National screening for bowel cancer is going well so far, but major challenges remain.
Health Minister David Clark had called for a review into the national bowel screening programme. Photo: RNZ / Richard Tindiller
That's the conclusion of an independent review into the national bowel screening programme, which was released today.
The review, led by Victoria University health dean Gregor Coster, was called for by the Health Minister David Clark in February.
It followed his revelation that 2500 eligible Waitemata residents failed to be invited for screening under an otherwise successful pilot in Waitemata.
Bowel cancer is diagnosed in 3000 New Zealanders a year and kills 1200.
The 90-page review stated substantial effort was going into transitioning from the pilot to national screening, which was being rolled out in stages, with five district health boards screening now and the rest by 2021.
The review endorsed the continued rollout as planned, saying the national screening programme "is in a good position and has considerable strengths".
It also stated the rollout was "progressing well" and the Health Ministry "continues to improve its processes to support this".
However, it highlighted DHB readiness and workforce, equity, funding, IT governance and relationships as areas needing action to ensure the success of the national implementation of screening.
The most pressing areas of concern for DHBs were colonoscopy capacity and quality and equity, the review stated.
"Colonoscopy wait-time data highlights that DHBs are currently struggling to meet their wait-time targets, even before the rollout."
It also noted concern about the capacity and fragility of the colonoscopy workforce, needed to diagnose bowel cancer in those who test positve in an initial screening test.
"The current rollout is in part constrained by workforce issues. The only way these constraints can be removed in the medium to long term is to increase the number of colonoscopists being trained," the report read.
"There is an urgent need to progress workforce development efforts so that a sufficiently skilled workforce is available and funded into the future."
The review recommended a workforce plan be developed and that the programme strengthen its approach to and accountability for equity for Māori and Pacific people in the programme.
It also called for the recognition of concerns of the health and disability sectors over current age-range restrictions (60-74); urgent consideration of "real-time" integration of programme IT systems with family doctors; and strengthened project management during the design, build and implementation of a national IT system to back screening.
The review also urged the ministry, which had faced a high staff turnover, resulting in a lack of institutional knowledge, to improve a strained relationship with Waitemata DHB.
The lack of institutional knowledge related to the pilot "has been exacerbated by an apparent breakdown in relations between the National Screening Unit and Waitemata DHB", the review stated.