King Annette: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
King Annette: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
[Volume:615;Page:11435] 
Hon ANNETTE KING (Minister of Health) 
:  
I move  
That the Health (National Cervical Screening Programme) Amendment Bill be now read a third time 
. This bill replaces section 74A of the Health Act which established the national cervical screening register. The purpose of the bill is to reduce the incidence and mortality of cervical cancer through the National Cervical Screening Programme referred to as NCSP and to facilitate the operation and evaluation of the programme. It also sets clear objectives for the National Cervical Screening Programme and will enable experts called evaluators to assess the performance and safety of the programme. 
This House has decided to ensure that our National Cervical Screening Programme is of a “gold standard” which were words used by Dr Euphemia McGoogan when she looked at New Zealand’s programme and said that it needed to decide what sort of programme it wanted—whether it wanted one that could not be properly audited or one with an audit and evaluation process that could ensure a gold standard. This legislation is a positive step toward New Zealand women’s health. It strengthens evaluation procedures and will ensure that the National Cervical Screening Programme can undertake evaluations that are absolutely crucial to the continuous improvement and quality assessment of the programme. 
The passing of this bill gives effect to four specific Gisborne Cervical Screening Inquiry recommendations. The bill is a continuing part of the history of cervical screening in New Zealand which goes back to the 1960s. It has been the subject of two major inquiries the first being that by the then District Court Judge Silvia Cartwright in 1988. One of the key recommendations from that inquiry was the establishment of a nationally planned cervical-screening programme. The National Cervical Screening Programme became operational in 1990. Evidence shows a reduction of 22.5 percent and 46.3 percent for cervical cancer registrations and deaths respectively for women of all ages between 1990 and 1998. 
Members may recall that in October 1999 the then Minister of Health Wyatt Creech established a committee of inquiry to look at the apparent under-reporting of cervical smear abnormalities in the Gisborne region. The committee of inquiry delivered its report on 10 April 2001. During the inquiry it became clear that statutory barriers preventing access to information were obstructing the comprehensive evaluation of the programme. Post the Gisborne inquiry the programme has undergone significant improvements over the last 3 years—the introduction of policy and quality standards increased national leadership and screening services and the establishment of a national leadership role in the development and implementation of health promotion strategies to name but a few. As of 1 February 2004 just under 1.1 million women aged between 20 and 69 were enrolled on the national cervical screening register which is 99 percent of the eligible population.  
The bill that is in its third reading has been subject to robust and widespread debate. A number of very positive changes have been made since the bill was introduced in the House in May 2002. It was sent to a select committee and reported back to this House with major changes made after select committee members heard the evidence presented to them. 
I take this opportunity to thank the members of the committee for the very solid work they put in on this bill to ensure that we had majority acceptance when we finally came to considering it in the Committee of the whole House. I particularly want to thank the chair of the committee Steve Chadwick who took the bill through the committee. I make particular mention of Dr Lynda Scott the National spokesperson on health and her commitment to us having a cervical screening programme that works and that is of a gold standard. I know that she put in a lot of work to ensure that her colleagues were convinced of what was being undertaken and the changes being made. I also acknowledge Barbara Stewart from New Zealand First for her contribution for listening to what was put before her and for ensuring that it was supported in the House. I thank Heather Roy who—and I will talk about some of these things in a moment—came up with recommendations at a later date that have now been included in the bill that will become the Act. I also acknowledge Judy Turner who has been a stalwart in ensuring that we get this bill through the House with changes that make it work for the women of New Zealand. I acknowledge the role that Sue Kedgley has played. She has not agreed with what is going through the House in its totality but she did support a review of the programme in an ongoing way. 
The bill had very convincing majority support in this Chamber during the Committee stage. That was really important to me as Minister and I publicly thank Selwyn Katene from my office who did a lot of work in ensuring that there was negotiation and work done around getting as much agreement as we could on this bill. 
Once the bill had been reported back we met in my office to see whether we could improve it further and out of that came a number of recommendations that I think have been very important. The independent review committee suggestion—as I have said—came from Heather Roy and that has been included in the bill. There will now be an independent review of the National Cervical Screening Programme. The review committee will review it once every 3 years. That has now been written into law and I think that gives some level of confidence that it will be an ongoing independent review of this programme. 
There was also the issue of ensuring that women were advised about the National Cervical Screening Programme thereby giving them the opportunity to know what the programme was about and to be able to give their consent. That issue I have to say was also led by Dr Lynda Scott and if I recall correctly Heather Roy and Sue Kedgley were very keen to see that women were informed about the programme. 
The evaluation issue was one of the hardest issues we had to deal with. It is worth noting that in the reviews that have been done of this programme including the Gisborne Cervical Screening Inquiry this was one of the most important things said about the programme and I quote from the Gisborne inquiry: “The choice for the Programme is stark. Effective evaluation can not be guaranteed if women’s consent is required; if the right of an individual to consent to access to her now-protected information is to predominate the Programme cannot effectively evaluate its effectiveness and therefore the safety of all women participants is potentially at risk.” That is a direct quote from the Gisborne inquiry. What we have endeavoured to address here is the ability to evaluate this programme. 
As far as I was concerned one of the most powerful comments made when we were looking at this issue was by Heather Roy who was an evaluator in her former life. She made the point that in her knowledge of evaluators they are not interested in looking at the salacious history of women at their other records or at any person they are evaluating. They are highly skilled people who look at the job in hand and evaluate the programme or process to ensure that we are able to know what works and what does not. I believe that the amendments we have made to ensure that when records are required from a general practitioner for example those general practitioners can have oversight of the information strengthen the bill somewhat. I know that Dr Scott would have liked to strengthen it more in terms of opting off that but the House decided not to do it. I was extremely pleased when we got to the end of the evening that this House by an overwhelming majority accepted this bill as the right approach for us to strengthen the National Cervical Screening Programme. 
I conclude by saying that I have not covered all the things that were covered in the bill but I know that other members will. I give heartfelt thanks for the work that was done. It was important to the women of New Zealand that we got as much agreement as we could and did the best possible job on this legislation.