Craig Liz; Verrall AyeshaDr LIZ CRAIG (Labour): Thank you. I just want a brief call. I'd like to just focus on clause 4 and 5 and just ask the Minister to comment on the impact she thinks that expanding the definition of a screening test and broadening the purpose of the Act will have in terms of reducing inequalities in cervical cancer and also futureproofing the screening programme.I think just thinking through these stories that we've heard in previous debates around smear takers having to wait for a fax to come through to get information from the screening programme. So just the impact of that narrow group of people that currently under the Act are allowed to access information which is reasonably restricted to those operating the programme and also appointed screening programme evaluators. I think looking at what clause 4 is doing in terms of broadening that so that we've got those providing cervical screening services assessment and treatment services and researchers who are authorised broadening that because we've also heard stories about people who are working to follow up people who are late for their smears. And again if they've got unduly restricted access to information the impacts of having to then wait for something to get faxed through by somebody in daytime hours if they're working after hours the complexities around that.Also looking at clause 5 where what we're doing is we're actually broadening the definition of a screening test to include things like high-risk HPV testing and also cervical or vaginal cytology. So just really thinking through the impact that will have in terms of futureproofing the screening programme so that we can have and use those more up-to-date tests and looking at what that will do in terms of making sure that we can follow up those who are late for their smear tests and secondly thinking through how we have reductions in inequalities in terms of cervical screening. So just talking through those points. Thank you Madam Chair.Hon Dr AYESHA VERRALL (Associate Minister of Health): I thank the member for her question. So clause 4 is to allow a wider range of health providers to access the register which enables providers in the course of their clinical work to look up the register rather than having to obtain essentially a clinical history sent by fax. And that enables much more timely access to that information. That means that people aren't sent away.The member's specific question was about equity and that is an issue. We know that there are people facing social disadvantage from low incomes who struggle to get to a provider and there are many barriers to getting a provider and that asking them to go away and then come back actually just magnifies that barrier. So that's one of the things.Then clause 5 specifically broadens the classes of specimens that might be referred to in the Act and is part of enabling the collection of the HPV sample rather than the traditional cervical smear that has been used up until that time. And that enables equity because it is a much less invasive procedure. It does not require another person to do a speculum exam; it can be done by a swab. It is therefore a more acceptable procedure and we know that from studies done here in New Zealand by researchers engaging with Māori and other communities to assess what their experience has been. And then ultimately it is possible that by implementing the HPV test women will be able to collect their own samples. That means that the barrier of even coming in for a smear may eventually be removed altogether. It may be that swabs could be posted out to women who are in remote locations and they could be instructed in how to collect their own sample. So all of those potential actions are made possible by the fact that we have a wider range of samples that could be used including the HPV test.