Nationwide bowel screening roll-out extended

The timetable for the roll-out of the National Bowel Screening Programme (NBSP) has been revised to enable more time to develop the National Screening Solution (NSS) technology required to run it.

Six additional DHBs will start bowel screening in 2018, as planned, though a number of others will be later than originally scheduled. The revision means the last five DHBs will start screening by the end of June 2021 and the full roll-out will now be completed that year, a year later than originally planned

NBSP Clinical Director Dr Susan Parry says the extra time is needed to select and adapt a software system. This will be used to run the programme as well as enhance monitoring of the quality of the bowel screening programme once it is rolled out to the whole country.

“We’d originally proposed to build this in-house but, with wider advice, decided to purchase a commercial product and work with an IT partner to adapt it to our needs. The Ministry is also seeking a system that’s capable of being extended for use by other health screening programmes, as well as bowel screening. This follows the approach of a number of other countries and provides better value for money.”

The first eight DHBs will implement the screening programme using the interim IT solution based on an enhanced version of the Waitemata Pilot IT system. This approach will allow the Ministry to progress the roll-out whilst allowing time for the best technology partner and solution to be found.

Dr Parry says the extended timeframe will provide extra time for some DHBs who had signalled concern about their ability to meet earlier deadlines.

“Although DHBs had been advised in 2016 of anticipated requirements for bowel screening, in relation to both the number of colonoscopies and the number of cancers that would be diagnosed, we recognise we are asking a lot of them. Bowel screening is only one of the many services they provide and some will welcome the extra time to make sure they have the required resources, including colonoscopists, to support the roll-out of a quality bowel screening programme in their DHB.”

The Ministry has been working with DHBs since 2012 to increase colonoscopy capacity and reduce waiting times, contributing $19million to support these endeavours, Dr Parry says.

“We are seeing steady improvements, with increased numbers of colonoscopies being delivered, and expect this to continue."

Dr Parry says while the revised timetable will mean a delay for some regions the National Bowel Screening Programme is well underway and much has been going on behind the scenes.

“Hutt and Wairarapa DHBs have successfully begun bowel screening, Waitemata is in the process of transitioning to the national programme and Southern, Counties Manukau, Nelson/Marlborough, Lakes and Hawkes Bay will begin screening this year. We’ve also set up the four regional centres, to support the roll-out of bowel screening, and a National Coordination Centre.

“Those are pretty significant milestones for the programme and real progress is being made on providing bowel screening to an increasing number of New Zealanders.”

Revised Timetable

The implementation timetable based on the current programme plan, is as follows:

Hutt Valley and Wairarapa DHB commenced screening in July 2017, and Waitemata DHB transition to the national programme this month.

Southern and Counties Manukau DHBs commence bowel screening by 30 June 2018.Followed by Nelson Marlborough, Lakes and Hawkes Bay DHBs by 30 November 2018. These eight DHBs will use the interim IT solution.

The NSS is planned to be ready for initial deployment by March 2019.Two DHBs (yet to be confirmed but proposed to be Whanganui and Mid-Central) roll-out bowel screening by 30 June 2019 using the NSS.

The remaining 10 DHBs will commence bowel screening over the next two financial years (2019/20 and 2020/21), using the NSS.The Ministry is re-evaluating the DHB roll-out order based on the five performance criteria used to assess readiness:

Colonoscopy Wait Time Indicators

Faster Cancer Treatment targets

Financial Performance

DHB Impact Assessment

DHB Electives Performance.

The timing of roll-out for the ten DHBs over two financial years is a change to the previously agreed timeframe but, given the proposed deployment date for the NSS and capability pressures being experienced by some DHBs, it provides greater surety of delivering a safe, quality programme. This has to be the priority.