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PUBLIC HEALTH SERVICES
NATIONAL SCREENING UNIT SCREENING
PROGRAMMES
BREASTSCREEN AOTEAROA
TIER LEVEL THREE
SERVICE SPECIFICATIONS
Status: FINAL DRAFT
Approved to be used for mandatory FOR APPROVAL
nationwide description of services to be
provided. MANDATORY
Review History Date
Approved by Nationwide Service Framework
Coordinating Group (NCG)
Published on NSFL
Review of the Public Health Handbook (2003)
Amendments: inserted into standard service specifcaiton
template, updated including regulatory requirements, February 2010
standard Māori Health clause, Purchase Unit Codes table
and linking to Public Health tier one and tier two national
screening programme service specifications .
Consideration for next Service Specification
Within three years
Review
Note: Contact the Service Specification Programme Manager, National Health Board
Business Unit , Ministry of Health to discuss the process and guidance available in
developing new or updating and revising existing service specifications. Web site address
of the Nationwide Service Framework Library: http://www.nsfl.health.govt.nz/.
PUBLIC HEALTH SERVICES
NATIONAL SCREENING UNIT SCREENING PROGRAMMES
BREASTSCREEN AOTEAROA
TIER LEVEL THREE
SERVICE SPECIFICATIONS
Background
Currently, around 630 women die each year from breast cancer in New Zealand, making
this the leading cause of cancer deaths in New Zealand females. Regular mammographic
screening can reduce the number of breast cancer deaths.
The breast screening programme, BreastScreen Aotearoa (BSA), was available nationally
from February 1999. On 1 July 2004 the programme was extended from women aged 50
to 64 years, to include women aged 45 to 49 years and women aged 65 to 69 years.
To achieve a 30% reduction in breast cancer mortality, BSA must screen 70% of the
eligible population every two years (coverage), detect sufficient small lymph node negative
cancers, and ensure timely access to appropriate treatment. Provider performance
against these and 43 other targets are independently monitored and published 6 monthly.
The National Screening Unit (NSU) is working closely with providers and DHBs to focus
efforts on improving disproportionately poor coverage of Māori and Pacific women.
This tier three service specification for BreastScreen Aotearoa is linked to the overarching
tier one Public Health service specifications and tier two screening service specifications.
1. Service Definition
BSA is a free national breast screening programme that provides to eligible women,
biennial mammography and any necessary follow-up tests (assessment) up to the point of
a breast cancer diagnosis, with the goal of reducing the number of women who die from
breast cancer.
Information about the programme can be found on the NSU’s website www.nsu.govt.nz.
The programme is delivered throughout the country by eight lead providers, and their sub-
contracted providers, via fixed and mobile units. The latter deliver screening services to
rural and some urban communities.
BSA provides a national screening programme, which covers:
promotion of screening
education about breast cancer, screening and treatment
identification and recruitment of women eligible for screening
invitation and recall of women eligible for screening at two-yearly intervals
screening mammography for eligible women
multi-disciplinary assessment for screened women including clinical examination,
ultrasound, fine needle aspiration biopsy, core needle biopsy, open biopsy,
stereotactic-directed biopsy and pathology services
communication of the screening results to women and their primary health care
providers
support and counselling for women undergoing assessment procedures
referral to treatment for those women identified with breast cancer
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an information system to support the screening programme
quality assurance, audit, monitoring and evaluation.
2. Service Objectives
2.1. General
The objectives of BSA are to:
reduce the number of deaths from breast cancer within the eligible age group
educate and inform women and families/whānau about breast health, the national
breast screening programme, breast cancer and the advantages of early detection
offer advice regarding the choices available in relation to breast screening and breast
health
encourage women to make an informed decision about enrolling in BSA
maximise equitable recruitment of 45-69 year old women.
2.2. Māori Health
Refer to the tier one Public Health Services service specification.
2.3 Health Promotion
BSA’s health promotion objectives include, but are not limited to:
improving, promoting and protecting the health of eligible women in New Zealand,
with a focus on BSA priority women
providing comprehensive information about the purpose of screening, in addition to
the potential benefits and limitations
ensuring participation by eligible women as a result of informed decision making and
ensuring informed consent underpins all health promotion activities
providing accurate, understandable and relevant information in a culturally
appropriate manner
encouraging participation in BSA
ensuring that strategies are evidence-based, and follow best practice standards and
ethical requirements
increasing the awareness of breast health, breast screening and breast cancer
promoting a positive health promotion message to women who choose not to attend
screening.
3. Service Users
BSA offers free mammography every two years to:
women aged 45 to 69 years of age
women who have not had mammography within the previous 12 months
women who are not pregnant or breastfeeding. Breastfeeding women who meet the
other criteria are able to have a mammogram within BSA no sooner than 3 months
after lactation has ceased
women who are free from breast cancer. If previously diagnosed with breast cancer,
women who are at least five years since diagnosis
asymptomatic women
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women who are New Zealand citizens including those whose usual abode is in the
Cook Islands, Niue or Tokelau
women who hold an immigration permit that allows a stay in New Zealand of two or
more years.
4. Access
Access is for asymptomatic women aged 45-69 years of age, whereby they are offered
two-yearly free mammography.
A particular emphasis has been expressed for identified priority groups. Māori and Pacific
women have a higher age-standardised mortality rate from breast cancer, 32.7 per
100,000 and 31.1 per 100,000 respectively, compared to 20.2 per 100,000 for all women
(NZHIS 2004). This is largely due to late diagnosis and treatment and is therefore
potentially remediable by breast screening.
Not all patients who are referred or present to the Service are eligible for publicly funded
services. Refer to the linked tier one Service Specification or
http://www.moh.govt.nz/eligibility for more eligibility information.
5. Service Components
5.1 BSA Providers
The BSA programme provides national direction, experience and expertise in the
maintenance and ongoing development of a high quality-screening programme for New
Zealand and internationally.
5.1.1 Lead Providers
The service is provided through eight Lead Providers at a mix of fixed sites and mobile
units throughout New Zealand. The Lead Providers are:
BreastScreen Waitemata and Northland (BSWN)
Northland, Waitemata
BreastScreen Auckland Limited (BSAL)
Auckland Central
BreastScreen Counties Manukau (BSCM)
Counties Manukau
BreastScreen Midland (BSM)
Waikato, Bay of Plenty, Lakes,
BreastScreen Coast to Coast (BSCC)
MidCentral, Taranaki, Wanganui, Hawkes Bay, Tairawhiti
BreastScreen Central (BSC)
Hutt Valley, Wairarapa, Capital & Coast
BreastScreen South Limited (BSSL)
Canterbury, Nelson-Marlborough, West Coast, South Canterbury
BreastScreen Health Care (BSHC).
Southern
Each Lead Provider is responsible for directly providing, or sub-contracting providers, to
deliver all services throughout their region. These services include:
health promotion
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recruitment
screening
assessment
referral to treatment
quality assurance.
Screening is provided at both fixed and mobile sites throughout each Lead Provider region
while assessment is provided at a reduced number of locations.
5.1.2 Independent Service Providers
Independent Service Providers are contracted to provide health promotion, recruitment,
and support services directly to specific groups of women who might otherwise not be
reached by Lead Providers, that is, Māori and Pacific women. Independent Service
Providers and Lead Providers work in partnership with each other.
5.2 Settings
5.2.1 Health Promotion
Screening health promotion arises in the context of women’s health, sexual health,
whānau health and general primary health. Health promotion activities occur in different
contexts and within many settings.
5.3 Support Services
Support services include but are but not limited to the following:
clinical support services such as:
– laboratory services
– pharmaceutical services
– imaging services
allied heath support services such as:
- social workers
ancillary services
interpreting services (including sign language)
5.4 Pacific Health
The Service will understand and respect the key principles and frameworks outlined in
relevant Pacific Health and disability strategy documents including Health and Disability
Action Plan 2002 and demonstrate a commitment to these principles in the provision of
these services.
5.5 Health For Other Ethnic Groups
The service must take in to account the particular needs of culturally diverse communities.
The service should strive to minimise barriers to access or communication and services
must be safe for all people. There must be no negative discrimination in any practice.
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6. Service Linkages
Lead Providers are required to co-ordinate and maintain linkages and co-operation with
the following providers and community agencies to ensure effective service delivery for
eligible women.
Service Provider Nature of Linkage Accountabilities
Individual women and Liaison, coordination Ensure women in the community are
women’s groups of services aware of screening programmes and
to increase coverage and
participation in screening
programmes
BSA Independent Liaison, consultation Ensure a regional approach to
Service Providers and referral screening programmes is developed
and maintained
Other Lead Providers Consultation and Ensure continuum of care
referral
Kaimahi and Pacific Liaison, consultation Have a coordinated approach to
Women working within and referral training requirements across the
the BSA screening region for Kaupapa Māori and Pacific
programme cultural service delivery
Treatment providers Consultation and Ensure a continuum of care
referral
DHBs Liaison and Maintain a community development
consultation approach
7. Exclusions
Under the agreement with Lead Providers, the NSU will not fund:
the provision of treatment services
the costs associated with acquiring the resources necessary to provide the services,
which are to be met by the provider.
8. Quality Requirements
The service must comply with the Provider Quality Standards described in the Operational
Policy Framework or, as applicable, Crown Funding Agreement Variations, contracts or
service level agreements.
Providers’ (including subcontractors’) compliance with the 90 standards in the BSA
National Policy & Quality Standards is audited every three years. These standards form
part of the BSA service specifications for providers, and are therefore contractual
requirements.
The standards are available online at http://www.nsu.govt.nz/Health-
Professionals/1045.asp.
There are 90 standards in the BSA National Policy & Quality Standards, and provider
performance is independently monitored against 46 quantitative targets for women aged
50 to 69. Provider performance for women aged 45 to 49 is reported, but is not subject to
targets, as there is insufficient international data from which to derive local cancer
detection targets for biennial screening of women under 50 years.
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Provider and subcontractor compliance with the 90 standards in the BSA National Policy
and Quality Standards is audited every three years. These standards form part of the BSA
service specifications for providers, and are therefore contractual requirements.
The independent monitoring reports are published six monthly on the NSU’s website at
http://www.nsu.govt.nz/Health-Professionals/1048.asp.
9. Purchase Units and Reporting Requirements
Purchase Units are defined in the joint DHB and Ministry’s Nationwide Service Framework
Purchase Unit Data Dictionary. The following purchase units apply to this service:
PU Code PU Code PU Definition PU Measure PU Measure National
Description Definition Collections
or Payment
Systems
BSA-51 Fixed Funding Funding provided for Programme Agreed lump sum Non Admitted
the fixed funding amount. Refer to Patient
component for breast service Collection
screening services specification for (NNPAC)
within the national contracted (Optional)
breast screening service volume
programme and description.
BSA-52 Breast Funding provided for Procedure The number of NNPAC
Screening the assessment individual (Optional)
Assessment component within the operative/diagnos
national breast tic/assessment
screening programme procedures in the
period.
BSA-53 Health Funding provided for Programme Agreed lump sum NNPAC
Promotion the fixed funding amount. Refer to (Optional)
component for health service
promotion services specification for
within the national contracted
breast screening service volume
programme and description.
BSA-61 Mammography Support for the woman, Completed Number of clients NNPAC
Support when appropriate, (and treatment seen during the (Optional)
any accompanying period for any
support person) to one diagnosis for
attend screening I.e. whom there is no
having a mammogram further sessions
(includes transport to or treatments
venues) booked.
BSA-62 Assessment Support for the woman, Completed Number of clients NNPAC
Support for when appropriate, (and treatment seen during the (Optional)
additional any accompanying period for any
investigation support person) to one diagnosis for
attend assessment whom there is no
services (includes further sessions
transport to venue or treatments
and/or support time at booked.
the assessment venue)
BSA-63 Treatment Support for the woman, Completed Number of clients NNPAC
Support for (and any treatment seen during the (Optional)
surgery accompanying support period for any
person) to attend one diagnosis for
assessment services whom there is no
(includes transport to further sessions
venue and/or support or treatments
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PU Code PU Code PU Definition PU Measure PU Measure National
Description Definition Collections
or Payment
Systems
time at the treatment booked.
venue)
BSA-64 BSA Innovative Funding for initiatives Programme Agreed lump sum NNPAC
Initiatives outside of 'business as amount. Refer to (Optional)
usual' to enhance service
coverage and specification for
participation for Service contracted
Users service volume
and description.
BSA-66 Health Developing and Programme Agreed lump sum NNPAC
Promotion implementing regional amount. Refer to (Optional)
health promotion plans service
specification for
contracted
service volume
and description.
BSAPROJ Breast Screen Funding to support Programme Agreed lump sum NNPAC
Aotearoa (BSA) projects in relation to amount. Refer to (Optional)
Projects BreastScreen Aotearoa service
specification for
contracted
service volume
and description.
9.1 BSA Reporting Requirements
Lead Providers must provide the following information in a narrative form electronically on
a six monthly basis:
any emergent issues and the steps taken to resolve these, if necessary
action taken by the service regarding issues unresolved from the previous reporting
period
any quality assurance/improvement initiatives undertaken
the professional/personal development opportunities attended by staff
all complaints received, if any, and the remedial action undertaken
any compliments received
the service linkages with other service providers that have occurred in the reporting
period and the maintenance of service linkages made previously
summary comment regarding the service’s performance over the last six months
progress to date against the Health Promotion Plan.
Lead Providers are also required to:
supply the NSU with the latest copy of the provider’s audited annual financial
statements within 4 months of 30 June each year
supply the NSU with information on the provider’s volumes, revenues and expenses
for the 12 months ending 30 June within 4 months of 30 June each year
report all incidents/sentinel events to the NSU.
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