King Annette: Health (Screening Programmes) Amendment Bill — Second Reading 
King Annette: Health (Screening Programmes) Amendment Bill — Second Reading 
[Volume:613;Page:9903] 
Hon ANNETTE KING (Minister of Health) 
: 
 I move  
That the Health (Screening Programmes) Amendment Bill be now read a second time 
. I am very pleased to welcome this bill back to the House for its second reading. The purposes of this bill are to reduce the incidence and mortality of cervical cancer through the National Cervical-screening Programme and to facilitate the operation and evaluation of the programme. The bill also establishes clear objectives for the cervical-screening programme and will enable the evaluators to assess the performance and safety of the programme. The bill gives effect to four specific Gisborne cervical-screening inquiry recommendations. 
The Health Committee has done an excellent job in considering the many thoughtful submissions that were made on this bill as first introduced. I congratulate the members of the Health Committee. I know that many of the issues were not easy to resolve. I am happy to recommend to the House that it accepts the committee’s amendments subject to some minor amendments. One important change as is apparent from the title of the bill is that it now relates only to the National Cervical-screening Programme. Any future extensions—and they may well be appropriate—will be dealt with in other legislative context. 
Let me remind the House why this Government introduced the bill. The National Cervical-screening Programme first became operational in 1990. It had considerable success in reducing cases of cervical cancer and in reducing deaths. Between 1990 and 1998 there is evidence showing a reduction of 22.5 percent and 46.3 percent for cervical cancer registrations and deaths respectively for women of all ages. In 1999 however it became apparent that there was under-reporting of cervical smear abnormalities in the Gisborne region. A committee of inquiry was established and the report was delivered on 10 April 2001. 
During the inquiry it became clear that there were many areas in operation of the screening programme that could be significantly improved. Over the last 3 years initiatives in policy training and leadership have all contributed to improving the programme. Such changes include policy and quality standards for the programme and in particular laboratories; an increased national leadership role in clinical expertise; the establishment of a national leadership role; and the development of new resources and training initiatives. However the select committee also identified a number of statutory barriers that prevent access to information. These barriers have obstructed the comprehensive evaluation of the programme. The bill will remove these barriers and set in place requirements for evaluation and more effective operation. 
The bill will enable the Director-General of Health to appoint appropriate qualified persons to carry out evaluations of the programme. These evaluations will generally focus on systemic issues and range from general monitoring of cervical cancer incidence and mortality to specific audits of the safety and effectiveness of the programme. As recommended by the Gisborne inquiry these evaluators will be either internal ministry employees or independent experts. 
Information and confidentiality are a key focus of the bill. I know that the select committee has given thoughtful consideration to the question of how to protect information and how to ensure the screening programme works as well as it can to protect all women. The issues are difficult and that is reflected in the fact that the select committee has recommended changes in that area. Not all the members of the committee agreed with those changes. There was one member in opposition—the Green member. 
I support the views of the majority of the committee and commend those to the House. I believe that most women in New Zealand would agree that achieving the best possible programme is the paramount objective. That means ensuring a full range of evaluating activities. This was emphasised during the Gisborne cervical-screening inquiry and the report states the following: “The choice of the programme is stark. Effective evaluation cannot be guaranteed if women’s consent is required. If the right of an individual to consent to access to her non-protected information is to predominate the programme cannot effectively evaluate its effectiveness and therefore the safety of all women participants is at risk.” 
The original version of the bill provided that evaluators would have access to information held only in hospitals and laboratories and on the register itself. That is the form of the bill that I introduced before it went to the Health Committee. That provision was very important to the evaluation but in the views of the majority of the select committee it was not enough. The committee has now recommended that the evaluators have access to all health information including general practitioner records in keeping with recommendation 11.17 of the Gisborne screening inquiry. I add that experience from the current audit of invasive cervical cancer and the expert opinion of Dr Euphemia McGoogan emphasise the importance of including primary-care records in those evaluations. After all it is in the primary-care setting that a woman usually has the majority of her contact with the National Cervical-screening Programme through screening tests. 
Additional safeguards for privacy have also now been recommended by the select committee. Women who made submissions to the committee considered and I agree that it will be essential to know what participation on the programme involves. Therefore the bill provides that when women are enrolled in the programme they will be advised that their records may be used for evaluation purposes. Of course they have the option of opting off at that point if for any reason aspects of the programme are unacceptable. New procedures to allow women to opt off the programme compared with opting off individual results—as is the case under the current cervical-screening legislation—will ensure that women who have not developed cervical cancer have a choice to participate in the National Cervical-screening Programme. 
There are also other safeguards in the bill to protect women’s health information. Evaluators can access information only for the purpose of evaluation and to the extent that the information is relevant to the evaluation. Personal matters—such as sexually transmitted infections sexual abuse and abortions—will be totally irrelevant to an evaluation or audit of any cervical-screening programme. Naturally evaluators will be subjected to confidentiality requirements set out in the legislation as well as their own professional and disciplinary standards. 
All information accessed by evaluators must be returned. The director-general can also limit access to certain information and regulations can be made to limit access to certain information. There are also provisions in the bill to ensure that women are made aware both by their smear taker and by the manager of the National Cervical-screening Programme how their health information will be used. 
I commend this bill to the House. I believe that it will improve the health of women in New Zealand. It will ensure that women have trust in the programme it will reduce the death rate from cervical cancer amongst women and it will save women’s lives. 
This has been an extremely good piece of work by the Health Committee. As I said the bill as introduced did not include access to the records of general practitioners. It was after hearing submissions from people who appeared before the committee and retaining Professor David Skegg as an adviser to the committee that those recommendations have come back to the House in this way. 
I commend the women who worked on this particular legislation. It was done in a very good way and we are determined to have the best possible cervical-screening programme for the women of New Zealand. They deserve no less.