Waikato DHB gastroenterologist Dr Liz Phillips says the rollout in the Waikato of the FIT bowel cancer screening programme offers real opportunities to change the health outcomes for many New Zealanders.
In her early teens, Liz Phillips briefly contemplated becoming an undertaker, based on her curiosity about death, cryopreservation, and Egyptian mummies.
When it became apparent that career choice might make her look odd among her classmates, she fell back on doctoring, which she had chosen when she was four. More than 40 years’ later, she has no regrets.
Dr Phillips is the clinical lead for Bowel Cancer Screening for the Waikato DHB, in which people aged between 60 and 75, will be invited to complete a faecal immunochemical test (FIT) to detect traces of blood in bowel motions that may be an early sign of pre-cancerous polyps (growths) or
bowel cancer.
The programme will be rolled out in March next year, after being delayed by Covid. With more than 26 years’ gastroenterology experience in the UK, including clinical director of gastroenterology across a three-site hospital in Northumberland in England for six years, she is well-qualified for the role.
She came to New Zealand in 2013 after overseeing a period of significant change in the National Health Service, which meant working “almost every single hour of every single day.”
While that work was stressful, it also encouraged new ways of working that she believes will have benefits for gastroenterology in New Zealand.
This country has one of the highest rates of bowel cancer in the world, and one of the highest death rates. But the number of gastroenterologists per head of population is low, leading to regional socio-economic and ethnic inequalities. A report in 2018 by the NZ Society of Gastroenterology said increases in bowel cancer, inflammatory bowel disease (IBD) and Hepatitis C, plus the demands of the National Bowel Screening Programme were placing huge pressure on GE specialists, and creating long waiting lists for follow-ups.
Dr Phillips says one solution, based on her experience in the UK is to train more nurse scopers (endoscopists) to do colonoscopies on some of the symptomatic patients, which frees up doctors and covers the time when those doctors are on leave, keeping wait times down.
When fully signed off, a nurse scoper could do a standard colonoscopy or upper gastrointestinal (GI) endoscopy and recognise pathology such as polyps. They would also be able to remove polyps of up to 1cm.
One fully trained nurse scoper employed by the Waikato DHB is now doing six colonoscopies a week.
In her role as clinical lead for the National Bowel Screening Programme, she also sees opportunities to get a higher uptake among Māori, who have a high incidence of presenting late with bowel cancer.
Based on the experiences of the Lakes DHB which rolled out the screening programme a year ago, and achieved a 45 per cent uptake, she is focused on working closely with iwi to reduce any barriers to participation. Invitations to participate will be sent out on an area by area basis, to forge local connections.
The messages about the need to screen will be based on a person’s whakapapa, rather than individual health. “It will be about looking after kaumātua so they can look after their family.”
The screening programme is predicted to increase the number of referrals to the DHB by around 28 per cent. While FIT test positive patients will be dealt with through the public health system, some other patients who have symptoms such as a change of bowel habits or a family history of bowel cancer will be outsourced to private hospitals such as Braemar.
The data indicates 1200 colonoscopies will have to be outsourced by Waikato DHB each year.
Dr Phillips says public and private can work well together to ensure everyone gets the treatment they need at the time they need it. It also ensures efficiency.
She says the bowel cancer screening programme provides the opportunity to change a lot of things. “If we don’t the Ministry will check on us. That means people in the Waikato will not get screening. It is a huge incentive for management to get processes right.”
