Screening programme leadership criticised

By MARTIN JOHNSTON, health reporter

The cervical cancer screening programme will continue to attract international criticism until it fixes weaknesses such as its lack of scientific leadership, says a leading gynaecologist.

Professor Ron Jones, the director of National Women's Hospital's colposcopy clinic, says the programme's lack of visionary scientific and medical leadership is its central defect.

"As far as I'm aware not a single scientific paper has emerged from the national cervical screening programme in its 13 years. That's a terrible indictment."

His criticisms echo those of international cervical screening expert Dr Euphemia McGoogan. In her final progress report this month on the 2001 Gisborne cervical cancer inquiry findings, she said that while the programme was maturing, authorities had decided not to implement some of the inquiry's recommendations.

One is that the manager should hold specialist medical qualifications in public health or epidemiology.

But the Health Ministry considers this "unrealistic" for a manager who also needs other skills.

The $70 million-a-year National Screening Unit within the ministry incorporates the cervical and breast screening programmes.

Unit manager Karen Mitchell, appointed two months before the Gisborne report, is a pharmacist with a background in British health management. The cervical programme manager, Jane McEntee, was originally a nurse.

The unit's public health leader, Dr Ashley Bloomfield, and the cervical programme's clinical leader, Dr Hazel Lewis, have specialist public health qualifications. The breast programme's clinical leader, Dr Madeleine Wall, is a specialist radiologist.

Dr McGoogan said the clinical leaders worked part-time on the screening programmes and shared management responsibility for staff with the operational managers.

Dr Bloomfield had "no line management responsibility for the cervical screening staff".

"I doubt whether the new clinical staff have the time and authority to ensure that all clinical risks are appropriately identified and managed through the operational processes," Dr McGoogan said.

"I remain concerned that despite the increase in the number of clinicians in the ... unit, their level may prevent them from having appropriate influences on the screening policy and implementation."

Ministry spokesman Dr Don Matheson asked if it was reasonable to expect the head of a programme to have clinical knowledge and credibility, plus management, financial and people skills.

He said the appointment of the public health leader and two clinical leaders fulfilled "the spirit" of the Gisborne report.