Ministry of Health: What further progress has been made to implement the Recommendations of the Cervical Screening Inquiry?
Foreword
Organised cervical screening was established in New Zealand in 1990. The National Cervical Screening Programme (the Programme) consumes significant public resources, with a budget of more than $30 million for 2003-04, and a further $6.5 million for the personnel and operating costs of the National Screening Unit (NSU) – which delivers the Programme and BreastScreen Aotearoa.
Theoretically, organised cervical screening can be effective in reducing the incidence of cervical cancer by as much as 91%, with three-yearly screening. Since 1990, both the incidence of, and mortality from, invasive cervical cancer have declined in this country. Cervical cancer rates decreased by 39% from 1988 to 1997, and mortality rates decreased by 44% during the same period.
However, cervical screening is not without its limitations, and even high quality screening programmes will not be able to prevent all cases of invasive cervical cancer. These limitations can be minimised if screening is properly organised, and appropriately monitored and evaluated.
The Ministerial Inquiry into the under-reporting of cervical smear abnormalities in the Gisborne region raised some serious concerns about whether the Programme is as effective as it could be. The Committee of Inquiry’s report, released in April 2001, made 46 recommendations for future action to improve the Programme.
Since then, the NSU and other parts of the Ministry of Health have been working to implement the recommendations. Progress has been monitored, and has also been reviewed by an independent expert, Dr Euphemia McGoogan, who has reported twice to the Minister of Health. My predecessor also reported (from a lay perspective) in February 2002. These reports raised additional issues and recommendations to improve the Programme.
In this follow-up review, I found that progress is continuing to be made in implementing the recommendations. However, the most significant issues for the future will involve ensuring that the appropriate assurance processes are in place around the quality aspects of the Programme – such as completing the Audit of Invasive Cervical Cancer, fully implementing the Operational Policy and Quality Standards and auditing service provider compliance with the standards, and continuing the reviews conducted by the Independent Monitoring Group. The NSU will need to be more open and collaborative with stakeholders, and ensure that all key staff positions are filled.
I also consider that the use of an independent expert to review implementation of the recommendations has added considerable value to the process, and would like to see this type of review continued and expanded to focus on the effectiveness of the whole Programme.
I will continue to keep the progress in implementing the Committee of Inquiry’s recommendations under review.
K B Brady
Controller and Auditor-General
3 December 2003