levels for a standard hospital of that size … so no, it’s never been an issue of staffing.”
A copy of the report has been released by the Opposition, which has described the findings as “shocking”.
“This is a damning indictment of the Government’s management of cancer services across Western Australia,” Opposition Leader Mark McGowan said.
“This report is one of the most shocking reports I have ever seen in my life.”
The report found that the shift of cancer care services to Fiona Stanley Hospital had led to a major reduction in cancer services at Royal Perth and Fremantle, with a damaging effect on patient care.
“In particular, the closure of Royal Perth Hospital medical oncology services, whilst still retaining high volume cancer surgery at the hospital, has resulted in fragmentation of care, delays in treatment and compromised patient safety,” the report said.
“This inevitably leads to serious and significant psychological impacts as well as potential physical ones.”
The taskforce found evidence that the problems with cancer services had undermined the confidence of cancer patients.
“There are anecdotal reports of a sharp increase in presentations to cancer counselling services in recent months, as patients fear their cancer outcome has been adversely affected by perceived delays,” the report said.
Opposition health spokesman Roger Cook said there could be no other conclusion than outcomes for patients had deteriorated because of the problems.
“There can only be one result if patients are being made to wait longer, and that is patients unfortunately are potentially dying and certainly getting more adverse outcomes because of this situation,” he said.
Patients wait up to six months for diagnostic treatment: Labor
Mr Cook said some patients were waiting six months for diagnostic surgery to determine if they had cancer instead of the standard six weeks.
He said patients who had a positive screening test for bowel cancer were being forced to wait four months for diagnostic treatment.
Mr Cook laid the blame at the foot of the Government.
“We see a series of government decisions about scaling down the radiation services and oncology services at RPH, eliminating specialist nurses in cancer treatment, FTE caps on the number of staff working in the cancer area,” Mr Cook said.
“All these decisions, made by the Barnett Government, which have gone to put our cancer services in Western Australia in a crisis situation.”
The report made 11 urgent recommendations, including the re-establishment of the Level 5 oncology service at Royal Perth Hospital.
It said the abolition of the integrated cancer care service at RPH had adversely impacted on patient care and the workload of medical staff.
“Patients are currently often undergoing surgery at RPH, chemotherapy at FSH, and radiotherapy at SCGH with poor communication between the sites, fragmentation of MD care and in some instances a breakdown of the MD meetings which coordinated the care, in others an inefficient replication of meetings at two sites,” it said.
Report recommends reinstating specialist cancer nurses
Another recommendation called for the rapid reinstatement of specialist cancer nurses at Fiona Stanley and Royal Perth.
“The abolition of key cancer nursing specialist positions in the move to Fiona Stanley Hospital has resulted in a dysfunctional approach to cancer care that has led to poor coordination or care, significant and unsafe delays in treatment and inefficient use of scarce specialist doctors’ time,” the report said.
The taskforce also expressed deep concerns about the impact of service changes on the coordinated medical care of patients using multidisciplinary teams.
“This has resulted in fragmented patient care, patients not receiving timely adjuvant treatment and very poor access to patient records resulting in numerous clinical incidents — not patient notes when a patient comes to theatre, no information available for the MD team meeting discussion, not information of prior chemotherapy treatment when attending for therapy, very frequent lack of notes available when a patient attends outpatient clinics,” the report said.
The taskforce said scarce time was being used trying to manage and work around these problems, placing additional pressure on medical staff.
“Another very concerning result is that a number of senior clinicians have resigned or refused to participate in MD care due to unsustainable workload and the current situational risks,” it said.
The Opposition said the Government should act immediately to address the issues raised in the report