breastscreen aotearoa an independent review - Ministry of Health

of enabling women to reach the screening units. This is done by a combination ofsub-contracted fixed screening sites, usually in hospitals serving communities farfrom the Lead Provider's main centre, and by the use of mobile screening units whichare towed to different localities and remain there for a set period of time judged to besufficient to screen the local population. I had the impression that, surprisingly, theneed to travel long distances for screening was less of a problem in very rural areaswhere people are accustomed to driving to town, than in outer suburban areas wherepeople on low incomes may not have a car and have to rely on public transport. Thisseems to be a particular problem for many Maori and Pacific Island women. Thesiting of the main Lead Provider Units in Auckland and Wellington, which have thelowest coverage rates, are not ideal from the point of view of accessibility by publictransport.5.9.2 The immediate environment of the screening unit may also be important. It isgenerally accepted that a service for well women should be provided in a non-clinicalenvironment, where they do not mix with patients attending hospital. Two of the sixLead Provider Units have adapted erstwhile private houses, which provide the idealenvironment, although one of them, BSCC, is too small. Two others are located inradiological clinics in buildings on the campus of a general hospital but physicallyseparate from it. The remaining two are inside general hospitals. One of these, BSC,is close by the main entrance and women who see the notice for Breast ScreenAotearoa can reach it without mixing with patients at the hospital’s main receptiondesk. The second, BSHC, is in a very unsatisfactory environment, on the first floor ofthe hospital, sharing facilities with the Nuclear Medicine Department, which onesupposes could deter some women. Nevertheless it must be acknowledged that thisunit which was one of the pilot programmes, has overall achieved the target of 70%coverage and the bulk of its work is now mainly rescreens. It also has one subcontractedfixed screening site, and one mobile so it is possible that coverage may behigher for the latter two, and lower for the main site. Two years ago this LeadProvider was given additional funding to convert premises on the ground floor of thehospital with a separate entrance, which would provide a much more suitableenvironment. But the District Health Board which administers the funding has so farnot managed to vacate the premises as promised, to allow the conversion to proceed.There seems no sense of urgency in this DHB to use the money for its intendedpurpose. The NSU should consider taking sanctions against this DHB, for exampleby not funding the DHB’s overhead costs for administering the screening centre.5.9.3 I did not visit any of the sub-contracted fixed screening sites so cannotcomment on the suitability of their environments. I was impressed with the onemobile unit I visited, where the welcoming friendly attitude of the receptionist and theMRT more than compensated for the necessarily cramped surroundings.5.9.4 Staff attitudes are another aspect of the acceptability of the service. The frontline staff for breast screening are telephonist/receptionists and MRTs. From the briefsuperficial observations I was able to make, both these categories of staff wereexcellent in their interaction with women. They were cheerful, friendly, spoke in acalm reassuring manner, and gave correct and honest information about the screeningprocess and its limitations. I had the impression that those whom I met enjoyed theirjobs and got much satisfaction from them. The acceptability of the service to the great17