CERVICAL SCREENING INQUIRY ANNUAL REVIEW 2001/02 AND
ANNUAL PLAN 2002/03
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
2
Introduction.....................................................................................3
Responsibilities ..............................................................................4
Summary of the Implementation of the Cervical Screening Inquiry Recommendations in 2001/02........................................................8
NCSP Operations.........................................................................10
Six Month Review.........................................................................22
Financial .......................................................................................24
Issues/Risks 2002/03 ...................................................................25
Summary of 2002/03 Plan............................................................28
2002/03 Budget ............................................................................38
Appendix 1: Inquiry Recommendations and Responsibilities.......39
Appendix 2: Summary of Reporting..............................................46
Appendix 3: Summary of Six-Month Reviews ..............................48
Appendix 4: April 2001 Plan .........................................................50
Appendix 5: Project Summary Plan..............................................54
Appendix 6: Glossary of Common Abbreviations .........................73
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
3
Introduction In April 2001 the Ministerial Inquiry into the Under-Reporting of Cervical Smear Abnormalities in the Gisborne Region released its findings including 46 recommendations (the Inquiry Recommendations) for the implementation of improvements to the National Cervical Screening Programme (NCSP). Refer to Appendix 1, Inquiry Recommendations and Responsibilities. A Ministry of Health-wide Steering Group, with the National Screening Unit (NSU) Group Manager as Chair, was set-up in May 2001. The Steering Group monitored implementation of the Inquiry Recommendations throughout 2001/02. Monthly progress reports were provided to the Minister. A Six-Month Summary Report was completed1. Refer to Appendix 2, Summary of Reporting, for a list of reports. Dr Euphemia McGoogan, cytopathologist and associate medical director of Lothian University Hospitals NHS Trust in Edinburgh, was appointed by the Minister to advise on progress to implement the Inquiry Recommendations. The Steering Group Chair and the Deputy Director-General Public Health regularly provided progress updates to Dr McGoogan. Dr McGoogan also visited New Zealand in November 2001 and provided to the Minister a six-month progress report2. As part of her six-month review of progress Dr Euphemia McGoogan made a series of further recommendations to improve the NCSP and the implementation process. These have been incorporated into an action plan. See Appendix 3, Summary of Six-Month Reviews. Dr McGoogan made a further visit to New Zealand in April 2002, and a third visit and a report on the work conducted to implement the Inquiry Recommendations is planned for January 2003. In addition the Office of the Controller and Auditor�General (OAG) conducted a review to determine the effectiveness of the actions that had been taken to implement the Inquiry Recommendations. The final report was published in February 20023. This document summarises the main activities carried out to implement the Inquiry Recommendations to June 2002. The risks and issues associated with the implementation of the Inquiry Recommendations for 2002/2003 are included together with a summary implementation plan for 2002/2003.
1 Ministry of Health. October 2001. The Six-Month Summary Report from the Ministry of Health to the Minister on the Implementation of the Recommendations of the Gisborne Cervical Screening Inquiry Report. 2 McGoogan E. 2001. Progress in Implementing the Cervical Screening Inquiry Recommendations: Independent Report . 3 Office of the Controller and Auditor �General. February 2002. Report of the Controller and Auditor �General: Ministry of Health: Progress in Implementing the Recommendations of the Cervical Screening Inquiry. Wellington: Office of the Controller and Auditor General.
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Responsibilities The Cervical Screening Inquiry (CSI) Steering Group comprises managers from across the various Ministry directorates responsible for implementation of the Inquiry Recommendations.
Table 1: CSI Steering Group
• Karen Mitchell (Chair), Group Manager, NSU, Public Health Directorate
• Julia Peters, Clinical Director, NSU (to April 02), Public Health Directorate
• Judy Glackin, Manager, Health of Older People and Sector Regulation, Sector Policy Directorate
• Helen Wyn, Manager, Strategic Analysis, Sector Policy Directorate
• Grant Adam, Manager, Health Legal, Corporate and Information Directorate
• Andrew Forsyth, Team Leader, Public Health Legislative Review Team (PHLR), Public Health Directorate
• Ria Earp, Deputy Director -General, Maori Health Directorate (late 02)
• Kallon Basham, Senior Communications Advisor, NSU, Public Health Directorate
• Catherine Scollay, Information Services Manager, NSU, Public Health Directorate
• Colin Tukuitonga, Director of Public Health, Public Health Directorate
• New Zealand Health Information Service (NZHIS) (representatives in attendance from time to time), Corporate and Information Directorate
The work to implement the Inquiry Recommendations was grouped as follows:
• Audit of Invasive Cervical Cancer � initially coordinated by the NSU and then transferred to Director of Public Health in April 02.
• Ethics recommendations � Sector Policy Directorate • Legislation � Sector Policy Directorate coordinated the original proposal
for a Comprehensive Bill, which included amendments to The Injury Prevention, Rehabilitation and Compensation Act 2001, the Health and Disability Services Commissioner Act 1994, the Health Practitioners Competence Assurance Bill (HPCA), and the Health Act 1956. The original proposal for the Comprehensive Bill did not go ahead resulting in the Bill being split into its constituent parts. Specific responsibility for the amendments to S74A of the Health Act 1956 relating to the NCSP then transferred to the PHLR in February 2002.
• Kaitiaki Regulations Review � Maori Health Directorate
• NCSP Operations � NSU
• Information Technology � NSU and NZHIS
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Responsibility for delivery of the Inquiry Recommendations was allocated to each of the Steering Group members as representing the various Ministry directorates and project teams. Refer to Appendix 1, Inquiry Recommendations and Responsibilities. Progress to deliver project requirements is measured by the CSI Steering Group on the basis of the achievement of key milestones related to the production of specific deliverables, project outputs and decisions. Various project teams from within the directorates provided monthly milestone reporting to the Steering Group Chair for the tracking of progress. To provide an objective means of measuring progress a milestone plan was formulated by the Ministry based upon the proposed timetable advised to the Minister in April 2001. See Appendix 4, April 2001 Plan. The April 2001 timetable was developed in advance of more detailed analysis of the Report of Ministerial Inquiry into the Under-Reporting of Cervical Smear Abnormalities in the Gisborne Region (the Inquiry Report) and its recommendations and of the scope of work needed to deliver them. In the proposed timetable for the implementation of the Inquiry Recommendations up to 15 recommendations were stated as requiring up to 18 to 24 months or more to implement, given their complexity. Recommendations related to the development and implementation of new information systems were highlighted as requiring longer to implement. As the scope of the work became more evident over the first six months a revised timetable was presented and was included with the six-month summary report. Refer to Appendix 5, Project Summary Plan, for the revised dates. The CSI Steering Group has continued to measure progress to implement the Inquiry Recommendations based on the achievement of key milestones, project outputs and decisions and specific deliverables, which are indicated in the Implementation Summary for 2001/02 (Table 2.0), and the Summary Implementation Plan for 2002/03 (Table 4.0). Some recommendations may more easily be measured as completed as they have a finite period in which they can be implemented; however many other recommendations have an ongoing component that will eventually be incorporated as business as usual into the NCSP. An overall plan of the completion and implementation dates for each of the recommendations is provided as Appendix 5, Project Summary Plan. In her first six-month report, Dr Euphemia McGoogan, noted that there should be a revised approach to measuring the way recommendations were progressed and completed. It is anticipated that her second report will outline this new approach in detail. The Ministry is awaiting her report in order to implement her revised measuring process.
NSU The Ministry of Health is required to ensure the effective delivery of the NCSP, in accordance with the programme�s objectives and appropriate standards. The programme is for New Zealand women aged 20 to 69 years and contributes to the Crown�s objective to reduce the incidence and impact of cancer.
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Of the 46 Inquiry Recommendations, 27 were either the direct responsibility of the NSU or required the input of NSU staff. The NSU is responsible for the national coordination and funding, policy development and monitoring of New Zealand�s two national cancer screening programmes: the National Cervical Screening Programme (NCSP) and BreastScreen Aotearoa (BSA). The NSU is an autonomous unit within the Ministry of Health Public Health Directorate. The 2001/02 year was the NSU�s first full year of operation. In addition to its core business, the NSU�s priorities for 2001/2002 included implementation of 19 of the Inquiry Recommendations, some of which commenced prior to the Inquiry report and many of which have an ongoing component as part of NCSP operations, including the:
• Audit of Invasive Cervical Cancer, (recommendation 1 - ongoing)
• implementation of interim quality standards with contracted providers, (recommendation 4 � achieved & ongoing except in relation to private colposcopists and smear takers who are non contracted providers)
• legal assessment of NCSP (recommendations 5 & 6 � achieved and ongoing)
• completion of 1996-98 Statistical Report, (recommendations 7 achieved and recommendation 8 ongoing)
• implementation of minimum volumes for laboratories, (recommendation 9 � ongoing)
• implementation of direct contracts with NCSP service providers, (recommendation 12 � achieved and ongoing except in relation to laboratories as contracts are held directly with District Health Boards (DHB�s)
• input to proposed amendments to Section 74A of the Health Act 1956, (recommendations 14, 15, 16, 17, 30 - ongoing)
• completion of Workforce Development Strategy, (recommendations 28, 40, 41, 42, - achieved and ongoing)
• provision of information to women, (recommendation 38 � achieved and ongoing)
• provision of information to smear takers, (recommendation 39 - achieved and ongoing).
Sector Policy Directorate Sector Policy Directorate provides strategic policy advice and analysis to the Minister of Health on the health and disability sector in New Zealand. Sector Policy Directorate houses the Secretariat for the National Ethics Advisory Committee (NEAC), and is also responsible for strategic policy advice on occupational regulatory frameworks. Sector Policy Directorate is responsible for the implementation of the Health Practitioners Competence Assurance Bill (HPCA) once enacted, which requires improved information flows between relevant agencies and systems
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to support early reporting by medical practitioners (recommendations 34, 35, 36 and 44). This Directorate also has responsibility for providing secretariat support for NEAC. NEAC will prioritise within its work programme the recommendations that relate to the operations and process of ethical review of medical and health services research (recommendations 19, 21, 22, 23).
Māori Health Directorate The Māori Health Directorate provides advice on the strategic direction of the health and disability sector with respect to Mäori. The Mäori Health Directorate was responsible for engaging in consultation with Mäori women about reviewing the Kaitiaki Regulations and the future role of the National Kaitiaki Group (recommendation 15 of the Inquiry Recommendations). The Review of the Kaitiaki Regulations is now finished. Cabinet agreed to maintain the status quo, with improved processes for the NCSP to access Mäori women�s aggregate data. The role of the Mäori Health Directorate is now complete.
PHLR The PHLR was established 1 July 2000 to complete a major review of the Health Act 1956 with the view to its eventual replacement with a new Public Health Bill. In Feb 2002 the PHLR team assumed responsibility for the final drafting, introduction to Parliament and subsequent Parliamentary stages of the Health (Screening Programmes) Amendment Bill [recommendations 14, 16, 17 and 30 refer].
NZHIS NZHIS is responsible for managing a number of collections of health data. These include the New Zealand Cancer Register, the Mortality Collection and the National Health Index (NHI). NZHIS produces a number of publications relating to statistics on the incidence and mortality of cancer. There is considerable analytical capability within NZHIS as well as a core competence in data warehousing. NZHIS is participating in the audit of screening performance by supplying information requested by the Cancer Audit Project about cases of cervical cancer registered by the New Zealand Cancer Register. Prior to supply the data are subjected to rigorous examination, which in some cases includes consultation with pathologists and relevant healthcare providers. NZHIS has successfully met the deadlines required by the project so far.
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Summary of the Implementation of the Cervical Screening Inquiry Recommendations in 2001/02 Audit of Invasive Cervical Cancer One of the key recommendations of the Ministerial Inquiry into the Under-Reporting of Cervical Smear Abnormalities in the Gisborne Region (the Inquiry) was an Audit of cases of invasive cervical cancer. The Audit will examine the screening histories of women diagnosed with cervical cancer to determine where improvements to the NCSP are needed. The Audit relates to a period in which the NCSP was not operating optimally and which was examined in detail by the Inquiry. The Audit is acknowledged as representing perhaps the largest and most complex of the projects to implement the Inquiry Recommendations. To ensure that the Audit would meet its objectives, considerable effort was expended during 2001/02 on the crucial set-up and design phases, including completion of Literature Research, Legal Review, Audit Framework, Detailed Audit Protocol, and testing of the New Zealand Cancer Register and NCSP-R data matching and extraction. Early in 2002, project sponsorship for the Audit changed and the project effectively moved out of the NSU, although remained within the Ministry. This was intended in part to provide some independence from the ongoing operational aspects of the NCSP and functions of the NSU. The Audit is now into Phase Four of its work, following the detailed design, development and planning work carried out throughout much of the year. A significant milestone, the obtaining of ethics committees� approval, was achieved in June 2002, allowing the Audit to proceed fully.
Ethics Progress to implement the Inquiry Recommendations regarding ethics committees was not straightforward. The Inquiry Report made five recommendations related to the operation of ethics committees (recommendations 18, 19, 20, 21, 22, 23). These recommendations as written were not specific to the NCSP but applied to the whole area of health and ethical review in New Zealand. Given that regional ethics committees in New Zealand are not established in legislation, it was necessary to find an appropriate vehicle for implementing the recommendations of the Inquiry. At the time the Inquiry Report was released, two methods were identified:
• through amendments to the National Standard, to which ethics committees are obliged to conform
• as part of the work of NEAC which was already planned to be set up under the New Zealand Public Health and Disability Act 2000.
At the time of the Inquiry Report, the National Standard for ethics committees had been under review. The opportunity was taken to incorporate the Inquiry
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Recommendations within this review. The Health Research Council and Regional Ethics Committees, both users of the National Standard, were not in full agreement with the Inquiry Recommendations. There was difficulty in reaching agreement and as a result non-contentious changes would be made to the original 1996 Standard, and contentious issues would be referred to NEAC. The Minister of Health agreed to the incorporation of recommendations 19, 21, 22 and 23 into the terms of reference for NEAC. Following a process of public advertising and Cabinet approvals, membership of this committee was announced in December 2001. NEAC commenced meetings in April 2002. NEAC has developed a work programme that addresses the recommendations and it is consulting with the Ministry of Health on the timeframes and approach for carrying out the work.
Legislation The Government�s timeframe for the implementation of recommendations to deliver legislative change, originally proposed to take place before the end of 2001 was extremely tight. Initially referred to as the Comprehensive Bill, legislative change covered information sharing, complaints processes and safety and effectiveness and evaluation of the NCSP. Changes were required to the Injury Prevention Rehabilitation and Compensation Act 2001, the Health and Disability Services Commissioner Act 1994, the HPCA and the Health Act 1956. Policy work on the constituent parts was completed on time, but drafting of the legislation took longer than anticipated and this, coupled with the complex nature of the Bills themselves, resulted in the Comprehensive Bill eventually being split into its constituent parts. The Injury Prevention Rehabilitation and Compensation Act 2001 was enacted in April 2001. The amendments that were required to the Health and Disability Services Commissioner Act 1994 were incorporated into the HPCA. Amendments to the Health Act 1956 were separated out as the main Bill. Recommendation 29 referring to the amendments to the Medical Laboratory Technologists Regulations 1989 will be implemented through the enactment of the HPCA and the provisions that relate to scopes of practice.
The Health (Screening Programmes) Amendment Bill Because of the history of cervical screening, and in particular as a result of the report of the Ministerial Inquiry, there is a very high level of public interest in the effectiveness and safety of the NCSP. The Inquiry generated some very specific recommendations on changes needed to the legislative framework governing the operation and ongoing review of the NCSP. A key focus is to strengthen the provisions that provide for evaluators to rigorously review the safety of the NCSP and its component services. In this respect, the new Health (Screening Programmes) Amendment Bill will be an important statute for the enhancements it will bring to the safety and effectiveness of the NCSP. The Bill will assist in building and maintaining public confidence in health services generally and, in particular, the need for women to have confidence in the NCSP.
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In addition to making provision for improved evaluation of the Programme, the Bill also allows for the making of regulations prescribing standards to be met by providers of screening and diagnostic and treatment services. At present there is no satisfactory way that standards can be made mandatory for non-contracted providers. This situation has been noted in several recent reports as a particular area of concern for the NCSP in relation to providers of smear-taking services, the large majority of which have no contractual relationship with the NCSP. The NSU played a key role in the development of the new Health (Screening Programmes) Amendment Bill. The Health (Screening Programmes) Amendment Bill received final Cabinet approval between 24 April and 13 May 2002 and was introduced to Parliament on 16 May 2002. The Bill received a category two priority from Cabinet on the legislative programme (must be passed this parliamentary year). However, this was anticipated by Cabinet when setting the interim legislation programme pending a general review. It was also noted by Cabinet, that because of the large volume of legislation brought forward from the last parliament and the limited House time for the remainder of 2002, many Bills would not make the progress in 2002 suggested by their priority descriptions. As of 21 October the Bill has commenced, but not yet completed its first reading in the House.
Kaitiaki Regulations Preparation of a discussion document on the review of the Kaitiaki Regulations was completed and distributed to up to 3000 people and organisations. Twelve regional hui took place between 12 March and 19 April. Following consultation with Maori women, Cabinet decided that the National Kaitiaki Group, would continue to consider all applications for access, use and publication of Maori women�s aggregate data on the NCSP-R and approve those applications that complied with the criteria described in the Kaitiaki Regulations. Processes for access to Maori women�s aggregate data will be improved for the NCSP so that the NCSP is better able to monitor, evaluate and audit the programme for the benefit of Maori women.
NCSP Operations Legal Review Recommendations 5 and 6 of the Inquiry Report called for a high level legal review of aspects of the NCSP. In June 2001, the NSU asked Kim Murray, Barrister, to carry out the legal review work. Mr Murray had previously represented the Health Funding Authority (HFA) and the Ministry at the Inquiry and was extremely knowledgeable of the NCSP and the complex issues that arose during the Inquiry. A report on his findings was provided to the NSU in December 2001.
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The legal review provided an objective assessment of some of the important legal issues raised by the Inquiry. The legal review referred to the legal inadequacies that were of most concern to the Inquiry. These included those related to the monitoring and evaluation of the NCSP and the compulsory imposition of quality assurance processes. Ultimately these concerns were primarily related to the ability of the NCSP to operate in an optimally safe and effective manner and thus it was necessary for the legal review to focus on the vital issue of quality standards for the Programme. The legal review noted progress towards addressing some of the issues raised in the Inquiry Report, but some gaps were found in the legal authority to manage the Programme and ensure its safety. To overcome these deficiencies the legal review recommended that:
• the proposed Health (Screening Programmes) Amendment Bill as currently drafted should go further to enhance the safety of the Programme
• standards need to be legally binding on all providers (public and private) with the associated power to conduct monitoring
• the Programme must be more clearly established in law with the Director General of Health given wider statutory responsibility and authority over the Programme.
Provision of Statistical Information The 1996-98 NCSP Statistical Report was published and distributed to stakeholders in April 2002, and work on the 1999-2000 report commenced. Four NCSP Independent Monitoring Group (IMG) quarterly reports were published during the year. Good progress has been made on the routine monitoring of performance indicators across the programme, including laboratories. These reports were distributed to around 170 providers and stakeholders and are available on the screening programme�s website www.healthywomen.org.nz
NCSP Policy and Quality Standards Good progress was made in the implementation of recommendations relating to the introduction of policy and quality standards with community laboratories and DHB�s providing a colposcopy and NCSP regional service. The two public hospital laboratories providing cervical cytology services, however, struggled to meet the required minimum volume of cytology cases despite their best endeavours. The NSU continues to support the need to retain public hospital cytology services and improve cytology education/training and academic pathology opportunities. In the current training year (to December 2002) the two public hospital laboratories are contracted by the Ministry to train 21.5 full time equivalent registrars in pathology, representing 48.3 percent of the total training in pathology, including cytology in New Zealand. Generally
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community laboratories do not have a direct contractual provision for the training of pathology registrars although some do provide this training on a subcontract basis with DHBs. The NSU is reviewing this situation further to determine whether there are opportunities in 2002/03 for increasing cytology test volumes at these laboratories, given their significant role in providing pathology training and education in New Zealand. Further work is needed with regard to implementation of standards for smear takers. The difficulties associated with the NSU implementing standards for smear takers were covered in some detail in the legal assessment provided to the Unit in response to recommendations 5 and 6. Further policy development work is required to examine the various options for implementing standards for smear takers.
NCSP Structure Recommendations relating to the structure of the NCSP were reported as complete in the Six-Month Summary Report and discussion followed within the body of the report highlighting how these recommendations had been implemented. The NSU was established in November 2000 as a separate business unit within the Public Health Directorate of the Ministry of Health. As a business unit the NSU has its own budget for the delivery of New Zealand�s two organised screening programmes. The Group Manager of the NSU has the delegated authority to manage the Unit, having due regard to Ministry policies and public sector rules and expectations regarding financial management, human resources, and use of capital and facilities management. The actual requirement for the NSU to have its own budget and contract directly with providers was largely implemented from 1 July 2001. Three new clinical leadership positions were created in 2001/02, namely the Public Health Leader Screening and Clinical Leader positions for each of the two programmes. Alongside recruitment to these positions, and in response to issues raised, the NSU commissioned a review of its organisation structure, specifically in relation to the requirement for clinical and public health leadership4. This review formed the basis of a facilitated �round table� discussion with key stakeholders. In summary the outcome of the review and �round table� discussion was as follows.
• Clinical leaders to be appointed for BSA and NCSP, with joint accountability with the incumbent Operational Managers of BSA and NCSP, and reporting to the NSU Group Manager.
• Public Health Leader Screening is to be appointed for the NSU, working alongside the incumbent NSU Group Manager and reporting to the Director of Public Health.
4 NSU, Organisation Structure Review, Project Report, Internal Review for the Ministry of Health, Downard Chadwick & Associates, June 2002.
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Workforce Development Considerable work was completed by the NSU on the development of a Workforce Development Strategy (the Strategy), which was published in draft form in December 2001. A number of the Inquiry Recommendations relate directly or indirectly to the development of the screening workforce. Some recommendations refer to key policies and standards to be implemented by the NCSP providers, such as minimum volumes for laboratory staff screening cervical smears. Five of the recommendations (28, 29, 40, 41 and 42) relate to screening workforce development directly and the Strategy contains initiatives to address the issues raised.
Information to Women The NSU contracted Women�s Health Action Group to develop a new, more detailed booklet for women regarding the NCSP including the benefits and risks of screening and having a cervical smear. This detailed booklet was published in June 2002. A tear-off information sheet booklet on cervical screening was produced and distributed to general practitioners. Basic information about the NCSP for smear takers, gynaecologists and women is available through a range of pamphlets and brochures. These resources are distributed by the programme�s regional offices in correspondence with women and are available free of charge to practitioners through their local Health Education Provider. The NSU also has a user-friendly website www.healthywomen.org.nz as well as an 0800 number to give easy access to women.
Information Technology
NCSP-R and the New Zealand Cancer Register Link The NSU and the New Zealand Cancer Register agreed upon a regular data assurance process between the NCSP-R and the New Zealand Cancer Register to be performed monthly. This process has been refined and enhanced since the first trial in 2001. Within this process, the New Zealand Cancer Register reviews information it holds and is able to obtain missing data directly from the source laboratories rather than the NCSP-R to update and correct the New Zealand Cancer Register information. In addition, by checking all the cancers reported to the NCSP-R, the New Zealand Cancer Register is now able to inform the NSU which are primary cervical cancers, enabling this important information to be recorded in the NCSP-R. Further investigation has taken place into the requirements for automated electronic links between the NCSP-R and the New Zealand Cancer Register (referred to in previous monthly reports as Phase 2). No compelling requirements for automated electronic links, beyond those already successfully implemented, were identified. Phase 2 has therefore been discontinued. This decision was further reviewed in the development of the regular Monthly Data Assurance process. It has been agreed that this process has been automated, as far as is desirable because it is imperative that individual discrepancies are manually checked and agreement reached
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on any corrections made. It is intended to give the New Zealand Cancer Register read-only access to the NCSP-R.
The New Zealand Cancer Register Information In essence the CSI report recommended that NZHIS should improve the currency of information about cervical cancer and generate meaningful statistics on a regular basis (recommendations 8 and 26). Provisional incidence statistics for 2001 were supplied to the NSU in April 2002 and posted on the NZHIS website. Registration of cases diagnosed up to June 2002 is complete. The New Zealand Cancer Register database was rebuilt in 2001 with the objective of providing improved functionality for data recording, data validation, and ad hoc reporting. Additional fields were included to enable recording of the name of the consultant healthcare provider; the tumour grade; and most importantly FIGO stage of disease classification. The inclusion of FIGO stage will enable much more detailed analysis of the extent of disease at the time of diagnosis. When linked to screening-history in routine audits FIGO stage will be a significant indicator of screening performance at a regional level.
Population Register NZHIS has initiated a project to create a population register for use in the health sector, based upon the NHI. Work has begun on establishing the user requirements for a population health register. In parallel with this process, work is continuing to improve the quality and coverage of the NHI system. The NHI currently covers approximately 98 percent of the New Zealand population in terms of registrations but is not configured in a way that would meet the needs of a population register for clinical use. The index is known to contain a number of duplicates, the majority of which date from the early days of the system. The work so far on the NHI has centred on addressing the duplicates from a data quality perspective and implementing technology and process changes to prevent the creation of duplicate registrations on an ongoing basis. An NHI duplicate resolution programme has been established. Already an average of four times as many duplicates per month are being found and addressed. NZHIS is in the process of employing additional resources to further increase the rate at which the remaining duplicates are found, with a view to resolving the bulk of the duplicates by June 2003. The requirements for a new user interface to the NHI for use by primary health care providers has been specified. Once developed, it is anticipated that the source code for the system will be made available to Patient Management Systems (PMS) vendors to enable them to upgrade their products.
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A new name search engine has been purchased and is being installed. Prototype testing already indicates a significant improvement in search speed and accuracy will be achieved. Options for delivering new education and training required as a result of the technology improvements are being developed. It is intended that training will be delivered interactively through the Internet. Collectively, these improvements will result in a more accurate and up-to-date register of the population of health care users.
Implementation Summary 2001/02 A summary of the key milestones reached to implement the Inquiry Recommendations for 2001/02 is included in Table 2 below.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
16
Tabl
e 2.
0 Im
plem
enta
tion
Sum
mar
y
Ref
. R
ecom
men
datio
n 20
01/0
2 Im
plem
enta
tion
1.
Ev
alua
tion
of N
CSP
Th
e Ev
alua
tion
and
Follo
w-u
p of
Wom
en w
ith A
bnor
mal
Sm
ears
• U
nive
rsity
of
Ota
go c
ompl
eted
the
Rev
iew
of
Follo
w-u
p of
Wom
en w
ith A
bnor
mal
Sm
ears
in S
epte
mbe
r 01.
Audi
t of I
nvas
ive
Cer
vica
l Can
cer
• Ph
ase
1 co
mpl
eted
Sep
tem
ber 0
1.
• Et
hics
Com
mitt
ee A
pplic
atio
n Fe
brua
ry 0
2.
• M
ain
Audi
t Tea
m a
ppoi
ntm
ents
fina
lised
Mar
ch 0
2.
• Ph
ase
2 co
mpl
eted
Apr
il 02
.
• Ph
ase
3 co
mpl
eted
Jun
e 02
.
• Ph
ase
4 co
mm
ence
d.
• Ph
ase
5 co
mm
ence
d.
2.
R
e-en
rolm
ent a
nd re
-scr
eeni
ng o
f wom
en.
3.
C
ox�s
199
7 co
mpr
ehen
sive
eva
luat
ion
of t
he
NC
SP s
houl
d be
com
men
ced
with
in 1
8 m
onth
s.
• Pa
rts
5,
6 an
d 8
incl
uded
w
ithin
th
e sc
ope
of
Part
3 (C
ance
r Au
dit)
� se
e re
com
men
datio
n 1
abov
e.
• Pa
rts
4,
7 an
d 10
in
clud
ed
with
in
scop
e of
N
CSP
St
atis
tical
R
epor
ting
- se
e re
com
men
datio
n 7
belo
w.
4.
Im
plem
enta
tion
of
Ope
ratio
nal
Polic
y an
d Q
ualit
y St
anda
rds
& Ev
alua
tion
& M
onito
ring
Plan
.
• Im
plem
enta
tion
of
cont
ract
ually
bi
ndin
g po
licy
and
qual
ity
stan
dard
s fo
r he
alth
pr
omot
ion,
col
posc
opy,
labo
rato
ries
July
01.
• N
CSP
Ind
epen
dent
Mon
itorin
g G
roup
Mon
itorin
g Pl
an f
inal
ised
, in
clud
ing
natio
nal
indi
cato
rs fo
r per
form
ance
mon
itorin
g.
• Pu
blic
atio
n of
Inde
pend
ent M
onito
ring
Gro
up N
CSP
qua
rterly
mon
itorin
g re
ports
1, 2
, 3
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
17
Ref
. R
ecom
men
datio
n 20
01/0
2 Im
plem
enta
tion
and
4.
5.
Fu
ll le
gal a
sses
smen
t of O
pera
tiona
l Pol
icy
and
Qua
lity
Stan
dard
s.
• R
epor
t pro
vide
d to
NSU
in D
ecem
ber 2
001.
• Br
iefin
g pr
ovid
ed M
arch
02.
6.
Le
gal a
sses
smen
t of N
CSP
Aut
horit
y.
• R
epor
t pro
vide
d to
NSU
in D
ecem
ber 2
001.
• Br
iefin
g pr
ovid
ed M
arch
02.
7.
St
atis
tical
Rep
ortin
g.
• 19
96-9
8 R
epor
t Pub
lishe
d Ap
ril 0
2.
• W
ork
on th
e 19
99/0
0 re
port
com
men
ced.
8.
R
egul
ar S
tatis
tical
Info
rmat
ion.
R
egio
nal i
ncid
ence
of c
ance
r and
labo
rato
ry re
porti
ng ra
tes
• N
SU a
nd U
nive
rsity
of O
tago
con
side
red
deliv
ery
of a
spec
ts o
f thi
s re
com
men
datio
n no
t po
ssib
le, h
owev
er fu
rther
con
side
ratio
n is
bei
ng g
iven
to th
is re
com
men
datio
n.
The
New
Zea
land
Can
cer R
egis
ter R
equi
rem
ents
• Th
e N
ew Z
eala
nd C
ance
r R
egis
ter
data
base
was
reb
uilt
in 2
001
with
the
obj
ectiv
e of
pr
ovid
ing
impr
oved
fun
ctio
nalit
y.
Incl
usio
n of
the
FIG
O s
tage
will
enab
le m
uch
mor
e de
taile
d an
alys
is o
f the
ext
ent o
f the
dis
ease
at t
he ti
me
of d
iagn
osis
.
9.
M
inim
um
Volu
me
Stan
dard
s fo
r C
ytol
ogy
Labo
rato
ries.
•
DH
B an
d C
omm
unity
Lab
orat
ory
Agre
emen
ts in
corp
orat
e m
inim
um v
olum
e st
anda
rds
� Ju
l 01.
• Tw
o pu
blic
hos
pita
l pro
posa
ls re
ceiv
ed J
une
01.
• Pu
blic
Hos
pita
l lab
orat
orie
s st
rugg
le to
mee
t min
imum
vol
ume
stan
dard
s Ju
ne 0
2.
10.
Ba
lanc
ed A
ppro
ach
to N
CSP
.
11.
Pr
eser
vatio
n of
Jul
ia P
eter
�s c
ultu
re.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
18
Ref
. R
ecom
men
datio
n 20
01/0
2 Im
plem
enta
tion
12.
N
CSP
M
anag
ed
as
a se
para
te
unit
with
a
sepa
rate
bud
get.
• N
SU e
stab
lishe
d as
sep
arat
e bu
sine
ss u
nit w
ith re
spon
sibi
lity
for N
CSP
and
BSA
.
• Bu
dget
est
ablis
hed
and
effe
ctiv
e fro
m J
uly
01.
13.
N
CSP
to b
e co
ntro
lled
by 2
nd o
r 3rd
tier
man
ager
w
ith M
inis
try.
• N
SU m
anag
ed b
y 3rd
tier
man
ager
.
• O
rgan
isat
ion
stru
ctur
e re
view
of N
SU c
ompl
eted
May
02.
14.
Am
end
S74
of th
e H
ealth
Act
195
6.
• D
iscu
ssio
n do
cum
ent c
ompl
eted
Jun
e 01
.
• D
iscu
ssio
n do
cum
ent s
ubm
issi
ons
rece
ived
Jul
y 01
.
• Po
licy
wor
k co
mpl
eted
and
pap
er to
Cab
inet
Sep
t 01.
• PC
O In
stru
ctio
n an
d dr
aftin
g of
legi
slat
ion
com
plet
ed A
pril
02.
• C
abin
et L
egis
lativ
e C
omm
ittee
Apr
il 02
.
• In
trodu
ctio
n to
Hou
se M
ay 0
2.
15.
Ka
itiak
i Reg
ulat
ions
. •
Initi
al d
iscu
ssio
n do
cum
ent a
nd fo
cus
grou
p D
ecem
ber 0
1.
• D
iscu
ssio
n do
cum
ent c
ompl
eted
Feb
ruar
y 02
.
• C
onsu
ltatio
n H
ui c
ompl
eted
Apr
il 02
.
• Br
iefin
g to
Min
iste
r May
02.
• C
abin
et P
aper
Jun
e 02
.
16.
Le
gal r
ight
to
acce
ss in
form
atio
n fro
m t
he N
ew
Zeal
and
Can
cer R
egis
ter.
• R
efer
to 1
4 ab
ove.
17.
Am
end
Hea
lth A
ct 1
956
to e
nabl
e ac
cess
to
med
ical
file
s.
• R
efer
to 1
4 ab
ove.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
19
Ref
. R
ecom
men
datio
n 20
01/0
2 Im
plem
enta
tion
18.
C
hang
e gu
idel
ines
un
der-w
hich
et
hics
co
mm
ittee
s op
erat
e.
• C
onsu
ltatio
n of
dra
ft op
erat
iona
l gui
delin
es c
ompl
eted
Aug
ust 0
1.
• O
pera
tiona
l gui
delin
es fi
nalis
ed O
ctob
er 0
1.
19.
R
evie
w o
f ope
ratio
ns o
f eth
ics
com
mitt
ees.
•
Wor
k to
be
unde
rtake
n by
NEA
C.
20.
Pr
ovid
e gu
idel
ines
to
et
hics
co
mm
ittee
s re
gard
ing
Priv
acy
Act &
Cod
e.
• R
efer
to 1
8 ab
ove.
21.
G
uide
lines
to
et
hics
co
mm
ittee
s fo
r ob
serv
atio
nal s
tudi
es.
• W
ork
to b
e un
derta
ken
by N
EAC
.
22.
N
atio
nal e
thic
s co
mm
ittee
� m
ulti-
cent
re s
tudi
es.
• W
ork
to b
e un
derta
ken
by N
EAC
.
23.
Ap
peal
pro
cess
for e
thic
s co
mm
ittee
dec
isio
ns.
• W
ork
to b
e un
derta
ken
NEA
C.
24.
N
CSP
Com
plai
nts
Syst
em.
• Ph
ase
1 co
mpl
eted
Jun
e 02
.
25.
El
ectro
nic
Link
be
twee
n th
e N
ew
Zeal
and
Can
cer R
egis
ter &
the
NC
SP-R
•
Proc
esse
s fo
r lin
king
and
mat
chin
g da
ta im
plem
ente
d N
ovem
ber 0
1.
26.
Pe
rform
ance
Sta
ndar
ds f
or N
CSP
-R a
nd t
he
New
Zea
land
Can
cer R
egis
ter.
• Th
e N
ew Z
eala
nd C
ance
r Reg
iste
r Reb
uild
com
plet
ed J
une
02.
• N
CSP
-R w
ork
to c
omm
ence
in 0
2/03
.
27.
St
anda
rds
for
the
NC
SP s
houl
d be
rev
iew
ed
ever
y tw
o ye
ars.
•
To c
omm
ence
in 0
2/03
.
28.
Th
e G
over
nmen
t m
ust
ensu
re
suffi
cien
t cy
tote
chno
logi
sts
and
cyto
path
olog
ists
an
d tra
inin
g si
tes.
• R
esea
rch
repo
rt co
mpl
eted
Aug
ust 0
1.
• W
orkf
orce
Sur
vey
com
plet
ed O
ctob
er 0
1.
• W
orkf
orce
Dev
elop
men
t Stra
tegy
Com
plet
ed D
ecem
ber 0
1.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
20
Ref
. R
ecom
men
datio
n 20
01/0
2 Im
plem
enta
tion
• Im
plem
enta
tion
plan
pre
pare
d.
• Fu
nds
iden
tifie
d fo
r ope
ratio
nal a
nd s
ervi
ce p
urch
asin
g.
29.
Am
end
Med
ical
La
bora
tory
Te
chno
logi
sts
Reg
ulat
ions
198
9.
• R
efer
to 3
4 be
low
.
30.
Im
pose
Leg
al o
blig
atio
ns o
n st
orag
e of
slid
es.
• R
efer
to 1
4 ab
ove.
31.
En
sure
el
ectro
nic
linka
ge
betw
een
NC
SP
Reg
iste
r and
Cyt
olog
y La
bs.
• M
igra
tion
of N
CSP
-Reg
iste
r to
Hea
lth In
trane
t com
plet
e.
32.
D
evel
op S
tand
ards
for
acc
urac
y of
lab
orat
ory
codi
ng.
• To
com
men
ce 2
002/
03.
33.
Th
e N
CSP
sho
uld
deve
lop
a po
pula
tion-
base
d re
gist
er.
• Th
e N
SU is
repr
esen
ted
on th
e M
inis
try�s
Pop
ulat
ion
Reg
iste
r Pro
ject
led
by N
ZHIS
.
34.
Le
gal m
echa
nism
s sh
ould
be
in p
lace
to
allo
w
the
ACC
, M
edic
al C
ounc
il an
d th
e H
ealth
&
Dis
abilit
y C
omm
issi
oner
to
sh
are
rele
vant
in
form
atio
n w
ith th
e M
inis
try�s
NC
SP.
• Po
licy
fram
ewor
k pa
per c
ompl
eted
May
01.
• C
ompl
aint
s pa
per c
ompl
eted
Aug
ust 2
001.
• PC
O In
stru
ctio
n an
d fin
al d
rafti
ng o
f leg
isla
tion
com
plet
ed S
epte
mbe
r 01.
• C
abin
et L
egis
lativ
e C
omm
ittee
Jun
e 02
.
• In
trodu
ctio
n to
Hou
se J
une
02.
35.
M
edic
al T
ribun
al to
sup
ply
info
rmat
ion
to N
CSP
. •
Ref
er to
34
abov
e.
36.
AC
C
& M
edic
al
Cou
ncil
shou
ld
exch
ange
re
leva
nt in
form
atio
n re
gard
ing
clai
ms
for m
edic
al
mis
adve
ntur
e.
• R
oyal
ass
ent r
ecei
ved
for I
njur
y Pr
even
tion
and
Reh
abilit
atio
n Bi
ll �
to c
ome
into
effe
ct
April
02.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
21
Ref
. R
ecom
men
datio
n 20
01/0
2 Im
plem
enta
tion
37.
Li
aiso
n w
ith R
oyal
Col
lege
of P
atho
logi
sts
• O
ngoi
ng.
38.
In
form
atio
n to
Wom
en.
• N
ew C
olpo
scop
y br
ochu
re J
uly
01.
• Te
ar-o
ff bo
okle
t for
GPs
pub
lishe
d M
ay 0
2.
• D
etai
led
book
let p
ublis
hed
June
02.
39.
Le
tters
to M
edic
al P
ract
ition
ers.
•
Lette
r sen
t Dec
embe
r 01.
40.
Ap
prop
riate
ly
train
ed
pers
onne
l sh
ould
do
ce
rvic
al s
cree
ning
. •
Ref
er to
28
abov
e.
41.
Al
l pat
holo
gist
s un
derta
king
cyt
olog
y sh
ould
be
appr
opria
tely
trai
ned.
•
Ref
er to
28
abov
e.
42.
C
ytop
atho
logi
sts
mus
t pa
rtici
pate
in
cont
inui
ng
educ
atio
n in
cyt
opat
holo
gy.
• R
efer
to 2
8 ab
ove.
43.
Pa
thol
ogis
ts o
ught
to b
e m
ore
open
-min
ded.
44.
Th
e M
edic
al C
ounc
il sh
ould
ens
ure
that
sys
tem
s ar
e in
pla
ce t
o su
ppor
t th
e ea
rly r
epor
ting
of
erra
nt m
edic
al p
ract
ition
ers
by th
eir c
olle
ague
s.
• R
efer
to 3
4 ab
ove.
45.
N
CSP
sh
ould
ha
ve
a sy
stem
fo
r id
entif
ying
de
ficie
ncie
s.
• R
efer
to 2
4 ab
ove.
46.
Th
ere
shou
ld b
e a
proc
ess
for
mon
itorin
g th
e im
plem
enta
tion
of
the
Com
mitt
ees
Rec
omm
enda
tions
.
• D
r McG
ooga
n�s
Six-
Mon
th R
epor
t rel
ease
d Fe
brua
ry 0
2.
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
22
Six Month Review Six months following the release of the Inquiry Report, two reviews on progress to implement the Inquiry Recommendations were completed. 1. Progress in Implementing the Cervical Screening Inquiry
Recommendations: Independent Report Dr Euphemia McGoogan, expert cytopathologist and advisor to Minister of Health, December 2001.
2. Report of the Controller and Auditor-General: Ministry of Health: Progress in Implementing the Recommendations of the Cervical Screening Inquiry. Office of the Controller and Auditor-General, February 2002.
In response to recommendation 46 of the Inquiry Report, expert cytopathologist Dr Euphemia McGoogan was engaged by the Minister of Health to provide independent advice on progress to implement the Inquiry Recommendations. Dr McGoogan visited New Zealand for 10 days in October/November 2001 to carry out a review of progress over the first six months. This visit included meetings with over 100 individuals in around 35 separate meetings. To assist Dr McGoogan in her review, the Ministry also supplied full documentation on activity to deliver the Inquiry Recommendations. A written report summarising her findings was provided to the Minister on 16 December 2001. Dr McGoogan also completed a 12-Month visit in April 2002. In October 2001 the OAG wrote to the Director-General advising her that the OAG intended to carry out a short piece of work to determine what action had been taken to implement the Inquiry Recommendations. A final draft of their report was provided to the Ministry on 30 January 2002. In her six-month report, Dr McGoogan made particular mention of the assistance she received to complete her review. She was satisfied that she was able to have frank and open discussion with the groups and individuals with whom she met and noted the immense volume of information obtained during her visit, only six months after the release of the Inquiry Report. The OAG found that good progress had been made in setting up structures and systems to address the Inquiry Recommendations. The OAG commented that in the course of its review the Office saw evidence of much determination - particularly among Ministry staff responsible for the programme - that the mistakes of the past would not be repeated again and that recommended changes to the programme would be made5. Dr McGoogan acknowledged the tremendous effort made by the NSU into improving the quality of the NCSP at all levels. She acknowledged the commitment, enthusiasm and dedication of the staff of the Unit and the efforts made to improve the NCSP despite a shortfall in staff.
5 Office of the Controller and Auditor �General. February 2002. Report of the Controller and Auditor �General: Ministry of Health: Progress in Implementing the Recommendations of the Cervical Screening Inquiry. Wellington: Office of the Controller and Auditor Genera. Page 9.
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
23
Both the OAG and Dr McGoogan concluded that good progress has been made on implementing quality standards and routine monitoring of performance indicators across the NCSP, including laboratories. Both Dr McGoogan and the OAG did express concerns regarding progress on several recommendations including:
• progress on the Audit of Invasive Cervical Cancer
• the ability to implement recommendations related to ethics committees
• the extended time taken to implement new legislation and the inability through the consultation processes to deliver all of the CSI recommendations fully
• the capacity and capability of the NSU.
As part of her review, Dr McGoogan also made a further 24 recommendations for improvements to the NCSP. Of these 24 recommendations, 10 related to workforce issues, five related to laboratory coding and reporting, and others related to information systems, monitoring, NCSP regional offices, and provision of information to NCSP participants. This brought the total number of recommendations from the Inquiry and Dr McGoogan to 70. The breadth of these recommendations ranged from relatively small operational improvements to broad organisational requirements, and to those requiring wider sector and Government action. All recommendations were incorporated into the NSU�s detailed work plan. Of the 37 Recommendations reported as under way by the Ministry in its Six-Month Summary Report, 16 were reported as On-Track and 21 as having Revised Delivery Dates6. Dr McGoogan was disappointed that revised timelines were required for 21 of the recommendations. She was satisfied that sufficient progress has been made on the implementation of 16 recommendations. She was not satisfied that sufficient progress had been made on 4 of the recommendations with revised delivery dates and on 7 of the 16 recommendations reported as On-Track.
6 Revised Delivery Dates refer to amendments to the original timetable proposed by the Ministry in April 2001 rather than any timeframes as may have been specified within the Inquiry Report.
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
24
Financial Table 3.0 below summarises expenditure on delivery of the Inquiry Recommendations against the CSI Cost Centre. Some further expenditure was allocated to NSU budgets and not accounted for against the CSI Cost Centre.
Table 3.0 Total CSI Expenditure
2001/02 Baseline
2001/02 Actual7
General 263,407
Cancer Audit 525,855
Legislation 110,948
Ethics 2,284
Legal Assessment 48,517
Statistical Reports 8,369
Policy & Stds Implementation 72,808
Complaints System 23,198
Workforce Development 150,986
Information to Women 4,622
NZHIS 800,000
CSI 3,467,000 2,020,631
7 Some expenditure not accounted for in CSI budget, but coded to NSU NDOC
CSI Annual Review 2001/2002 and Annual Plan 2002/03 November 2002
25
Issues/Risks 2002/03
Audit of Invasive Cervical Cancer The Inquiry and Dr McGoogan, have set out an expectation that the Audit will be the primary mechanism to reassure women that the NCSP today is �safe and effective�, and that until the findings of the Audit are known, these assurances cannot be given. The overall goal of the audit is to provide information to support improvements to the NCSP and thus contribute to a reduction in New Zealand women�s incidence and mortality from invasive cervical cancer. It will be important for the NCSP to liaise closely with the audit team to ensure any areas of the programme requiring improvement that are identified via the audit are actioned as early as possible. To facilitate this, the Clinical Leader of the NCSP will liaise with the audit team and be a member of the audit multidisciplinary advisory and liaison group. An effective communications strategy will be implemented to ensure the stakeholders and the public are informed of the findings of the Audit and how they relate to the NCSP today. Other means of ensuring the programme is operating effectively will also be undertaken by NCSP and communicated, and more work needs to take place in this area.
Ethics The National Ethics Advisory Committee will need to take a consultative approach to the work programme. This will be time consuming and it is unlikely to complete its proposed work programme until November 2003.
The Health (Screening Programmes) Amendment Bill (S74A of the Health Act 1956) As of 9 September the Bill has been allocated a category two priority for the 2002 parliamentary calendar. This priority indicates that the Bill is required to be passed this year. However, this was anticipated by Cabinet when setting the interim legislation programme pending a general review. It was also noted by Cabinet, that because of the large volume of legislation brought forward from the last parliament and the limited House time for the remainder of 2002, many Bills would not make the progress in 2002 suggested by their priority descriptions. Key issues centre on the timing of progress with and content of the Bill. It is estimated that the NSU will need in the order of 6 � 9 months after enactment to prepare for the full implementation of the new legislation. Anything other than speedy passage will require the commencement date to be extended beyond July 2003 as currently envisaged. The Bill includes provisions that are potentially controversial and it is possible that these (or other) provisions could be changed as part of the parliamentary process. The Ministry�s role is limited to advising the Select Committee and
CSI Annual Review 2001/2002 and Annual Plan 2002/03 November 2002
26
the Minister on any amendments that might arise. Any amendments that might be made to the Bill would need to be carefully considered in terms of their implications for the NCSP.
NCSP Operations
Legal Review The NSU is undertaking a further legal review of the roles and responsibilities of the NCSP and its contracted providers. In particular the legal review will look at professional boundary and responsibility issues that exist between the NSU, NCSP regional services and clinical providers (both public and private), with particular reference to current practice and the stated role of the NCSP in providing a �back up� service for women.
Policy and Quality Standards Over the past year the two public hospital laboratories providing a cytology service to the NCSP have not obtained the minimum volume of 15,000 cytology smears per annum. Over the next year these two laboratories will need to continue their efforts to achieve this requirement.
A review of the colposcopy chapter of the Interim Operational and Policy and Quality Standards October 2000, and development of new NCSP Regional Office policy and quality standards will require extensive consultation. The review of the colposcopy chapter will include reviewing the minimum volume and requiring a colposcopist to undertake 100 new colposcopies annually.
The inability to enforce standards with smear takers continues to be of concern to the NSU. During 2002/03 the NSU will review options to ensure compliance of smear takers with the NCSP policy and quality standards.
Workforce Development Funding for 2002/03 to implement the Workforce Development Strategy has enabled priority projects that relate to laboratory workforce to be progressed. The implementation of initiatives for the development of the laboratory workforce requires cooperation between the laboratory sector and the NSU.
Information Technology
NCSP-R and the New Zealand Cancer Register Link The successful migration of the NCSP-R on to the Health Intranet has laid the groundwork for the New Zealand Cancer Register to establish a read-only link to the NCSP-R. This will allow appropriately authorised staff to view the data on the NCSP-R and improve the existing data quality assurance processes. Central to the success of this is the ongoing operation of the Health Intranet and its components. Although there is a current issue around the certificating authority for the Health Digital Certificates, it is expected that this will be resolved without any interruption of service to current and intending users.
CSI Annual Review 2001/2002 and Annual Plan 2002/03 November 2002
27
The issues resolution is being led within the Ministry of Health from within the Corporate and Information Directorate.
Population Register
Work has commenced within the NZHIS-led project to define the user requirements and agree the key deliverables for a population register. It is anticipated that the first key deliverable will be met in June 2003 with the establishment of a population denominator for the NHI. There is also other work ongoing to improve the NHI, which will also form the basis of the population register. The NSU is a key business owner for the project.
Areas beyond the technology component that still need to be addressed in substance from this project include governance, legislation, privacy, communication, and education. As these issues are addressed, further issues may arise that impact on the timely delivery of this project.
NZ Context for Screening International experts - Dr McGoogan and Professor Chamberlain, in their recent reviews of the NCSP and BSA respectively, have reflected on the difficulties in implementing organised screening programmes in New Zealand. These difficulties relate in part to the structure of the health sector, which includes both private and public service provision along the screening pathway. In addition, both experts commented that privacy concerns regarding the use of population registers for inviting individuals to participate in screening programmes, and regarding the use of data for evaluation, actually lessened the public�s chances of benefiting from preventative services. These difficulties were made very apparent in the work on new legislation for the NCSP and in the inability to implement and monitor standards in primary care. The NSU is participating in the Ministry of Health�s project to develop a population register for New Zealand, based upon the NHI. Clearly this project will benefit many areas of the health sector and public health programmes. Policy issues may present themselves as the register develops, given privacy concerns in New Zealand, presenting difficulties for the register project quite apart from any information systems development issues.
CSI Annual Review 2001/2002 and Annual Plan 2002/03 November 2002
28
Summary of 2002/03 Plan A summary of the Implementation Plan for 2002/03 including key milestones is provided in Table 4.0 In 2002/03 emphasis will be on the following activities:
• the Audit of Invasive Cancer Phases 4 to 6
• implementation of direct NCSP laboratory agreements
• introduction of new legislation
• improvements to the NCSP-R
• laboratory workforce initiatives
• population register development
• development of NCSP provider audit tools. Many of the 2002/03 implementation activities now form part of the NSU�s ongoing core business, including:
• publication of regular quarterly monitoring reports
• publication of annual statistical reporting
• ongoing development and implementation of policy and standards
• ongoing development of health promotion resources
• liaison with Colleges and other professional organisations
• sharing of information with Accident Compensation Corporation, the Health and Disability Commissioner and the Medical Council of New Zealand
• NCSP-R and the New Zealand Cancer Register data assurance processes.
CSI
Ann
ual R
evie
w 2
001/
200
2 an
d An
nual
Pla
n 20
02/0
3
N
ovem
ber 2
002
29
Tabl
e 4.
0 Su
mm
ary
Impl
emen
tatio
n Pl
an 2
002/
03
Ref
. R
ecom
men
datio
n 20
02/0
3 Pl
an
1.
Ev
alua
tion
of N
CSP
. Au
dit o
f Inv
asiv
e C
ervi
cal C
ance
r
• Ph
ase
4 (c
onta
ctin
g an
d in
terv
iew
ing
wom
en) o
ngoi
ng.
• Ph
ase
5 (in
form
atio
n co
llect
ion)
ong
oing
.
• Ph
ase
6 (s
lide
revi
ew) t
o be
impl
emen
ted.
2.
R
e-en
rolm
ent a
nd re
-scr
eeni
ng o
f wom
en.
3.
C
ox�s
199
7 co
mpr
ehen
sive
eva
luat
ion
of t
he
NC
SP s
houl
d be
com
men
ced
with
in 1
8 m
onth
s.
• Pa
rts
5,
6 an
d 8
incl
uded
w
ithin
th
e sc
ope
of
Part
3 (C
ance
r Au
dit).
(S
ee
reco
mm
enda
tion
1abo
ve).
• Pa
rts 4
, 7
and
10 i
nclu
ded
with
in s
cope
of
NC
SP S
tatis
tical
Rep
ortin
g. (
Ref
er t
o re
com
men
datio
n 7
belo
w).
4.
Im
plem
enta
tion
of
Ope
ratio
nal
Polic
y an
d Q
ualit
y St
anda
rds
& Ev
alua
tion
& M
onito
ring
Plan
.
• Pu
blic
atio
n of
Inde
pend
ent M
onito
ring
Gro
up N
CSP
qua
rterly
mon
itorin
g re
ports
5, 6
, 7
and
8.
• Pu
blic
atio
n of
IMG
Ann
ual M
onito
ring
Rep
ort 2
001.
• Pu
blic
atio
n of
NC
SP &
BSA
Qua
lity
Fram
ewor
k.
• R
evie
w
of
optio
ns
to
man
date
st
anda
rds
for
NC
SP
Prov
ider
s.
(Ref
er
also
to
re
com
men
datio
n 14
bel
ow).
5.
Fu
ll le
gal a
sses
smen
t of O
pera
tiona
l Pol
icy
and
Qua
lity
Stan
dard
s.
• Fu
rther
le
gal
asse
ssm
ent
of
NC
SP
prac
titio
ner�s
re
spon
sibi
litie
s,
incl
udin
g N
CSP
R
egio
nal O
ffice
s.
6.
Le
gal a
sses
smen
t of N
CSP
Aut
horit
y.
• R
efer
to re
com
men
datio
n 14
bel
ow.
7.
St
atis
tical
Rep
ortin
g.
• 19
99-0
0 R
epor
t Pub
lishe
d.
CSI
Ann
ual R
evie
w 2
001/
200
2 an
d An
nual
Pla
n 20
02/0
3
N
ovem
ber 2
002
30
Ref
. R
ecom
men
datio
n 20
02/0
3 Pl
an
8.
R
egul
ar S
tatis
tical
Info
rmat
ion.
•
Ong
oing
.
9.
M
inim
um
Volu
me
Stan
dard
s fo
r C
ytol
ogy
Labo
rato
ries.
•
Ong
oing
.
10.
Ba
lanc
ed A
ppro
ach
to N
CSP
. •
Ong
oing
.
11.
Pr
eser
vatio
n of
Jul
ia P
eter
s C
ultu
re.
• O
ngoi
ng.
12.
N
CSP
M
anag
ed
as
a se
para
te
unit
with
a
sepa
rate
bud
get.
• Im
plem
enta
tion
of d
irect
NC
SP L
abor
ator
y Ag
reem
ents
.
13.
N
CSP
to
cont
rolle
d by
2nd
or
3rd t
ier
man
ager
w
ith M
inis
try.
• O
ngoi
ng.
14.
Am
end
S74
of th
e H
ealth
Act
195
6.
• H
ealth
(Scr
eeni
ng p
rogr
amm
es) A
men
dmen
t Bill
o
Firs
t Rea
ding
.
o
Sele
ct C
omm
ittee
.
o
Seco
nd R
eadi
ng.
o
Com
mitt
ee o
f Who
le H
ouse
.
o
Enac
tmen
t.
o
Impl
emen
tatio
n Pl
an.
o
Com
mun
icat
ions
Stra
tegy
o
Rev
ise
NC
SP In
form
atio
n to
Wom
en a
nd p
ract
ition
ers
reso
urce
s.
15.
Ka
itiak
i Reg
ulat
ions
. •
Impl
emen
t im
prov
ed p
roce
sses
.
CSI
Ann
ual R
evie
w 2
001/
200
2 an
d An
nual
Pla
n 20
02/0
3
N
ovem
ber 2
002
31
Ref
. R
ecom
men
datio
n 20
02/0
3 Pl
an
16.
Le
gal r
ight
to
acce
ss in
form
atio
n fro
m t
he N
ew
Zeal
and
Can
cer R
egis
ter.
• R
efer
to re
com
men
datio
n 14
abo
ve.
17.
Am
end
Hea
lth A
ct 1
956
to e
nabl
e ac
cess
to
med
ical
file
s.
• R
efer
to re
com
men
datio
n 14
abo
ve.
18.
C
hang
e gu
idel
ines
un
der-w
hich
et
hics
co
mm
ittee
s op
erat
e.
• Im
plem
ente
d.
19.
R
evie
w o
f ope
ratio
ns o
f eth
ics
com
mitt
ees.
•
Wor
k to
be
unde
rtake
n by
NEA
C.
20.
Pr
ovid
e gu
idel
ines
to
et
hics
co
mm
ittee
s re
gard
ing
Priv
acy
Act &
Cod
e.
• R
efer
to re
com
men
datio
n 18
abo
ve.
21.
G
uide
lines
to
et
hics
co
mm
ittee
s fo
r ob
serv
atio
nal s
tudi
es.
• W
ork
to b
e un
derta
ken
by N
EAC
.
22.
N
atio
nal e
thic
s co
mm
ittee
� m
ulti-
cent
re s
tudi
es.
• W
ork
to b
e un
derta
ken
by N
EAC
.
23.
Ap
peal
pro
cess
for e
thic
s co
mm
ittee
dec
isio
ns.
• W
ork
to b
e un
derta
ken
by N
EAC
.
24.
N
CSP
Com
plai
nts
Syst
em.
• N
ew In
form
atio
n Sy
stem
s in
pla
ce.
• M
OU
with
AC
C, H
DC
, Med
ical
Cou
ncil
in p
lace
.
25.
El
ectro
nic
Link
th
e N
ew
Zeal
and
Can
cer
Reg
iste
r & N
CSP
-R
• O
ngoi
ng.
26.
Pe
rform
ance
Sta
ndar
ds f
or N
CSP
-R a
nd t
he
New
Zea
land
Can
cer R
egis
ter.
• O
ngoi
ng.
• N
CSP
-R w
ork
to c
omm
ence
in 0
2/03
.
CSI
Ann
ual R
evie
w 2
001/
200
2 an
d An
nual
Pla
n 20
02/0
3
N
ovem
ber 2
002
32
Ref
. R
ecom
men
datio
n 20
02/0
3 Pl
an
27.
St
anda
rds
for
the
NC
SP s
houl
d be
rev
iew
ed
ever
y tw
o ye
ars.
•
Rev
iew
of C
olpo
scop
y St
anda
rds.
• R
evie
w o
f Reg
iona
l Offi
ce S
tand
ards
.
• R
evie
w o
f NC
SP S
mea
r Tak
er M
anag
emen
t Rep
orts
.
28.
Th
e G
over
nmen
t m
ust
ensu
re
suffi
cien
t cy
tote
chno
logi
sts
and
cyto
path
olog
ists
an
d tra
inin
g si
tes.
• La
bora
tory
Wor
kfor
ce A
dvis
ory
Gro
up.
• La
bora
tory
Wor
kfor
ce O
ptio
ns R
evie
w.
• La
bora
tory
Orie
ntat
ion
and
Supe
rvis
ion
Proj
ect.
• M
ore
BMLS
c St
uden
ts.
• Su
ppor
t for
the
NZ
Soci
ety
of C
ytol
ogy
Con
fere
nce.
29.
Am
end
Med
ical
La
bora
tory
Te
chno
logi
sts
Reg
ulat
ions
198
9.
• Ad
dres
sed
thro
ugh
scop
es o
f pra
ctic
e fo
llow
ing
the
impl
emen
tatio
n of
the
HPC
A.
30.
Im
pose
Leg
al o
blig
atio
ns o
n st
orag
e of
slid
es.
• R
efer
to re
com
men
datio
n 14
abo
ve.
31.
En
sure
el
ectro
nic
linka
ge
betw
een
NC
SP
Reg
iste
r and
Cyt
olog
y La
bs.
• La
bora
tory
link
age
to h
ealth
intra
net.
32.
D
evel
op S
tand
ards
for
acc
urac
y of
lab
orat
ory
codi
ng.
• Ad
ditio
n of
new
SN
OM
ED c
odes
.
• In
trodu
ctio
n of
Bet
hesd
a 20
01 c
odes
.
33.
Th
e N
CSP
sho
uld
deve
lop
a po
pula
tion-
base
d re
gist
er.
• Th
e N
SU is
rep
rese
nted
on
the
Min
istry
�s P
opul
atio
n R
egis
ter
Proj
ect l
ed b
y N
ZHIS
�
ongo
ing.
34.
Le
gal m
echa
nism
s sh
ould
be
in p
lace
to
allo
w
the
ACC
, M
edic
al C
ounc
il an
d th
e H
ealth
&
Dis
abilit
y C
omm
issi
oner
to
sh
are
rele
vant
in
form
atio
n w
ith th
e M
inis
try�s
NC
SP.
• Pr
ovis
ions
Incl
uded
in th
e H
ealth
Pra
ctiti
oner
s C
ompe
tenc
e As
sura
nce
Bill
• Fi
rst R
eadi
ng.
CSI
Ann
ual R
evie
w 2
001/
200
2 an
d An
nual
Pla
n 20
02/0
3
N
ovem
ber 2
002
33
Ref
. R
ecom
men
datio
n 20
02/0
3 Pl
an
• R
efer
ral t
o Se
lect
Com
mitt
ee O
ctob
er 2
002
(sub
mis
sion
s cl
ose
27 N
ovem
ber 2
002)
.
• Se
cond
Rea
ding
.
• Th
ird R
eadi
ng.
• C
omm
ittee
of W
hole
Hou
se.
• C
omin
g in
to fo
rce,
six
mon
ths
afte
r bei
ng p
asse
d.
35.
M
edic
al
Prac
titio
ners
D
isci
plin
ary
Trib
unal
to
su
pply
info
rmat
ion
to N
CSP
. •
Ref
er to
34
abov
e.
36.
AC
C
& M
edic
al
Cou
ncil
shou
ld
exch
ange
re
leva
nt in
form
atio
n re
gard
ing
clai
ms
for m
edic
al
mis
adve
ntur
e.
• Im
plem
ente
d.
37.
Li
aiso
n w
ith R
oyal
Col
lege
of P
atho
logi
sts.
•
Ong
oing
.
38.
In
form
atio
n to
Wom
en.
• D
evel
opm
ent o
f new
Hea
lth P
rom
otio
n St
rate
gy.
• R
evie
w M
aori
& Pa
cific
Res
ourc
es.
39.
Le
tters
to M
edic
al P
ract
ition
ers.
•
Ong
oing
.
40.
Ap
prop
riate
ly
train
ed
pers
onne
l sh
ould
do
ce
rvic
al s
cree
ning
. •
Ref
er to
28
abov
e.
41.
Al
l pat
holo
gist
s un
derta
king
cyt
olog
y sh
ould
be
appr
opria
tely
trai
ned.
•
Ref
er to
28
abov
e.
42.
C
ytop
atho
logi
sts
mus
t pa
rtici
pate
in
cont
inui
ng
educ
atio
n in
cyt
opat
holo
gy.
• R
efer
to 2
8 ab
ove.
CSI
Ann
ual R
evie
w 2
001/
200
2 an
d An
nual
Pla
n 20
02/0
3
N
ovem
ber 2
002
34
Ref
. R
ecom
men
datio
n 20
02/0
3 Pl
an
43.
Pa
thol
ogis
ts o
ught
to b
e m
ore
open
-min
ded.
44.
Th
e M
edic
al C
ounc
il sh
ould
ens
ure
that
sys
tem
s ar
e in
pla
ce t
o su
ppor
t th
e ea
rly r
epor
ting
of
erra
nt m
edic
al p
ract
ition
ers
by th
eir c
olle
ague
s.
• R
efer
to 3
4 ab
ove.
45.
N
CSP
sh
ould
ha
ve
a sy
stem
fo
r id
entif
ying
de
ficie
ncie
s.
• D
evel
opm
ent
of N
CSP
Aud
it Fr
amew
ork
and
Tool
s an
d co
mm
ence
men
t of
Pro
vide
r Au
dits
.
• M
anag
emen
t of N
CSP
Issu
es R
egis
ter.
46.
Th
ere
shou
ld b
e a
proc
ess
for
mon
itorin
g th
e im
plem
enta
tion
of
the
Com
mitt
ee�s
R
ecom
men
datio
ns.
• O
ngoi
ng
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
35
A further 24 recommendations for improvements to the NCSP were made by Dr Euphemia McGoogan as a result of her six month review visit in October/ November 2001 and subsequent report in December 2001. The recommendations are summarised below and form part of the 2002/2003 implementation plan.
Table 5.0 Dr McGoogan Recommendations
Ref. Recommendation 2002/03 Plan
1. Regional Offices. • Interim reconfiguration of Regional Office Register Operations.
2. Smear takers. • Smear taker training fund
• NCSP communication ongoing
• Update smear taker training courses offered.
3. CSI Report published in hardcopy form.
• Printed and distributed April 02.
4. Clinical Director input to teleconferences.
• Ongoing, NCSP Clinical Leader
5. Training programme & quality standards for staff reading liquid based cervical preparations.
• Detailed Review Chapter 5 - Providing a Laboratory Service (planned 03/04).
(Refer also to recommendation 27 of the Inquiry Recommendations).
6. Development of New Zealand EQA Scheme.
• Workforce Development Project initiative.
• Included in the detailed review of Chapter 5 of the NCSP Operational Policy and Quality Standards (planned 03/04).
(Refer also to recommendation 27 of the Inquiry Recommendations).
7. Regular Cytology update courses. • Sponsorship of Annual Society of Cytology Conference.
• Included in the detailed review of Chapter 5 of the NCSP Operational Policy and Quality Standards (planned 03/04).
(Refer also to recommendation 27 of the Inquiry Recommendations).
8. NSU Organisational Development.
• Ongoing
9. Significance abnormal smear results and colposcopy information for women.
• Colposcopy pamphlet printed June 2001
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
36
Ref. Recommendation 2002/03 Plan
10. Send interim NCSP information leaflet pads to providers.
• Sent to providers May 2002
11. Standardised criteria for reporting unsatisfactory smears.
• Bethesda 2001 project. (See also recommendation 32 of the Inquiry Recommendations).
12. Issue guidance to labs about implementation of Bethesda 2001.
• Bethesda 2001 project. (See also recommendation 32 of the Inquiry Recommendations).
13. Identify duplicate additional smears at colposcopy.
• Colposcopy Policy and Standards review. (Refer also to recommendation 27 of the Inquiry Recommendations).
14. Short-interval re-screening � important to define who is being screened by each laboratory and how often.
• Short-interval re-screening analysis underway.
15. Audit of laboratory returns including �opt-off�.
• Health (Screening Programmes) Amendment Bill � Implementation project. (Refer also to recommendations 14, 16, 17, 30 of the Inquiry Recommendations).
16. Recording of conventional smears and thin prep samples on NCSP-Register.
• To be implemented
17. Additional SNOMED codes on NCSP Register.
• SNOMED coding project. (Refer also to recommendation 32 of the Inquiry Recommendations).
18. Inclusion of Colposcopy Data on the NCSP-Register.
• Health (Screening Programmes) Amendment Bill � Implementation project. (Refer also to recommendations 14, 16, 17, 30 of the Inquiry Recommendations).
• Colposcopy Policy and Standards Review (Refer also to recommendation 27 of the Inquiry Recommendations).
19. Improved communication between IMG, providers and NSU.
• Ongoing
20. Direct access to NCSP-Register for Labs.
• Ongoing
21. Improved information on NCSP laboratory referral form from smear-takers to laboratories.
• Review of electronic smear-taker forms
22. Role of regional office in relation to repeat smears for individual women.
• Legal review of roles and responsibilities. (Refer also to recommendations 5 and 6 of the Inquiry Recommendations).
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
37
Ref. Recommendation 2002/03 Plan
23. 14 regional offices is an inefficient use of resources.
• Regional Office reconfiguration project.
• Legal review of roles and responsibilities. (Refer also to recommendations 5 and 6 of the Inquiry Recommendations.
24. Standards for smear takers and compliance cost issues.
• Ongoing
• Review of electronic smear-taker forms
• Health (Screening Programmes) Amendment Bill � Implementation project (Refer also to recommendations 14, 16, 17 and 30 of the Inquiry Recommendations).
25. Participation in the NCSP must be further improved.
• Continued work with the NCSP Regional
Offices and Independent Service
Providers on Health Promotion Plans with
the aim to improve coverage and
participation.
• Reducing Inequalities project
• Review and ongoing development of
NCSP Resources for women. (Refer also
to recommendation 38 of the Inquiry
Recommendations).
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
38
2002/03 Budget Table 6.0 below summarises expenditure on delivery of the Inquiry Recommendations against the CSI Cost Centre. Actual figures for 2001/02 are provided in column 1, the budgeted figures for 2002/03 are contained in column 2.
Table 6.0 Total CSI Budget
2001/02 Actual8 2002/03 Budget
General 263,407 172,000
Cancer Audit 525,855 1,410,000
Legislation 110,948 151,340
Ethics 2,284
Legal Assessment 48,517
Statistical Reports 8,369 44,460
Policy &Stds Implementation 72,808 219,020
Policy & Stds Review 508,000
Complaints System & Provider Audits
23,198 450,000
Workforce Development 150,986 345,000
Information to Women 4,622 65,000
NZHIS 800,000 191,000
CSI 2,020,631 3,555,820
8 Some expenditure not accounted for in CSI budget, but coded to NSU NDOC
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
39
Appendix 1: Inquiry Recommendations and Responsibilities
Ref. Recommendation Responsibility
1. Evaluation of NCSP The remaining two phases of the national evaluation designed by the Otago University team must proceed. Until those phases are completed the Programme�s safety for women cannot be known. It is imperative that this exercise is completed within the next six months. Particular attention should be given to the discrepancy between the average reporting rate of high-grade abnormalities of Douglass Hanly Moir Pathology (2.5%-3.7%) for the re-read of the Gisborne women�s smear tests and the current New Zealand national average for reporting high-grade abnormalities (0.8%). Unless this exercise is carried out the possibility that the national average is flawed and that there is a systemic problem of under-reporting in New Zealand laboratories cannot be excluded.
Director of Public Health
2. Re-enrolment and re-screening of women. If the national evaluation throws doubt on the accuracy of the current national average then the Committee recommends that all women who are or who have participated in the Programme should be invited to re-enroll on the register as new entrants and they should be offered two smear tests 12 months apart. Women who have never enrolled on the Register or who have had their names removed from the Register should be invited through notices in the print media to also go through the process of having two smear tests twelve months apart.
National Screening Unit
3. Evaluation of NCSP A comprehensive evaluation of all aspects of the National Cervical Screening Programme which reflects the 1997 Draft Evaluation Plan developed by Doctors Cox and Richardson should be commenced within 18 months. This exercise should build upon the three phase evaluation referred to in recommendation 11.1.
National Screening Unit
4. Operational Policy and Quality Standards & Evaluation & Monitoring Plan. The Policy And Quality Standards For The National Cervical Screening Programme and the Evaluation and Monitoring Plan For The National Cervical Screening Programme prepared by Dr Julia Peters and her team must be implemented fully within the next 12 months.
National Screening Unit
5. Full legal assessment of Operational Policy and Quality Standards. There needs to be a full legal assessment of the Policy & Quality Standards for the NCSP and the Evaluation and Monitoring Plan to ensure that the requisite legal authority to carry out these plans is in place.
National Screening Unit
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
40
Ref. Recommendation Responsibility
6. Legal assessment of NCSP Authority. The NCSP should be thoroughly evaluated by lawyers to determine whether or not those persons charged with tasks under the NCSP have the necessary legal authority to discharge them.
National Screening Unit
7. Statistical Reporting. The NCSP should issue annual statistical reports. These reports should provide statistical analysis to indicate the quality of laboratory performance. They should also provide statistical analysis of all other aspects of the programme. They must be critically evaluated to identify areas of deficiency or weakness in the NCSP, these must be remedied in a timely manner.
National Screening Unit
8. Regular Statistical Information. Meaningful statistical information should be generated from both the National Cervical Screening Register and the Cancer Register on a regular basis. Attention must be paid not only to laboratory reporting rates but also to trends and the incidence of the disease, assessed by regions that are meaningful to allow some correlation between reporting profiles laboratories and the incidence of cancer. Because cervical smear tests may be read outside the region in which the smear test is taken, a recording system needs to be devised which identifies the region where smears are taken.
National Screening Unit NZHIS
9. Minimum Standards for Cytology Laboratories. The compulsory setting of a minimum number of smears that should be ready by laboratories each year must be put in place. The proposal to impose three minimum volume standards on laboratories must be implemented. These are: each fixed site will process a min of 15,000 gynaecology cytology cases, each pathologists will report at least 500 abnormal gynaecological cytology cases, cytotechnical staff must primary screen a min of 3,000 gynaecological cytology cases per annum. This should be implemented within 12 months.
National Screening Unit
14. Amend S74 of the Health Act 1956. The Health Act 1956 should be amended to permit the National Cervical Screening Programme to be effectively audited, monitored and evaluated by any appropriately qualified persons irrespective of their legal relationship with the Ministry of Health. This requires an amendment to s.74A of the Health Act to permit such persons to have ready access to all information on the National Cervical Screening Register.
Public Health Legislative Review Team
15. Kaitiaki Regulations. There needs to be reconsideration of the Kaitiaki Regulations, and the manner in which those regulations currently effect the Ministry of Health gaining access to aggregate data of Maori Women enrolled on the NCSP-Register. The Ministry of Health and any appropriately qualified persons engaged by it require ready access to the information currently protected by the Kaitiaki Regulations in order to carry out any audit, monitoring or evaluation of the Programme.
Maori Health Directorate
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
41
Ref. Recommendation Responsibility
16. Legal right to access information from the Cancer Register. The present legal rights of access to information held on the Cancer Registry need to be clarified. The Ministry and any appropriately qualified persons it engages to carry out audits, monitoring, or evaluation of cervical cancer incidence and mortality require ready access to all information stored on the Cancer Registry about persons registered as having cervical cancer.
Public Health Legislative Review Team NZHIS
17. Amend Health Act 1956 to enable access to medical files. The Health Act 1956 requires amendment to enable Ministry of Health and any appropriately qualified persons it engages to carry out audits, monitoring or evaluation of cervical cancer incidence and mortality to have ready access to all medical files recording the treatment of the cervical cancer by all health providers who had a role in such treatment.
Public Health Legislative Review Team
18. Change guidelines under-which ethics committees operate. There needs to be change to guidelines under which ethics committees operate to make it clear that any (external and internal) audit, monitoring and evaluation of past and current medical treatment does not require the approval of ethics committees.
Sector Policy
19. Review of operations of ethics committees. There should also be a review of the operation of ethics committees and the impact their decisions are having on independently funded evaluation exercises and on medical research generally in New Zealand.
Sector Policy
20. Provide guidelines to ethics committees regarding Privacy Act & Code. Ethics Committees require guidance regarding the application of the Privacy Act and the Privacy Health Information Code. Ethics Committees need to be informed that the interpretations of legislation relating to personal privacy is for the agency holding a patient�s data to decide. They would, therefore, benefit from having at least one legally qualified person on each regional committee.
Sector Policy
21. Guidelines to ethics committees for observational studies. Ethics committees require guidance regarding the weighing up of harms and benefits in assessing the ethics of observational studies.
Sector Policy
22. National ethics committee � multi-centre studies. A national ethics committee should be established for the assessment of multi-centre or national studies.
Sector Policy
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
42
Ref. Recommendation Responsibility
23. Appeal process for ethics committee decisions. The procedures under which ethics committees operate need to be re-examined. Consideration should be given to processes to allow their decisions to be appealed to an independent body.
Sector Policy
24. NCSP Complaints System. The National Cervical Screening Programme requires its own system to deal with complaints regarding the Programme�s delivery. It also needs to have in place a user-friendly system which can respond to complaints of Programme failures, such as under-reporting. The difficulty that witness A experienced in having her medical misadventure recognised as a failure of the Programme and a failure of Gisborne Laboratories must be avoided in the future.
National Screening Unit
25. Electronic Link Cancer Register & NCSP Register. The National Cervical Screening Register needs to be electronically linked with the Cancer Register.
National Screening Unit NZHIS
26. Performance Standards for NCSP Register and Cancer Register. Performance standards should be put in place for the National Cervical Screening Register and the Cancer Registry. The currency of the data on both Registers needs to be improved. The Cancer Registry should be funded in a way that enables it to provide timely and accurate data that is meaningful.
National Screening Unit NZHIS
27. Standards for the NCSP should be reviewed every two years. Standards for the NCSP should be reviewed every two years and more frequently if monitoring indicates that some of the standards are inappropriate.
National Screening Unit
28. The Government must ensure sufficient cytotechnologists and cytopathologists and training sites. The Government in consultation with other bodies or agencies needs to ensure that there are sufficient trained cytotechnologists and cytopathologists and that there are appropriate training sites for them. There should also be a review of the training requirements and maintenance of competence of smear test readers and cytopathologists.
National Screening Unit
29. Amend Medical Laboratory Technologists Regulations 1989. The Medical Laboratory Regulations 1989 should be amended to permit only registered medical practitioners with specialist qualifications in pathology and appropriate training in cytopathology or appropriately trained cytoscreeners to read cervical smear tests.
Sector Policy
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
43
Ref. Recommendation Responsibility
30. Impose Legal obligations on storage of slides. Legal obligations in addition to those mandated by IANZ must be imposed on all laboratories reading cervical cytology requiring them to retain records of patients� cytology and histology results (including slides, reports and any other material relating to the patient) in safe storage for a period of no less than five years from the date on which the results were reported. Secondly all laboratory owners must be made legally responsible for ensuring that a patient�s records are readily accessible and properly archived during the five year storage period irrespective of changes in the laboratory�s ownership through a sale of shares or a sale of the laboratory�s business. The vendor of the shares or the laboratory�s business should carry a primary legal responsibility to store the records, though the option to transfer this legal responsibility as a condition of the sale to the purchaser should be permitted. Similar provisions should apply to laboratory amalgamations. In this case the newly merged entity should be responsible for storing the records.
Public Health Legislative Review Team
31. Ensure electronic linkage between NCSP Register and Cytology Labs. The cervical smear test and histology histories of women enrolled on the National Cervical Screening register should be made electronically available online to all laboratories reading cervical cytology.
National Screening Unit
32. Develop Standards for accuracy of laboratory coding. Standards must be developed for ensuring the accuracy of laboratory coding and this aspect of the National cervical Screening Register must be subject to an appropriate quality assurance process.
National Screening Unit
33. The NCSP should develop a population-based register. The NCSP should work towards developing a population based register and move away from being the utility based register that it now is.
NZHIS
34. Legal mechanisms should be in place to allow the ACC, Medical Council and the Health & Disability Commissioner to share relevant information with the Ministry�s NCSP. There should be a legal obligation on the ACC, the Medical Council and the Health and Disability Commissioner to advise the NCSP�s manager of complaints about the professional performance of providers to the Programme when complaints are made to those various organisations about the treatment of a patient in relation to the Programme.
Sector Policy
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
44
Ref. Recommendation Responsibility
35. Medical Tribunal to supply information to NCSP. Consideration should be given to the addition of an express requirement in the provisions governing medical disciplinary proceedings which would oblige the Tribunal seized of the facts of any given case specifically to consider whether there are any grounds for concern that there may be a public health risk involved. If that concern is present the Tribunal should be required to inform the Minster of Health.
Sector Policy
36. ACC & Medical Council should exchange relevant information regarding claims for medical misadventure. There should be an exchange of information between the Accident Compensation Corporation and Medical Council regarding claims for medical misadventure and disciplinary actions against medical practitioners.
Sector Policy
38 Information to Women. The Programme must provide women with information to enable them to make informed decisions about screening and provide them with information regarding potential risks and benefits. Until the Programme has been monitored and evaluated in accordance with the current three phase national evaluation the Programme has an obligation to inform women that the quality of the performance of some of its parts has not been tested. Women should also be informed that screening will not necessarily detect cervical cancer.
National Screening Unit
39 Letters to Medical Practitioners. Medical practitioners need to be reminded that cervical smear tests are not a means of diagnosing cervical cancer. They need to be alert to signs of cervical cancer, and they should not place too much reliance on a patient�s smear test results to discount the possibility of cervical cancer being present.
National Screening Unit
40 Appropriately trained personnel should do cervical screening. Primary screening of cervical smears should only be performed by individuals who are appropriately trained for that task. Consideration should be given to requiring pathologists to train as cytoscreeners if they want to function as primary screeners.
National Screening Unit
41 All pathologists undertaking cytology should be appropriately trained. If cytology is a significant component of a pathologist�s practice then he or she must participate in continuing medical education in that subject.
National Screening Unit
42 Cytopathologists must participate in continuing education in cytopathology. If cytology is a major component of a pathologist�s practice, it is desirable that he or she should have added qualifications in cytopathology; either a fellowship slanted towards cytopathology or a diploma in cytopathology. Consideration should be given to making this a mandatory requirement.
National Screening Unit
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
45
Ref. Recommendation Responsibility
43 Pathologists ought to be more open-minded. Pathologists should be more open minded and critical of laboratory performance. They should be alert to the possibility that their practice or the practice of their colleagues may be sub-optimal.
44 The Medical Council should ensure that systems are in place to support the early reporting of errant medical practitioners by their colleagues. The Medical Council should ensure that systems are in place whereby medical practitioners are not deterred from reporting to it their concerns about the practice of an individual medical practitioner. Complainants should be assured that their reports will not result in them being penalised in any way.
Sector Policy
45 NCSP should have a system for identifying deficiencies. The screening programme should have in place a system over and above the audit and monitoring reports, to identify deficiencies in its process. A form of survey of users so that they can be proactive rather than reactive in the delivery of the programme would be useful.
National Screening Unit
46 There should be a process for monitoring the implementation of the Committees Recommendations. A process to ensure that the recommendations made by the Committee are implemented should be put in place.
CSI Steering Group
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
46
Appendix 2: Summary of Reporting The reports below are available on the Gisborne Ministerial Inquiry website CSI website www.csi.org.nz.
TITLE DATE OF
REPORT
Second Quarterly (10 June to 10 September) Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
10/09/02
First Quarterly (10 April to 10 June) Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
10/06/02
Eleventh Monthly Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
18/03/02
Ninth/ Tenth Monthly Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
19/02/02
Review of Progress (six month) to Implement the Recommendations of the Gisborne Cervical Screening Inquiry Report. Response to the reports of Dr Euphemia McGoogan and Office of the Auditor General.
07/02/02
Seventh/ Eighth Monthly Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
12/12/01
Six-Month Summary Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
26/10/01
Sixth Monthly Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
18/10/01
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
47
TITLE DATE OF REPORT
Fifth Monthly Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
24/9/01
Fourth Monthly Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
15/08/01
Third Monthly Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
16/07/01
Second Monthly Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
12/06/01
First Monthly Report From The Ministry Of Health To The Minister On The Implementation Of The Recommendations Of The Gisborne Cervical Screening Inquiry.
08/05/01
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
48
Appendix 3: Summary of Six-Month Reviews A summary of the key issues of both reviews is provided below.
Table 3.0 Summary9
Key Issue Ministry Comment
a) Progress Reporting:
Criticism regarding the reporting of the status of recommendations as complete or on-track and dissatisfaction with progress on 11 recommendations.
Officials recommend that clarification be sought with Dr McGoogan and the OAG regarding their expectations of progress and agreement for measuring progress.
b) Timetable for Implementation of Recommendations.
Dr McGoogan states that the timetable for implementation is 1 year.
Officials recommend that further clarification be sought from Dr McGoogan regarding the basis for the assumed timetable.
c) Audit of Invasive Cervical Cancer
Concern that the Audit has not yet commenced.
Concern that sufficient expertise has not yet been employed on the Audit.
The NSU advises that it is the data collection (external to Ministry) aspect of the Audit that has not yet commenced. Dr McGoogan states that she is impressed with the work done to date by the NSU�s Cancer Audit Project Team in the first two phases of the Audit design and development.
Since Dr McGoogan�s visit the NSU has made substantial progress in obtaining the expertise to carry out the Audit. This means that the Audit is on target to submit its application to ethics committees in March 2002
d) Legislative Changes
Concern regarding delays and complexities of these changes, as well as concern regarding the use of the discussion document.
Officials have acknowledged the shortcomings of the discussion document given the context of Cabinet decisions and timeframe for its release.
Delay to the introduction of legislative changes is also acknowledged, given the extremely tight timeframe, which was unable to be met given the complexity of policy development and legislative drafting.
e) Ethical Review
Dr McGoogan highlights the difficulties associated with implementing the Inquiry�s Recommendations and concludes that progress is unlikely to be made at present.
Officials agree that ethics committees are not in support of the Inquiry Recommendations.
9 Table included within Briefing on Ministry Response to 6-Month Reviews.
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
49
Key Issue Ministry Comment
f) Smear Takers
Dr McGoogan highlights difficulties associated with implementing standards for smear-takers and ensuring appropriate training.
The ability to ensure that smear takers meet the standards required of NCSP is a concern to the NSU. The main obstacle is the current unavailability of contractual or other mechanisms, including appropriate funding, to ensure standards are met. Development of the most appropriate mechanisms will need to be the subject of ongoing policy development work, pending available resources.
g) NSU Organisation and Workforce
Both reviews highlighted issues related to the available workforce required to implement the recommendations and for the ongoing operation of the NCSP. Structural issues related to the authority of the NSU and the qualifications of the Group Manager are also highlighted.
The NSU acknowledges recruitment and workforce difficulties. The availability of skilled and experienced workforce is limited and requires some time to build up. The NSU will need to re-prioritise work including the Inquiry Recommendations.
The NSU acknowledges that the Group Manager does not hold medical qualifications but that the operations of the NSU necessitate this approach. Dr McGoogan, however, acknowledges the managerial skills, leadership and expertise of the Group Manager despite the lack of medical qualification.
h) Information to Women
Dr McGoogan expresses concern over the need to ensure women are adequately informed regarding the risks and benefits of cervical screening. This relates to the ability of the NSU to provide more timely information and the ability of health service practitioners to discuss aspects of the programme adequately.
The NSU has supplied Dr McGoogan with the full range of available information for women, which were not acknowledged in her report. The NSU acknowledges that a new booklet has taken time to develop. The NSU agrees that information provided to women by health practitioners has not been adequately assessed and relates to the ability of the NSU to mandate standards for primary care in particular.
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
50
Appendix 4: April 2001 Plan Ref Recommendation Status Timeframe10 1. Parts 2 and 3 of the National Evaluation of the National
Cervical Screening Programme (NCSP) to be completed with six months.
Work In Progress Completion: Part 2: 30 June 2001 Part 3: August 200211
2 Once Part 3 is completed and if there is any doubt about the acceptable rate of abnormal smears in New Zealand, then all women should be asked to re-enrol in the NCSP and have two annual smears.
If Required on Completion of Part 3
From January 2003
3 Cox's 1997 recommended evaluation of the NCSP should be commenced within eighteen months.
Of the 13 aspects of the evaluation, 5 are Complete, 2 are In Progress.
Remaining 6 aspects to commence prior to August 2002
4 The Policy and Quality Standards for the National Cervical Screening Programme and the Evaluation and Monitoring Plan for the National Cervical Screening Programme should be implemented fully within the next 12 months.
Completed Final Implementation1 July 2001
5 There should be a full legal assessment of the Policy and Quality Standards for the National Cervical Screening Programme and the Evaluation and Monitoring Plan for the National Cervical Screening Programme.
To Commence Complete by Nov 2001
6 The NCSP should be legally assessed for the authority to discharge its responsibilities.
To Commence Complete by Nov 2001
7 The NCSP should issue statistical reports on an annual basis. These reports to focus on quality aspects of the NCSP, including laboratory quality.
Current Practice 1996 to 1998 Report by 30 June 2001 1999/2000 Report by December 2001
8 The Cancer Register and NCSP-Register should generate regular statistical information. This information to include regional laboratory reporting rates as well as trends and incidence of disease.
Current Practice, scope can be reviewed
Ongoing
9 All cytology laboratories should comply with a standard related to minimum volumes per annum
Completed Final Implementation by 1 July 2001
10 There needs to be a balanced approach to all aspects of the NCSP
Current Practice Ongoing
11 Dr Julia Peter's culture needs to be preserved Current Practice Ongoing 12 The NCSP must be managed within the Ministry as a
separate unit, lead by a manager with the authority to contract directly with providers
Current Practice Ongoing
13 The NCSP manager should be second or third tier. The manager to hold medical specialist qualifications in public health or epidemiology
*12
10 Where the timeframe refers to Legislation, the date upon which that legislation might come into force will depend upon whether particular elements are fast tracked and upon availability of parliamentary time. 11 Scope of Audit may require legislative change and Footnote 1 is relevant to this. 12 Dr Julia Peters, a specialist in public health medicine, is the clinical leader for the NCSP. This leadership role is shared with a recently appointed third tier manager.
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
51
Ref Recommendation Status Timeframe10 14 Amend s74A of the Health Act 1956 to enable audit and
evaluation of the NCSP Currently already approved by Cabinet (Legislative changes required) Consultation to occur in June/July
Complete by June 2002, but note that this is likely to require fast tracking, see footnote 1.
15 Reconsider the Kaitiaki Regulations to ensure appropriate access to aggregated Maori data for audit, monitoring and evaluation
(Legislative changes required)
Complete by June 2002
16 Clarify the legal right to access information on the Cancer Register
(Legislative changes required)
Complete by June 2002
17 Amend the Health Act 1956 to enable access to all medical files pertaining to the treatment of women with cervical cancer, for audit purposes.
(Legislative changes required)
Complete by June 2002
18 Change the guidelines under which ethics committees operate.
To Commence (Review by National Ethics Committee: legislated for in the NZPHD Act 2000)
From September 200113
19 Review the operation of the ethics committees, including the impact of their decisions on the evaluation of services and medical research generally
To Commence (Review by National Ethics Committee)
From September 2001
20 Provide guidelines to ethics committees regarding application of the Privacy Act and Privacy Health Information Code. A Lawyer should sit on each ethics committee
Work in Progress Complete by June 2001
21 Provide guidance to ethics committees about the ways to balance harms and benefits of observational studies
Work in Progress Complete by June 2001
22 Establish a national ethics committee for multi-centre studies Work in Progress Complete by Sept 2001
23 Establish an appeal procedure to allow for re-examination of ethics committee decisions
To Commence From September 2001
24 The NCSP should have its own consumer complaints system To Commence Complete by Nov 2001
25 Electronically link the Cancer Register and the NCSP-Register
To Commence (Legislative changes required)
From June 200214
26 There should be Performance Standards for the NCSP-Register and the Cancer Register
Work in Progress Complete by December 2001
27 Standards for the NCSP should be reviewed every two years To Commence First Review by October 2002
28 The Government must ensure sufficient cytotechnologists and cytopathologists and sufficient training sites
Work in Progress (Workforce Development Project)
Project Work Complete by December 2001
29 Amend the Medical Laboratory Technologists Regulations 1989 to permit only registered practitioners with specialist qualifications in pathology and appropriate training in cytopathology or appropriately trained cytoscreeners to read smears
To Commence (legislative changes required)
Complete by June 2002
13 Committee membership proposals to go to Cabinet shortly. 14 Date to be confirmed once scope determined as part of the NSU Information Systems Strategy Review.
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
52
Ref Recommendation Status Timeframe10 30 Impose legal obligations, related to storage of slides, on
laboratories that take over slides from laboratories that close To Commence (legislative changes required)
Complete by June 2002
31 Ensure electronic linkage between NCSP-Register and cytology laboratories
To Commence (Legislative changes required)
From June 200215
32 Develop standards for accuracy of laboratory coding Work in Progress (Refer 27, Standards Review)
Complete by June 2002
33 The NCSP should develop a population register To Commence Project
*16
34 Legal Mechanisms should be in place to allow the ACC, Medical Council, and the Health and Disability Commissioner to share relevant information with the Ministry's NCSP.
To Commence (legislative changes required)
Complete by June 2002 (this is linked to Cull Report Recommendation)
35 The Medical Tribunal should be required to provide relevant information to the Ministry's NCSP if there is a threat to public health.
To Commence (legislative changes required)
Complete by June 2002 (this is linked to Cull Report Recommendation)
36 The ACC and Medical Council should exchange relevant information regarding claims for medical misadventure and disciplinary actions against medical practitioners.
Implemented in part. Further work to Commence (legislative changes required)
Complete by June 2002 (this is linked to Cull Report Recommendation)
37 The NCSP should establish a collaborative relationship with the Royal College of Pathologists of Australasia.
Current Practice Ongoing
38 The NCSP should provide women with explicit information about the risks and benefits of the NCSP, including information that the Programme has not been fully tested.
Current Practice Ongoing
39 Remind medical practitioners that cervical smear takes are not a diagnostic tool
To Commence Ministry Letter to go out by May 2001
40 Cervical screening should be done by appropriately trained personnel - including pathologists who want to function as primary screeners
Work in Progress (Workforce Development Project)
Project Work Complete by December 2001
41 Cytopathologists must participate in continuing education in cytopathology
Work in Progress (Workforce Development Project)
Project Work Complete by December 2001
42 All pathologists undertaking cytology should be appropriately trained. This ought to be mandatory.
Work in Progress (Workforce Development Project)
Project Work Complete by December 2001
43 Pathologists ought to be more open minded and critical of laboratory performance
To Commence Ministry Letter to go out by May 2001
44 The Medical Council should ensure that systems are in place to support the early reporting of errant medical practitioners by their colleagues
To Implement. Policy work completed (legislative changes required)
Complete by June 2002 (this is linked to Cull Report Recommendation)
45 The NCSP should have a system for identifying deficiencies. Consumer surveys are recommended
Work in Progress Ongoing
15 Refer to Footnote 2. 16 Refer to Footnote 2.
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
53
Ref Recommendation Status Timeframe10 46
There should be a process for monitoring the implementation of the Committee's recommendations.
Minister is appointing an international expert to assess progress in 6 months and 1 year. Minister will receive monthly reports for the first 6 months. The reporting timeframe will be reviewed thereafter.
Ongoing
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%)
for
the
re-
read
of t
he G
isbo
rne
wom
en�s
sm
ear t
ests
and
th
e cu
rrent
New
Zea
land
nat
iona
l ave
rage
for
re
porti
ng
high
-gra
de
abno
rmal
ities
(0
.8%
).
Unl
ess
this
ex
erci
se
is
carri
ed
out
the
poss
ibilit
y th
at t
he n
atio
nal
aver
age
is f
law
ed
and
that
ther
e is
a s
yste
mic
pro
blem
of u
nder
-re
porti
ng i
n N
ew Z
eala
nd l
abor
ator
ies
cann
ot
be e
xclu
ded.
Part
2 Th
e Ev
alua
tion
and
Follo
w u
p of
W
omen
with
Abn
orm
al S
mea
rs; a
nd
Part
3 (C
ance
r Aud
it) o
f the
Nat
iona
l
Jun
2001
Aug
2002
Jul 2
001
Oct
200
2
Com
plet
ed S
ep 0
1
Dec
200
3
Rev
ised
tim
etab
le d
ue to
17
The
Pro
ject
Sum
mar
y Pl
an p
rovi
des
an o
vera
ll pl
an fo
r im
plem
enta
tion
of th
e In
quiry
Rec
omm
enda
tions
. Th
e da
tes
shou
ld b
e re
ad a
s co
mpl
etio
n da
tes
unle
ss o
ther
wis
e sp
ecifi
ed.
Whe
re a
reco
mm
enda
tion
is o
ngoi
ng th
is is
als
o in
dica
ted.
18
Cab
inet
Pap
er A
pril
2001
19
6-M
onth
Rev
iew
Jan
uary
200
2
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
55
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
Eval
uatio
n Pl
an o
f the
NC
SP to
be
com
plet
ed w
ithin
six
mon
ths.
Au
g 20
02
Oct
200
2 D
ec 2
003
chan
ge in
Pro
ject
Tea
m la
te
2001
, eth
ics
appl
icat
ion
and
appr
oval
, res
pons
e to
hea
lth
prof
essi
onal
con
cern
s
2.
R
e-en
rolm
ent a
nd re
-scr
eeni
ng o
f w
omen
. If
the
natio
nal e
valu
atio
n th
row
s do
ubt o
n th
e ac
cura
cy o
f the
cur
rent
nat
iona
l ave
rage
then
th
e C
omm
ittee
reco
mm
ends
that
all
wom
en
who
are
or w
ho h
ave
parti
cipa
ted
in th
e Pr
ogra
mm
e sh
ould
be
invi
ted
to re
-enr
oll o
n th
e re
gist
er a
s ne
w e
ntra
nts
and
they
sho
uld
be o
ffere
d tw
o sm
ear t
ests
12
mon
ths
apar
t.
Wom
en w
ho h
ave
neve
r enr
olle
d on
the
Reg
iste
r or w
ho h
ave
had
thei
r nam
es
rem
oved
from
the
Reg
iste
r sho
uld
be in
vite
d th
roug
h no
tices
in th
e pr
int m
edia
to a
lso
go
thro
ugh
the
proc
ess
of h
avin
g tw
o sm
ear t
ests
tw
elve
mon
ths
apar
t.
3.
Ev
alua
tion
of N
CSP
A
com
preh
ensi
ve e
valu
atio
n of
all
aspe
cts
of
the
Nat
iona
l Cer
vica
l Scr
eeni
ng P
rogr
amm
e w
hich
refle
cts
the
1997
Dra
ft Ev
alua
tion
Plan
de
velo
ped
by D
octo
rs C
ox a
nd R
icha
rdso
n sh
ould
be
com
men
ced
with
in 1
8 m
onth
s. T
his
exer
cise
sho
uld
build
upo
n th
e th
ree
phas
e ev
alua
tion
refe
rred
to in
reco
mm
enda
tion
1.
To c
omm
ence
by
Aug
2002
D
ec 2
002
Dec
200
2 So
me
aspe
cts
alre
ady
com
plet
ed o
r inc
lude
d w
ithin
ot
her w
ork
incl
udin
g C
ance
r Au
dit a
nd S
tatis
tical
R
epor
ting.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
56
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
4.
O
pera
tiona
l Pol
icy
and
Qua
lity
Stan
dard
s &
Eva
luat
ion
&
Mon
itorin
g Pl
an.
The
Polic
y An
d Q
ualit
y St
anda
rds
For T
he
Nat
iona
l Cer
vica
l Scr
eeni
ng P
rogr
amm
e an
d th
e Ev
alua
tion
and
Mon
itorin
g Pl
an F
or T
he
Nat
iona
l Cer
vica
l Scr
eeni
ng P
rogr
amm
e pr
epar
ed b
y D
r Jul
ia P
eter
s an
d he
r tea
m m
ust
be im
plem
ente
d fu
lly w
ithin
the
next
12
mon
ths
DH
Bs &
Lab
orat
orie
s
Smea
r Tak
ers
Jul 2
001
Jul 2
001
Jul 2
003
Jul 2
003
Del
ay in
impl
emen
ting
smea
rtaki
ng s
tand
ards
. NSU
do
es n
ot c
ontra
ct d
irect
ly
with
sm
earta
kers
.
5.
Fu
ll le
gal a
sses
smen
t of
Ope
ratio
nal P
olic
y an
d Q
ualit
y St
anda
rds.
Th
ere
need
s to
be
a fu
ll le
gal a
sses
smen
t of
the
Polic
y &
Qua
lity
Stan
dard
s fo
r the
NC
SP
and
the
Eval
uatio
n an
d M
onito
ring
Plan
to
ensu
re th
at th
e re
quis
ite le
gal a
utho
rity
to c
arry
ou
t the
se p
lans
is in
pla
ce.
Nov
200
1 N
ov 2
001
Com
plet
e M
ar 0
2
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
57
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
6.
Le
gal a
sses
smen
t of N
CSP
A
utho
rity.
Th
e N
CSP
sho
uld
be th
orou
ghly
eva
luat
ed b
y la
wye
rs to
det
erm
ine
whe
ther
or n
ot th
ose
pers
ons
char
ged
with
task
s un
der t
he N
CSP
ha
ve th
e ne
cess
ary
lega
l aut
horit
y to
dis
char
ge
them
.
Nov
200
1 N
ov 2
001
Com
plet
e M
ar 0
2
7.
St
atis
tical
Rep
ortin
g Th
e N
CSP
sho
uld
issu
e an
nual
sta
tistic
al
repo
rts.
Thes
e re
ports
sho
uld
prov
ide
stat
istic
al a
naly
sis
to in
dica
te th
e qu
ality
of
labo
rato
ry p
erfo
rman
ce.
They
sho
uld
also
pr
ovid
e st
atis
tical
ana
lysi
s of
all
othe
r asp
ects
of
the
prog
ram
me.
The
y m
ust b
e cr
itica
lly
eval
uate
d to
iden
tify
area
s of
def
icie
ncy
or
wea
knes
s in
the
NC
SP, t
hese
mus
t be
rem
edie
d in
a ti
mel
y m
anne
r.
1996
-98
1999
-00
Jun
2001
Dec
200
1
Dec
200
1
Dec
200
2
Com
plet
e Ap
r 02
Dec
200
2
Con
sulta
tion
on fi
nalis
atio
n of
NC
SP S
tatis
tics
Rep
ort
1996
/98
has
push
ed o
ut
prep
arat
ion
of n
ext r
epor
t.
Rev
ised
tim
etab
le d
ue to
pl
anne
d la
te p
ublic
atio
n of
N
CSP
Sta
tistic
s R
epor
t 19
90/0
0.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
58
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
8.
R
egul
ar S
tatis
tical
Info
rmat
ion.
M
eani
ngfu
l st
atis
tical
in
form
atio
n sh
ould
be
ge
nera
ted
from
bo
th
the
Nat
iona
l C
ervi
cal
Scre
enin
g R
egis
ter
and
the
Can
cer
Reg
iste
r on
a re
gula
r bas
is.
Atte
ntio
n m
ust b
e pa
id n
ot
only
to
labo
rato
ry r
epor
ting
rate
s bu
t al
so t
o tre
nds
and
the
inci
denc
e of
th
e di
seas
e,
asse
ssed
by
regi
ons
that
are
mea
ning
ful
to
allo
w
som
e co
rrela
tion
betw
een
repo
rting
pr
ofile
s la
bora
torie
s an
d th
e in
cide
nce
of
canc
er.
Beca
use
cerv
ical
sm
ear
test
s m
ay b
e re
ad o
utsi
de th
e re
gion
in w
hich
the
smea
r tes
t is
ta
ken,
a
reco
rdin
g sy
stem
ne
eds
to
be
devi
sed
whi
ch
iden
tifie
s th
e re
gion
w
here
sm
ears
are
take
n.
Dec
200
1 D
ec 2
002
As a
bove
C
onsu
ltatio
n on
fina
lisat
ion
of N
CSP
Sta
tistic
s R
epor
t 19
96/9
8 ha
s pu
shed
out
pr
epar
atio
n of
nex
t rep
ort.
R
evis
ed ti
met
able
due
to
plan
ned
late
pub
licat
ion
of
NC
SP S
tatis
tics
Rep
ort
1990
/00
9.
M
inim
um S
tand
ards
for C
ytol
ogy
Labo
rato
ries.
Th
e co
mpu
lsor
y se
tting
of a
min
imum
num
ber
of s
mea
rs th
at s
houl
d be
read
y by
labo
rato
ries
each
yea
r mus
t be
put i
n pl
ace.
The
pro
posa
l to
impo
se th
ree
min
imum
vol
ume
stan
dard
s on
la
bora
torie
s m
ust b
e im
plem
ente
d. T
hese
are
: ea
ch fi
xed
site
will
proc
ess
a m
in o
f 15,
000
gyna
ecol
ogy
cyto
logy
cas
es, e
ach
path
olog
ists
w
ill re
port
at le
ast 5
00 a
bnor
mal
gy
naec
olog
ical
cyt
olog
y ca
ses,
cyt
otec
hnic
al
staf
f mus
t prim
ary
scre
en a
min
of 3
,000
gy
naec
olog
ical
cyt
olog
y ca
ses
per a
nnum
. Th
is s
houl
d be
impl
emen
ted
with
in 1
2 m
onth
s.
Jul 2
001
Jul 2
001
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
59
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
10.
Ther
e ne
eds
to b
e a
bala
nced
app
roac
h,
whi
ch re
cogn
ises
the
impo
rtanc
e of
all
aspe
cts
of th
e N
CSP
.
11.
The
cultu
re th
at w
as d
evel
opin
g in
the
HFA
rega
rdin
g th
e m
anag
emen
t of t
he
NC
SP u
nder
the
man
agem
ent o
f Dr J
ulia
Pe
ters
nee
ds to
be
pres
erve
d.
12.
The
NC
SP m
ust b
e m
anag
ed w
ithin
the
MoH
as
a se
para
te u
nit b
y a
man
ager
who
ha
s th
e po
wer
to c
ontra
ct d
irect
ly w
ith th
e pr
ovid
ers
of th
e pr
ogra
mm
e.
13.
The
NC
SP s
houl
d be
und
er th
e co
ntro
l of
a se
cond
or t
hird
tier
man
ager
with
in th
e M
inis
try.
The
Man
ager
of t
he u
nit s
houl
d as
a m
inim
um h
old
spec
ialis
t med
ical
qu
alifi
catio
ns
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
60
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
14.
Am
end
S74
of th
e H
ealth
Act
195
6.
The
Hea
lth A
ct 1
956
shou
ld b
e am
ende
d to
pe
rmit
the
Nat
iona
l C
ervi
cal
Scre
enin
g Pr
ogra
mm
e to
be
ef
fect
ivel
y au
dite
d,
mon
itore
d an
d ev
alua
ted
by a
ny a
ppro
pria
tely
qu
alifi
ed
pers
ons
irres
pect
ive
of
thei
r le
gal
rela
tions
hip
with
the
Min
istry
of
Hea
lth.
Thi
s re
quire
s an
am
endm
ent t
o s.
74A
of th
e H
ealth
Ac
t to
per
mit
such
per
sons
to
have
rea
dy
acce
ss
to
all
info
rmat
ion
on
the
Nat
iona
l C
ervi
cal S
cree
ning
Reg
iste
r.
Jun
2002
Ju
n 20
02
20
02/0
3 tim
etab
le
depe
nden
t upo
n le
gisl
ativ
e pr
oces
s th
roug
h H
ouse
.
15.
Kai
tiaki
Reg
ulat
ions
. Th
ere
need
s to
be
reco
nsid
erat
ion
of th
e Ka
itiak
i Reg
ulat
ions
, and
the
man
ner i
n w
hich
th
ose
regu
latio
ns c
urre
ntly
effe
ct th
e M
inis
try
of H
ealth
gai
ning
acc
ess
to a
ggre
gate
dat
a of
M
aori
Wom
en e
nrol
led
on th
e N
CSP
-Reg
iste
r.
The
Min
istry
of H
ealth
and
any
app
ropr
iate
ly
qual
ified
per
sons
eng
aged
by
it re
quire
read
y ac
cess
to th
e in
form
atio
n cu
rrent
ly p
rote
cted
by
the
Kaiti
aki R
egul
atio
ns in
ord
er to
car
ry o
ut
any
audi
t, m
onito
ring
or e
valu
atio
n of
the
Prog
ram
me.
Jun
2002
Ju
n 20
02
Com
plet
e Ju
n 02
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
61
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
16.
Lega
l rig
ht to
acc
ess
info
rmat
ion
from
the
Can
cer R
egis
ter.
The
pres
ent l
egal
righ
ts o
f acc
ess
to
info
rmat
ion
held
on
the
Can
cer R
egis
try n
eed
to b
e cl
arifi
ed.
The
Min
istry
and
any
ap
prop
riate
ly q
ualif
ied
pers
ons
it en
gage
s to
ca
rry o
ut a
udits
, mon
itorin
g, o
r eva
luat
ion
of
cerv
ical
can
cer i
ncid
ence
and
mor
talit
y re
quire
re
ady
acce
ss to
all
info
rmat
ion
stor
ed o
n th
e C
ance
r Reg
istry
abo
ut p
erso
ns re
gist
ered
as
havi
ng c
ervi
cal c
ance
r.
Jun
2002
Ju
n 20
02
20
02/0
3 tim
etab
le
depe
nden
t upo
n le
gisl
ativ
e pr
oces
s th
roug
h H
ouse
.
17.
Am
end
Hea
lth A
ct 1
956
to e
nabl
e ac
cess
to m
edic
al fi
les.
Th
e H
ealth
Act
195
6 re
quire
s am
endm
ent t
o en
able
Min
istry
of H
ealth
and
any
app
ropr
iate
ly
qual
ified
per
sons
it e
ngag
es to
car
ry o
ut
audi
ts, m
onito
ring
or e
valu
atio
n of
cer
vica
l ca
ncer
inci
denc
e an
d m
orta
lity
to h
ave
read
y ac
cess
to a
ll m
edic
al fi
les
reco
rdin
g th
e tre
atm
ent o
f the
cer
vica
l can
cer b
y al
l hea
lth
prov
ider
s w
ho h
ad a
role
in s
uch
treat
men
t.
Jun
2002
Ju
n 20
02
20
02/0
3 tim
etab
le
depe
nden
t upo
n le
gisl
ativ
e pr
oces
s th
roug
h H
ouse
.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
62
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
18.
Cha
nge
guid
elin
es u
nder
-whi
ch
ethi
cs c
omm
ittee
s op
erat
e.
Ther
e ne
eds
to b
e ch
ange
to g
uide
lines
und
er
whi
ch e
thic
s co
mm
ittee
s op
erat
e to
mak
e it
clea
r tha
t any
(ext
erna
l and
inte
rnal
) aud
it,
mon
itorin
g an
d ev
alua
tion
of p
ast a
nd c
urre
nt
med
ical
trea
tmen
t doe
s no
t req
uire
the
appr
oval
of e
thic
s co
mm
ittee
s.
To c
omm
ence
Sep
t 20
01
Com
men
ced
Com
plet
ed O
ct 0
1
19.
Rev
iew
of o
pera
tions
of e
thic
s co
mm
ittee
s.
Ther
e sh
ould
als
o be
a re
view
of t
he o
pera
tion
of e
thic
s co
mm
ittee
s an
d th
e im
pact
thei
r de
cisi
ons
are
havi
ng o
n in
depe
nden
tly fu
nded
ev
alua
tion
exer
cise
s an
d on
med
ical
rese
arch
ge
nera
lly in
New
Zea
land
.
To c
omm
ence
Sep
t 20
01
Com
men
ced
20
02/0
3 tim
etab
le
depe
nden
t upo
n co
nsid
erat
ion
by N
atio
nal
Ethi
cs C
omm
ittee
20.
Prov
ide
guid
elin
es to
eth
ics
com
mitt
ees
rega
rdin
g Pr
ivac
y A
ct
& C
ode.
Et
hics
Com
mitt
ees
requ
ire g
uida
nce
rega
rdin
g th
e ap
plic
atio
n of
the
Priv
acy
Act a
nd th
e Pr
ivac
y H
ealth
Info
rmat
ion
Cod
e. E
thic
s C
omm
ittee
s ne
ed to
be
info
rmed
that
the
inte
rpre
tatio
ns o
f leg
isla
tion
rela
ting
to
pers
onal
priv
acy
is fo
r the
age
ncy
hold
ing
a pa
tient
�s d
ata
to d
ecid
e. T
hey
wou
ld,
ther
efor
e, b
enef
it fro
m h
avin
g at
leas
t one
le
gally
qua
lifie
d pe
rson
on
each
regi
onal
co
mm
ittee
.
Jun
2001
Se
pt 2
001
Com
plet
e O
ct 0
1
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
63
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
21.
Gui
delin
es to
eth
ics
com
mitt
ees
for
obse
rvat
iona
l stu
dies
. Et
hics
com
mitt
ees
requ
ire g
uida
nce
rega
rdin
g th
e w
eigh
ing
up o
f har
ms
and
bene
fits
in
asse
ssin
g th
e et
hics
of o
bser
vatio
nal s
tudi
es.
Jun
2001
C
omm
ence
d
2002
/03
timet
able
de
pend
ent u
pon
cons
ider
atio
n by
Nat
iona
l Et
hics
Com
mitt
ee
22.
Nat
iona
l Eth
ics
Com
mitt
ee �
mul
ti-ce
ntre
stu
dies
. A
natio
nal e
thic
s co
mm
ittee
sho
uld
be
esta
blis
hed
for t
he a
sses
smen
t of m
ulti-
cent
re
or n
atio
nal s
tudi
es.
Sept
200
1 C
omm
ence
d
2002
/03
timet
able
de
pend
ent u
pon
cons
ider
atio
n by
Nat
iona
l Et
hics
Com
mitt
ee
23.
App
eal p
roce
ss fo
r eth
ics
com
mitt
ee d
ecis
ions
. Th
e pr
oced
ures
und
er w
hich
eth
ics
com
mitt
ees
oper
ate
need
to b
e re
-exa
min
ed.
Con
side
ratio
n sh
ould
be
give
n to
pro
cess
es to
al
low
thei
r dec
isio
ns to
be
appe
aled
to a
n in
depe
nden
t bod
y.
To c
omm
ence
Sep
t 20
01
Com
men
ced
20
02/0
3 tim
etab
le
depe
nden
t upo
n co
nsid
erat
ion
by N
atio
nal
Ethi
cs C
omm
ittee
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
64
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
24.
NC
SP C
ompl
aint
s Sy
stem
. Th
e N
atio
nal C
ervi
cal S
cree
ning
Pro
gram
me
requ
ires
its o
wn
syst
em to
dea
l with
com
plai
nts
rega
rdin
g th
e Pr
ogra
mm
e�s
deliv
ery.
It a
lso
need
s to
hav
e in
pla
ce a
use
r-frie
ndly
sys
tem
w
hich
can
resp
ond
to c
ompl
aint
s of
Pr
ogra
mm
e fa
ilure
s, s
uch
as u
nder
-repo
rting
. Th
e di
fficu
lty th
at w
itnes
s A
expe
rienc
ed in
ha
ving
her
med
ical
mis
adve
ntur
e re
cogn
ised
as
a fa
ilure
of t
he P
rogr
amm
e an
d a
failu
re o
f G
isbo
rne
Labo
rato
ries
mus
t be
avoi
ded
in th
e fu
ture
.
Nov
200
1 Ju
n 20
02
Com
men
ced
25.
Elec
tron
ic L
ink
Can
cer R
egis
ter &
N
CSP
Reg
iste
r. Th
e N
atio
nal C
ervi
cal S
cree
ning
Reg
iste
r ne
eds
to b
e el
ectro
nica
lly li
nked
with
the
Can
cer R
egis
ter.
From
Jun
200
2
Com
plet
e N
ov 0
1
26.
Perf
orm
ance
Sta
ndar
ds fo
r NC
SP
Reg
iste
r and
Can
cer R
egis
ter.
Perfo
rman
ce s
tand
ards
sho
uld
be p
ut in
pla
ce
for t
he N
atio
nal C
ervi
cal S
cree
ning
Reg
iste
r an
d th
e C
ance
r Reg
istry
. Th
e cu
rrenc
y of
the
data
on
both
Reg
iste
rs n
eeds
to b
e im
prov
ed.
The
Can
cer R
egis
try s
houl
d be
fund
ed in
a
way
that
ena
bles
it to
pro
vide
tim
ely
and
accu
rate
dat
a th
at is
mea
ning
ful.
Dec
200
1 Ju
n 20
02
Com
men
ced
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
65
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
27.
Stan
dard
s fo
r the
NC
SP s
houl
d be
re
view
ed e
very
two
year
s.
Stan
dard
s fo
r the
NC
SP s
houl
d be
revi
ewed
ev
ery
two
year
s an
d m
ore
frequ
ently
if
mon
itorin
g in
dica
tes
that
som
e of
the
stan
dard
s ar
e in
appr
opria
te.
Oct
ober
200
2 D
ec 2
002
Com
men
ced
28.
The
Gov
ernm
ent m
ust e
nsur
e su
ffici
ent c
ytot
echn
olog
ists
and
cy
topa
thol
ogis
ts a
nd tr
aini
ng s
ites.
Th
e G
over
nmen
t in
cons
ulta
tion
with
oth
er
bodi
es o
r age
ncie
s ne
eds
to e
nsur
e th
at th
ere
are
suffi
cien
t tra
ined
cyt
otec
hnol
ogis
ts a
nd
cyto
path
olog
ists
and
that
ther
e ar
e ap
prop
riate
tra
inin
g si
tes
for t
hem
. Th
ere
shou
ld a
lso
be a
re
view
of t
he tr
aini
ng re
quire
men
ts a
nd
mai
nten
ance
of c
ompe
tenc
e of
sm
ear t
est
read
ers
and
cyto
path
olog
ists
.
Proj
ect w
ork
com
plet
e by
Dec
200
1 D
ec 2
001
Ong
oing
29.
Am
end
Med
ical
Lab
orat
ory
Tech
nolo
gist
s R
egul
atio
ns 1
989.
Th
e M
edic
al L
abor
ator
y R
egul
atio
ns 1
989
shou
ld b
e am
ende
d to
per
mit
only
regi
ster
ed
med
ical
pra
ctiti
oner
s w
ith s
peci
alis
t qu
alifi
catio
ns in
pat
holo
gy a
nd a
ppro
pria
te
train
ing
in c
ytop
atho
logy
or a
ppro
pria
tely
tra
ined
cyt
oscr
eene
rs to
read
cer
vica
l sm
ear
test
s.
Jun
2002
Ju
n 20
02
20
02/0
3 tim
etab
le
depe
nden
t upo
n le
gisl
ativ
e pr
oces
s th
roug
h H
ouse
.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
66
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
30.
Impo
se L
egal
obl
igat
ions
on
stor
age
of s
lides
. Le
gal o
blig
atio
ns in
add
ition
to th
ose
man
date
d by
IAN
Z m
ust
be i
mpo
sed
on a
ll la
bora
torie
s re
adin
g ce
rvic
al
cyto
logy
re
quiri
ng
them
to
re
tain
re
cord
s of
pa
tient
s�
cyto
logy
an
d hi
stol
ogy
resu
lts (
incl
udin
g sl
ides
, re
ports
and
an
y ot
her
mat
eria
l re
latin
g to
the
pat
ient
) in
sa
fe s
tora
ge f
or a
per
iod
of n
o le
ss t
han
five
year
s fro
m th
e da
te o
n w
hich
the
resu
lts w
ere
repo
rted.
Sec
ondl
y al
l lab
orat
ory
owne
rs m
ust
be m
ade
lega
lly re
spon
sibl
e fo
r ens
urin
g th
at a
pa
tient
�s r
ecor
ds a
re r
eadi
ly a
cces
sibl
e an
d pr
oper
ly a
rchi
ved
durin
g th
e fiv
e ye
ar s
tora
ge
perio
d irr
espe
ctiv
e of
ch
ange
s in
th
e la
bora
tory
�s
owne
rshi
p th
roug
h a
sale
of
sh
ares
or
a sa
le o
f th
e la
bora
tory
�s b
usin
ess.
Th
e ve
ndor
of
the
shar
es o
r th
e la
bora
tory
�s
busi
ness
sh
ould
ca
rry
a pr
imar
y le
gal
resp
onsi
bilit
y to
sto
re t
he r
ecor
ds,
thou
gh t
he
optio
n to
tra
nsfe
r th
is le
gal r
espo
nsib
ility
as a
co
nditi
on o
f th
e sa
le t
o th
e pu
rcha
ser
shou
ld
be p
erm
itted
. S
imila
r pr
ovis
ions
sho
uld
appl
y to
labo
rato
ry a
mal
gam
atio
ns.
In th
is c
ase
the
new
ly m
erge
d en
tity
shou
ld b
e re
spon
sibl
e fo
r st
orin
g th
e re
cord
s.
June
200
2 Ju
ne 2
002
20
02/0
3 tim
etab
le
depe
nden
t upo
n le
gisl
ativ
e pr
oces
s th
roug
h H
ouse
.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
67
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
31.
Ensu
re e
lect
roni
c lin
kage
bet
wee
n N
CSP
Reg
iste
r and
Cyt
olog
y La
bs.
The
cerv
ical
sm
ear t
est a
nd h
isto
logy
his
torie
s of
wom
en e
nrol
led
on th
e N
atio
nal C
ervi
cal
Scre
enin
g re
gist
er s
houl
d be
mad
e el
ectro
nica
lly a
vaila
ble
onlin
e to
all
labo
rato
ries
read
ing
cerv
ical
cyt
olog
y.
Jun
2002
Ju
n 20
02
Com
plet
e/on
goin
g
32.
Dev
elop
Sta
ndar
ds fo
r acc
urac
y of
la
bora
tory
cod
ing.
St
anda
rds
mus
t be
deve
lope
d fo
r ens
urin
g th
e ac
cura
cy o
f lab
orat
ory
codi
ng a
nd th
is a
spec
t of
the
Nat
iona
l cer
vica
l Scr
eeni
ng R
egis
ter
mus
t be
subj
ect t
o an
app
ropr
iate
qua
lity
assu
ranc
e pr
oces
s.
Jun
2002
Ju
n 20
02
Com
men
ced
33.
The
NC
SP s
houl
d de
velo
p a
popu
latio
n-ba
sed
regi
ster
. Th
e N
CSP
sho
uld
wor
k to
war
ds d
evel
opin
g a
popu
latio
n ba
sed
regi
ster
and
mov
e aw
ay fr
om
bein
g th
e ut
ility
base
d re
gist
er th
at it
now
is.
Ju
n 20
03
Jun
2003
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
68
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
34.
Lega
l mec
hani
sms
shou
ld b
e in
pl
ace
to a
llow
the
AC
C, M
edic
al
Cou
ncil
and
the
Hea
lth &
Dis
abili
ty
Com
mis
sion
er to
sha
re re
leva
nt
info
rmat
ion
with
the
Min
istr
y�s
NC
SP.
Ther
e sh
ould
be
a le
gal o
blig
atio
n on
the
ACC
, th
e M
edic
al C
ounc
il an
d th
e H
ealth
and
D
isab
ility
Com
mis
sion
er to
adv
ise
the
NC
SP�s
m
anag
er o
f com
plai
nts
abou
t the
pro
fess
iona
l pe
rform
ance
of p
rovi
ders
to th
e Pr
ogra
mm
e w
hen
com
plai
nts
are
mad
e to
thos
e va
rious
or
gani
satio
ns a
bout
the
treat
men
t of a
pat
ient
in
rela
tion
to th
e Pr
ogra
mm
e.
Jun
2002
Ju
n 20
02
20
02/0
3 tim
etab
le
depe
nden
t upo
n le
gisl
ativ
e pr
oces
s th
roug
h H
ouse
.
35.
Med
ical
Trib
unal
to s
uppl
y in
form
atio
n to
NC
SP.
Con
side
ratio
n sh
ould
be
give
n to
the
addi
tion
of a
n ex
pres
s re
quire
men
t in
the
prov
isio
ns
gove
rnin
g m
edic
al d
isci
plin
ary
proc
eedi
ngs
whi
ch w
ould
obl
ige
the
Trib
unal
sei
zed
of th
e fa
cts
of a
ny g
iven
cas
e sp
ecifi
cally
to c
onsi
der
whe
ther
ther
e ar
e an
y gr
ound
s fo
r con
cern
that
th
ere
may
be
a pu
blic
hea
lth ri
sk in
volv
ed.
If th
at c
once
rn is
pre
sent
the
Trib
unal
sho
uld
be
requ
ired
to in
form
the
Min
ster
of H
ealth
.
Jun
2002
Ju
n 20
02
20
02/0
3 tim
etab
le
depe
nden
t upo
n le
gisl
ativ
e pr
oces
s th
roug
h H
ouse
.
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
69
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
36.
AC
C &
Med
ical
Cou
ncil
shou
ld
exch
ange
rele
vant
info
rmat
ion
rega
rdin
g cl
aim
s fo
r med
ical
m
isad
vent
ure.
Th
ere
shou
ld b
e an
exc
hang
e of
info
rmat
ion
betw
een
the
Acci
dent
Com
pens
atio
n C
orpo
ratio
n an
d M
edic
al C
ounc
il re
gard
ing
clai
ms
for m
edic
al m
isad
vent
ure
and
disc
iplin
ary
actio
ns a
gain
st m
edic
al
prac
titio
ners
.
Jun
2002
Ju
n 20
02
Com
plet
ed A
pr 0
2
37.
It is
reco
mm
ende
d th
at th
e pr
ogra
mm
e lia
se
with
the
Roy
al C
olle
ge o
f Pat
holo
gist
s of
Au
stra
lia
38.
Info
rmat
ion
to W
omen
. Th
e Pr
ogra
mm
e m
ust p
rovi
de w
omen
with
in
form
atio
n to
ena
ble
them
to m
ake
info
rmed
de
cisi
ons
abou
t scr
eeni
ng a
nd p
rovi
de th
em
with
info
rmat
ion
rega
rdin
g po
tent
ial r
isks
and
be
nefit
s. U
ntil
the
Prog
ram
me
has
been
m
onito
red
and
eval
uate
d in
acc
orda
nce
with
th
e cu
rrent
thre
e ph
ase
natio
nal e
valu
atio
n th
e Pr
ogra
mm
e ha
s an
obl
igat
ion
to in
form
wom
en
that
the
qual
ity o
f the
per
form
ance
of s
ome
of
its p
arts
has
not
bee
n te
sted
. W
omen
sho
uld
also
be
info
rmed
that
scr
eeni
ng w
ill no
t ne
cess
arily
det
ect c
ervi
cal c
ance
r.
Ong
oing
Ju
n 20
02
Com
plet
e/on
goin
g Ju
n 02
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
70
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
39.
Lette
rs to
Med
ical
Pra
ctiti
oner
s.
Med
ical
pra
ctiti
oner
s ne
ed to
be
rem
inde
d th
at
cerv
ical
sm
ear t
ests
are
not
a m
eans
of
diag
nosi
ng c
ervi
cal c
ance
r. Th
ey n
eed
to b
e al
ert t
o si
gns
of c
ervi
cal c
ance
r, an
d th
ey
shou
ld n
ot p
lace
too
muc
h re
lianc
e on
a
patie
nt�s
sm
ear t
est r
esul
ts to
dis
coun
t the
po
ssib
ility
of c
ervi
cal c
ance
r bei
ng p
rese
nt.
May
200
1 O
ct 2
001
Com
plet
e/on
goin
g D
ec
2001
40.
App
ropr
iate
ly tr
aine
d pe
rson
nel
shou
ld d
o ce
rvic
al s
cree
ning
. Pr
imar
y sc
reen
ing
of c
ervi
cal s
mea
rs s
houl
d on
ly b
e pe
rform
ed b
y in
divi
dual
s w
ho a
re
appr
opria
tely
trai
ned
for t
hat t
ask.
C
onsi
dera
tion
shou
ld b
e gi
ven
to re
quiri
ng
path
olog
ists
to tr
ain
as c
ytos
cree
ners
if th
ey
wan
t to
func
tion
as p
rimar
y sc
reen
ers.
Dec
200
1 D
ec 2
001
Com
men
ced/
ongo
ing
41.
All
path
olog
ists
und
erta
king
cy
tolo
gy s
houl
d be
app
ropr
iate
ly
trai
ned.
If
cyto
logy
is a
sig
nific
ant c
ompo
nent
of a
pa
thol
ogis
t�s p
ract
ice
then
he
or s
he m
ust
parti
cipa
te in
con
tinui
ng m
edic
al e
duca
tion
in
that
sub
ject
.
Dec
200
1 D
ec 2
001
Com
men
ced/
ongo
ing
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
71
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
42.
Cyt
opat
holo
gist
s m
ust p
artic
ipat
e in
con
tinui
ng e
duca
tion
in
cyto
path
olog
y.
If cy
tolo
gy is
a m
ajor
com
pone
nt o
f a
path
olog
ist�s
pra
ctic
e, it
is d
esira
ble
that
he
or
she
shou
ld h
ave
adde
d qu
alifi
catio
ns in
cy
topa
thol
ogy;
eith
er a
fello
wsh
ip s
lant
ed
tow
ards
cyt
opat
holo
gy o
r a d
iplo
ma
in
cyto
path
olog
y. C
onsi
dera
tion
shou
ld b
e gi
ven
to m
akin
g th
is a
man
dato
ry re
quire
men
t.
Dec
200
1 D
ec 2
001
Com
men
ced/
ongo
ing
43.
Path
olog
ists
oug
ht to
be
mor
e op
en-m
inde
d.
Path
olog
ists
sho
uld
be m
ore
open
min
ded
and
criti
cal o
f lab
orat
ory
perfo
rman
ce.
They
sho
uld
be a
lert
to t
he p
ossi
bilit
y th
at t
heir
prac
tice
or
the
prac
tice
of t
heir
colle
ague
s m
ay b
e su
b-op
timal
.
May
200
1 D
ecem
ber 2
001
CSI
Ann
ual R
evie
w 2
001/
02 a
nd A
nnua
l Pla
n 20
02/0
3
N
ovem
ber 2
002
72
Ref
. R
ecom
men
datio
n O
rigin
al
Tim
etab
le A
pril
2001
(C
omm
ence
/ C
ompl
ete)
18
Rev
ised
Tim
etab
le S
ix-
Mon
th R
evie
w
(Com
men
ce/
Com
plet
e)19
Rev
ised
Tim
etab
le
June
200
2 (C
omm
ence
/ C
ompl
ete)
Com
men
t
44.
The
Med
ical
Cou
ncil
shou
ld e
nsur
e th
at s
yste
ms
are
in p
lace
to s
uppo
rt
the
early
repo
rtin
g of
err
ant m
edic
al
prac
titio
ners
by
thei
r col
leag
ues.
Th
e M
edic
al C
ounc
il sh
ould
ens
ure
that
sy
stem
s ar
e in
pla
ce w
here
by m
edic
al
prac
titio
ners
are
not
det
erre
d fro
m re
porti
ng to
it
thei
r con
cern
s ab
out t
he p
ract
ice
of a
n in
divi
dual
med
ical
pra
ctiti
oner
. C
ompl
aina
nts
shou
ld b
e as
sure
d th
at th
eir r
epor
ts w
ill no
t re
sult
in th
em b
eing
pen
alis
ed in
any
way
.
Jun
2002
Ju
n 20
02
20
02/0
3 tim
etab
le
depe
nden
t upo
n le
gisl
ativ
e pr
oces
s th
roug
h H
ouse
.
45.
NC
SP s
houl
d ha
ve a
sys
tem
for
iden
tifyi
ng d
efic
ienc
ies.
Th
e sc
reen
ing
prog
ram
me
shou
ld h
ave
in
plac
e a
syst
em o
ver a
nd a
bove
the
audi
t and
m
onito
ring
repo
rts, t
o id
entif
y de
ficie
ncie
s in
its
proc
ess.
A fo
rm o
f sur
vey
of u
sers
so
that
they
ca
n be
pro
activ
e ra
ther
than
reac
tive
in th
e de
liver
y of
the
prog
ram
me
wou
ld b
e us
eful
.
Ong
oing
O
ngoi
ng
Com
men
ced/
ongo
ing
46.
Ther
e sh
ould
be
a pr
oces
s fo
r m
onito
ring
the
impl
emen
tatio
n of
th
e C
omm
ittee
s R
ecom
men
datio
ns.
A pr
oces
s to
ens
ure
that
the
reco
mm
enda
tions
m
ade
by th
e C
omm
ittee
are
impl
emen
ted
shou
ld b
e pu
t in
plac
e.
Ong
oing
O
ngoi
ng
Com
men
ced/
ongo
ing
CSI Annual Review 2001/02 and Annual Plan 2002/03 November 2002
73
Appendix 6: Glossary of Common Abbreviations Abbreviation Official Name
BSA BreastScreen Aoteaoroa
CSI Cervical Screening Inquiry
DHB District Health Board
HFA Health Funding Authority
HPCA Heath Practitioners Competence Assurance Bill
IMG Independent Monitoring Group
NHI National Health Index
NCSP National Cervical Screening Programme
NCSP-R National Cervical Screening Programme Register
NEAC National Ethics Advisory Committee
NSU National Screening Unit
NZHIS New Zealand Health Information Services
PHLR Public Health Legislation Review Team
OAG Office of the Controller and Auditor-General
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