Verrall AyeshaHEALTH (NATIONAL CERVICAL SCREENING PROGRAMME) AMENDMENT BILLSecond ReadingHon Dr AYESHA VERRALL (Associate Minister of Health): I present a legislative statement on the Health (National Cervical Screening Programme) Amendment Bill.ASSISTANT SPEAKER (Hon Jacqui Dean): That legislative statement is published under the authority of the House and can be found on the Parliament website.Hon Dr AYESHA VERRALL: I move That the Health (National Cervical Screening Programme) Amendment Bill be now read a second time.This bill will strengthen and improve the National Cervical Screening Programme a programme that protects the health of women throughout our country. It will enable the programme to take advantage of modern information technology. The new rules are needed because Part 4A of the Health Act did not anticipate the information technology that is available now. The bill also paves the way for the screening programme to move to human papillomavirus (HPV) testing which causes 99 percent of cervical cancer. As we have discussed earlier today in Budget 2021 we included investment of up to $53 million to complete the design and implementation of human papillomavirus screening. The new test will replace the current smear test for the 1.4 million eligible women aged 25 to 69 years old. It is a simple and quick swab that women in the future will be able to do themselves and does not require an invasive speculum exam. We anticipate based on trials that have occurred here in New Zealand that this will greatly reduce the barriers to getting screened.Tonight in my remarks I want to discuss the purpose of the Health (National Cervical Screening Programme) Amendment Bill outline the recommendations from the select committee and then describe a tabled Supplementary Order Paper to address the unintended consequences of some of the select committee recommendations and a remedy to them.So first the underlying bill: currently clinicians who want to access the screening record of a participant have to request and receive that information via fax—via fax. Fax should have been abolished ages ago in the health system. They are unsafe unreliable and have a privacy risk attached to them. This bill clears the way for a move to direct secure log-in access just like all the other information systems used across our health system. This is a standard that we should aspire to for every programme particularly a vital public health programme. This will mean that healthcare providers have the most up-to-date clinical information when a participant attends an appointment either for cervical screening or follow-up and it's crucial information because if you don't know the past history of a woman in the screening programme you can't decide what to do next—ASSISTANT SPEAKER (Hon Jacqui Dean): Order! Not the Speaker.Hon Dr AYESHA VERRALL: —one can't decide what to do next and how that woman should be referred. As a result there can be delays and women who present for what should be a simple matter are asked to come back once the information has been sent via fax from the screening programme meaning in some cases an additional appointment is needed.You can imagine that this is troublesome enough in the type of settings where screening usually occurs—say in a general practice clinic—but if we want to be more innovative and we could be in the future with self-sampling then perhaps we'd want to be able to do this in different settings as well and being able to use direct log-on with mobile information technology would mean we'd be able to move the screening programme into the community in a way we haven't been able to previously. So we can and should be doing better for participants in the cervical screening programme and this bill will allow us to.I'd now like to turn to the second matter: the Health Committee's recommendations and there were four I'll canvass. The Health Committee reported the bill back to the House on 19 September 2018. I'd like to thank the committee for its consideration of the bill and everyone who took the time to make a submission. The committee unanimously recommended four changes to the bill and I'll go over them now.Firstly minor changes have been recommended to the definitions of diagnostic test" "screening test" and "specimen" for the purposes of the programmes. Members will find these proposed changes in clauses 5(1AAA) 5(3) and 5(4) of the bill. These changes would apply to all provisions in Part 4A of the Health Act. This will mean that we will move away from using the term "smear test" as samples with the new HPV test are not smeared on to a slide and the definition of "screening test" will now also include reference to the human papillomavirus.Secondly changes are proposed to the new section 112J(4)(d) which relates to the disclosure of information for the purpose of enabling compilation and publication of non-identifiable statistics from the register. So I stress: these are non-identifiable statistics. The change is to use the phrase "unless the disclosure is prohibited by" instead of the phrase "in accordance with". This change is designed to make it clear that any regulations cannot authorise disclosure that is prohibited under another provision.Thirdly the consequential amendment is the recommendation to the kaitiaki regulations themselves. The kaitiaki group oversee the use of Māori women's data by the cervical screening programme. Members will find this proposed change in clause 9(1A) of the bill. This change is recommended because clause 5(1) of the bill will amend the definition of National Cervical Screening Programme register to include "any part of the register that is replaced". It therefore makes sense to amend the definition of National Cervical Screening Programme register in the kaitiaki regulations so that it is consistent with the definition used in the principal Act. I fully support the adoption of these recommendations.The fourth change and the one I propose to change through the Supplementary Order Paper is a change to clause 6A. The Health Committee recommended the introduction of a new clause 6A to the bill. The clause provides that section 112ZE(1) of the principal Act does not override the requirements of the kaitiaki regulations. The regulations provide for the national kaitiaki group and give it a role in the protection of use of information on and from the register that identifies participants as being Māori. The committee has identified that section 112ZE of the principal Act enables screening programme employees to retain access and use and disclose any cervical-screening information to the extent necessary to perform their functions as employees. This provision being the principal Act overrides the kaitiaki regulations. The amendment will change the operation of section 112ZE so that all screening employees' use of data would become subject to the kaitiaki group's approval.I accept the Health Committee intent in introducing clause 6A. However the information that is likely to be captured by the legislation is necessary; it needs to be used on a daily basis for routine internal data analyses data modelling and data quality checking. I think this is an unintended consequence. It is also possible that clause 6A might be interpreted as requiring approval of the automated use and disclosure of data during even things as simple as electronic data uploads to existing electronic applications. It would be unworkable for the programme employees to be prohibited from accessing this information until approval was sought for their day-to-day work. This could impede the provision of timely data to the sector used for monitoring and quality assurance activities as well as having unintended consequences on the workload of the national kaitiaki group.The timely execution of these internal processes is vital to the quality of cervical-screening programmes. As clause 6 was not considered in the development of the bill an independent panel of reviewers with expertise on the screening pathway considered its impact. It also included expertise on Māori health and it has considered that to both meet the intent of the Health Committee and mitigate the risk of unintended consequences a legislative response is required. To this end I've tabled a Supplementary Order Paper that would replace clause 6A as recommended by the Health Committee with a new clause 6A. The new clause will retain the Health Committee's clear intent that the screening programme employees must gain the kaitiaki group's approval for using programme information but only when that information is intended for publication. This would include annual reports monitoring reports cancer case reviews parliamentary review committee reports any public-facing component of a new electronic application other publication of information captured by the legislation and external requests for information captured by the legislation.However the new clause 6A would also require that the kaitiaki group's approval will not be required for the programme's internal processes that are not intended to result in a publication nor would applications be required for data uploads to existing electronic applications or for existing publications. These changes would provide assurance that the programme's internal data and information management can continue at pace and will not be subject to delays. I believe the Supplementary Order Paper goes a considerable way to addressing the select committee's intent and recommending clause 6A is necessary given the identified risks.In summary I am pleased with the very robust consideration that the bill has received since introduction both at select committee and the independent review panel and I look forward to the passage of the bill so that the improvements can be made—ASSISTANT SPEAKER (Hon Jacqui Dean): The member's time has expired. The question is that the motion be agreed to."