Hutchison Paul: Health (Screening Programmes) Amendment Bill — Second Reading 
Hutchison Paul: Health (Screening Programmes) Amendment Bill — Second Reading 
[Volume:613;Page:9905] 
Dr PAUL HUTCHISON (National—Port Waikato) 
: 
 Thank you for the opportunity to speak on this very important and long-awaited Health (Screening Programmes) Amendment Bill. I am very conscious of the fact that this bill has emanated from one of the worst medical tragedies that has affected New Zealand—ever. I am referring of course to the findings and concerns in the 1989 report of the inquiry into the treatment of cervical cancer at National Women’s Hospital. Then to make matters worse almost a decade later many of the same problems arose in Gisborne. The Gisborne inquiry arose from that initial inquiry and a whole range of recommendations were put to the Minister to achieve. One of them was to ensure that we had a highly effective health-screening programme. 
I was not a member of the Health Committee which discussed the details of this bill. I am aware that great efforts were made by all members of the committee to try to get it right. However I am concerned there are still problems with this bill and at this stage of events National will reserve its position until the Committee stage when we can see the details. 
One of the things that did worry me tonight was why the bill had come up on the Order Paper so suddenly. Maybe it is purely a coincidence that it arrived on the Order Paper on the same day that a particularly worrying article by Sandra Coney appeared in the  
New Zealand Herald. 
 It concerns the question of informed consent which has been one of the main areas of contention with the bill but which the select committee has done its very best to overcome. One of the points that I think is worth making is that it is important to look at the whole question of informed consent in the full context of cervical cancer and its morbidity and mortality. The rate of cervical cancer mortality has been coming down steadily over the last 60 to 70 years even before cervical-screening programmes were instigated in a whole variety of countries including Canada and the United Kingdom. The mortality rates were coming down and only in recent decades has there been an upward increase in the rate of cervical cancer in younger women. That has been for a variety of reasons probably to do with the spread of the human papilloma virus and the herpes simplex virus. 
It is important to realise that we must not get too hung up on that relatively small area when it comes to looking at the wider picture—that is whether the need to ensure that general practitioner notes or primary-care notes are looked at by evaluators without informed consent will make a fundamental difference to the diminution of cervical cancer. It is very easy to get into this sort of debate without being aware that there are wider questions that should be answered first of all. 
 Included amongst those is the fact that it is vital to get the quality control mechanisms in place because that was not the case in Gisborne. In fact many people are not aware that Dr Bottrill was not a pathologist. He was actually grandfathered into his position without having ever come through a full course in pathology and cytology training. There is no doubt that at the time quality control mechanisms in terms of his laboratory were absolutely deficient. Over the last few years these mechanisms have improved considerably and that is absolutely fundamental in terms of trying to get an optimal service and screening programme under way in New Zealand. 
Quality control is necessary at a whole variety of levels within the screening programme including of course at the primary practitioner level—the smear taker’s level—because there are all sorts of confounding factors that can occur if smear taking is not done properly. So it is absolutely fundamental that there is an audit a quality control and a feedback mechanism to ensure that that very fundamental thing of smear taking is done properly is done consistently and that there is a report back where the accuracy is well over the 95 to 96 percent rate. Those things are all extremely important. 
One of the biggest points of contention of course has been this question of informed consent. One of the reasons that National is reserving its position at this point is that we understand there may be some changes that will appear during the Committee stage and we would like the opportunity to scrutinise those extremely carefully. I did want to make mention of one of the perspectives on cervical screening that has been put up by perhaps one of the most experienced clinicians and colposcopists in New Zealand and that is Professor Ronald Jones. He co-authored the paper with McIndoe back in 1988 that led to the inquiry into the treatment of cervical cancer at National Women’s Hospital. He has great reservations regarding the structure of the cervical-screening programme and I think it is important that his views are taken notice of. 
He does say that it is worrying that Dr Karen Poutasi the Director-General of Health believes that all pieces of the screening programme are present but still have to come together to create a cohesive picture. After 13 years and after all the problems with cervical cytology screening he asks whether it is reasonable for the public to wait and hope a cohesive picture will emerge. He says that after 13 years he is unaware of a single scientific paper to have emerged from the screening programme. That is an indictment on what has happened over the last 13 years. There have been terrible mistakes. There have been inquiries yet no scientific papers have arisen despite the huge number of evaluations that have occurred over those 13 years. 
He asked whether it would be possible for a system within the bureaucratic framework and culture of the Ministry of Health to survive long term. He says that the answer is almost certainly no. He says that a national laboratory and associated screening unit would need some independence similar to that of other countries. I think that those warnings should be taken note of. He ends by saying that sadly his guess is that the screening programme will continue to muddle along within the insular world of the ministry. Thus it will continue in relative ignorance of what it could and should achieve be reluctant to accept criticism and be propped up by health bureaucrats who see New Zealand as peculiarly different. 
I end by saying that National intends to reserve its position on this bill until we have seen the details that will emerge in the second reading. We have grave concerns about the issue of informed consent.