Gisborne Cervical Screening Inq recommendations
July 3, 2003
Report on implementation of Gisborne Cervical Screening Inquiry recommendations
Health Minister Annette King says the final report from UK cervical screening expert Dr Euphemia McGoogan into the implementation of recommendations from the Gisborne Cervical Screening Inquiry offers much encouragement, but warns there is still a lot to do.
Ms King appointed Dr McGoogan, an expert cytopathologist and Senior Lecturer in Pathology at Edinburgh University, to report on the implementation of the Inquiry’s recommendations after they were delivered in April 2001. Dr McGoogan visited New Zealand to appraise progress in October-November 2001, April 2002, and January 2003, producing an initial report after her first visit.
“I appointed Dr McGoogan because I believed it was essential to receive an independent evaluation to ensure New Zealand developed a cervical screening programme in which women could feel genuine confidence,” said Ms King.
“I’m pleased that Dr McGoogan recognises that a great deal of work has occurred and a structured National Cervical Screening Programme (NCSP) is emerging.
“I’m also heartened at her assessment that the NCSP continues to mature month on month, but I accept her warning that there is still much work to be done for New Zealanders to realise their hope of having the best cervical screening programme in the world.”
Ms King said there has been continual improvements to the programme, including new and revised standards for colposcopy and regional services, implementation of provider compliance audits, a new complaints system, a range of workforce development and training initiatives, and the programme itself was being independently monitored in a number of ways.
Ms King said there would be debate about some aspects of Dr McGoogan’s report, such as the need for a population register, privacy issues, the length of time it is taking to complete the cancer audit, the need to improve the understanding of public health screening, and the make-up of the National Screening Unit (NSU).
"Dr McGoogan likens a National Cervical Screening Programme to a jigsaw puzzle. People know how many ‘pieces’ there should be, but we do not get the completed picture until each ‘piece’ is connected to the other. Dr McGoogan says all the ‘pieces’ of a National Cervical Screening Programme are present in New Zealand, but they still have to come together to create a cohesive picture."
Legislation was one way the Government was putting the pieces together, said Ms King. “I hope Dr McGoogan’s valuable insights will provide crucial input into public debate around the Health (Screening Programmes) Amendment Bill, now before the Select Committee.
“Dr McGoogan is a strong advocate of access without informed consent by researchers and health professionals to an individuals health information, and believes that an excessive concern with privacy issues can be harmful to health. The Select Committee has heard many contrary views, but I am sure Parliament will give Dr McGoogan’s views considerable weight.”
Ms King said it was clear that Dr McGoogan was still concerned about management of the NSU. “But another international expert, Professor Jocelyn Chamberlain, who independently reviewed BreastScreen Aotearoa in February 2002, stated specifically that she believed the present NSU manager ‘has all the desired qualities’. Clearly there are different opinions, even among experts, but we will continue to rely on independent monitoring of the NSU”.
Ms King said Dr McGoogan was clearly disappointed that the outcome of the cancer audit would not be known until 2004, but accepted that the cancer audit group had to overcome many difficulties and had been “very active”.
“Dr McGoogan says the audit will deliver important and useful information, although she is concerned that it will not answer whether there was a systemic problem of underreporting in New Zealand in the late 1990s.
“I have asked the Ministry to discuss the whole issue of re-screening with Dr McGoogan, given the number of women, more than 750 000, who have been screened since new standards were put in place during 2000. The Ministry says that by the end of this year all those enrolled in the programme would have been eligible for at least one re-screen under the new standards.”
Ms King said Dr McGoogan is critical of the fact that New Zealand does not have a population register that could be used to invite all women to attend for a cervical smear.
“I recognise the value of a population register, although it is only one of a number of tools that can improve coverage and monitor outcomes. The participation of New Zealand women in the cervical screening programme is already high, and I am keen to back all initiatives to further improve participation, including the development of Primary Health Organisations.”
Ms King said she noted that Dr McGoogan did not yet believe New Zealand had yet achieved a fully effective cervical screening programme. “I accept that, but I am encouraged by her report to believe we are now well on the way. I am also encouraged by the fact that in the ten years from 1987 to 1997, the cervical cancer death rate dropped 44 percent, and that the incidence rate of cervical cancer dropped by 39 percent in the same period.
“Although there continues to be differences of opinion over aspects of our programme, everyone agrees that the best protection against cervical cancer is regular screening, and I would encourage all women to participate.”
For Questions and Answers and a copy of Dr McGoogan’s report see the Gisborne Cervical Screening Inquiry website: www.csi.org.nz.