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Monday, 20 August 2018
Page: 7663


Dear Mrs Wicks

I refer to your letter of 21 May 2018 seeking my response to a petition regarding colonoscopy waiting times. I regret the delay in responding.

The Australian Government is committed to reducing the morbidity and mortality from bowel cancer in Australia through early detection. The National Bowel Cancer Screening Program (NBCSP) is a population-based screening program, initiated by the Government in 2006 in partnership with state and territory governments, to help detect bowel cancer early. Bowel screening is recommended for all Australians aged 50 to 74, every two years. The NBCSP sends eligible men and women a free screening kit that can be completed at home. Those who receive a positive screening result are encouraged to see their GP and seek diagnostic assessment, usually colonoscopy. An effective bowel screening program relies on underpinning colonoscopy services that reflect quality, consistency, accessibility and appropriateness.

I note that the petition incorrectly states that 90 per cent of NBCSP participants wait between 116 and 181 days for colonoscopy after a positive screening result. This has been misrepresented from data published by the Australian Institute of Health and Welfare (AIHW); between 1 January 2016 and 31 December 2017 the median waiting time for NBCSP participants with a positive screening result was 54 days, ranging from 40 days in Victoria to 67 days in Tasmania. Nationally, only 10 per cent of NBCSP participants who received a positive result waited longer than 147 days for a colonoscopy. This is broadly in line with the National Health and Medical Research Council (NHMRC) endorsed Clinical Practice Guidelines for the prevention, early detection and management of colorectal cancer, which recommends a maximum colonoscopy waiting time of 120 days from a positive screening result.

It is important to note that this is a broader issue than demand relating to the NBCSP. The NBCSP is not envisaged to significantly contribute to colonoscopy waiting times. From 2019, it is expected the NBCSP will contribute only 10 per cent of colonoscopies in Australia. There is evidence of widespread inappropriate use of colonoscopy as a first line screening tool and this is likely to be contributing to unnecessary demand and waiting times, and potentially increasing the risk of harm to patients.

The Government is committed to reducing colonoscopy waiting times by supporting appropriate use of colonoscopy services and reducing demand for unnecessary colonoscopy. The Medicare Benefits Schedule colonoscopy items are currently under review by the Gastroenterology Clinical Committee and revised items are anticipated to be released by the end of 2018. In addition, the Government is funding the revision of the NHMRC Clinical Practice Guidelines for Surveillance Colonoscopy. Service providers should be encouraged to only use colonoscopy in-line with relevant clinical guidelines, noting that appropriate screening for average risk people is through immunochemical Faecal Occult Blood Testing, which the Commonwealth funds for the target population through the NBCSP.

Planning and delivery of colonoscopy services, including management and reporting of waiting times and adverse events, is managed by state and territory governments and the private sector. As with other hospital procedures, the Commonwealth does not specifically fund colonoscopies. The Commonwealth contributes 45 per cent of the growth in the efficient price to deliver public hospital services. This includes elective surgery procedures such as colonoscopies. This funding is provided on the basis of activity. When more public hospital services are delivered, e.g. more surgeries performed, the Commonwealth contributes funding for the increased activity. In 2016-17 the Commonwealth also contributed $184 million for colonoscopy services through Medicare benefits.

As agreed at the recent COAG Health Council meeting, the Government will work with states and territories to develop an action plan that reflects our respective roles in ensuring capacity can meet the demand for colonoscopy services into the future, beyond the small percentage generated by the NBCSP.

The Government has invested significantly into the quality of colonoscopy services in Australia since the commencement of the NBCSP. This includes $1.32 million funding to the Gastroenterological Society of Australia to implement a skills development and re­certification program for colonoscopists and practitioners. The Government is also funding the Australian Commission on Safety and Quality in Health Care to develop and implement a national safety and quality model for colonoscopy services in Australia.

While colonoscopy performance measures are not reported at a national level, the AIHW publishes annual monitoring reports against NBCSP key performance indicators, including waiting times and adverse events following colonoscopy. The AIHW will also be tasked with including a 120-day reporting timeframe for waiting times to colonoscopy in future reports.

Thank you for writing on this matter.

Yours sincerely

from the Minister for Health, Mr Hunt