Melissa Vining tells Southern District Health Board to provide health services southerners deserve

On the morning of 7 July, Southland Charity Hospital board member – and widow of Blair Vining, whose epic fight for an end to the “postcode lottery” was a key driver the formation of our hospital – spoke to the Southern District Health Board at its meeting in Dunedin. The transcript of her speech has since gone viral, with more than 70,000 views on the Southland Charity Hospital Facebook page.

Keep reading, below.

My name is Melissa Vining. I stand here today on behalf of the many Southland and Otago people who have contacted me regarding their dissatisfaction with the performance of the Southern District Health Board, too sick to speak up, in too much pain to speak up or too tired to keep fighting the system when they are fighting an illness, suffering in pain or paralysed with fear from the unknown during a lengthy wait.

Access to quality, timely health care is a fundamental right for every human. The Southern District Health Board is not meeting this basic right across many of the service areas it works in: access to CT scans, MRI scans, First Specialist Appointments, Oncology services, elective surgeries, and important diagnostics services such as colonoscopy.

It pained me to read your many years of board papers, that clearly identify demand exceeding capacity, and your solution to this is to focus on ways to reduce the demand, systems that deny patients the care they need. Patients can not refer themselves, so at some point, a medical practitioner has requested the test, appointment, or scan – not to overload the system but because in their expert medical opinion the patient needs it. I am not denying that at times the referrals may be unnecessary and triaging is required but what you as a DHB is doing in my view is rationing health care services from the very people who pay your wages, the taxpayer.

Fundamentally the NZ health system is flawed. I understand that you have “one pot of money” and that there are many conflicting demands and challenges. However, instead of just looking at rationing, I encourage you to take a different view. Look at what the need is and request the money from the government accordingly. Take a stand: tell us the public what our healthcare costs need to be to provide the service we deserve and need, demonstrate leadership, and look at improving efficiency and patient experience with the dollars you do have.

Today I am here to address the underperformance of the endoscopic services and the failings of the SDHB management to rectify these issues in a timely manner.
3 reports in 3 years, and still patients are suffering.
I do not have a medical degree or background and yet the recommendations from those reports seem clear:

• namely dysfunction in the department, the reports indicate the dysfunction comes from Specialists feeling their patients were being harmed by their referrals being overridden and denied care. This issue has been left unresolved for many, many years, and shows a complete failure and lack of competence from Senior Management. I cannot understand how it is even medically ethical for one Doctor to override another doctor’s medical opinion without a clinical assessment.

• The inappropriate use of national referral guidelines to effectively ration access to colonoscopy. Clearly, this tool was developed for non-GI specialists, it should not have taken two external reports to clarify this. Again, in my view a failing of Management to identify and resolve, still no one has been held accountable for the incorrect implementation of this tool that has caused irreversible harm to patients, as recently as in the last two weeks. This was a clear recommendation over a year ago.

• The Endoscopy User Group was identified as dysfunctional and remains that way to this day, meetings have not occurred for the last two months, with the explanation provided to me it was because of COVID. A very weak excuse given the rest of the country managed to continue utilising technology to conduct meetings.

• Despicable, unacceptably long waits. Bowel cancer if caught early is curable, MOH guidance requires DHB’s to provide colonoscopies within the following timeframes:
– Within 2 weeks for urgent patients
– Within 6 weeks for non-urgent patients
– Within 4 months for surveillance

The people of Otago and Southland are experiencing waits of up to 11 months. It is despicable. We all accept that the MOH required services to be suspended during the lockdown but you all knew the service was going to be on hold and just like the rest of the country you knew when we were moving out of lockdown. During lockdown, you could have been like the many business owners that worked tirelessly planning for how to recover and being ready to go. The data suggests that post lockdown you provided colonoscopies to screening patients and sent out blanket 7 and 8-month wait letters to symptomatic patients like Jason Mitchell, medically and ethically symptomatic patients should have been seen first.
You report wait times of 7 and 8 months but this in some cases is 10-11 months, as your measure does not take effect until that letter is generated. In my view, the time should start from the date of referral.

Systems, tools, and poor management aside, the facts still remain that Southern Region; Otago Southland have one of the highest rates of colorectal cancer in the country, one of the highest rates of spread beyond the bowel at the time of treatment, one of the highest rates of emergency surgery for colorectal cancer and still one of the lowest colonoscopy rates, SDHB has been congratulated on its performance with the bowel screening programme. Bowel screening is something I would like to see available to all New Zealanders 50 and over however not at the expense of symptomatic patients.
Chris, you have always been communicative with regards to my concerns and I appreciate that.

You have assured the public that it was your job to deliver colonoscopies in a timely manner and there was no need for a charity hospital, but here we are nearly a year on and we are no further ahead. The people of Southland and Otago deserve better.
The community should not have to build their own hospital, a 40-year-old widow should not have to continually point out this hospital’s failings and advocate for the people. I ask you and the government to provide the health care services we deserve.

You as a board have a simple responsibility to the people of Otago and Southland to provide health services through improving, promoting, and protecting the health of our region. Under resourcing and rationing adversely affects the medical professionals as well as the patients they serve, these long waits and delays are not only cruel, and inhumane but they kill people.

I thought what happened to Blair was a one-off, that he fell through the cracks, increasingly it appears to me that what happened to him was a policy decision.

As a board I am pleading with you to dig deep, show leadership, monitor hard, provide resources and deliver what the people of Otago and Southland deserve – access to quality health in a timely manner.