The Cancer Society has expressed concern that critical cancer care targets, such as monitoring the time from diagnosis to treatment, do not feature in the 12 new health system indicators in an open letter to Hon Minister Little.
The letter details our position and responds to comments that the Cancer Society is ‘off the planet’ and ‘misinformed’.
Lucy Elwood, CEO of Cancer Society of New Zealand says:
“We are not ‘off the planet’, we are on the ground. Around the clock we are assisting those affected by cancer and in our work, we can clearly see that what we know of people’s experiences is not reflected in the new health system indicators. We’re worried this signals that cancer care is not considered a priority.”
“We know that the Government tracks lots of pieces of data about the performance of the public health system and cancer outcomes. But we’re concerned that a cancer treatment indicator is no longer included in the “top table” list of health system indicators, especially as the Government has said these reflect the Government’s priorities and areas where improvement is needed most. Cancer is New Zealand’s biggest killer and needs to be a priority.”
The Cancer Society exists to support all New Zealanders affected by cancer working within communities through services like supportive care nurses, transport to treatment and accommodation.
“We work tirelessly to ensure that the 71 New Zealanders who receive a diagnosis every day in Aotearoa can turn to us for support during one of the most difficult times of their lives.”
“While we certainly acknowledge that much progress has been made, for example the establishment of Te Aho o Te Kahu, the Cancer Control Agency and a national cancer plan, we are acutely aware there is much that we can improve to deliver better outcomes.”
“This is also not only an anecdotal assessment – cancer is New Zealand’s biggest killer. New Zealand is at or near the bottom of comparable countries for many cancer outcomes.” ( New Zealand Cancer Registry, International Cancer Benchmarking Partnership)
“Cancer care must remain a priority within the new health system.”
“As the Cancer Society, it is our responsibility to unashamedly be the voice of those we support and advocate for world class cancer care for all New Zealanders.”
Minister Little. The Cancer Society is not "Off the Planet", we're on the ground. Across the country we are based in our communities and see the harm inflicted by cancer every day of every year.Lucy Elwood, Chief Executirve, Cancer Society NO
Open letter to Hon Minister Andrew Little
Monday 16th August 2021
1 Museum Street
Dear Hon Minister Andrew Little,
Cancer Society is on the ground, not off the planet
We’re troubled by your comment that Cancer Society is “Off the Planet” for suggesting that the newly announced Health System Indicators should include a strong measure for patients with cancer. Initially we wondered if you were misquoted, but in later tweets you doubled-down on this language (e.g. “They are off the planet when they say this isn’t happening when it is”). We thought we’d write to clarify our position. We are hopeful that we have each misunderstood what the other is communicating.
We’re not off the planet, we are on the ground. Across the country we are based in our communities and see the harm inflicted by cancer every day of every year. Each year in New Zealand, around 25,000 people are diagnosed with cancer and about 10,000 die from cancer. Cancer survival rates in New Zealand are not improving as quickly as survival rates in other high-income countries and there are shocking inequities of cancer outcomes within New Zealand - for example, Māori are twice as likely to die from cancer as non-Māori. We see the harm of this every single day.
The Cancer Society is here for every New Zealander, no matter what cancer. We provide supportive care services, including a helpline, counselling, transport, and accommodation to individuals and their whānau during treatment. For every paid staff member, we have 14 volunteer staff members in our communities who help us to provide these crucial services. Last year despite all the uncertainties and difficulties of Covid, over 8,000 cancer patients referred to us were helped by our services. We know from previous engagements with your officials that the public health system relies on our services. For example, our accommodation and driving services are essential in helping cancer patients to get to treatment. We also know from the 874,572 km that we drove around country last year and the 49,340 bed nights that people stayed in our lodges last year what these services mean to these patients.
In the past few years, we’ve been encouraged by progress made by the Government. We support, for example, the goals in the Government’s New Zealand Cancer Action Plan 2019–2029 | Te Mahere mō te Mate Pukupuku o Aotearoa 2019–2029 and we support the establishment of Te Aho o Te Kahu |The Cancer Control Agency. We are hugely supportive of the Government’s commitment to:
- A health system that delivers consistent and modern cancer care.
- New Zealanders experiencing equitable cancer outcomes.
- New Zealanders having fewer cancers.
- New Zealanders having better cancer survival, supportive care and end-of-life care.
We remain hopeful that, in addition to setting these goals, the Government will pursue them as a key priority.
Given this context, you can imagine our disappointment when the 12 Health System Indicators announced earlier this month didn’t include a measure that would track outcomes for people with cancer – especially when the previous health targets had included a faster cancer treatment target. Cancer is our country’s biggest killer and the burden of disease means that a specific high-level indicator for patients with cancer is justified. The complexities of cancer treatment, also mean that cancer outcomes can be a very useful indicator of the performance of the public health system. If you can improve the public health system to deliver equitable and modern cancer care, then benefits from the system changes made to achieve this will flow to other aspects of the public health system.
The announcements on the new indicators explained that the initial set of 12 national, high-level indicators aligned with the Government’s priorities and the areas where improvement is needed the most. We’re concerned. To us the omission of a cancer treatment target from this list suggests that improving cancer outcomes isn’t one of the Government’s top priorities.
Cancer Society doesn’t dispute that there is more being done on cancer than previously, and there are several hundred detailed measures for cancer. We acknowledge with thanks the work being done by Te Aho o Te Kahu to improve cancer information. But we are troubled that there isn’t a focused measure at the top table.
We hope the Government reconsiders the list of Health System Indicators and make a cancer treatment indicator a key priority too. We’d encourage you to be bold. For example, the Government could support a broader indicator than the previous faster cancer treatment target (such as an indicator of 62 days from diagnosis to first treatment).
We’re very aware (as you have highlighted) that the previous health targets still form part of DHB accountability arrangements for 2020/21, although we understand they have technically been downgraded from a target to being reported as a measure. However, what will happen when DHBs are disestablished and the new Health Authority is established? It is important the Government monitors whether cancer inequities and outcomes improve as the health system moves through this significant period of change.
The latest set of reports against the previous health targets suggests there is still more to be done. The target is 90% of patients receiving their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks. Yet for the quarter ended April 2021, the achievement against the target was 85.1% at a national level, and the DHB level data highlights the true extent of the post code lottery issues that exist. For example, only 3 DHBs actually met the faster cancer treatment target in that quarter and the performance in some DHBs raises acute concerns about waiting lists and inequities in those areas (e.g. Southern DHB achieved 64.9% and Northland achieved 68.7%, whereas Canterbury achieved 94.9%). New Zealanders deserve a better public health system.
As for us, the Cancer Society will unashamedly keep advocating for New Zealand to deliver the cancer outcome improvements we see in similar countries (which are also on this planet). We will also keep our feet on the ground in our communities, where our whānau are living with a heavy cancer burden every day, and we will continue bringing this patient voice to our engagements with you and your officials.
Ngā mihi nui
Chief Executive / Tumu Whakarae
Cancer Society of New Zealand, National Office