Difficulties in the relationship between the National Screening Unit and the independent advisory group for BreastScreen Aotearoa were made public in December in Australian screening specialist Jennifer Muller's hard-hitting review of the national screening programme. Information released under the Official Information Act suggests tension and frustration continue. Elspeth McLean reports.
Members of the national breast-screening programme's independent advisory group "will not tolerate any more mucking around", the Ministry of Health has been told.
This blunt message from the group's chairwoman, Dr Mary Obele, is revealed in email correspondence released under the Official Information Act relating to the cancellation of the group's first 2012 meeting on April 24, five days before it was due to take place in Wellington (it had been scheduled last year).
The 12-member group's next meeting will not be until July 23, eight months after its last meeting.
The cancellation advice came on April 19, a day after the ministry announced the outcome of its investigation into the Southern District Health Board's breast-screening programme (BreastScreen Healthcare), which cleared concerns the rate of "false negatives" was unacceptably high.
The investigation followed an ad hoc clinical audit, which suggested there had been delays in diagnosing cancer in 28 women between 2007 and 2010.
Some advisory group members expressed their unhappiness with the reason given for the cancellation by NSU group manager Jacqui Akuhata-Brown. An email from her referred to NSU's supporting BreastScreen Healthcare through the investigation process.
"We are at the point of meeting with women affected, which needs to be concluded early next week. On that basis, and to ensure the women's health needs are met as soon as possible", the April meeting would be cancelled, the email said.
The exchange of emails shows Dr Obele was not consulted about the cancellation.
Dr Obele begins her first email to the NSU about the cancellation advice by stating she was chairwoman of the BreastScreen Aotearoa Advisory Group (BSAAG).
"Women's needs and the investigation process are obviously important. Your email perhaps has not explained how this got our BSAAG meeting cancelled."
The lack of apology "appears to say something about how much you value our work: I'm sure you didn't mean this".
She pointed out members of the group were busy people and had set aside an "entire day to take care of women's needs".
She asked for an explanation and sought comment on the perceived value of the group's work.
Fellow group member medical physicist Jeremy Nicoll described the cancellation decision as "extraordinary", particularly since there were "current issues" related to the safety and performance of BreastScreen Aotearoa and a meeting last year also had been cancelled.
He noted the important role of the advisory group in the "quality, acceptability and safety" of the programme and its function in advising and validating in an objective way the policies and decisions of the NSU.
"I can understand that it is often convenient to obtain advice and comment from professionals in an ad hoc way, but this I would suggest lessens both the safety and validity of that support."
Another member, breast nurse Pru Wood, also expressed her unhappiness with the cancellation, asking: "when the issue in Dunedin has been going on for as long as it has, why all of a sudden does it have to be sorted out on Tuesday of this week?"
In a response to Dr Obele, Ms Akuhata-Brown said, with "the limited time frame and keeping the women at the centre of the service, it was essential that NSU resources be available to provide face-to-face support to the women in the South" and BreastScreen Healthcare.
In another email, she described the advisory group and the uni-disciplinary groups (which also provide advice) as "pivotal to the safe running" of the breast-screening programme.
New programme leader Maree Pierce, who is yet to meet the group, began her introductory email to members by apologising for the cancellation, and said she would like to reassure members the NSU did value their contributions.
She said she saw the group as a vital part of ensuring high-quality screening for women on the programme.
Ms Pierce and NSU staff attempted to organise another meeting in May before the next scheduled one in July, but this did not succeed, and on May 1 Dr Obele again raised concern about the NSU attitude to the group.
"NSU does not appear to value the BSAAG: actions speak louder than words" ... It appears NSU is avoiding us. The group members have now rearranged their schedules several times to accommodate NSU requirements, and NSU still can't find a solution."
July was "just too late", she said in an email to the NSU. The group had much to do at that meeting and, "at this rate, we will get even more behind schedule".
A teleconference as an alternative was not suitable to the group either. Dr Obele said teleconferences did not work well for such large groups.
NSU executive assistant Lani Apperley said the issue was one of logistics. The NSU did value the group and was certainly not avoiding it. The options for venues were constrained by the Ministry of Health travel and conference policy, she said.
Acting NSU group manager Deborah Harris, in a May 2 email, said the NSU fully recognised the need for the group to meet on a regular basis.
She referred to the NSU dealing with two serious events related to the breast-screening programme (the BreastScreen Healthcare audit, and the case reported by the Herald on Sunday in June involving an Auckland woman in the BSA programme who had a breast removed after a pathology error meant she was wrongly diagnosed with cancer).
"All of this on top of the normal NSU workload with fewer staff than ever before. This meant that priorities had to be reassessed and a number of things were moved or postponed as a result."
A video conference at the end of May was suggested as an option, although the adequacy of that forum was also questioned by members. By May 9, plans for this faltered because too many of those involved were unable to attend.
