Health NZ's work on medical scanning systems due to be completed

Work replacing unfit systems was due to be done by June this year. File photo.

Photo: Gorodenkoff Productions OU / 123RF

Health New Zealand is due to finish urgent work stabilising highly fragmented medical scanning systems, which have posed a critical risk to health care for years.

A major issue has been old radiology information systems (RIS) failing to link up all of a patient's vital scan reports. This means people can be misdiagnosed, even when the scanning machines themselves are new, because the RIS they link to are not.

Emergency work was launched two years ago. The third part of that began in December and involved replacing unfit systems in the south and central regions and an upgrade in Auckland. All three parts of the work were due to be done by June this year.

Repeated crises since at least 2020 have been marked by internal warnings. "Patient death or life changing delay to treatment could occur," was one warning in 2022.

A 2022 upgrade appeared to make little difference - by 2024 faults were reported to have risen from 30 a year to more than 800.

The failures led to an investigation in Hawke's Bay in 2022-23. A new investigation into radiology was launched in April after a whistleblower alleged Health NZ leaders allowed radiology risks to multiply. That new investigation by a top lawyer is due to be finished in August.

Unable to fix all this in earlier upgrades, Health NZ responded with a three-stage stabilisation programme to run from 2024-26.

Grey Power health campaigner Dr Victor Luca is deeply sceptical and has been unable to get hold of a national stocktake of radiology systems.

HNZ told the ex-mayor of Whakatane it had no such stocktake - and that it was too much work to compile one.

"I was shocked and horrified," Luca said.

Gains have been made in a separate project to boost patient scanning numbers. The government launched it in September and while the Apex union had been issuing dire warnings, it told RNZ on Friday the project was making a real difference.

Grey Power health campaigner Dr Victor Luca

Photo: Supplied

'Immediate action is essential' - first report

Three documents - recently released to RNZ - reveal the issues and more than two dozen fixes due by this month, except for one to upgrade imaging in the northern region, which extends for another year.

Health NZ has been asked for an update on whether it had finished the work, but did not respond by publication time.

"The current radiology systems across the nation are highly fragmented, with significant variation in technology capabilities and commercial agreements between regions," said the first document for the 2024-26 repair programme.

"This fragmentation has led to critical clinical, reputational and technical risks, of which some are being incurred especially in the Te Waipounamu [South Island] and Northern regions."

Most of the specific "risks" have been blanked out by Health NZ on the grounds it was "free and frank" opinion that was not to be discouraged. It did not blank out the more positive-sounding parts.

The critical issue was for significant "emergency" investment to stabilise outdated systems across all regions, said the first document.

"Immediate action is essential."

'This action is critical now' - second report

By the second report, seven groups of major changes were listed but blanked out, as well as nine stabilisation projects.

Health NZ had hit problems with Auckland districts' technology being so fragmented that it might take four years to fix.

Under "Criticality" it said: "This action is critical now to prevent ongoing operational disruptions, reduce the risk of clinical harm, and avoid escalating costs."

"Further endorsement and investment are now required to mitigate Auckland risk whilst future-proofing the system," it said.

The sums involved in the fixes were all blanked out by HNZ, but are in the multi-millions.

'End-of-life systems' - third report

The third and final document listed 10 urgent stabilisation projects needed since December 2025.

The priorities had been matched to funding that was available in 2025-26 and there was a funding gap it was trying to resolve, it said.

"The initiatives have been prioritised based on clinical risk, system readiness, and logical sequencing to reduce immediate patient safety exposure and clinical workflow risks."

The 10 initiatives included more outsourcing in the central North Island, where public-funded scans are done by private clinics. Te Manawa Taki region - Waikato, Bay of Plenty, Taranaki and Tai Rāwhiti - needed breast cancer IT integration. Te Wai Pounamu was down for "replacement of end-of-life systems", as was the central region.

'Six hours to collate'

The third document referred to a national stocktake.

But when Victor Luca asked Health NZ for a stocktake in April, it told him it did not have one.

"Although Health NZ is now responsible at a national level for publicly funded health services, detailed information about diagnostic imaging assets, funding arrangements, operators, and patient throughput is not held in a single national dataset in the form requested," it said.

"Much of this information continues to sit across districts and, in some cases, with individual providers."

HNZ Te Whatu Ora was set up in 2022 in part to centralise health asset management.

The agency also refused to let Luca get the information himself off each of its 19 districts nation-wide.

"One district alone with three hospitals estimated that it would take them up to six hours to collate the information. This district does not have the capacity to do this work, even if funded by the requester, without impacting their service delivery," wrote manager of government services Matthew McLay to Luca.

Luca has been trying to establish how much privatisation of radiology has occurred.

'Scandalous'

When Health NZ rebuffed him, he tried again, even offering to compile a stocktake for free.

"I consider it scandalous that HNZ does not maintain such a catalogue as a matter of routine," he wrote in a draft opinion piece for the local paper.

"How can you run a service if you don't know what tools you have?"

Luca - who was Whakatane mayor until last year and has consulted to the International Atomic Energy Agency - did an initial radiology stocktake in 2021 by sending an Official Information Act request to individual district health boards. It was laborious - but now HNZ had prevented him from doing even that, he said.

Health NZ was asked for comment about this.

'Not lined up' - but getting there

Apex union warned last year that waiting times were blowing out for MRI and CT scans, as exhausted staff struggled with old machines.

But that was being turned around, said national secretary Deborah Powell.

"Certainly the diagnostic boost is now delivering on patients getting their scans quicker ... In Hawke's Bay we've taken MRI wait lists down to almost zero, same in Wellington."

Apex covers 1500 technicians who do the actual scans.

A lot of new scan machines were being put in, and the union had helped expand work hours so weekend and evening scanning was rising.

"Getting the Taupo CT scanner to run more than 0900-1500 Monday to Friday is in our sights," said Powell.

The boost was separate from, but still relied on having the radiology information systems stabilised. The two were not quite in step, she said.

"I'd like to say they're in parallel, but they're sort of not because digital is worst, if I can say that, in the north and the south. But our machine capacity is probably most critical in our sort of middle of the North Island area, so they're not lined up," said Powell.

She was optimistic they would help HNZ get there including with more machines in smarter places, such as in Kenepuru for easy access from Kapiti rather than in Wellington city.

"We're reducing our waiting lists, getting patients through quicker, and also reducing outsourcing.

"And that's bringing more money back into the system, of course, because outsourcing is incredibly expensive."

Technicians faced a shift in work patterns and were "embracing the challenge but... it does take more staff".

"I suspect it will take a couple more years before we have changed the whole system but we are on track and... proving this works."

Sign up for Ngā Pitopito Kōrero, a daily newsletter curated by our editors and delivered straight to your inbox every weekday.