APPENDIX A.

Programme models within Australia

Jurisdiction	Model	Additional state/territory funding?	Features
New South Wales [A40]	Usual care	No.	Participants referred back to GP to organize follow-up of positive FOBT. Participants can be referred to either the public sector or private sector for their assessment colonoscopy. NSW Health is paying for a new Endoscopy Information System, using the same software as Queensland, which will allow improved reporting to the national register.
Queensland14 [A35]	Designated provider	Yes – $10.4 million (~£6.7 million) over 3 years in 2006 to develop its own programme (the Queensland Bowel Cancer Screening Program).	Offers an integrated screening pathway for public patients which commences at FOBT invitation and concludes at the point of histopathological diagnosis or re-screening. 28 designated facilities that offer high quality and timely assessment colonoscopies. Facilities selected for their capacity to provide additional colonoscopy services. Some public patients may be offered colonoscopy in a private facility in areas where public waiting lists are long. Both facilities and proceduralists required to demonstrate compliance with state and international quality requirements (not national) as part of the authorization process. Facilities are paid $1,240 (~£800) per colonoscopy – includes all costs (proceduralist, sedationist, and histopatholgy). Established a State Coordination Unit, a network of 12 Gastroenterology Nurse Coordinators and 11 Health Promotion Officers. Captured 100% of data at designated centres. Piloting an alternative delivery model in some remote Indigenous communities where kits are distributed through Indigenous health workers/health centres. From July 2009, implementation of the Endoscopy Services Information System Solution (ESISS) will significantly enhance the integrity and timelines of clinical data.
South Australia [A39]	Mixed	Yes – they pay the greater share of costs for pathway coordinators (the rest paid for by the Commonwealth).	Five nurse pathway coordinators located at five public hospitals who conduct pre-colonoscopy assessments. Flinders Medical Centre offers one dedicated NBCSP list per week.
Tasmania [A38]	Usual care	No	As for NSW.
Victoria [A37]	Mixed	Yes – $14 million (~£9 million) over four years allocated in 2007.	Usual care but with some designated providers (19 as at February 2011) for public patients. Designated providers are selected for their ability to provide colonoscopy capacity to support the programme. Participants can still go to non-designated public and private providers.
Western Australia [A36]	Usual care	No	As for NSW.
Australian Capital Territory (ACT) [A41]	Mixed	No	One hospital (The Canberra Hospital) offers a clinic for NBCSP participants, where they are given priority booking for colonoscopy.
Northern Territory (NT) [A42]	Opportunistic screeninga	No	Kits not sent directly to participants. When people aged 45 or over present to a health clinic, they are offered an adult health check which includes an FOBT.

^aUsual care is not considered appropriate for the NT because it has a high proportion of Indigenous people (36.1%)³⁹, the vast majority (81%) of whom live in remote or very remote areas.⁴⁰ This raises both practical and cultural barriers. The practical issues include the absence of postal addresses in remote communities, where all mail is sent to the health clinic or community council. The kits themselves are often addressed incorrectly, as Aboriginal people may have several names over their lifetime. Moreover, most patients in the NT have several co-morbidities such as diabetes, renal failure and chronic obstructive pulmonary disease, and require more targeted invitational approaches. The cultural issues include the fact that faeces is considered shameful in Aboriginal culture, so clinical staff need to be involved in explaining the collection process, helping with the collection and returning the kits to the pathology lab [A42].