Minister of Health’s review of the National Bowel Screening Programme
In February 2018 Health Minister Dr David Clark initiated a review of the NBSP after it was found some people did not receive invitations for screening during the pilot phase of the programme that ran from 2011 to 2017. (See National Bowel Screening Programme to be reviewed on the Beehive website.)
The issue relates to the updating of addresses in the bowel screening register. The following information outlines what happened and how we have responded.
What was the issue?
The Ministry identified in late September 2017 that approximately 2,500 eligible people in the Waitemata DHB district did not receive invitations to participate in the bowel screening pilot programme.
The Ministry takes full responsibility for this oversight, which was identified as part of ongoing quality improvement processes for the transition from bowel screening pilot to the National Bowel Screening Programme.
The issue occurred when some of the invitation letters sent to potential participants were returned, because the person no longer lived at that address and updated addresses were not able to be found.
These people should have been re-invited if their address was subsequently updated through routine data-matching against the National Health Index (NHI) database.
Instead, some were classified as having ‘withdrawn’ from the programme. Classification as ‘withdrawn’ from the programme results in a person's details not being updated automatically and them not being sent any further invitations.
It should be noted that around 198,000 people in the Waitemata DHB were invited for free bowel screening during the pilot and 375 cancers were detected.
What have we done to correct the issue?
The issue only affects people who live in the Waitemata DHB region. People outside this area don’t need to worry.
We are now regularly cross referencing addresses in the NHI with those in the bowel screening register, and updating the register where necessary.
We will continue to do this for all participants until the national screening IT solution comes on stream that will automatically update addresses.
Have you contacted the people who were missed?
Yes. We wrote to the 2,500 people who didn't receive invitations to apologise and invite them for free bowel screening. We have also contacted, through their GPs, the two people who developed bowel cancer. They were already receiving treatment.
We also discussed the case with the GP of the person who died.
We can't be certain the outcomes for these people would have been different if they had been offered the opportunity to be screened but we are very sorry they didn't get that opportunity.
Why did you not ‘go public’ with this issue?
The Ministry decided to prioritise contacting the people directly affected. We were able to identify these people and therefore regarded this a ‘contained’ issue.
We considered our obligation was to contact those affected to explain what happened and to apologise.
The Ministry sees not inviting eligible people as a serious issue. To address the wider public interest the Ministry took steps to improve processes and is carrying out an independent review to understand how the problem occurred. This review, separate to the Minister’s review, will report back probably by April. The findings will be made public.
What is the Minister’s review for?
The Minister has announced a wider review to look at a broad range of factors, including information technology, DHB capacity, operational management and clinical matters. The intention is to assure the public that we are delivering a safe and effective programme and this review will help ensure just that. This is expected to be completed by June.
Where can people get more details about the Minister’s review?
The terms of reference have still to be finalised. Once confirmed they will be published on the Ministry of Health website.
Will the roll out of the NBSP be affected by the Minister’s review?
The programme roll out is continuing as planned.
Southern will be underway in April, Counties Manukau by the end of June, followed by Nelson Marlborough in August, Lakes in September and Hawkes Bay in October.
Whanganui and Mid-Central will roll out by June 2019.
The remaining ten DHBs will be rolled out over the following two years. All will be live by June 2021.
Can the public have confidence in the National Bowel Screening Programme?
We believe the public can have absolute confidence in this programme, which is based on a very successful pilot that was designed and operated with great care. The NBSP is reviewed and monitored constantly as we move towards full implementation. It was as the result of a quality improvement review, during the transition from the pilot to NBSP, that the technical issue with the updating of addresses was identified.
Furthermore, New Zealand's approach has been endorsed by international experts. Professor Stephen Halloran (MBE, FRCPath) who is a member of the UK Bowel Cancer Screening Advisory Committee and advisor on population-based CRC (colorectal cancer) screening to many international government health organisations, had this to say:
‘Your programme has the hallmark of quality, thorough research, detailed planning, meticulous preparation and a focus on ease of access and equity for the population at most risk.
‘New Zealand applied a highly professional approach to developing its screening programme. Short term fixes rarely work although can attract positive, but short term publicity. I’m very pleased that your country has taken the long-term perspective and it will now begin to see the benefits.’
Dr Linda Rabeneck, Global Chair, Colorectal Cancer Screening Committee, World Endoscopy Organization (WEO) and Chair of the International Committee of the American Gastroenterological Association commented:
‘The New Zealand team has designed and planned the NBSP with great thought and care, taking into account the NZ context, scientific evidence, and the experience of other jurisdictions who have already rolled out CRC screening programs. New Zealand is well positioned to execute a terrific CRC screening program that will address the high burden of disease in the country.’
What if a member of the public wants to check if they are going to be invited?
They should be referred to the National Coordination Centre, freephone 0800 924 432.