Scott Lynda: Health (National Cervical Screening Programme) Amendment Bill — In Committee 
Scott Lynda: Health (National Cervical Screening Programme) Amendment Bill — In Committee 
[Volume:615;Page:11269] 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 Part 2 makes amendments to the principal Act which in this case is the Health Act of 1956—a rather elderly Act. The McGoogan report came from the inquiry into under-reporting of cervical cancer in Gisborne. Euphemia McGoogan is a world expert on cervical screening who came to have a look at our system and made recommendations for change. Recommendation 11.14 states: “The Health Act 1956 should be amended to permit the National Cervical Screening Programme to be effectively audited monitored and evaluated by any appropriately qualified persons irrespective of their legal relationship with the Ministry of Health. This requires an amendment to section 74A of the Health Act to permit such persons to have ready access to all information on the National Cervical Screening Register.” 
Recommendation 11.17 states: “The Health Act 1956 requires amendment to enable the Ministry of Health and any appropriately qualified persons it engages to carry out (external or internal) audits monitoring or evaluation of cervical cancer incidence and mortality to have ready access to all medical files recording the treatment of the cervical cancer by all health providers who had a role in such treatment.” 
The crux of one of the major debates that we have had about this bill is the section about “ready access to all medical files”. If we want a cervical-screening programme that can be appropriately audited then we need access not just to laboratory and hospital data but also to primary-care records. We have heard Sue Kedgley’s concerns in this regard and many in National’s caucus have similar concerns because it comes down to the issue of informed consent as opposed to the issue of having a gold standard screening programme that we know is effective. We will not repeat any of the mistakes that we had in Gisborne and we will follow Euphemia McGoogan’s report and recommendations. 
One of the issues is that this programme is an opt-off programme. From 1990 to 1993 it was an opt-on programme—people had to sign to say that they wanted to be part of the programme. Initially people joined and then over the months of 1993 the numbers of people signing up tailed off and dropped. The Ministry of Health decided to have an opt-off programme. That meant that when people had their first smear they were registered on the programme. At that point they were sent a whole lot of information and if they chose they could opt off the programme. We have had a lot of debate about how women will be informed if we make changes to allow access to primary-care records. We have had meetings with the Minister and from that we have had a guarantee that a letter will be sent to all 1 million women on the programme informing them of the changes in this bill and giving them the option to opt off. 
I have introduced a Supplementary Order Paper because I believe that if a lot of women opt off it will reduce the effectiveness of the screening programme in New Zealand and means that we may have a higher incidence of cancer as a result. I have an amendment which I will discuss later that would allow people to opt off just that section relating to access to primary-care records. But there are other things in the bill that follow these two recommendations and the amendment to the principal Act. Those qualifications are that the evaluators have access only to the information that they specifically need to evaluate the programme. Those evaluators cannot use that data for anything else and they are under the control of the Director-General of Health. Doctors initially had concern about access to primary-care records as well. They also have been reassured by the fact that they will be able to have oversight over access to primary-care records to ensure that if people are accessing notes they are looking only at the issues of cervical cancer smears and screening.