Chadwick Steve: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
Chadwick Steve: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
[Volume:615;Page:11439] 
STEVE CHADWICK (Labour—Rotorua) 
: 
 I am delighted to be given an opportunity to speak about this bill today and I would like to thank all my colleagues on the Health Committee. This is one of the workings of Government that I think is often overlooked in terms of reporting Parliament—that is watching how select committees work. In this particular case with a majority on the select committee being women we really did focus in on this Health (National Cervical Screening Programme) Amendment Bill with great concern. We were all reminded about the inquiry in Gisborne called in 1999. We were all very aware of the need for women and their families to find answers for the current cervical cancer rates and we wondered how on earth we were ever going to improve mortality and morbidity figures. 
The inquiry looked into the under-reporting of cervical cancer. That was the main problem with cervical smear anomalies. An under-reporting of these anomalies caused unnecessary delays for treatment and follow-up and we all shared the anxiety of the women who went through the Gisborne inquiry. The inquiry highlighted several problems with the current cervical-screening programme. Many of us were aware of them. I managed a women’s health service at the time and was very aware of some of the barriers to a robust cervical-screening programme approach. The inquiry identified those barriers and said that the main issue for us to focus on in this bill was that the information needed by evaluators of the programme could not be collected adequately or was exceptionally difficult to access because they had to get the consent of the women. Often those women could not be traced thereby resulting in a missing piece of the puzzle. At that stage evaluators had access only to hospital laboratory specimens and findings and the clinical record when women were in hospital or secondary care. There was absolutely no linkage with when women first went to their general practitioner or to what was contained in their health record held by general practitioners or midwives that was very very pertinent to their cervical-screening history. 
The subsequent amendment to this bill that came in was thanks to my colleagues Lynda Scott and Heather Roy and I really would like to thank them. It showed how we can all work collectively to address the concernsof the women of New Zealand. This Supplementary Order Paper takes away those barriers that were identified by Dr Euphemia McGoogan in her four recommendations that said we had to look at legislation that would amend the old Act. It was a 1956 Act that we had been functioning under and that is a long time ago. Cervical-screening programmes had really overtaken the way the Act was set up to implement screening programmes. Ithe recommendation was clear that evaluators had to have access to all medical record files—all of them—recording the treatment of cervical cancer and it was also an issue that concerned Sue Kedgley in terms of privacy issues. We all were concerned—all of us. We too did not want to see people trolling through records but those of us with a health background—and this was really interesting with my colleagues—absolutely understood the value of relationships in the health sector. They knew about evaluators in this health-screening programme they knew they were trained they knew they did not go in and troll right through the record and they knew about the need for access into that primary record. 
Lynda Scott proposed an amendment and it went to Professor David Skegg who said it would weaken the current programme and that is why the amendment was rejected. How else without going into that primary record would we ever learn about risk factors presenting symptoms referral patterns on to specialists and secondary care intervention rates current treatment methodology and even whether it is effective if we did not have access to the primary record? It was as fundamental as that. 
This bill addresses the legal barriers that are preventing that comprehensive evaluation of the programme from proceeding. The Supplementary Order Paper strengthens provisions around privacy issues. Those were the things that we brought the Minister back to the select committee about. We put her under robust investigation about the process behind the recommendations that first came to us in the bill and we then went back again and looked at the informed consent provisions that worried us all. Informed consent was absolutely paramount. It had to be a procedure undertaken between the smear-taker and the woman or in fact the specialist when a gynaecological investigation is undertaken which is usually done in a secondary environment. Women have to know that evaluators will be accountable to general practitioner oversight. They do need to be informed about that and that only information and specimens that are relevant to an evaluation will be accessed. The independent programme review committee that is proposed will be separate from the Ministry of Health and I think that is a very robust strategy that is in the Supplementary Order Paper and a review and evaluation of the programme in 3 years will ensure we now have a procedure for ongoing continuous improvement. 
In conclusion with this approach and the support for the bill it is a pity we did not get universal support from all parties. If only we could have gone out there to the women of New Zealand to say that we are all with them on this that we all buy into it and that it includes all of us in the health field. I know that we will reduce the current rate of 70 to 75 New Zealand women who die of cervical cancer each year. I know that those rates will improve.