SpeechSARAH PALLETT (Labour—Ilam): Well goodness that was an unnecessarily cross speech I've just listened to. I rise to take what is probably going to be the last time I stand to make a substantial call in this term of Government to speak on the Pae Ora (Healthy Futures) (Provision of Breast Cancer Screening Services) Amendment Bill which has been brought to the House by Dr Shane Reti as we heard earlier. Madam Speaker I'm going to just ask for your indulgence as this is possibly my last substantial speech for this term because I want to just spend a very short amount of time this evening just thanking the many many people that actually stand behind us as we stand here and do our job in creating the best possible legislation that we can for Aotearoa New Zealand. I want to just acknowledge Team Ilam" first: Nellie McIntyre—Nicola Grigg: Is this a valedictory?SARAH PALLETT: —Hannah Long; Alex Seren-Grace; Casper Howell my executive assistant; and Beth Walters. I'm beyond grateful to them for their dedication to the people that they serve. No I'm not giving a valedictory speech Ms Grigg but I am going to take some time to explore the virtue of gratitude. I'm going to explore the virtue of gratitude towards the people who were—Nicola Grigg: How about the bill?SARAH PALLETT: —I'm going to get to the bill; please bear with. We've got 10 minutes; you can spare me a few seconds. I'm going to spend a few seconds just acknowledging and thanking with your indulgence Madam Speaker the people who work so hard here in the House: Jenny Peter Ivan Kelly and the team the amazing people in the Office of the Clerk our security teams ICT cleaners Parliamentary Service translators and interpreters. There are so many people that stand behind us as I said as we do this and I apologise for taking my time to do this. But I do want to address the bill which I'm going to come to now.The Labour Party supports the extension of the age range of breast cancer screening from the current upper age of 69 years to 74 years. So I just want to start by saying that we support this bill. We've heard some really disparaging comments from the Opposition about the work that we've done already towards making sure that this age extension doesn't come at the cost of adverse impacts to the rest of the population because this is a really significant problem that we need to avoid. Breast cancer is basically the most common cancer affecting New Zealand women. It affects about—well we've got 3550 cases diagnosed and 600 deaths from breast cancer each year. Breast cancer screening in New Zealand is an extraordinarily important part of our healthcare provision because it has reduced breast cancer mortality by 30 percent for the women screened compared with women who have never been screened.This is where things get personal for me because I lost my mother to breast cancer. My mother was diagnosed with breast cancer when I was eight years old and it came back when I was a little older. She died when I was 21 years old. She didn't have breast screening when she was asymptomatic. She discovered a lump in her breast and that's how the cancer was detected.When my first daughter—my eldest child—was eight years old I found I had breast cancer but I was lucky. I was actually much younger than whom the screening programme in Aotearoa actually covers but I fell into a high-risk category and I was part of a screening programme that was completely separate from the one that we're exploring this evening. But I was extremely fortunate. I had no symptoms. I had no lump in my breast. But when my eldest child was eight years old the same age that I was when my mother was diagnosed that mammogram that I had as part of the screening programme that had been created for my high-risk situation—that screening process discovered that I had very early stages of breast cancer. Because I had that mammogram when I was asymptomatic because I was fortunate enough to be able to have that screening process before a lump was large enough to be felt—to be palpated—I was lucky enough to have cancer detected early enough to have successful treatment. I was 36 years old when I was diagnosed with cancer and I'm 56 now. I have been 19 years cancer-free—I am extraordinarily fortunate. So for me this isn't just about population health; this is personal as I said. The Labour Party is doing a great deal to ensure that that screening process is available for women. But one thing we need to bear in mind is that Māori and Pacific women have lower rates of screening participation and the last time we extended the age of screening what happened was that the gap between Māori and non-Māori extended from 11 percent to 20 percent reduction in screening. There was a significant negative impact and that's something that in our intention to do the right thing we need to make sure doesn't happen. We know that Māori people have cancer at a higher rate and to address the accusation that Dr Reti made that this party doesn't care about cancer—well it's kind of funny that we set up an entire Cancer Control Agency to look precisely at what is going on in New Zealand with this disease that takes so many of us too early and to give us the tools and give us the information that we need to make sure that we do the right thing. In addition to Māori and Pacific people women living with disabilities gender-diverse people and women who live rurally are also going to have distinct barriers to breast screening. So what are we doing already? Whilst we do recognise that this needs to be done and although we've heard an impassioned speech from the other side the science is not as clear as it might be. In the UK for example screening ends at age 70. In Scotland which is obviously part of the UK screening ends at age 70. When I sat on the Petitions Committee we read and heard some compelling evidence to show that actually screening cannot necessarily bring benefit for those older women but we have come to a position of accepting the evidence on the other side. With these things often things aren't necessarily clear-cut but we accept that this screening needs to happen. So what are we already doing? We're tackling this problem from three points: workforce ICT and screening equity as I've already outlined to a small degree earlier. The current capacity for delivering mammograms is constrained by our shortage of medical imaging technologists and radiologists so we're addressing that through the health workforce plan and the BreastScreen Aotearoa Workforce Development Strategy 2022 - 2032. The overarching aim is that we have a sustainable and diverse workforce and that population-based register that we heard Dr Reti be scathing about the one that cost $55.6 million of Government investment—the current register does not have the integration flexibility or scalability required to provide a modern breast cancer screening service and to be able to provide and support these programme changes so we desperately need this. We desperately need this investment and that's why this Government has stepped up and provided it. Once the current ICT rebuild is completed there will be 122000 additional women aged 45 to 69 years old who are eligible for breast screening but who are not currently enrolled with Breast Screening Aotearoa. We're going to be capturing as many women as we possibly can which is going to be critical to saving lives and screening equity—the quality improvement review of clinical quality and safety was commissioned in response to the identification that a large number of people had been waiting longer than they should have to be offered their appointment for their first mammogram and 26 recommendations were made on the need to improve equity. One of the review's recommendations was to establish Pae Whakatere for three years to oversee and ensure the implementation of these recommendations.We recognise the value in extending screening; we are already doing the work that we need to do it but we will commend this bill to the House. Tìoraidh an-dràsta."