SpeechDr LIZ CRAIG (Labour): Thank you Madam Speaker. So breast cancer is the most common cancer affecting New Zealand women and around 3500 cases are diagnosed each year. Unfortunately around 600 women pass away as a result of breast cancer each year. That's why early detection and screening is so important because what the New Zealand evidence suggests is that breast cancer screening can reduce mortality by about 30 percent when you're comparing those who have been screened to those who have never been screened.So as we've already heard in the House Labour supports the extension of the upper age range of breast cancer screening from 69 to 74 years but it's also important that we do it in a way that ensures those that are currently eligible for screening are not adversely impacted. I think my colleague Sarah Pallett talked about some of the work that's already been under way to ensure that occurs. Why that's important was because when the age range for screening was last extended back in 2004 and it was in the context of constrained capacity what we found was that participation for Māori women was negatively impacted. What we saw were inequities between Māori and non-Māori women increase significantly. This is something that we really want to avoid happening again.So what the Government has been doing is making a number of substantial changes and efforts to improve national breast cancer screening. Just going through a range of these things. I mean the first one is significant work to regain the participation rates that fell during the COVID-19 pandemic. So there's been work—things like Saturday clinics and after-hours screenings—just to make sure that people have got every opportunity to get screened and to get caught up. Also working with primary health organisations to make sure that they're actively following up people that are unscreened or who've fallen behind in terms of their screening.We've also heard about some of the significant investments in the new IT register because it's important that we've got the IT and the tools to back up the delivery of a modern screening service. So in Budget 2021 significant funding was allocated over four years to replace the existing IT infrastructure so that it can support that innovation and change which is critically important.There's also some of the constraints around workforce. So work is also under way to address workforce shortages particularly for medical imaging technologists and radiologists. And making sure that as we look at expanding we've got the workforce there that can support that. Also addressing inequity issues because basically we still have significant inequities particularly for Māori and Pacific women so making sure that we can get those inequities addressed in a very meaningful way.So what we've done is we've got a lot of work that's already under way to make sure that if we go through and roll out that age extension then there are not going to be those capacity constraints which result in the impacts that we saw back in 2004 when they extended it last time and to make sure that we can maintain our current screening rates for all those who are currently eligible.So while we support the extending of the upper age range to 74 years we do have a number of concerns just particularly around this bill. So we're quite keen to see that a significant amount of work happens at the select committee process to address these. I think the first one is just the uniqueness of prescribing something so specific in the primary legislation around screening but also particularly the age range. Because what it means is as the evidence underpinning the screening programme changes or technology changes best practice changes the question is do we really want to have to come back and address the primary legislation each time? It's also not clear why we've gone into that very very specific level about a particular age group without thinking about other aspects of the screening programme more broadly in terms of quality and in terms of mechanisms to ensure informed decision-making clinical quality and safety. So thinking around if you're going to put something in legislation which bits do you put in versus why are we so specific on this element.I think there's also concern around the same level of specificity in the women's health strategy so talking about one particular intervention but it's potentially precedent setting because then there's a whole range of other interventions that may well be very relevant to New Zealand women and why aren't we including those? But if we do do we lose the ability to have that high-level strategy? So we're happy to support this to select committee process where I think significant more work will need to be done. Thank you Madam Speaker.