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Performance audit addressing the issue of prostate cancer

Last change:
30. 3. 2018

Audit data


Audit goal:

To express an opinion on performance concerning the issue of prostate cancer.

Audited period:
From 1.1.2014 until the issue of the draft audit report

Decision no.: 320-1/2017/12
Date: 23. 3. 2017


Corrective measures addressing the issue of prostate cancer

The Court of Audit of the Republic of Slovenia implemented the audit of effectiveness of the Ministry of Health as regards addressing the issue of prostate cancer in the period from 2014 to 15 September 2017. The Court of Audit assessed that in the period covered by the audit the Ministry was ineffective.

Data on prostate cancer incidence show that in Slovenia this is the most common type of cancer in men and the second most common cancer in general. By 2011, the prostate cancer incidence steeply increased, and later reached a more stable trend with somewhat more than 1,400 cases identified per year. The same progression applies to prostate cancer mortality, which is somewhat more than 350 deaths per year. However, the data thereon are available only up to the year 2014, as the manner of data collection and processing has not not provided for more up-to-date data on prostate cancer incidence.

In the period covered by the audit the existing IT support did not enable the Ministry to be provided with correct, accurate and up-to-date data on waiting periods in the field of urology. However, the data the Ministry did hold clearly show that in the period covered by the audit there were on average 434 persons waiting for first examination at an urologist longer as permitted, with an average waiting period thus being 140 days. In 2017, the IT solution eNaročanje for keeping a record on waiting periods for most of healthcare services was established, however, the data gathered by the system were not correct, accurate and up-to-date. The Ministry failed to analyse causes for excessively long waiting periods and did thus not obtain accurate and up-to-date information that would enable the adoption of correct decisions and measures for reducing waiting periods and for assessing the impacts thereof. Nevertheless, in 2016 and 2017 the Ministry adopted several measures which could not solve the concerned issue in a long term.

The Ministry also lacked direct and unrestricted access to data on the number of urologists in the public healthcare network. According to the latest data available (for the year 2014) the number of urologists in Slovenia represents only 46 percent of the EU average. However, in 2016 and 2017 the number of urologists significantly increased due to higher number of medical specialty trainings published. As regards the required number of urologists in future, the Ministry has not yet carried out the population needs analysis respectively established the system for monitoring the population needs to be able to make such estimation. A good knowledge of the current situation respectively staffing coverage and the forecast of future staffing needs and requirements based on the population needs and demographic trends analysis are of significant importance for taking appropriate measures to provide for adequate staffing.

Deciding on human resources development depends also on defining the public healthcare network, which the Ministry failed to do both at secondary and tertiary level and did thus not specify the type and scope of healthcare services guaranteed by healthcare service providers, namely through human and other resources required to implement specific healthcare services. It also failed to prepare analyses in terms of organisation and arrangement of urological services which could provide a basis for possible changes in this field, especially in achieving the aim of more specialised hospitals. In the period covered by the audit, prostate cancer surgeries were performed by 9 healthcare service providers, with the majority of those surgeries (out of 900 per year) being implemented by 2 healthcare service providers.

In the period covered by the audit the Ministry lacked an overview of all available operating rooms and required equipment for the needs of urological treatments. It also failed to perform analyses regarding the sufficient number of personnel required to ensure appropriate and timely urological treatments. The data the Court of Audit obtained from the hospitals show that the lack of operating rooms available and the lack of personnel (mostly urologists, anaesthesiologists and nurses) hinder and disable performance of higher number of surgeries, which extends waiting periods for urological surgeries. In some hospitals waiting periods for certain surgical treatments (benign diseases) were up to two years.

More efficient treatment of patients would be enabled by the computerisation of medical documentation (standardisation of key types of medical records, computerisation of complete data on diseases and unified electronic record of diseases by patients with a malignant disease), which the Ministry failed to provide in the period covered by the audit. Computerisation of such data would also facilitate comparison of treatment in terms of quality between prostate cancer patients and oncology patients in general. The quality of treatment and equal treatment could be significantly improved also through the introduction of clinical guidelines and pathways which in Slovenia have not yet been adopted at secondary and tertiary level.