Verrall AyeshaHEALTH (NATIONAL CERVICAL SCREENING PROGRAMME) AMENDMENT BILLThird 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 third time. It's a pleasure to see this bill through to its third reading. This legislation is needed to enable the National Cervical Screening Programme to take advantage of modern information technology and also pave the way for HPV primary testing which causes 99 percent of cervical cancers.As we've discussed previously in relation to this bill the current situation is that when a woman presents to a provider for cervical screening if the provider isn't her regular general practitioner the provider will need to request by fax access to that person's screening history. This happens via outdated technology including fax. So this bill clears the way to allow health practitioners to have direct look-up access into the screening histories of participants in the screening programme which will be secure by log-in and read-only access. This is the same as many other information systems used throughout our health system.And if we just reflect for a moment on the importance of cervical cancer in countries without a cervical cancer screening programme cervical cancer is one of the leading killers of women in the middle of their lives. And our cervical cancer screening programme does a good job of preventing that type of impact; however we must improve it so it can continue to be a world-class system.We have covered at length during the second reading some of the technical aspects of this bill so I thought I would like to take the time during this third reading to cover some of the history of this screening programme to contextualise the present changes. The National Cervical Screening Programme was New Zealand's first population-based screening programme and it led the way for all our other screening programmes. The programme was established in 1990 after the Cartwright inquiry in 1988 which investigated allegations concerning the treatment of cervical cancer at National Women's Hospital and several other related matters.As a result of the inquiry there were also important changes in other areas of health which I'll come to later. That inquiry arose out of a groundbreaking article in Metro magazine written by Sandra Coney and Phillida Bunkle about allegations of women under the care of Dr Herbert Green at National Women's Hospital. Women with carcinoma in situ so early cancer weren't informed that they were the subject of cervical screening research. Dr Green had been monitoring them and not treating them. This went against the current practice at the time—it's not a case of treatment standards evolving during the period of his practice; it was against practice at the time. As a result of this mismanagement a number of women developed cancer and subsequently died.I want to acknowledge some of the people that contributed towards the sweeping changes as a result of the inquiry. Firstly Sandra Coney and former MP Phillida Bunkle who were authors of the groundbreaking article and were also involved in the setting up of the Cartwright Collective: a women's health advocacy group for cervical screening. Of course Dame Silvia Cartwright herself—the judge who chaired the inquiry—and survivors like Clare Matheson who spoke out to the media about their experiences sharing their story publicly so that the public and the country could understand the very human impact of what had happened.There were also medical advisers to the inquiry who subsequently had long roles in advising the development of the National Cervical Screening Programme. These include Professor Charlotte Paul a specialist in public health and epidemiology; colposcopist Dr Gary Fentiman; and Dr Peter Sykes. Another person who was instrumental in the setting up of the national screening programme in the years after Cartwright was Professor David Skegg an epidemiologist who continues to help the Government with many of the COVID challenges we are facing—recently serving on the Epidemic Response Committee.Early on the programme was regionally based—it wasn't initially a national screening programme and women across the country worked hard to encourage others to be screened nurses took up roles as smear takers and trained as smear takers and very dedicated women in health administration set up their own registers and set up measures to make sure that women were followed up.After the Cartwright inquiry the National Cervical Screening Programme has gone on to be nationally linked up and a number of positive developments in the quality of the programme have occurred over time but it has not been without controversy including when women in the Tai Rāwhiti region had errors in their slides being read and legislation was subsequently passed to ensure that the deficits in the programme then were addressed.But Cartwright had wider impacts beyond just the impact on the cervical screening programme and I think it's worth going into those further as well—not just in New Zealand actually around the world. I entered medical school a decade after the Cartwright inquiry precipitated a range of improvements in our health system. The Health and Disability Commissioner framework was set up in response to that and that's the cornerstone of our patient rights practice in New Zealand. Our health ethics committees make sure we didn't have the same problems with research without consent—informed consent practice improved in both research and clinical settings. I was very lucky as a medical student to be lectured on these changes by Professor Charlotte Paul. Charlotte's teaching on these issues was informed by her firsthand involvement in the Cartwright inquiry as an expert adviser. And she also brought to that a deep knowledge of the complexities of screening and a moral clarity on the harm done to those women and the changes we needed to make to ensure that that never happened again.Another important point about the inquiry that's relevant to the changes we're making in cervical screening now is the experience of Māori women. The inquiry was a turning point for Māori women's health because they had the opportunity through the inquiry to express deeply felt cultural beliefs about the sanctity of te whare tangata. And it bears repeating that the barriers for Māori in accessing cervical screening are not new. We have known about them since Cartwright and we have struggled to address them for a long time.So following on from the inquiry legislation to ensure the protection of women and Māori data by way of the Health (Cervical Screening (Kaitiaki)) Regulations in 1995 was put in place. And the National Kaitiaki Group mandated as part of the regulations was established in 1995. Until these regulations came into force in 1993 the first interim National Kaitiaki Group representatives were women including Dr Erihapeti Rehu-Murchie Dr Irihāpeti Ramsden and Dr Lorna Dyall and they were joined by Ramari Maipi and Keri Wikitera. Many other wāhine Māori have been guardians of Māori data on the National Kaitiaki Group since that time. The National Kaitiaki Group is important for being the first group in New Zealand mandated to manage Māori data governance. So I'd like to acknowledge all of the women who have served on the National Kaitiaki Group over this period. In more recent years wāhine Māori particularly Dr Bev Lawton have led research on cervical screening and Bev's focus has been on the use of the HPV polymerase chain reaction test and self-swabbing in New Zealand. And we know from her hard work that self-swabbing which is partially enabled by this bill is a really much more acceptable way for Māori women to have their samples collected.So following on from the Cartwright inquiry it was felt that it was really important to legislatively mandate all aspects of the cervical screening programme and Part 4A of the Health Act puts this into practice. No other screening programme is regulated in this way but I think you'll understand from the history why that is the case. So by way of conclusion this bill enables direct look-up access for practitioners to participants' screening histories. It'll make cervical screening more efficient and it enables smears in a wider range of settings. Along with investments announced by this Government in Budget 2021 it enables HPV screening. This bill will enable the use of information technology and diagnostics to ensure we have a high quality and modern screening programme. A world-class screening programme takes constant work and I am grateful to the many doctors nurses screening experts health officials and women's health advocates who have brought us to this point. But more than that these changes will enable screening to be performed in conjunction with the developments we're making in HPV screening at home or in the community. HPV testing will also enable women to collect their own samples.My view is that the women at National Women's Hospital were harmed and experimented on because they were disempowered and discounted in the medical system. That's why I'm leading changes that will take cervical screening out of the clinic into settings where women feel more comfortable from something that is done to us to something that we can do for ourselves. This Government will also ensure that wāhine Māori find the procedures acceptable and that they trust that their information will be used sensitively. I commend this bill to the House.ASSISTANT SPEAKER (Hon Jacqui Dean): The question is that the motion be agreed to.