Editorial: Stop playing games with cervical tests

The pattern that has emerged from reports into the national cervical cancer screening programme begs one question: is the Ministry of Health serious about establishing an effective programme?

Could it be, in fact, that it is content to muddle along, making the right noises about improving performance when the programme is criticised, but aware that the vast resources required for improvement will never be brought to bear?

That suspicion is heightened by the final report of Dr Euphemia McGoogan, the Scottish expert appointed to assess the implementation of the Gisborne cervical screening inquiry's recommendations. She has a number of serious concerns, the total of which does nothing to remedy the crisis of confidence that has afflicted the programme since the misreading of smears by Dr Michael Bottrill.

Some of Dr McGoogan's criticism is searing. That, for example, the ministry does not have "a good understanding of the principles of a public health screening programme". And that women must wait another 18 months for the completion of an audit of the programme. The Gisborne inquiry recommended in 2001 that the audit be available within six months. Even when it is completed, however, it will not be able to say if the programme failed in other parts of the country, and whether other women developed cancer because their smears were misread.

The most dispiriting aspect of this criticism is its similarity to remarks in Dr McGoogan's initial report in February last year. Then, in an assessment echoed by an inquiry by the Office of the Auditor-General, she wrote of the cervical screening unit being "in a state of crisis". The unit was severely under-resourced, staff were overstretched and research to reassure women the programme was working was far behind schedule. There is little in her latest report to suggest improvement. In fact, in at least one regard the opposite may apply. Not only is research dawdling but Dr McGoogan now laments that there will be no reassurance for women because of the audit's inability to say where else there might be problems similar to Gisborne.

Probably not even a specialist such as Dr McGoogan believes a totally effective screening programme can be implemented. Health, by its very nature, defies that. Her beef is that the recommendations from the Gisborne inquiry are at best being implemented listlessly. She lays the blame at the door of ministry officials who do not understand what is required for an effective programme. An alternative view might be that those officials are well aware of the requirements, but are also conscious of the huge resources in money and time needed to achieve accurate screening. To them, a half-hearted effort might seem the better option.

If such is the view at the ministry, the public should be told. Officials should debate the merits of their case, and say where cervical screening lies on their priority list. Whatever their argument - and a strong case can be made for any improvements having to be cost-effective - there is no excuse for not taking certain steps to improve the programme.

To do otherwise is to negate the fact that cervical cancer is a disease identifiable by screening. Thus, there is every reason for a programme, and for women to participate if they are sufficiently confident it is reliable. But there will not be optimum participation until women are reassured that other regions were not affected by the deficiencies found in Gisborne. An audit of each new case - to find if the cancer might have been previously missed in smear-reading and if that could mean other women were at risk - will require considerable resourcing. But it must be done. As must the Ministry of Health be more upfront about how it sees the final shape of the cervical screening programme.