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Review Of Otago/Southland Breastscreening Service

Ministry Of Health And Otago District Health Board Release External Review Of Otago/Southland Breastscreening Service

The Ministry of Health and the Otago District Health Board today released the external report into the Otago and Southland breastscreening Service.

The report was compiled by an independent review team appointed by the Health Funding Authority (now part of the Health Ministry), following the detection of errors in the files of 50 women enrolled in the Otago and Southland service BreastScreen HealthCare (BSHC).

Health Ministry National Screening Manager Dr Julia Peters and Otago District Health Board Chief Executive Dr Bill Adam welcomed the report agreeing that its recommendations would help restore confidence for Otago and Southland women in the local breastscreening service.

"The report provides a thorough analysis of the local service with a number of recommendations. The Ministry of Health's National Screening Unit will be working closely over coming weeks with Otago District Health Board to develop a framework for implementing the report's recommendations," Dr Peters said.

"Otago and Southland women have shown a strong commitment to the breastscreening programme and we will ensure the actions outlined in the report are implemented in order to maintain that commitment," Dr Adam said.

The report says the errors detected reflect a "systems error" and calls for improved leadership within the local service. It recommends improving screening pathways and notes that the errors detected last year caused distress for local women.

The report also acknowledges the positive actions undertaken by both Healthcare Otago and the National Screening Team. These include the rapid action that was taken once the errors were discovered namely suspending screening until additional safety checks were in place and alerting the Health Ministry and the HFA quickly. It also acknowledges that the 14,641 women whose files were reviewed were informed of the review process greatly reducing distress.

"The External Review Team was generally impressed that BSHC had acted promptly when it detected a problem and commends it for the openness with which it has redressed the situation," the report says.

The Report also provided an update of an extended review covering files belonging to women enrolled in the pilot programme between 1991 to 1997. "This review commenced in August 2000 and has provided us with a complete picture of any issues that may have affected the Otago/Southland pilot programme. The files of all 6,290 women have been checked and women requiring any additional follow-up have been contacted," Dr Adam said.

The report includes a number of recommendations to reinforce the service overall. These include examining the reasons for the high cancer detection rate and a review of rates for women recalled to assessment, and a review of informed consent processes.

The report also calls for strengthening the leadership of the programme and improving the service's organisational structure.

"With the appointment of a new clinical director of the programme as well as planning for the new facilities being well underway, we believe we have made significant progress in improving the service," Dr Adam said.

The report also raises concerns that a number of issues highlighted in the evaluations of the pilot programme don't appear to have been addressed. "This is something that is of much concern to both the Ministry and the Otago District Health Board. We now have this current review and are fully committed to implementing the recommendations and ensuring the women of Otago and Southland have the best screening service available," Dr Adam and Dr Peters agreed.

"The National Screening Unit will be working closely with Otago DHB to develop a framework for implementing the recommendations and a monitoring process to assess progress. We will provide the Otago DHB with any additional expertise it may need to ensure the recommendations are put into operation," Dr Peters said.



On June 23 2000 Healthcare Otago began a comprehensive re-examination of the files belonging to 14,641 women enrolled in the Otago and Southland breast screening programme - BreastScreen Healthcare (BSHC). The review commenced when Healthcare Otago became aware of data entry errors that affected the files of three women.

The first woman was identified in late May when she came in for her regular breast screening examination. This error was initially thought to be a one-off mistake. In June two further women returning for their regular breast screening examination were identified as having a similar data entry error in their files.

Following an initial investigation, which uncovered two further errors, HealthCare Otago, on 23 June, instigated a review of all files dating back to July 1997. On the same date HCO postponed regular screening while the search was underway and alerted the Health Funding Authority and the Ministry of Health about the errors and the re-examination of files.

On 2 July Healthcare Otago announced that on examining some 13,000 files out of the 14,641, errors had been detected in files belonging to 50 women.

The following day the Health Funding Authority announced it was appointing an independent external review group to review the Otago/Southland breast screening service.

The membership of the External Review Team was announced on Friday 7 July 2000. Their Terms of Reference were also defined and sent to Healthcare Otago. Dr Phil Shoemack, public health medicine specialist and Medical Officer of Health for the Bay of Plenty, chaired the team. Other members were Dr Mary Rickard (Sydney), Professor John Collins (Auckland), Sandra Coney (Auckland), Helen McKinnon (Hamilton) and Thelma Brown (Dunedin).

The External Review Team commenced work on 20 July with a two-day visit to Dunedin. The team met face-to-face as a full team on three occasions, 20/21 July 2000 in Dunedin, 31 July/1 August 2000 in Dunedin and 18/19 August 2000 in Auckland. In addition two further meetings were held in Auckland on 12 October 2000 and 27 November 2000.

On 20 July the External Review Team recommended that Healthcare Otago could resume screening of women subject to meeting several conditions. Healthcare Otago was required to have additional checking and audit procedures for entering mammography results into the database and there would be a phased approach to the resumption of screening at the service's three sites. Healthcare Otago met these conditions and resumed screening.

On 21 August the External Review recommended Healthcare Otago extend its review of files to include the files of women enrolled in the Otago/Southland breastscreening service between 1991 and 1997. Healthcare Otago commenced the extended review of the files of some 6290 women.

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