Roy Heather: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
Roy Heather: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
[Volume:615;Page:11443] 
HEATHER ROY (ACT) 
: 
 It gives me pleasure to speak to the third reading of this bill. I would like to reiterate the comments made by many members on how constructively the work proceeded particularly at the select committee level. There was great cooperation amongst the committee members. It may not sound like it from listening to the previous speaker but in fact her concerns revolved around the privacy issues only. She certainly acted very cooperatively in other regards. 
It is important to remember what the aim of the bill is—that is to assist the operation and evaluation of the National Cervical Screening Programme. The bill also addresses the extension of these provisions to other screening programmes—or it was to but in fact that was changed during the select committee proceedings and quite rightly so. This bill is very specific to cervical screening and it was felt inappropriate to make the parameters available to other screening programmes that would have very different needs. The aim of screening programmes is to detect abnormalities early so that treatment can be begun early and the problems can be referred on. 
The National Cervical Screening Programme costs New Zealand taxpayers $35 million every year. It is important to remember this. It is not a figure that is often heard. It is a lot of money out of the health budget and that means we must spend it very wisely. If we had not spent the time getting things right at the select committee level and during the Committee stage which deals with amendments this money would not be spent appropriately. I had a conversation with Professor David Skegg from the University of Otago who is probably the foremost expert in New Zealand on cervical-screening programmes. I said to him: “Is this programme going to be good value for money because $35 million is a lot of money? It could well be spent elsewhere. If we don’t get things right in this programme then we would be better off just leaving each individual general practitioner to recall women and monitor the results.” He agreed with me entirely. At the end of the day I think we can content ourselves with the fact that this bill addresses the problems. We have addressed the problems that have arisen. I would like to compliment the Minister of Health on listening to the concerns of the Opposition and addressing those concerns. We have come to conclusions that most of us are very very happy with and will see a very good programme being put in place for the benefit of New Zealand women. 
We have heard that cervical screening has had many rocky patches in New Zealand and Dr Euphemia McGoogan’s reports have been instrumental in many of the changes. She has put forward many recommendations some of which are still being worked through and many have been incorporated in this legislation. We must not have knee-jerk responses when we hit rocky patches like the ones we have had with cervical cancer. It is very important that we do not have knee-jerk political responses to what are essentially medical problems. As I said the committee has worked very constructively and what we have ended up with are scientifically based medical responses to this very medical problem. The opt-on and the opt-off provisions have been discussed at length. We know that we have had the opt-off programme since 1993 and when it comes to screening programmes some privacy issues have to be dealt with very carefully. It is essential with screening programmes that opt-off programmes exist because we know that the more people who participate the better and if we get 100 percent participation the effect is much greater than if we have even a few people opting off. It is essential that an opt-off is the order of the day for the public good. 
The ACT party supported this bill at its first reading so that it would go forward to the select committee stage. We did so because we realised the importance of having an effective screening programme. We opposed the bill at the second reading stage because we felt that some things had not been taken into account and that some issues had not been addressed adequately. I felt very strongly about two things in particular and I said that the bill certainly would not get ACT party support unless those things were addressed. I would like to go through those. The first issue was the independent review of the programme. As the Minister said that has now been put into the legislation and will happen at least once every 3 years. This is extremely important. Nobody no matter how good she or he is can be responsible for establishing a programme setting it up running it and evaluating it themselves. Human nature means that all of us think we can do a very good job of whatever it is we are doing but it is important that there is good-quality independent evaluation of the processes so that we get the best possible result. I am very proud of the fact that that has been put into the legislation and also very pleased that that particular amendment has had unanimous support. 
The second issue I felt very strongly about was the writing of the letters to each of the nearly 1 million women who participate in the programme. If every woman on the programme was not told of the changes that would come about as a result of the new legislation particularly with regard to the accessing of primary-care records and the privacy concerns surrounding that there was danger that some women might not actually see their general practitioner before their notes would be accessed and that in the time lag their records may be accessed against their will and they would have no say in this matter. The writing to every one of those women is extremely important and I am very pleased that it will happen. I have had an assurance from the Minister herself that those letters will be written and will be under way soon. 
With regard to the privacy issues I would like to address some of the concerns of the Green member Sue Kedgley. I have as the Minister pointed out worked as an evaluator. I spent 10 years conducting research projects and have been involved with the evaluation processes. They happen in a very quick efficient and professional manner. Evaluators have a job to do like everybody else. They access the records. Usually they are not left alone to trawl through records and they are looking for very specific factors that will be of benefit to an evaluation process. It is vitally important to the success of the programme that primary-care records can be accessed for this purpose. If that were not the case the jigsaw puzzle would never be able to be completed. If we cannot do that then we are wasting every bit of the $35 million that we spend on cervical screening. A very good example of this is the audit that is being conducted at the moment of the National Cervical Screening Programme. It has taken much longer than it should have done. There are many reasons for this but one of the major reasons is that at the moment every single woman whose primary-care records need to be accessed has to give individual consent. Many of those women have shifted some of them many times and just cannot be found. Some of those women have died and their next-of-kin cannot be found. Those records will never be able to be accessed. That means the relevance of the auditors in question and certainly the quality of the information will not be what it should be even when the audit comes to a close. 
In closing I would like to say I am very pleased that this bill has majority support. The concerns of the Green Party are solely around the issues of privacy. With the passing of this legislation I look forward to changes in the National Cervical Screening Programme that will see the saving of even more lives. Many lives have been saved over the years since New Zealand has participated in a screening programme for cervical cancer. With the passing of this legislation I look forward to the mortality rate of cervical cancer dropping even further.