Internal Health New Zealand briefings have warned of the potential collapse of Southland's urology service, with no permanent full-time urologist in the region and patients being sent as far as Christchurch for treatment.
The documents, released under the Official Information Act, show the service's risk rating was lifted to extreme after two specialists resigned earlier this year. The briefings warned of adverse impacts on patients.
To keep the service running, Health NZ approved locum pay of $3,000 a day. It has since confirmed that four locums have supported the Southland service.
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 had been rescheduled. Some of the cancelled treatments were cancer surgeries.
Patients have been sent to Dunedin and Christchurch, although the briefings described Dunedin's own urology service as already under-recruited and struggling to meet demand.
Health NZ said it would defer surgery only where absolutely necessary and clinically safe.
'No magic bullet'
Health NZ's Southland general manager, Simon Donlevy, said patients with the greatest clinical need or the longest waits were being prioritised, and he acknowledged that people needing less urgent care were waiting longer than the organisation wanted.
Senior doctors were in demand internationally, he said, and New Zealand was not immune to that competition. Health NZ declined interview requests but said it was committed to strengthening its urology workforce.
Cancer Society Southern chief executive Christine Price said hiring urologists needed to be Health NZ's top priority. Invercargill was severely understaffed, she said, which put more pressure on Dunedin, and locums and other short-term measures were not a long-term fix.
Prostate Cancer Foundation networker Trish Wright said the situation was dire and the referrals to Christchurch showed the service was running out of options. She linked the shortage to too few medical graduates being trained or encouraged to stay in New Zealand.
Southland Kidney Society president Nobby Clark said there was no quick fix. The hospital was about one and a half operating theatres short, he said, a shortfall that predated the resignations and meant urgent cases could take theatre time away from planned surgery. "There is no magic bullet," he said.
Sarah Dalton, executive director of the Association of Salaried Medical Specialists, rejected any suggestion the resignations were normal turnover. She called for recruitment and retention allowances for hard-to-staff regions such as Invercargill, and said forcing remaining doctors to work beyond their usual scope was "causing patient harm".
The Royal Australasian College of Surgeons says the problem is not confined to Southland. Its chairperson, Dr Sharon English, said Tauranga and Nelson hospitals also relied on locums, and that New Zealand had lost a number of urology trainees to Australia in recent years because they had no assurance of a job to return to.
