Health (National Cervical Screening Programme) Amendment Bill — In Committee 
Health (National Cervical Screening Programme) Amendment Bill — In Committee 
[Volume:615;Page:11263] 
Health (National Cervical Screening Programme) Amendment Bill 
In Committee 
The CHAIRPERSON (H V Ross Robertson) 
: Because we are doing this bill part by part it is important to remind members that recent changes to the Standing Orders have altered the way in which the Committee will consider a bill. The debate will now begin with the question that Part 1 stand part rather than clause 1 “Title”. Any schedules will be debated along with the part to which they principally relate. I will inform members which schedules belong to each part. So instead of debating the schedules separately they will be debated as part of the part they belong to. Schedules will be voted on separately without further debate once the parts have been disposed of. Debate on clause 1 and any other preliminary provisions that are not in a part will take place at the end. The preliminary provisions will be debated together but are voted on separately. 
LINDSAY TISCH (Junior Whip—National) 
: 
 I raise a point of order Mr Chairperson. I am interested in the new Standing Orders. Have they been circulated? I am hearing this for the first time. I am not disputing anything. I am just interested to know the number of the Standing Order. Can you refer the number to me? 
The CHAIRPERSON (H V Ross Robertson) 
: I am more than happy to. It is Standing Order 296. The new Standing Orders have been available for a little while. 
Part 1 Preliminary provision 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 It is with pleasure tonight that I take the first call on the Health (National Cervical Screening Programme) Amendment bill that amends the Health Act which is referred to as the principal Act in the bill. The commencement provisions in Part 1 have been changed. The Act is to come into force on 1 July 2004—that date having been changed from 1 July 2003 which is well past. 
This legislation has been somewhat contentious. Initially the legislation that was to come into force on 1 July 2003 was to be an omnibus bill for health screening programmes although it had been based almost exclusively on the need to have an effective National Cervical Screening Programme. There was a great deal of debate throughout the Health Committee as to whether this bill should apply to all screening programmes or whether it should be specific to the Cervical Screening Programme. The decision of the committee was that it would be specific to the Cervical Screening Programme. Hence there has been a great deal of consultation on this bill and that is why it now comes into force on 1 July 2004. 
However amendments in the Minister’s Supplementary Order Paper state that only new section 112D and section 6 come into force on 1 July. New clauses provide that the Act comes into force 12 months after the date on which it receives the royal assent. That is to allow the appointment of appropriate people to be made under the Act so that they can implement the provisions in the bill. 
If one looks at cervical cancer statistics in this country in 1981 12 women per 100000 developed cervical cancer and five per 100000 would die of it. In 2000 after the screening programme was set up in 1990 to show how effective that programme was the incidence of cervical cancer had gone down and 10.6 women per 100000 now develop cervical cancer in this country and three die. That is a 46 percent reduction in the death rate. It is a very significant reduction in the death rate from a terrible disease that killed too many New Zealand women. With no screening one in 200 women would die. With screening one in 1280 women die. 
That is a huge difference. That is why it is so important for this country to develop screening programmes. But for that to happen an effective measure is needed by which to screen. Screening for cervical cancer is not a really exact science. When one is looking down a slide in a laboratory to find abnormal cells it is a bit like looking for a needle in a haystack. The cell does not jump out and say: “Hey I’m cancer here.” One has to be very skilled. Part of what we have been doing with this programme has been in response to the McGoogan report to the inquiry in Gisborne making changes to cervical-screening programmes so that we can ensure we have a gold standard programme here that will ensure effective delivery at the coalface—where women are screened—in the laboratories and by the clinicians. Then there is the treatment for those women. That is why we need to get this legislation into effect as soon as possible and why its commencement needs to be this year 1 July 2004. 
In 2001 191 women developed invasive cervical cancer and 71 died. We still have more ground to cover. We want to see women on the programme. At the moment 1 million women are on the programme. We want to ensure that those women can have absolute confidence in the National Cervical Screening Programme. We also want to make sure that if this programme is used for other sorts of screening we have a standard that we can apply. Later in the debate we will be talking about the specifics that have delayed this bill to some degree which is why it is now coming into force in 2004 and not 2003 and looking at why the programme changed from “opt-on” to “opt-off”. It became an opt-off programme looking at access to primary-care records. But that is for further debate later in the bill. We know that other screening programmes are being developed in New Zealand for breast cancer and prostate cancer. 
Hon ANNETTE KING (Minister of Health) 
: 
 I shall take an early but short call to endorse the comments made by the Opposition spokesperson on health in her opening remarks on the Health (National Cervical Screening Programme) Amendment Bill. I do not think I could have put it better than the member already has. 
The key point she made is that we are looking for a screening programme that is of gold standard; that is the best we can possibly provide to the women of New Zealand. This bill addresses a number of issues concerning the development of a very good screening programme. It gives effect to four specific Gisborne cervical-screening inquiry recommendations of the 46 recommendations made and some of them relate to changes that we need to make in this Parliament. 
 The point I would like to make very clearly is that very good work has been done across parties in this Committee to get as much consensus as we can around the issues in this bill. 
The bill came back from the Health Committee which had done an extremely good job on it. The committee made quite a number of amendments to the bill which I accepted. There were some issues however that were of concern particularly to the women in the House. We met sat around a table and thrashed out how we could improve on what had been reported back to Parliament to make it even better. As Dr Lynda Scott said we will mention some of those when we get into the next part of the bill. 
But I want to acknowledge that really positive work. It was one of those occasions which does not always happen in Parliament when members sat down looked at issues and then came up with some decisions. I acknowledge that work; I am putting it on the record. We will debate some of the other issues in detail when we get into the next part of the bill. 
BARBARA STEWART (NZ First) 
: 
 On behalf of New Zealand First I am pleased to speak on Part 1 of the Health (National Cervical Screening Programme) Amendment Bill. The commencement date is 1 July 2004. We know that that commencement date is important particularly to all of those who are affected by this particular bill. We want to have women enrolled in this programme we want to have a gold standard programme and we want a programme that the women of New Zealand can have total confidence in. 
I am particularly pleased that it is 2004 because the sooner we get on to this legislation the better but also because by this time all the people who are already enrolled in this programme can be informed of the changes to the programme they originally joined—namely access to their health records by programme evaluators. We know that this step cannot be undertaken until this legislation is passed. So the sooner it is passed the sooner we will be able to progress this. 
I am pleased too to think that in the very near future all the women in New Zealand enrolled in this programme can expect to be fully informed about the new process and we will look forward to monitoring the progress of this process. New Zealand First definitely supports the development of screening programmes of this nature that benefit the health of all New Zealanders. Women’s health is particularly important because of the families that they are part of. We know that this is a disease we do not want our women to have. 
SUE KEDGLEY (Green) 
: 
 Some of the previous speakers have talked about the commencement date of this bill and we are frankly very relieved to know that the majority of the provisions in the bill will not come into effect for another 12 months. I think that there needs to be time for a woman in New Zealand to understand the true implications of this bill. Would that it were true what the New Zealand First representative said—that the women of New Zealand will be fully informed of the whole screening programme and the implications of this bill. But in our view this bill regrettably will erode the confidentiality and the privacy of personal health information and the approach to privacy issues that New Zealand has taken over many years. It will also undermine the confidentiality of the patient-doctor relationship and I am sure I do not need to remind members that confidentiality is at the heart of the patient-doctor relationship. Most of us would not divulge details about our health and well-being to a doctor if we felt that what we were going to put on a doctor’s records could be accessed by an unspecified number of people—and that I regret to say is exactly the implication of this bill. 
The CHAIRPERSON (H V Ross Robertson) 
: This debate is about the commencement date. 
SUE KEDGLEY 
: I listened with great interest to the speaker from the National Party and others and they spoke in an extremely wide-ranging manner. I took my cue from them. No one objected to them and that is why I am speaking in this way. 
The CHAIRPERSON (H V Ross Robertson) 
: That is not correct because I did bring them in a couple of times as well to talk about the commencement date. The member can try. 
SUE KEDGLEY 
: I think that it is a good thing that there are 12 months before the provisions fully come into effect so that the women of New Zealand can become aware of the implications of this bill. Basically under the provisions of this bill all doctors in New Zealand will be required to hand over the medical records of any woman out of a million women who are enrolled in the National Cervical-screening Programme and of course of any other woman who chooses to join the programme. I think that at the moment many women are not aware of the amendments made to this bill that will undermine the privacy of health information. That is why it is fortunate indeed that there are 12 months in which to contemplate the implications of this bill. 
Frankly I am absolutely amazed that most of the parties in this Parliament including the National Party New Zealand First and ACT who expressed serious concerns during the debate last time accept the bill on this occasion and will support it. I wonder whether they too have thought through the implications of the amendments that are contained in the Minister’s Supplementary Order Paper. Basically once the commencement date of this bill has come into effect New Zealand women will be faced with Hobson’s choice: either they stay on the National Cervical-screening Programme and surrender their right to informed consent or they opt off the programme and risk both their health and the efficacy of a nationwide screening programme. 
I believe that far from strengthening the National Cervical-screening Programme the last-minute eleventh hour amendments to this bill will cause many many women to choose to opt off the national cervical-screening register because quite frankly they will not be happy with the thought that their personal health records can suddenly be automatically accessed without their consent by an unspecified number of evaluators. 
So over the next 12 months as women become aware of the amendments and the implications of this bill I believe that there will need to be some rethinking of these last-minute amendments which have been parachuted into this bill. They were not in the bill when it went to the select committee but were put in at the last minute. I think that when we think this through we will have time hopefully to rethink this bill. 
JUDITH COLLINS (National—Clevedon) 
: 
 I rise to speak to the Health (National Cervical Screening Programme) Amendment Bill and in particular to Part 1. The commencement date is 1 July 2004 now rather than 2003 and I will hopefully have a little latitude to talk about this. 
I note the comments of Sue Kedgley my former colleague from the Health Committee who is concerned very much about the privacy issues. If there is one thing I am somewhat concerned about it is privacy issues and confidentiality. I was very concerned when I first looked at this bill. I was extremely concerned that we might need to put the commencement date out further because I was worried about the implications. 
Certainly it was very concerning to me that anybody I thought could have a look at the records and get access to them. But I was very much assured and reassured really not only by the Minister and the officials but by looking at the amendments to see that in fact the only people who will have access to women’s medical records in relation to this bill—and I note that the commencement date is 1 July 2004—are in fact the people who are evaluating or in other words auditing the process. That is why I felt that it was very important that the bill be passed this year rather than next year. 
One of the concerns about the auditing is that lawyers’ records—and having been a lawyer for so long I am very much aware of this—are regularly audited by auditors. They look through files and check that things are where they are supposed to be. Of course that is the way it should be yet lawyers never get authorities for that and the reality is that that is all the auditors look at—to make sure that things are as they should be. This particular bill is about the auditing. It is a terrible crock—in fact it is a shocking thing to do to women—to have cervical-screening programmes that do not have any auditing or evaluation. It is nonsense. It is worse than nothing because it gives people a feeling of well-being— 
Hon Member 
: False! 
JUDITH COLLINS 
: It gives them a false feeling of well-being and that is something we should not allow. That is what led to the Gisborne cervical cancer inquiry—the McGoogan inquiry. We do not want to see that this year next year or any other year. That is why I am particularly pleased to see this legislation being passed this year. 
The reality is that women will still be able to get Pap smears done even if they are not part of the screening programme. The people that Ms Kedgley mentioned in her speech will not be chopped out of having their cervical tests done. They will be able to have them done usually by their general practitioners or whoever else does the tests for them and they will still get the results but they will not get the letter from the national cervical-screening register telling them when their call-up time is. In fact their general practitioners will be doing that. It is not as though they will suddenly be bereft of any medical assistance. They can choose to be in charge with their doctor of their own records and their own call-ups. 
I do not think that some of Ms Kedgley’s concerns will necessarily come out this year or next year as being quite so major. But certainly in the National Party we will be very much concerned if it looks as though people are just opting out altogether and not taking part in the programme to discuss with the other parties whether there should be an amendment to the legislation. I can see the Minister in the chair Annette King nodding away because none of us wants to see an epidemic of the proportions that there has been in this country. That is why we are particularly keen to see the commencement date be 1 July 2004 and not later. 
Dr MURIEL NEWMAN (ACT) 
: 
 I rise on behalf of the ACT party to speak in the debate on the Committee stage of the Health (National Cervical Screening Programme) Amendment Bill and in particular Part 1. Part 1 consists of the commencement date which I note has now been pushed out by a year. I am not the ACT member who sat on the Health Committee to look into the bill and I understand from that member that the committee has done a very thorough job which is why I understand the date has been pushed out to 1 July this year. But I do note that the bill itself has changed as I understand it from being a “think big” bill—in other words it was supposed to be an umbrella bill under which a whole lot of screening programmes could have been slotted in—to being a more modest and specific proposal to deal with just the cervical-screening programme. I am very pleased to hear that because anybody who knows anything about national programmes—databases screening programmes or whatever one wants to call them—knows that they are or can be fraught with problems. The fact that the Government has another half-year to get its planning into place before it launches the provisions in this bill must allow the Minister to sleep a little easier. 
I already know from my own experience and the experience of people I know that the present cervical-screening and breast-screening programmes are fraught. They are fraught with problems because people get advised late—years late—that they are due for another screening. When they turn up for a screening—in the breast-screening programme in particular—they are told to go to the wrong place at the wrong time. All sorts of problems arise because the programmes are trying to deal with a lot of people. In this case I understand that about a million women will have to be brought on to the programme and as we have already heard there is now an opt-out provision. But a million women means an awful lot of planning. Again the fact that the commencement date is 1 July this year does allow some grace for all those officials who will have to take part in that planning process because it is no mean feat. 
I understand that some of the concerns raised by the ACT party have been taken into account in the way the bill has been set up and I say to the Minister that it is a positive thing—she has enabled the concerns of all the members on the committee to be looked at taken into consideration and addressed. The problem that we have from the outside is that it would be very nice to have an assurance or a plan from the Minister to tell us how she plans to implement the programme which as I say will be dealing with a million women. It starts on 1 July 2004 so the question is whether that is the date on which planning starts—or is the planning already under way right now so that on 1 July 2004 the first lot of women get their letters to say that they are now due for their tests? 
Given that this bill is in its Committee stage—which does allow different submissions to be put to the Committee on changes and modifications that could be made to the bill—it would be very helpful to the Committee of the whole House if the Minister could walk us through the programme and the progress that she intends to take between now and 1 July 2004 and then walk us through what she intends to do on 1 July to get this programme dealing with a million women under way. 
JUDY TURNER (United Future) 
: 
 The bill before us has been very thoroughly and robustly examined by the Health Committee. Originally it was thought that the legislation would be able to apply in a more general sense to future health-screening programmes. However the advice from the Regulations Review Committee was such that it was decided to limit its scope to the Cervical-screening Programme that we are looking at today. 
When we talk about the time frame for commencement we also need to remind ourselves that we are talking about the time frame of a disease—a very preventable cancer. About 90 percent of all cases of the most common forms of cervical cancer are preventable if detected at an early stage and treated appropriately. Preventing deaths is possible but it hinges on the effectiveness of the screening programme in operation. As a country we have mourned the results of a screening programme that did not guarantee 100 percent accuracy for women and we have been given the mandate to put that right to the best of our ability. We also need to go back in time and remember the Gisborne inquiry that started this process. The evaluation that was so missing at that time will be addressed by this legislation. 
 I commend the chair of the Health Committee Steve Chadwick for her leadership in this regard. I mention Dr Lynda Scott—it is always great on a committee to have people with a medical background—and also Heather Roy from ACT whose contribution I found extremely helpful in the process. The most delightful aspect of this bill—and I say to Mrs Collins that it was delightful to work with her also—was that the cooperation worked. I also thank the Minister for the extended meetings regarding the bill and for the open and frank discussions that we had over ongoing concerns after it was reported back. 
It is important to remind ourselves when we talk about the time frame of this bill that we are dealing with a screening programme which is different from a diagnostic programme. There are flaws in a screening programme just by its very nature and if we do not have in place the kind of checks and balances that this legislation seeks to establish then a screening programme is not worth the paper it is written on and the system that is set in place can become a very dangerous tool. 
United Future is thrilled to support this bill and we will make further comments in Part 2. 
DIANNE YATES (Labour—Hamilton East) 
: 
 I move  
That the question be now put 
. 
Motion agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 184 in the name of the Hon Annette King to Part 1 be agreed to. 
Amendment agreed to and Part 1 as amended agreed to. 
Part 2 Amendments to principal Act and transitional provision 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 Part 2 makes amendments to the principal Act which in this case is the Health Act of 1956—a rather elderly Act. The McGoogan report came from the inquiry into under-reporting of cervical cancer in Gisborne. Euphemia McGoogan is a world expert on cervical screening who came to have a look at our system and made recommendations for change. Recommendation 11.14 states: “The Health Act 1956 should be amended to permit the National Cervical Screening Programme to be effectively audited monitored and evaluated by any appropriately qualified persons irrespective of their legal relationship with the Ministry of Health. This requires an amendment to section 74A of the Health Act to permit such persons to have ready access to all information on the National Cervical Screening Register.” 
Recommendation 11.17 states: “The Health Act 1956 requires amendment to enable the Ministry of Health and any appropriately qualified persons it engages to carry out (external or internal) audits monitoring or evaluation of cervical cancer incidence and mortality to have ready access to all medical files recording the treatment of the cervical cancer by all health providers who had a role in such treatment.” 
The crux of one of the major debates that we have had about this bill is the section about “ready access to all medical files”. If we want a cervical-screening programme that can be appropriately audited then we need access not just to laboratory and hospital data but also to primary-care records. We have heard Sue Kedgley’s concerns in this regard and many in National’s caucus have similar concerns because it comes down to the issue of informed consent as opposed to the issue of having a gold standard screening programme that we know is effective. We will not repeat any of the mistakes that we had in Gisborne and we will follow Euphemia McGoogan’s report and recommendations. 
One of the issues is that this programme is an opt-off programme. From 1990 to 1993 it was an opt-on programme—people had to sign to say that they wanted to be part of the programme. Initially people joined and then over the months of 1993 the numbers of people signing up tailed off and dropped. The Ministry of Health decided to have an opt-off programme. That meant that when people had their first smear they were registered on the programme. At that point they were sent a whole lot of information and if they chose they could opt off the programme. We have had a lot of debate about how women will be informed if we make changes to allow access to primary-care records. We have had meetings with the Minister and from that we have had a guarantee that a letter will be sent to all 1 million women on the programme informing them of the changes in this bill and giving them the option to opt off. 
I have introduced a Supplementary Order Paper because I believe that if a lot of women opt off it will reduce the effectiveness of the screening programme in New Zealand and means that we may have a higher incidence of cancer as a result. I have an amendment which I will discuss later that would allow people to opt off just that section relating to access to primary-care records. But there are other things in the bill that follow these two recommendations and the amendment to the principal Act. Those qualifications are that the evaluators have access only to the information that they specifically need to evaluate the programme. Those evaluators cannot use that data for anything else and they are under the control of the Director-General of Health. Doctors initially had concern about access to primary-care records as well. They also have been reassured by the fact that they will be able to have oversight over access to primary-care records to ensure that if people are accessing notes they are looking only at the issues of cervical cancer smears and screening. 
BARBARA STEWART (NZ First) 
: 
 Part 2 is the heart of the bill. It outlines the operation of the National Cervical-screening Programme. It is really pleasing to see in section 112M inserted by clause 4 that women having their first test will be fully informed about the procedure and the programme by the person taking the specimen. This information is absolutely essential to ensure that there is no decrease in the number of women on the screening programme. We must continuously try to reduce cervical cancer morbidity. 
New Zealand First was very pleased too to see in the Supplementary Order Paper that an independent review of the National Cervical-screening Programme will be carried out every 3 years. We believe that an independent review is absolutely essential for the credibility of the programme because it is only then that the women of New Zealand can have absolute confidence too in the process. The requirements for the review as set out in sections 112OA to 112OD inserted by clause 4 are very clear. In this way New Zealand women can have confidence in the report that will be produced and provided by the Director-General of Health. 
As has been mentioned by the previous speaker and the Minister of Health we have been reassured by Ministry of Health officials that access to women’s primary health records will be controlled and that a member from a practice will be present or will locate that information when the evaluation is carried out. The women of New Zealand can have absolute confidence that auditors will look only at the relevant information. These audits are needed if we are to have some confidence in the system. It does need that check. Above all we want to ensure there is not a decrease in the number of women participating in the National Cervical-screening Programme which would mean a reduction in the number of women being screened. 
This screening programme is absolutely essential for the health of all New Zealand women. The whole aim of this legislation is to ensure that the programme is safe and that all components are safe. Therefore primary-care records need to be subject to evaluation as do the other components of the screening programme. Participation in evaluation is for the benefit of all New Zealand women. New Zealand First will be supporting this legislation. 
SUE KEDGLEY (Green) 
: 
 First of all I want to correct an impression the Minister gave when she said there was consensus on this bill amongst the parties. Certainly there is not consensus on the part of the Green Party. We would love to be able to support the bill and we worked diligently in the Health Committee to do so. We thought we would be able to do so until at the eleventh hour—in the last minute after the bill had been sent to the select committee after Cabinet had approved it and so forth—suddenly amendments were introduced to the original bill. As I have said this will effectively mean that the privacy of women’s primary health-care records—their general practitioner records—will be eroded. It will mean that an unspecified number of evaluators will be able to have automatic access to the health-care records of any woman who is enrolled in the National Cervical-screening Programme. 
The Green Party’s view is that consent should always be sought before a person’s health-care information and records can be accessed. It has long been recognised that medical records contain highly sensitive and intimate information and need special protection. That is why we have a Health Information Privacy Code that protects the confidentiality of patient information and access to medical records. Indeed New Zealand has been a leader in its approach to privacy—in particular the privacy of health information. Well this bill is the beginning of the erosion of the privacy of health information. Indeed parts of whole sections of this bill are really there to require doctors to get around the Health Information Privacy Code and to require doctors to hand over any confidential health-care or general practitioner records of any woman enrolled in the programme. 
The New Zealand First member said that the women of New Zealand can have absolute confidence that the evaluators who will automatically be able to access women’s personal health information will be able to look only at relevant information. I would like the member to look at the fine print of the bill because in fact when one looks at it one sees that evaluators will be able to access anything they decide is necessary to perform their functions. If we think about it we know that sexually transmitted diseases are thought to be one of the main reasons why women develop cervical cancer. Therefore evaluators could very easily argue that records of women’s sexually transmitted diseases—or anything else such as previous pregnancies—could in their view be relevant to and necessary for their research or evaluation. There is no point in looking shocked as some members are. We have been assured that that is a major reason why women may develop cervical cancer; therefore it would probably be useful for evaluators to look at those records. 
Now in a great concession at the last minute because of the concerns raised by women’s groups around the country—who I might say are up in arms at these last-minute amendments—there has been an amendment introduced that says that when the evaluators are rifling through the health information of any woman on the screening programme a health practitioner may oversee that access—he or she “may” oversee it. We were told that person would be a doctor. I do not know about other members but the doctors I know are extremely busy and I am not certain they will have time to be standing around while the evaluators go through women’s files. But even if they did have time I can assure members that this provision will not reassure many women. Women do not want to hand over to doctors the responsibility for deciding what confidential health-care information should or should not be handed over to authorities. Women want to make that decision for themselves. 
Hon ANNETTE KING (Minister of Health) 
: 
 I feel I need to answer some of the points raised by Sue Kedgley. She left the impression that somehow or other the bill that went to the Health Committee was changed by the Government or somebody else. I remind the Committee that the bill that went to the select committee underwent a very extensive consultation process by the members of that committee who were drawn from all parties in this House. The amendments made by the committee were reported back to Parliament and they were quite major changes to the original bill. 
Members will recall that I saw the amendments and accepted the advice of the committee. As far as I was concerned it was Parliament working at its best. It was legislation that a Government introduced which was then looked at in terms of the evidence given to the select committee and the amendments made by the select committee came back to this House as recommendations. 
There were of course some things we wanted to improve and I will talk about those in a moment. But Sue Kedgley said in her first speech tonight that at the last minute amendments were parachuted in with this Supplementary Order Paper. If the member looked at the Supplementary Order Paper she would see that those amendments came directly out of the meeting I had—and she was there at that meeting—in my office. We discussed how we could address the outstanding issues in order to make the legislation work as well as we could—as well as address the concerns our women members of Parliament had raised. 
Muriel Newman is standing in for Heather Roy tonight and Heather Roy played a very constructive part in the amendments. Her main concern was that there should be an independent review of this programme and members will see in the Supplementary Order Paper that we have built in an independent review. That was a concern from ACT and I had feedback from Heather Roy that she was happy with the way we had completed the bill. 
Certainly Lynda Scott was very keen to ensure oversight of the evaluators’ work with general practitioners and that concern came through from the general practitioners themselves. We have ended up by giving general practitioners oversight. They might be busy people but they said they would like the right to have that oversight and we have included it in the Supplementary Order Paper. 
Another important issue that was raised by women in my room that night—I think Dr Scott has already raised it—was ensuring that the women were given the information to opt out of the programme which involves over a million of them if they wanted to. Those were the three main concerns that came out of our meeting and into the Supplementary Order Paper that is now on the Table of the House. 
Subsequent to that Dr Scott tabled a Supplementary Order Paper and I know it is one in which she has thought through the issues. She is trying to find a way through the issue of primary health records and I gave her an undertaking that I would get advice on that matter and look at it seriously. 
Over the dinner break we sought advice from Professor Skegg and members will recall that the professor was an adviser to the committee throughout the hearings. I was unable to contact him initially and first of all had a response from Dr Julia Peters. Dr Peters has also been an expert on the National Cervical-screening Programme. She was previously the clinical director of the programme and is a public health specialist. I asked her and finally Professor Skegg to look at Dr Scott’s amendment and both of them felt that if the amendment were to pass it would compromise the evaluation of the programme. Based on that advice I will not support Dr Scott’s Supplementary Order Paper but I recognise the spirit in which it was presented. That advice from Professor Skegg and Dr Julia Peters is available if people would like to see it. 
I think what has taken place here needs to be kept in perspective along with what we are trying to achieve. The issue is whether we have a gold-standard cervical-screening programme for New Zealand women or whether we do not. The key as Dr Scott has said is that we have to be able to evaluate a programme properly. If we cannot we do not know whether we do or not. 
SIMON POWER (National—Rangitikei) 
: 
 It may seem a little odd that I am taking a call in the Committee stage of this particular legislation as health is not a matter—nor is the Health Committee a select committee—that I have been heavily involved in. But I do want to make some remarks regarding Supplementary Order Paper 184 and in particular the way that this bill was brought to my attention by women’s health groups in my electorate that have very strong views on particular aspects of the bill. As a lawyer I approach most things from the point of view that no one should undertake any activity without informed consent and I take this opportunity before we get into the detail of some of the Supplementary Order Paper to pay a very high compliment to my colleague Dr Scott who has talked and walked me through this bill. She has brought me to the conclusion in our discussions about the Supplementary Order Paper and from the discussions she had with the Minister that in fact—initially anyway—this programme is as good an option as possible to make available to the women of New Zealand. I do quite genuinely worry about the issue of access to primary health-care records. As I say it is the hard work that has gone into the Supplementary Order Paper that has brought me to the conclusion that it should be supported. 
The inclusion of the new section 112OA “Establishment of NCSP review committee” is a very good measure indeed because if nothing else it allows that review committee to be formed by the Minister. I like the fact that that has to be done at least once every 3 years and I like the fact that it reviews not only the operation of the National Cervical-screening Programme but more particularly the evaluation activities. That is a very important point. As I said before I do not pretend to be an expert on this matter but I know good systems and bad law when I see them and I believe that the inclusion of section 112OA will indeed be useful. 
The transitional provisions contained in new clause 6 particularly clause 6(2) relating to the National Cervical-screening Programme manager having to take reasonable steps to ensure information about the programme and the effect of the Act is made available to women are a substantial step towards informed consent. But they are not the final step in terms of informed consent by any stretch of the imagination. I would have preferred to see that clause set out a requirement that a registered letter was to be sent to the women concerned advising them about the effect of the Act and the programme. Members on the Opposition side of the Chamber are taking the Minister at her word that that is how clause 6(2) will be played out. I have assurances on that from the Minister—I see her nodding there—and I have assurances from my colleague Dr Lynda Scott who I know has worked extremely hard on the production of the Supplementary Order Paper. 
I know that my colleague Dr Scott is disappointed that her further amendment will not be included. From listening to the Minister’s explanation on that issue I can say that this bill and Supplementary Order Paper have really exercised my mind in a way that frankly other legislation has not. Other legislation has not needed the careful attention that I have found myself giving to this legislation largely because of the very strong representations that were made to me in my electorate. As I say I am not an expert on this issue by any stretch of the imagination. 
I conclude by saying that National will be supporting the passage of this particular Supplementary Order Paper and bill. I will watch very carefully to see how the review and evaluation process unfolds and more particularly how the issues of informed consent are dealt with through that process. Once again I congratulate my colleague Dr Lynda Scott on working so hard to try to address as many as possible of the issues that worried me in the short term. 
DIANNE YATES (Labour—Hamilton East) 
: 
 I move  
That the question be now put 
. 
JUDY TURNER (United Future) 
: 
 This is the substantial part of the bill and it is important for all of us to comment on it. I have to keep coming back in my thinking to the context of this part which is that while we have made some real progress in controlling cervical cancer in recent years our outcomes still fall significantly behind those of many other countries. Of the 70 to 75 New Zealand women who die from cervical cancer each year about 20 would not die if we had the same mortality rate in that regard as say Australia. Many of them are young women with children and it is important to keep that figure in mind because the success of the screening programme benefits not just women but the families who rely on them. 
During the Gisborne inquiry Dr McGoogan explained that in her country each case is reviewed by the examination of medical records without special consent being required. Consent to access the records is not an issue because the evaluation is regarded as routine and as an essential public health measure. Professor David Skegg described the privacy issue in this way: “In New Zealand there is currently an extreme climate about privacy and doctors are nervous about providing access to records without legislative authority.” He also commented that the current delays encountered by those who were attempting to trace women and seek their consent were “making the current audit almost unworkable”. 
Every now and then I have to step back and personalise the issue in terms of myself. I ask myself this: if my test results were part of the small group needing to be reviewed would I want to have the information that I needed additional medical diagnosis held up by an audit process predicated on privacy issues rather than on health need or would I just want to be contacted as soon as possible so that I could get on with addressing my health needs? The answer for me is obvious. 
I do have before me the very well-intentioned amendment in the name of Dr Lynda Scott that would allow women to partially opt off—the intention being I understand to allow provision for women who want to have the benefit of the screening programme without the added safeguard of allowing evaluators to access their primary health records. I weighed that amendment up very seriously because I fully believe that Dr Lynda Scott would not have put it up without serious consideration. But I have come to the conclusion that I cannot support it not because it is not well-thought-through but because I have a real difficulty with the thought that women would be happy to take advantage of the millions of dollars this programme will cost the taxpayer and then not allow their data to form part of the overall picture that may pick up a discrepancy and save lives. I believe that the safeguards that Supplementary Order Paper 184 in the name of the Hon Annette King puts in place that mean that general practitioners’ records are accessed only under supervision provide very reasonable standards of privacy to individuals without compromising the programme. It is interesting that even now general practitioner audits are conducted on general practitioners’ patient records without patient consent. That process is already common practice and we are now just applying it to this programme. 
Safe screening programmes rely heavily on high levels of participation and the issue of the common good is an integral part of their success. To legislate so that some women can opt out of their commitment to the common good is to legislate for selfishness. Although United Future in no way wants to criticise the motives of the member who proposed the amendment we cannot support it. However we have received assurances from the Minister that if sizeable numbers of women pulled off the programme over that issue she would be willing immediately to redress it—by looking for instance at the suggestion that Dr Scott is putting forward. We would like to give the programme the chance to succeed in its present form. 
I will finish my speech by quoting Professor David Skegg: 
The three members of the committee of inquiry in Gisborne recommended legislation to ensure that people engaged to carry out external or internal audits monitoring or evaluation of cervical cancer incidence and mortality should have ready access to all medical files recording the treatment of the cervical cancer by all health providers who had a role in such treatment." 
Dr MURIEL NEWMAN (ACT) 
: 
 Part 2 is the heart of the bill. It sets out the mechanism for establishing the database carrying out the screening procedures analysing the samples and referring on the results. Then of course the next stage is the treatment of women. I would just like to say to the Minister in the chair that on behalf of the 1 million New Zealand women who are to be enrolled in the programme I hope the shambles that presently surrounds the treatment of women with breast cancer does not occur to women who have been identified as having positive results with their cervical smear. It is very worrying that we have to send people who have such a serious illness to Australia to be fixed and that we cannot treat them here in New Zealand. 
In the discussion that the Minister has had during this debate she has referred to this programme as being gold plated. I hope she will not live to regret that statement because I know that other national registers have very easily become a shambles. In the time I have been in Parliament we have debated a number of opportunities to establish national registers to sort problems out but they are always fraught with difficulty. If the Minister is promising New Zealanders that this will be a gold-plated programme then obviously we will hold the Minister and the Government to account on that. 
The first thing I would say to the Minister is that I am very disappointed that she has failed so far in this debate to do what I called for her to do the last time I spoke: to explain exactly what steps she intends to take between now and 1 July this year when this legislation gains the royal assent and comes into force so that we can have some idea of the planning that is going on within the ministry to ensure that on day one this programme is launched with the minimum of problems associated with it. 
The CHAIRPERSON (Hon Clem Simich) 
: Would the member please come back to Part 2. 
Dr MURIEL NEWMAN 
: Mr Chairperson we are talking about the implementation of the cervical-screening programme. I realise the Minister has been complaining about what I have been saying but in the debate on the previous part I did ask the Minister to put her plan on the record by sharing with the Committee exactly what she intends to do on day one after this bill gets passed regarding the steps she will take to ensure we do end up with a gold-plated cervical cancer screening programme. 
The concern that my colleague Heather Roy who sits on the Health Committee had was that in the original plan the Government was to set up implement run and evaluate the National Cervical-screening Programme. The ACT party believes that it would not be very good to have the Government doing all that and at an absolute minimum there should be an independent audit. We suggested that some of those services could be contracted out but I realise this Government is ideologically opposed to private sector contracting. However the bill does put down the way that the audit group review committee will be established and I note the Minister is in charge of appointing people to it. I would like the Minister to explain—and again I think this is a very important point—how we can be assured there will be some independence if the appointment process is up to the Minister and what the difference is between having a committee that is established by the Minister and the Government running the review itself. I realise there is a difference but I think it would be positive to put that on the record. 
JUDITH COLLINS (National—Clevedon) 
: 
 I want to deal with a couple of issues that do not seem to have had a lot of airtime so far. One of those is the issue of education. The bill does not actually say a lot about education except in the negative and that is in relation to the kaitiaki regulations. 
One of the things that really shocks me as a woman of now 45 years— 
Opposition members 
: Surely not! 
JUDITH COLLINS 
: Yes and today too. 
Opposition members 
: Happy birthday! 
JUDITH COLLINS 
: I am shocked that a lot of women have very very little knowledge about cervical cancer. Basically if they do not read about it in magazines such as  
New Zealand Woman's Weekly 
  
New Idea  
or  
Woman's Day 
—I do not want to miss out any—then they generally do not know about it. The fact is that a lot of us women get our information about such things from women’s magazines because we do not all come from a medical background. I am really concerned that we are not doing enough to educate women about cervical cancer. That is one of the problems. In particular the issue of the kaitiaki regulations was brought up in the Health Committee. I mention that issue now because to me it is an example of something that was brought in in an attempt to be culturally sensitive to the needs of Maori women—and I will not blame the current Government for it because it is not its fault and that is probably the last time it will ever hear me say that. Those regulations prevent information about Maori women's cervical cancer screening rates from being published or from being accessed without yet another very difficult and complicated process having to be gone through. 
I was appalled to hear in evidence in the select committee that Maori women's cervical cancer rates were something like four to five times those of non-Maori. That is an absolute national disgrace. One of the awful things I learnt was that this information is not available out in the public. Nothing is being said about it. Partly that has to do with the causes of cervical cancer. The causes seem to include the wart virus which is so easily spread and is something that people need to talk about. I know we do not normally talk about these things in the Chamber but this is actually extremely important. The virus is something that can be spread by men so it is a male issue as well. 
Until we stop hiding behind cultural sensitivity and start telling the truth Maori women will be hard done by. They will be worse off than anyone else because they are not getting the information. They are not being told the truth; nor is anyone else. That is a real crying shame. I am appalled we are not dealing with that issue. I note that in the report back to the House we made comment that some of us were very concerned that access to this information was not being made available to screening programme evaluators. It really does need to be. I am sure that once this bill becomes an Act it will have to come back to the House because some tweaking will need to be done on a cross-party basis. I hope that by that stage we will be big enough to own up to the causes of cervical cancer and do what we can to stop women from getting it. 
This evening I was speaking to my sister who rang me up to wish me "Happy birthday". She is a registered nurse and is somewhat older than I am. She said to me: “Judith can you please mention the fact that women are getting cervical cancer at a much greater rate and a much earlier age than ever before.” She puts it down to the fact that women are engaging in more sexual activity at an earlier age and with more partners. That is something we need to deal with. I know that all the men around here are saying: “Ooh ah that’s awful! How can you mention that Judith?”. The fact is it is true. Until one starts talking about the situation it will not change. If what it takes to make any scrap of difference is for me to speak about it in the House then I jolly well will. It is about advising women and girls particularly those who are most at risk. We must be able to tell girls aged 12 13 14 15 and 16 that cervical cancer is a very serious and often fatal disease that it can be prevented but because they will not know whether they have it or are carrying the virus that causes it they will have to be extra vigilant and extra careful. I really do hope that we can get some sort of message across. I would love to hear that the Ministry of Health is going to do something about it. 
KEITH LOCKE (Green) 
: 
 Dame Silvia Cartwright who is now the Governor-General wrote a very highly commended report some years ago in relation to cervical cancer after that very thorough inquiry. She said: “If such a register is set up it must be maintained under the strictest rules of confidentiality and privacy.” This bill does not allow that because it is quite clear that the evaluators that it talks about do have the right to go through women’s medical records without their permission. Of course the bill says that can be done only to get what is needed but in terms of medical records what is needed is often amongst a lot of other stuff and one cannot help but notice the other material when trying to get at what is needed. 
The control supposedly is that the doctors have oversight. Well when I go to my doctor there are 20 people in the waiting room. The doctors are shuffling through patients and they do not have the time to step aside. They will be reluctant to stand around while an evaluator trawls through a record to get what is needed. Even the Minister of Health when she made her comments before did not say that the doctor will be looking over the shoulder of the evaluator. She said that the doctor will have the right to have oversight. As my colleague Sue Kedgley points out the word used in the legislation is “may”. So there is no guarantee at all that there will be proper oversight and that information that women do not want accessed will not be accessed or seen. 
My colleague also made the point that the women do not know what the information is that the evaluator will obtain. They are a bit in the dark and they are a bit worried about what that information might be. Judith Collins’ previous speech will not have made them any happier because both Judith Collins and Sue Kedgley said that there does seem to be in many people’s minds a relation between sexual history and cervical cancer. So the evaluators and the researchers will be interested in that. I think that is one of the problems and one of the things that will scare people off. Because the evaluators are moving into an unknown area and because sexual history is relevant they might look at the files in that respect and women will not want anything to do with it whereas if women were given the right to buy in to give their consent consciously they might be more happy about the whole process. 
A doctor’s skill is to elicit from a patient very personal information; that is his or her skill. A doctor can use this skill effectively because confidentiality is well built into the medical profession and that is why the medical profession and many health practitioners are up in arms about this provision breaching confidentiality. It is very difficult for a doctor to get personal sexual information because most people for a start are very embarrassed about disclosing much about their sexual history. Whether women or men people are very embarrassed on that level and often are very embarrassed about what might be the consequences if that information were to get out especially if it involves things like sexually transmitted diseases and AIDS. Sometimes information about a male’s or a female’s other sexual partners is disclosed to the doctor as a health measure but the last thing that the patient wants is for that information to get out amongst other people and perhaps back to his or her partner. People do not want that. The other function of a doctor who might not be fully trained to the level of a psychologist is to play a counsellor role to a lot of patients. All of those things mean we have to defend confidentiality very greatly. 
PANSY WONG (National) 
: 
 I want to make three points in this 5-minute speech. First of all I would like to acknowledge the effort of my colleague Dr Lynda Scott who is National’s spokesperson on health.. She has worked extremely hard to strike a balance between maintaining the success of this cervical-screening register versus the right of women to choose for very personal reasons to withhold their consent for their primary health records to be audited. 
From my experience and knowledge most women are very cooperative and want to ensure that a cervical-screening register will work. They cooperate in good faith and I think that is proven by the number of participants in the present system. But to decide that because a woman for whatever very personal reasons has opted to say she does not want her private record to be audited she will be expelled and excluded from participating in the cervical-screening programme is I think harsh and punitive. I wonder what women have done to deserve that. I would caution the Minister of Health the Hon Annette King a fellow woman to consider that very carefully to reconsider her decision in good faith and to accept the amendment recommended by my colleague Dr Lynda Scott. Women do not usually hold back consent for selfish reasons and I think we do have to respect women’s individual rights. Dr Lynda Scott has gone to extreme lengths to maintain that delicate balance. 
My second point is that I was really disappointed with United Future’s Judy Turner who said that women should be punished if for any reason they did not allow their primary health records to be audited—that they should be punished by removal from the register. I could not believe that a fellow woman MP would say that in Parliament. I felt really really frustrated and I hope United Future will reconsider its position. I think that men for various reasons would want their primary health records to be withheld and we should as a society respect individuals being responsible for making those decisions. I urge the Minister of Health and United Future to reconsider because we have to make a very difficult decision in trying to balance the right of privacy with the success of the cervical-screening system. I think Dr Lynda Scott has struck that very very sensitive fine balance. I think it would be a shame today in Parliament for any woman MP to say we should punish women because for very valid personal reasons they do not want to subject their primary health records to audit. 
The last point I want to make is that I believe that the Minister of Health wants to engage women in the programme in good faith so I appeal to her to pay special attention to women of ethnic communities and to consider ways of using a language that they understand in order to get their consent. It is important to strike a balance between privacy and the success of the programme and to ensure that women truly understand that their rights are respected. I appeal to the Minister to do that. 
I emphasise once again that Dr Linda Scott has worked long and hard. It was a very difficult situation for the National caucus to strike a balance between the rights of women and the wish we have that the system should be able to be successful. 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 I wish to talk to the amendment I have put forward. Although we do want a gold standard programme we have to accept the history in New Zealand of informed consent. We have had previous inquiries which began with the Cartwright inquiry into the practices of Herbert Green who had with the very best intentions tried to investigate whether all women who had invasive cervical changes went on to develop cervical cancer or whether some actually regressed back and became normal again—no one knew at that stage. But he did not tell the women what he was doing. He did not ask for informed consent. That influenced opinion in New Zealand about the absolute necessity for women and men to be told what is happening to them and to be asked for their consent for treatment. That set the ground in New Zealand for us to have heightened awareness of the need for informed consent. That is why we have had a great deal of debate about the access to information. 
My amendment to clause 4 states: “If a woman decides that she does not wish to allow an evaluator to have access to her primary care records she can by way of informing the NCSP cancel her enrolment in the NCSP”—that is she can opt off—“or opt-off for access to primary care records alone but remain as part of the overall NCSP.” I have to say to United Future that it is not selfishness that drives women to want to opt off; people having access to their primary-care records is of intense concern to them. But I also understand that access to that information will be limited to what the director-general specifies and for audit purposes only. Evaluators can look only at what is provided by the primary-care provider in relation to the National Cervical-screening Programme. They cannot trawl through records to see what people’s mental health might be or what medications they are on but can look at only very specific information. They cannot disclose information except for the purposes of accessing that programme. 
My amendment tries to strike a balance. My fear is that a lot of women will opt off especially if the Greens raise a lot of fear in this regard. Women may opt off and if they opt off they are lost to the programme for good. There will be no opportunity for further explanation of the programme. There will be no ability if they develop cancer to go back to look at even their secondary-care level. I would not want to see that happen. I want women to stay on the programme. I want them to have confidence in the programme. What I have proposed is a middle road. I think only a small number will choose to opt off when they get the information but if they have concerns my amendment would allow them to stay there and it would allow them to still be recalled and still get the results. 
At the moment women can flag certain parts of the programme that they do not want to be part of; that is part of the programme that is there. At the moment there also is not any access to primary-care records. That has been the problem with doing an evaluation of the National Cervical-screening Programme. So my amendment is a way to get a compromise position. I understand why Julia Peters and Professor Skeggs said what they did; they want a gold standard programme. But we have to consider not just the scientists but also the women. We have to consider the history of New Zealand. 
My amendment may be a very good compromise position. I urge the Minister of Health to give it further consideration. When we have a review in 18 months if we find that women have opted off and that that is compromising the programme then we should look at this option for them if we cannot convince them that the access to their records is only for the purpose of evaluation not for research that it is only to ensure that the programme is effective in all layers and that it is only in response to what Euphemia McGoogan had suggested that we need in New Zealand. This could be a good example. If we get it right on the National Cervical-screening Programme what has occurred in this bill can go to other programmes. 
JILL PETTIS (Junior Whip—Labour) 
: 
 I move  
That the question be now put 
. 
SUE KEDGLEY (Green) 
: 
 I would like to inform people that the Green Party has put up a Supplementary Order Paper. In it we have basically reinstated the informed-consent provisions that were originally in this bill for general-practitioner and primary health-care records. We have reinstated informed consent. 
The bizarre thing is that nobody objects to evaluators having automatic access to laboratory records to records that are on the screening register or indeed to hospital records. The concern is around evaluators having automatic access without consent to highly confidential and sensitive medical health-care records. The extraordinary thing is that no good explanation or convincing rationale has even been put up as to why we would want to set aside the privacy of personal health information in this way. The officials have said that they need automatic access to 1 million general-practitioner records so that they can evaluate whether women who develop cervical cancer are properly referred to and treated by their general practitioners. 
But if that is the reason that officials allege they need automatic access to general practitioner records without women’s consent then it simply does not stand up. Only about 200 women develop cervical cancer each year and it would be extremely easy to get consent from those women to carry out an evaluation of their primary health-care records at the time they are diagnosed. I am absolutely convinced that the overwhelming majority of women—certainly those who are diagnosed with cervical cancer—would be only too happy to give consent at that stage. 
The problem is that by doing it in this way—by saying that somehow in order to access the records of 200 women we need automatic access to the very personal and sensitive general-practitioner records of 1 million women—we will undermine confidence in the entire National Cervical-screening programme. 
The member for the National Party said that if the Green Party whipped up fear about this bill then that might result in women opting off. I can assure members that it will not be the Green Party that will whip up the fear. The fear is there. I have been contacted by women’s organisations and by women around New Zealand who first of all resent the fact that their personal health-care records will be able to be accessed in this way. They resent the fact that they will basically be given Hobson’s choice. If they want to be on the programme they have to agree to surrender their right to informed consent. They have to allow automatic access to all their private health-care records without their consent or they have to opt off the programme and risk both their health and the efficacy of the whole nationwide screening programme. Pansy Wong was right when she said that is the key issue. 
Why should women have to have Hobson’s choice? Why should they have to surrender personal consent in order to be on the programme? Officials told us that allegedly we needed these last-minute amendments to strengthen the cervical-screening programme. In my view they will not strengthen the cervical-screening programme. They will erode confidence in it and they will erode confidence in the doctor-patient relationship which is founded on confidentiality and privacy. Once women realise that this confidentiality may not be maintained—that an unspecified number of evaluators can access their personal health-care records and without their consent—it will undermine the whole confidence in the doctor-patient relationship. 
I notice that the latest New Zealand Medical Association records point out that the code of ethics of the World Medical Association and the New Zealand Medical Association state that physicians must preserve absolute confidentiality in all they know about their patient even after the patient has died. 
MOANA MACKEY (Labour) 
: 
 I move  
That the question be now put 
. 
A party vote was called for on the question  
That the question be now put. 
Ayes 62 
New Zealand Labour 52; United Future 8; Progressive 2. 
Noes 55 
New Zealand National 25; New Zealand First 13; Green Party 9; ACT New Zealand 7; Independent: Awatere Huata. 
Motion agreed to. 
The question was put that the following amendment in the name of Dr Lynda Scott to clause 4 be agreed to: 
to amend new section 112F of the principal Act by adding the following subsection: 
(4)If a woman decides that she does not wish to allow an evaluator to have access to her primary care records she can by way of informing the NCSP cancel her enrolment in the NCSP or opt-off for access to primary care records alone but remain as part of the overall NCSP. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 42 
New Zealand National 25; Green Party 9; ACT New Zealand 7; Independent: Awatere Huata. 
Noes 75 
New Zealand Labour 52; New Zealand First 13; United Future 8; Progressive 2. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 184 in the name of the Hon Annette King to insert new sections 112OA to 112OE in clause 4 be agreed to. 
Amendment agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 187 in the name of Sue Kedgley to insert in clause 4 new section 112T be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 9 
Green Party 9. 
Noes 108 
New Zealand Labour 52; New Zealand National 25; New Zealand First 13; ACT New Zealand 7; United Future 8; Progressive 2; Independent: Awatere Huata. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 187 in the name of Sue Kedgley to section 112U(1) in clause 4 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 9 
Green Party 9. 
Noes 108 
New Zealand Labour 52; New Zealand National 25; New Zealand First 13; ACT New Zealand 7; United Future 8; Progressive 2; Independent: Awatere Huata. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 187 in the name of Sue Kedgley to section 112U(2) in clause 4 be agreed to.  
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 9 
Green Party 9. 
Noes 108 
New Zealand Labour 52; New Zealand National 25; New Zealand First 13; ACT New Zealand 7; United Future 8; Progressive 2; Independent: Awatere Huata. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 187 in the name of Sue Kedgley to section 112U(2)(e) in clause 4 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to.  
Ayes 9 
Green Party 9. 
Noes 108 
New Zealand Labour 52; New Zealand National 25; New Zealand First 13; ACT New Zealand 7; United Future 8; Progressive 2; Independent: Awatere Huata. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 187 in the name of Sue Kedgley to insert in clause 4 new sections 112V and 112W in clause 4 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 9 
Green Party 9. 
Noes 108 
New Zealand Labour 52; New Zealand National 25; New Zealand First 13; ACT New Zealand 7; United Future 8; Progressive 2; Independent: Awatere Huata. 
Amendment not agreed to. 
The question was put that the remaining amendments set out on Supplementary Order Paper 184 in the name of Hon Annette King to clause 4 be agreed to and that the following amendment in her name be agreed to: 
to omit from subsection (2) of section 1122AA in clause 4 the word “provided” in each case where it appears and substitute in each case the words “made available”. 
A party vote was called for on the question  
That the amendments be agreed to. 
Ayes 108 
New Zealand Labour 52; New Zealand National 25; New Zealand First 13; ACT New Zealand 7; United Future 8; Progressive 2; Independent: Awatere Huata. 
Noes 9 
Green Party 9. 
Amendments agreed to. 
A party vote was called for on the question  
That Part 2 as amended be agreed to. 
Ayes 108 
New Zealand Labour 52; New Zealand National 25; New Zealand First 13; ACT New Zealand 7; United Future 8; Progressive 2; Independent: Awatere Huata. 
Noes 9 
Green Party 9. 
Part 2 as amended agreed to. 
Clause 1 Title 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 The original title of the bill the Health (Screening Programmes) Amendment Bill was changed in the select committee. We consulted the Regulations Review Committee about the change. The committee felt it was not appropriate to have this bill extended to other screening programmes. The committee thought it a constitutional principle that matters of policy are set out in an Act of Parliament and the details of those matters are left for regulation and that using regulations to extend this bill to other screening initiatives infringed on this principle as any future screening programme should be a matter that is sanctioned by Parliament and not by secondary legislation. The select committee had quite a debate on that particular principle and in the end decided it would limit this legislation just to the cervical-screening programme. 
The fact is that this particular bill will be a template for other screening programmes. We have been talking about the breast-screening programme and the extension of the age and I had a couple of emails today from two men with prostate cancer. Men often ask why they do not have a really well-organised screening programme for prostate cancer. I always write back that we do not have a test that does not have a high level of false negatives and false positives but as soon as we do have a good test for prostate cancer I am absolutely certain there will be a screening programme. When I first went through medical school they said that men died with prostate cancer not from it. That is far from the truth these days. A very good friend of mine died on election day the year before last. He had only just turned 60. These days a lot of men are getting prostate cancer and they often feel that cervical cancer and breast cancer get far more attention than prostate cancer. These days more men are dying of prostate cancer and the scientific community continues to work to get a good screening programme for prostate cancer. 
 As for breast cancer we know today that the screening programme will be extended in age for free screening. It will be important that that screening programme has the capacity to be able to deliver to all the new women who will be coming into the programme for free screening. So the Health (National Cervical Screening Programme) Amendment Bill being limited to cervical screening does not mean that in the future there will not be other screening programmes that will act very much under this particular type of legislation where there will be an opt-off programme to try to get the maximum number of women or men involved in the screening programme in order to achieve a very good programme. It does not mean that a system will not be set up whereby information is gathered from a mammography for example by the radiologist who is reading it and information on what happens to the woman—the treatment she receives. It is known that there is a considerable problem in this country with being able to get timely access to radiotherapy. That can impact on the local recurrence of breast cancer and make the programme less effective. There needs to be not just the screening but also appropriate and adequate treatment. There is no point in doing massive screening if nothing can be delivered that can save people’s lives. The reason why HIV is often not screened for is that although there is treatment there is no cure. 
So what can be done for prostate cancer and breast cancer? There is no definitive test for prostate cancer yet and with breast cancer there is the problem of not being able to get as timely access to radiotherapy treatment as we would want. Certainly surgery is offered within a timely manner. It was excellent when we got to the point of learning that lumpectomy and radiotherapy gave as good an outcome for early breast cancer as radical mastectomy because then women could save a breast. 
BARBARA STEWART (NZ First) 
: 
 An important part of any debate is the debate on the title. The title should be concise it should be unambiguous it should be specific and it should leave the reader in no doubt as to what the legislation is about. This title meets all those criteria. It is clear that this is a health screening amendment bill. It is an amendment to some existing legislation. New Zealand First supports this part of the bill. 
JUDITH COLLINS (National—Clevedon) 
: 
 I will take a short call in relation to the title of this bill. The Health (Screening Programmes) Amendment Bill as it was first brought to the Health Committee did come in for a change of name. That change made in relation to the advice from the Regulations Review Committee but it was also a concern of many of us on the committee that this bill was being used as a mechanism to set up screening programmes that could simply be enacted by the Ministry of Health when it issues a policy that should be debated in the House and that the people of New Zealand should have the opportunity to make submissions on through the select committee process. 
So even if we had not had that very good advice from the Regulations Review Committee there was a very good chance that we would have changed the name of this bill because we are very concerned to make sure that these programmes are set up properly carefully and with a great deal of consultation as they involve people’s private records their business and their health. Of course they cost a tremendous amount of money as well. So it is all money that is going into the health budget. If the money is going into a programme that will not be effective or that will help only a very small portion of the population then it could possibly go into other areas in health. I was very pleased to see that the Minister accepted our recommendations. That was a very good move from the Minister because we felt that no matter what we wanted to see any other screening programmes back here in the House. 
I take the point too that my colleague on the Health Committee and our spokesperson on health Dr Lynda Scott made. Men often talk about the fact that all they hear about in terms of cancer is cervical cancer and breast cancer. In other words they primarily hear about women’s cancer. I know Dr Scott has brought up issues about some of the specific men’s cancers but I would really like to hear more said about cancers that are prevalent among men—in particular more education about those cancers. I do not know that men will necessarily find the same level of help that women often find from the  
New Zealand Woman’s Weekly 
 on those issues—and I do not know which particular magazine we would have to put it in—but it would be great to be able to have something that is absolutely focused on men as well. 
MOANA MACKEY (Labour) 
: 
 I move  
That the question be now put 
. 
SUE KEDGLEY (Green) 
: 
 Originally this bill was called the Health (Screening Programmes) Amendment Bill. Thankfully that title has been changed to the Health (National Cervical Screening Programme) Amendment Bill. The reason it was called the Health (Screening Programmes) Bill was that basically the provisions of the bill were to have applied to any screening programme that exists or would exist in the future. In other words under the original way the bill was worded we would have had the whole issue of informed consent undermined in all screening programmes. There would have been no informed consent for any person who was on any screening programme in New Zealand. 
As other members have mentioned we have managed to get that changed but the problem is that officials have stated that there is an intention to move a generic amendment—probably under the Public Health Bill which is due to be introduced to Parliament later this year—to extend the provisions of the bill that we are about to pass to any other screening bill. That will mean that any screening programme in the future will have the same provisions as this bill. It will mean that the whole issue of informed consent for health-care records will be undermined in any future screening programme. 
In other words any person who is on any screening programme be it the breast-screening programme a prostate-screening programme—if one is set up—or a vaccination-screening programme will have Hobson’s choice in having to surrender informed consent and having to allow any evaluator to access his or her very sensitive general practitioner records without that person’s consent. 
Although I am very very pleased that we managed to get the title changed and thereby not extend the provisions of this bill to other screening programmes at the moment let me assure members of this Committee that officials have stated that their intention is to extend the provisions to all other legislation. That ought to be a huge concern for the medical profession as well as for all New Zealanders because as I was saying doctors take the Hippocratic oath which dates back to the 4th century BC in which they swear to keep confidential all patient records and everything they learn about a patient. 
The New Zealand Medical Association states that doctors must preserve absolute confidentiality about everything they know about their patients and that is the basis of the general practitioner - patient relationship. Mark my words that confidential relationship will be eroded by the provisions of this bill and by the intention to extend those provisions to other screening programmes. 
Progress reported. 
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