Review of the National Cervical Screening Programme 2011
“The history of the NCSP and the Ministry's relationship with it requires that the future involvement of the Ministry of Health be treated with caution” and in arguing for the establishment of a national cancer control agency separate from the Ministry she recommended that the NCSP be located within such an agency.2
The women’s health groups who attended and closely followed the Gisborne Inquiry were strongly opposed to the prospect of the NCSP remaining within the Ministry of Health due to some of the very problems identified in this report.
After the Gisborne Inquiry, the NZ Cancer Control Trust was established in February 2001.4 Unfortunately the NCSP remained within the Ministry of Health.
Ethnicity and Inequalities
The Parliamentary Review Report noted that increasing participation in the NCSP and reducing disparities in the screening coverage for Maori, Pacific and Asian women are hugely important issues that have yet to be fully appreciated and addressed.
Echoing concerns expressed by women’s health groups over the past few years regarding the establishment of the HPV vaccination programme, the report stated: “there is room for improvement in the organised programme via improved collaboration and integration with the HPV immunisation programme and improved alignment with New Zealand’s cancer control strategy.”
Six of the 39 recommendations concerned improving coverage, participation, equity, access and reducing the burden of disease.
Quality Assurance and Monitoring
A woeful and utterly negligent lack of monitoring is one of the issues that led to the Gisborne Inquiry – prior to 2000 the NCSP had never been monitored despite repeated calls from women’s health groups during the late 1990s for an audit of the programme5 – and while the review commend- ed progress in the resources that have been expended on quality initiatives, the report stated that “consultation and collaboration between the NSCP and key stakeholders require significant improvement” as “awareness of current NCSP quality activities is very limited.” (page 8)
There were six recommendations on quality assurance and monitoring issues.
Once again echoing the concerns repeatedly raised during the Gisborne Inquiry, the report stated:
“From 2001 to 2011, reports and inquiries on cervical screening highlighted concerns and recommend-ed change in the development, management, autonomy and leader-ship of the NSU.” (page 43)
“Enhanced leadership capacity – including population health, public health and screening expertise – is urgently required within the NCSP to improve the depth and breadth of expertise and experience within the NSU and NCSP.” (page 9)
Despite the major problems identified during the Gisborne Inquiry regarding clinical leadership within the NCSP, followed by the recommendations from the Office of the Auditor-General Ministry in 2002/03, the report noted “Ministry of Health restructuring over time has confirmed a management structure within the organisation that may had had the effect of compromising clinical leadership," and warned “Clinical experts and advisors must remain as the linchpin in any clinical programme.” (page 44)
There were six recommendations on workforce issues.
The NCSP Register
The register has been a thorny issue since the very beginning of the NCSP and Sandra Coney’s submission to the Gisborne Inquiry contained a detailed account of the repeated attempts women’s health groups made to keep the establishment of New Zealand’s first screening programme focused on cervical screening rather than the register, despite the ongoing intransigence of the Ministry of Health.5
The report noted that “complaints to the NCSP have highlighted the need for ongoing public education efforts to inform participants that their screening information is included in the NCSP Register and to advise them of their withdrawal options.” (page 10)
There were six recommendations concerning the NCSP Register.
Organisational & Structural Issues
Health Promotion Agency