Health reforms 'detrimental' to cancer screening

By FRANCESCA MOLD

GISBORNE - A senior health official giving evidence at the Gisborne inquiry has admitted that health reforms in the early 1990s could have made the national cervical screening dysfunctional.

Under intensive cross-examination, Judy Glackin, Ministry of Health deputy director-general of prevention policy, agreed that a split in responsibility for the programme after the health reforms may have had a detrimental effect on how well it was run.

Between 1992 and 1996, its management was divided between a "plethora" of bodies, including the Ministry of Health and four regional health authorities.

Lawyer Bruce Corkill said a 1992 report by the cervical screening advisory committee (CSAC) to the Ministry of Health had expressed concern that the creation of a separate purchaser and provider under the health reforms would lead to structural problems for the programme.

He suggested to Ms Glackin that the group's fears that this would create fragmentation and fractures was very real.

Ms Glackin agreed this was a "fair conclusion to reach," but it had been possible the programme could run well if the different agencies worked together efficiently.

Throughout yesterday's hearing, Ms Glackin was extremely guarded when answering questions on the ministry's role.

A lawyer for the Health Funding Authority, Kim Murray, had earlier raised concerns that witnesses must feel free to give evidence without fear of their personal opinions being taken as policy.

But the chairwoman of the inquiry, Ailsa Duffy, said it was up to the lawyers to object if they felt their client should not answer questions Ms Glackin faced extensive cross-examination from Mr Corkill about a 1996 Health Ministry review which recommended to former Associate Health Minister Katherine O'Regan that the running of the cervical screening programme be handed over to regional health authorities. It also recommended that the CSAC be disbanded.

The review caused an outcry from the advisory group, the programme's national coordinator, managers and consumer groups who were not consulted before the decision was made.

Ms Glackin said the terms of reference for the review team, written by the then-Deputy Director-General of Public Health, Gillian Durham, specified no external consultation should be undertaken at that stage.

Other "key stakeholders," like programme staff and the advisory groups were to be told only once the decision had been made. They would then be consulted over how to implement that decision.

At a meeting with programme staff, Mrs O'Regan later apologised for the lack of consultation and admitted she may have made a hasty decision signing off the review paper. She later reversed her decision and extended the life of the CSAC a further 12 months.

Mr Corkill: "This episode caused a lot of alarm and distress for those running the programme."

Ms Glackin: "I believe it caused a lot of confusion. It was a depressing experience for all those involved."

She said the fact that no overall body supervised the running of the entire programme, as had been recommended by experts in the past, was the reason for the suggestion it be handed completely to the regional health authorities.

Mr Corkill said that if there was a view that the splitting of the programme was dysfunctional, then suggestions it should be handed over to the four RHAs could only make it worse.

Ms Glackin was also questioned about the resignation of national coordinator Teenah Handiside in 1996.

Ms Glackin said the coordinator's resignation was because the job description had been changed to ensure staff reported to her rather than Ms Handiside.

But Mr Corkill said it was also well known that Ms Handiside had been very critical of the way the review had been carried out.

"That's true," said Ms Glackin.

During yesterday's hearing it was also revealed that the Ministry of Health had produced annual statistical reports about cervical screening in only three of the past eight years.

Ms Glackin said they were not done because data analysis "proved complex and very time-consuming."