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• Reflecting on 2011

  

  It has been a busy 12 months for the National Screening Unit (NSU) in this, our tenth year.

  There have been some notable achievements, including the continuing increase in coverage for Māori and Pacific women in the National Cervical Screening Programme (NCSP) and BreastScreen Aotearoa (BSA) Programme, and both programmes meeting or exceeding their overall coverage targets.

  Significant progress has been made on the project to upgrade and rationalise the BSA radiology information system Concerto Breast Screen (cBS) and implement a national digital mammography Picture Archiving Communication System (PACS).

  We have had two reviews undertaken. The BreastScreen Aoteroa Programme review focused on recent performance and identifies opportunities to ensure future programme sustainability. The review found that the world-class programme is continuing to provide a high quality, safe service for New Zealand women and is performing well in terms of performance indicators, with participation rates increasing for key audiences and exceeding that of other comparative national programmes. In addition the first NCSP Parliamentary review, a legislative requirement, was completed.

  All 20 District Health Boards (DHBs) have now implemented the Antenatal HIV Screening Programme and the Universal Newborn Hearing Screening and Early Intervention Programme, and uptake rates are high for both programmes. Nearly 100 percent of New Zealand newborn babies continue to be tested for metabolic disorders, and quality improvements are being introduced for antenatal screening for Down syndrome and other conditions.

  But of course it has also been a year of tragedy in New Zealand, with the large loss of life from the earthquake in Canterbury on 22 February. As a Cantabrian myself, I was personally touched by this terrible event, and the thoughts of the NSU are with all those who continue to be affected.

  As always, a big thank you to the screening workforce throughout New Zealand – both at the provider level, and NSU staff. The stakes are high and people’s lives and quality of life can depend on the work we do. The dedication and compassion shown by our workforce is equal to the challenges we face, and will hold us in good stead in the coming year.

  On behalf of the NSU, I wish you a safe and happy holiday season.

  Jacqui Akuhata-Brown, Group Manager, National Screening Unit
  

• Free Smears for Priority Group Women in Northland

  

  A new way of contracting for National Cervical Screening Programme (NCSP) services in Northland means all priority group women will be able to have free smear tests.

  Two Northland Primary Health Organisations (PHOs) – Manaia and Te Tai Tokerau – are now contracted to directly invite, screen and recall priority group women.

  Paul Baines, Portfolio Manager, Primary Care for Northland District Health Board (DHB), says the new contracts began from 1 September this year.

  “Cervical screening is a core service in primary care, and by giving the management of screening directly to the PHOs we will get better outcomes. We are putting the responsibility for the screening where the work actually happens,” he says.

  Mr Baines says by handing the contracts directly to the PHOs, the DHB has been assured all priority group women will now get a free smear.

  “Previously, free smears were provided to some women, but it depended on which GP they went to.”

  The two PHOs are currently working on ensuring a range of community-based cervical screening services are available throughout Northland.

  Mr Baines says while it is too early to see results for the new way of contracting, a pilot earlier this year was very successful.

  “Northland DHB participated in the NSU pilot from April to June. We contracted the two PHOs to deliver 1000 smears. Te Tai Tokerau PHO co-ordinated the initiative and the end result was 1600 smears.”

  Manaia PHO CEO Chris Farrelly says the trial proved that free screening makes a huge difference.

  “It’s not surprising really that in an environment where there is poverty, women will choose to feed their children first. We found that, with free screening, large numbers of priority group women came forth that had never been screened before. It was very moving.” 

  Te Tai Tokerau CEO Rose Lightfoot agrees. 

  “Most women find the intimacy of a cervical smear procedure challenging, but for many Maori and Pacific women the procedure has wider significance and has links to much deeper values and emotions.”

  She says the role of Lorna Smeath, the PHO’s whanau ora clinical facilitator, has been pivotal in the success of the project.

  “Lorna provided a safe environment and completed many procedures with a process that has acknowledged and responded to cultural issues as they have arisen, thus ensuring cultural as well as clinical safety.”

  Paul Baines says the new contracting approach is a very positive move.

  “Northland is a really good example of how providers can pull together to get the work done!”

• NCSP Register Update

  

  Welcome to a new, regular feature updating you on the NCSP Register. As the national repository for information relating to cervical screening events, the Register is a key component of the National Cervical Screening Programme (NCSP).

  Every result reported to the NCSP from a screening test, or from a diagnostic test, is recorded on the Register, if that result relates to a woman who is enrolled in the NCSP.

  In this newsletter, we hear from Mandy Bohte, Manager Datam Health Services.

  Datam Health Services is responsible for the Register services provided to the NCSP, and has been providing these services for the past 16 months.

  During this time, we have had a strong focus on improving the stability of the Register for users. A project is currently underway to refresh the Register hardware, as well as providing a separate geographical location for our disaster-recovery equipment, prompted by the Christchurch earthquakes.

  The next Register release is scheduled for early 2012. The release was to take place in November, but was delayed when user acceptance testing uncovered issues that needed to be addressed. Datam has added further resource to this project to ensure the changes can be delivered in the New Year.

  The operational team has been busy with a number of projects, including working with laboratories to ensure all results are on the Register. With the introduction of HL7 electronic messaging last year, some results have errored causing them to be rejected back to the laboratory and these results need to be resubmitted. This project has been quite time-intensive, however it is crucial these results are captured. There are now under 2000 outstanding results, and we are working to have these all entered onto the Register by early 2012.

  I look forward to providing further updates in future issues of Screening Matters. In the meantime, the Register Central Team wishes you a Merry Christmas and Happy New Year!

• Welcome to Ivan Rowe

  

  Ivan Rowe has recently joined the Ministry of Health in the Cancer Screening Team, where he works as a senior analyst on the NCSP.

  Ivan is a trained economist, having completed bachelor’s and master’s degrees in horticultural science at Massey University and working for 16 years on economic policy for legislation reform, innovation and business cases at the Ministry of Agriculture and Forestry.

  He is based in the Wellington office.

• New TV Commercials for BSA Campaign

  

  Three new television commercials are being developed for BreastScreen Aotearoa and will go to air in February 2012.

  BSA programme leader Barbara Irwin says the current campaign is now over three years old and it is time for a refresh.

  “We are very pleased with the performance of the current campaign – it has been well received and has contributed to an increase in the number of Maori and Pacific women having breast screening.

  “The refreshed campaign will aim to continue this success, by increasing understanding of why breast screening is important and motivating women to have regular screening every two years.”

  Several concepts for commercials have been tested with priority audiences, including Maori and Pacific women and their whanau/aiga.

  The concept that received the most support at testing features two well-known women – one Maori and one Pacific – going to different places and talking to women and men about breast screening.

  The commercials:

  • encourage women to go for breast screening and stress the importance of finding cancer early
  • encourage men to take some responsibility for the health of the women in their lives
  • demystify the process of having a mammogram (identified as a key barrier to women not being screened).

  Barbara Irwin says the commercials will continue to use humour – an approach that has worked extremely well.

  “Although around 70 percent of the eligible population are now being screened, Pacific and Maori audiences are still behind at 66.4 percent and 61.1 percent respectively.

  “The use of humour has been very successful in reaching this key audience. We want to build on this success, with a focus on providing information about the importance of finding breast cancer early.

  “We also want to motivate women aged between 45 and 69 to take action – to make an appointment and be screened, and to understand the importance of continuing to have breast screening every two years.”

• Newborn Hearing Screeners First to Complete NZQA Qualification

  

  Two newborn hearing screeners have become the first to complete a new qualification  – the New Zealand Qualification Authority (NZQA) National Certificate in Health, Disability and Aged Support (Newborn Hearing Screening). The national certificate recognises screeners’ specific knowledge of newborn hearing screening.

  Auckland District Health Board (DHB) lead screener Jenny Woodward, and Lynne Forsman, Programme Manager for Waikato DHB, recently completed the requirements for the new qualification.

  A workforce of newborn hearing screeners was developed after the announcement in 2007 of the introduction of the Universal Newborn Hearing Screening and Early Intervention Programme. One-hundred and twelve people completed training run by the University of Canterbury. Along with DHB orientation, this training allowed screeners to meet minimum levels to begin screening independently.

  Since then, the NSU has worked with Careerforce to develop the national certificate qualification. To acquire it, screeners need to complete 13 compulsory unit standards and one elective unit standard.

  Lynne Forsman says it’s great to be able to get a specific qualification for the work she does.

  “For newborn hearing screeners to be formally recognised through the NZQA national certificate is a really positive step forward.”

  The course can be completed over 12 months but Jenny and Lynne began their study in August and finished at the end of October.

  Jenny says she and Lynne were willing guinea pigs for the new course.

  “It presented a very different way of learning than any I had done before. NZQA sent out the workbooks and portfolios and when I first opened them I was a bit daunted. I had to get back into the mind-set of studying!”

  Jenny and Lynne say assessor Deb Marshall from Careerforce was very helpful and guided them through the course.

  “All learning is valuable and the study helped me take a fresh look at what I do and how I do it,” says Jenny.

  The national certificate covers the use of Automated Otoacoustic Emission and Automated Auditory Brainstem Response newborn hearing screening methods; understanding of safety requirements, risk factors and protocols for well babies and babies in neonatal and special care units; administration procedures; the use and maintenance of hearing screening equipment; communicating with parents of newborns; demonstrating competency in carrying out newborn hearing screening and referral; and intervention options for newborns with hearing loss.

  Holders of the qualification will also be able to apply the Code of Rights when supporting people, demonstrate knowledge of infection control requirements and describe and apply culturally safe operating principles and Maori values in a health and disability setting, as well as applying knowledge of communication process theory.

• Antenatal Screening for HIV

  

  The purpose of testing for HIV in pregnancy is to reduce the risk of HIV transmission from an infected mother to her baby. In New Zealand, there has not been a baby perinatally infected with HIV if an HIV positive mother has been diagnosed and appropriately treated during pregnancy.

  All women are to be offered HIV screening with their first antenatal bloods.

  This month, the National Screening Unit will post monitoring reports for Antenatal HIV on its website. The reports cover the period April 2010 to June 2011.

  Key findings include:

  • the national uptake of antenatal HIV screening has improved over this period. For April to June 2011, the uptake rate is 87 percent
  • there is little difference in antenatal HIV screening uptake rate by age group
  • GPs are the more common requestors for antenatal HIV screening
  • approximately 1 in 6000 women had a reactive result (0.02%)
  • no babies have been born with HIV over this time period to women who have been screened.