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DHBs to review colposcopy services

2 May, 2006

DHBs to review colposcopy services

The National Cervical Screening Programme today indicated that it would be requesting all DHBs to review colposcopy services, following a review by Waitemata DHB that identified issues with its colposcopy services.

The Waitemata review was prompted by a complaint to the Health and Disability Commissioner regarding the treatment and follow up of a woman with invasive cervical cancer.

Clinical Leader of the National Cervical Screening Programme, Dr Hazel Lewis, assured women that the request was part of on-going quality improvement to ensure all DHBs were meeting the standards for colposcopy services.

"Waitemata DHB acted appropriately in reviewing colposcopy services as a result of the case referred to the Health and Disability Commissioner. They put in place a thorough review process and we are pleased with the actions taken as a result of the review," said Dr Lewis.

Dr Lewis said the focus now was on ensuring the learnings from the Waitemata case were shared across the national programme.

All 21 DHBs provide colposcopy services and are required to report to the NCSP on a monthly basis. They are required to report on the number of women outside the waiting times against three standards:
• women in whom the smear is suspicious of invasive disease must receive colposcopy or a gynaecological oncology assessment within one week
• women who have high grade smear abnormalities must receive colposcopy within four weeks
• women in whom there are persistent low grade abnormalities must receive colposcopy within 6 months

An analysis of the figures supplied by DHBs to the end of February 2006 showed that all women with suspicion of invasive disease were receiving colposcopy within the standards (1 week from receipt of referral). A small number of DHBs were not meeting the standards for colposcopy for women with high and low grade abnormalities.

To address this, DHBs are scheduling more colposcopy clinics, employing more colposcopists and ensuring women who miss appointments are followed up as appropriate.

In signalling the request for DHBs to review colposcopy services, Dr Lewis outlined the changes and improvements that had been made to the NCSP since the completion of the Gisborne Cervical Screening Inquiry in 2001.

"We've made huge progress since Gisborne. The recommendations of the Gisborne Inquiry have been largely implemented. However, there will still be programme improvements and reviews required to ensure the overall quality of the programme. Today's request for DHBs to review colposcopy services is part of that," said Dr Lewis.

The Gisborne report ["Report on the Ministerial Inquiry into the Under-Reporting of Cervical Smear Abnormalities in the Gisborne Region"] was released in April 2001. The report contained 46 recommendations for future action that the Government or its agencies should consider taking.

The Minister of Health at the time, Hon Annette King, subsequently accepted all 46 recommendations and directed the Ministry of Health to implement them. Thirty seven of the 46 recommendations have now been completed or implemented. Of the 9 recommendations that remain outstanding seven are expected to be implemented in 2006/07 and decisions have been made not to implement the other two.

The initial priority following Gisborne was to strengthen laboratory services, to develop Operational Policy and Quality Standards and to put in place a legislative framework for ensuring a strong, effective national programme. Significant legislative changes were introduced in 2004, with the changes coming into effect in March 2005.

Updated colposcopy standards were adopted in July 2004 and with the appropriate legislative changes in place, the focus has shifted to monitoring and audit of colposcopy services, with all DHBs scheduled for audit over the next 2 years.

The NCSP is in the process of finalising the first two audits of DHB colposcopy services. Four more audits are scheduled to be completed by June 2006 with the remainder of the country's 21 DHBs, all of whom provide colposcopy services, due for audit in 2007 and 2008.

As a result of the issues identified by Waitemata DHB's review of colposcopy services, DHBs will be requested to review their colposcopy services ahead of their scheduled audits.

Cervical cancer is one of the most preventable of all cancers. A woman's best protection against developing cervical cancer is having regular cervical smear tests. The NCSP recommends women have cervical smear tests every three years from the age of 20 until they turn 70 if they have ever been sexually active.

A review of the first ten years of the NCSP (1991 - 2001) found that since the introduction of the programme in New Zealand, there had been a 40 per cent reduction in the number of women who develop cervical cancer (morbidity) and a 60 per cent reduction in deaths from cervical cancer. Approximately 60 women die from cervical cancer in New Zealand each year.


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