Craig Liz; Rurawhe AdrianDr LIZ CRAIG (Labour): Thank you Madam Speaker. It's a real pleasure to be speaking here on the third and final reading for this bill the Health (National Cervical Screening Programme) Amendment Bill. Just like the previous speaker Dr Shane Reti I sat on the Health Committee and we heard a number of submissions on the bill. It was great to hear just the support people had for the changes that were being made. Even though some of the changes are just very technical and it might seem that the changes are quite small I think this bill has huge potential to basically improve uptake of cervical screening and to reduce inequalities and to save women's lives.I want to focus on just three areas tonight and I think the first one is just something that seems to be quite small and technical and that's the change in definition to a screening test. What that change does is pave the way for HPV testing which obviously as we've heard talked about tonight has the significant potential to increase women's uptake of screening. So what the new definition is: basically it says a test such as a high-risk HPV test or a cervical or vaginal cytology test designed to identify women who may have or are at higher risk of developing cervical cancer or a precursor to cervical cancer". I think what that does is futureproof the definition. So we've got HPV but we've also got some of the changes in terminology that are current right now.I think combined with the Government's $53 million investment in this year's Budget that's going to pave the way for HPV testing what that means is that from July 2023 women will be able to access the HPV test. And I think that's going to make a huge difference to many women's experience. I think first of all embarrassment was seen in many research articles as one of the key barriers to cervical screening in a lot of the literature. And I think when you talk to people that's quite clear. I think the ability to self-test will make a huge difference for many women's lives. I think basically being able to turn up to a healthcare professional and be able to take your self-test your own swab in privacy will make a real difference. Or women still can have a health professional take the vaginal swab if they so choose but you don't need the whole procedure that currently cervical screening needs at the moment.I think the other thing with the HPV testing is that then screening needs to happen less often. So if a woman has a negative test she can be reasonably reassured that she's very unlikely to get some of those changes that lead up to cervical cancer within the next five years. And so what that means from a screening perspective is that women can be screened every five years rather than the current three which will make a huge difference as well. Initially women will still need to obtain their swabs via a healthcare provider even if they're self-testing but what the ministry is doing is looking at ways to make screening even more accessible and that's things like mailing out self-assessment kits and making sure that they work safely for women.So basically what the research suggests—there's been some recent research that's looked at the impact that HPV testing would have in terms of screening uptake. And in a recent study that found that an offer of HPV self-testing could increase uptake of cervical screening by almost three times in under-screened Māori women. That's a huge impact in terms of reducing inequalities and reducing barriers to screening. So I think one of those simple changes in the bill changing the definition has the potential to really make huge differences in people's lives.One of the aspects though that's also been talked about is improved access to the information that you need as a screener in terms of being able to look up the data on the register rather than having that information faxed through. I think there's been quite a lot of conversations and people noting the old system of having their data faxed through to a smear taker having to wait for that and then moving forward. But I think if you look at some of the inequalities again in our cervical screening rates and making sure that those staff that are working for the ministry or DHBs who have been hired to follow up women who are basically not responding to their screening recalls and just seeing if they can get in touch and talk through that with them—and I think being able to do that work a lot of that work in terms of trying to contact people is basically happening in the evenings or after hours. And so being able to have the flexibility to be able to use the look-up access functions of the register is quite important in that respect rather than having to wait for somebody else who may or may not be on duty at the particular time sending you that information through. So I think that again offers quite a big improvement in terms of reducing barriers to screening and access.The direct access will be expanded also to include those who are undertaking research and evaluation but just making it quite clear that those privacy protections—that protection of the register—will still be in place; so basically privacy requirements preventing unauthorised access and preventing publication of any information that identifies individuals. But also that level of protection in that the national screening programme manager still contains control over who's granted access to the register and it's also got access as an auditable activity. So it means that those protections are in place. And there's also basically an offence if you amend the register without the national programme manager's authorisation. So I think there's a range of protections in the bill so that while we are expanding access to be able to look up data on the register for particular purposes those protections are there.Just in the final few minutes I'd like to focus on the Supplementary Order Paper (SOP) that the Government has put through and that relates to some of the changes around the regulations in the National Kaitiaki Group and this was something that we spent quite a lot of time on as a select committee discussing because it's really important in terms of governance when we're looking at data that's identifiable in terms of Māori data that the kaitiaki group has approval of what happens to that data. What the SOP looks at is how we can make sure that those working within the screening programme can get on and do some of those more routine mundane data updates without having to seek that approval but at the same time making sure that if you are going to be publishing information which is identifiable in terms of ethnicity in publications then you do need to get approval from the National Kaitiaki Group in terms of the way that that occurs. Also if you're compiling statistics on other issues the same thing applies—but just in terms of the day-to-day functions making sure you can do your data refreshes your data back-ups making sure staff can get on and do that at pace with the usual business of the work that goes on within the screening programme.So basically what we've spent time on in the SOP is just clarifying those functions and what does need approval and what doesn't which is incredibly important because where we've got larger inequalities in terms of access to screening in terms of screening uptake it's really really important that the National Kaitiaki Group has approval and has involvement in the publication of data that relates to Māori. So that's crucial. And the kaitiaki group members and the ministry will be continuing to work together in partnership to strengthen Māori governance around the data within the programme. So that's incredibly useful.What I'd just like to conclude with though is just talking about some of the changes in the bill—not in the bill but in the way that the bill will then lead to—and particularly the use of HPV screening because this is the research I quoted earlier. This was a study that was taken up in Northland looking at women who hadn't been screened for some time a group of Māori women. What they found was with the offer of self-screening with HPV then following through to who actually took up screening 59 percent were screened whereas if they were just offered the traditional cervical smear what they found was only 21.8 percent of those women were screened. That's a huge difference. So what that was was basically 2.8 times more likely to be screened if you were offered this HPV rather than the standard cervical screening. So that's the huge potential that we've got to reduce inequalities in cervical cancer by improving our cervical screening rates.So just summing up what this bill does it does a whole range of things but basically we're updating the definition of screening so that that does allow for HPV screening. It provides secure login access to those that need to use the register for a range of purposes and also with the Government SOP it provides clarity around the role of the National Kaitiaki Group in terms of providing approval for the use of identifiable data where people are identified as Māori. So a really important bill—DEPUTY SPEAKER: Order! The member's time has expired."