Scott Lynda: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
Scott Lynda: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
[Volume:615;Page:11437] 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 It is with pleasure that I rise to speak on the Health (National Cervical Screening Programme) Amendment Bill. This bill has the support of all parties in this House except the Greens. The select committee worked very hard and gave a great deal of thought to progressing this bill in a way that gave effect to the McGoogan report after the Gisborne Cervical Screening Inquiry which as we have heard was set up in 1999 by Wyatt Creech due to under-reporting. 
In New Zealand we have had a history of concerns about informed consent caused initially by the Cartwright inquiry looking into the practices at National Women’s Hospital at that time. What it has done is heighten New Zealand women’s concerns in this regard to informed consent. We had regard for that issue around the select committee table and in our caucuses. I was very pleased that following debate we managed to make changes after the bill had been reported back to the House and before the Committee stage to look at ensuring that women would be informed of these issues with regard to this programme which is an opt-off programme via a letter about the changes this bill makes—that is access to primary-care records as well as hospital records. The material will be provided on an individual basis to the 1 million women who are on the programme and if they have concerns they will have the option at that point to opt off the programme. The programme has been an opt-off programme since 1993. It is particularly important that we continue to have a national cervical-screening programme because it has reduced mortality for women. 
From 1990 to 1993 the programme was an opt-on programme where women had to sign up to the programme. In 1993 we saw from a month-by-month breakdown that it had become static. Women were not signing on. The change made then was that the programme became an opt-off programme. An opt-off programme means that when a woman has her first smear she becomes registered in the programme. At that point she gets information sent to her. If she does not wish to remain on the programme once she has been fully informed of what it means to be on it she can then opt off. 
I am pleased that a letter will go to every woman who is on the cervical-screening programme to tell them about the changes this bill makes. There were many changes but the most important one related to concerns raised about access to primary-care records. Once women have been informed they can opt off the programme. I sincerely hope they do not. I do not want to see New Zealand women opting off. It has significantly reduced mortality in New Zealand. We originally had a death rate much higher than we have now. In 1981 we had a rate of 12 women per 100000 who developed the disease five of whom would die of it. In 2001 the rate reduced to 10.6 per 100000 of whom only three died of it. That is a 46 percent reduction in mortality. We know that if the screeners who are doing the test are audited and competent if the laboratories that are looking for that needle in the haystack—that is those abnormal cells amongst all the normal ones—are audited and competent if the data is collected and kept and if the whole programme is audited so that women can have faith in the whole process of the cervical-screening programme then we will reduce even further the incidence of cervical cancer and people dying from it. 
The thing about informed consent is that women will be able to opt off once they are informed. I wish to talk to that issue further because I do not want women to opt off the programme. I brought in an amendment which was not passed that would allow women to opt off only one section—that is the ability for investigators to look at primary-care records. It was not that I was greatly concerned in that particular issue; it was that I did not want to see women opting off the whole programme because then they would not get a recall notice. If women stay on the cervical-screening programme I believe they can have faith and confidence in it. 
Originally this bill was to be a national screening programme template covering all other screening programmes. If we look at the role of evaluators in New Zealand we will see they are not trawling through notes to look for individual information that they can then tell anybody about. They cannot do that—they would be struck off for doing that. They never have been able to do that. At the moment we have accident compensation audits and we have health pac audits. Those auditors do not go through and look at all the women’s personal details and then have an ability to tell anybody about them; they look specifically for information to do with whether the service one said one would be delivered is delivered or in the case of cervical screening to ensure that the cervical-screening programme is working. In this particular situation the information will relate only to that which is relevant to the programme. 
I was also pleased that arrangements were made for primary-care practitioners to be involved in overseeing evaluators’ access to health information. This will mean that the primary health-care practitioners are supportive of the evaluation that involves accessing the primary-care records. It also means they will be able to oversee that someone is able to find the data they need with speed and to look just at that data. 
So I believe that New Zealand women can have confidence in this programme and in confidentiality with their general practitioner. Its expansion to other screening programmes was considered to be not appropriate. It was felt that this bill should be about the specific programme it was dealing with—that is the National Cervical Screening Programme—and that if we needed other legislation say for the breast-screening cancer programme or if at some time in the future we develop a screening test for prostate cancer that has more reliability and validity then that also would need to go through the House as a separate bill rather than have expansion of the bill we are debating tonight. 
The reason that prostate cancer is not part of a routine paid-for screening programme is that the test which is the prostatic sensitive antigen test is not specific enough and has a high rate of false positives and false negatives. With screening programmes such as the cervical-screening programme or the mammography programme there is a high level of certainty that one will pick up the changes that may lead to cancer further down the track; also that the treatment one can then offer can effectively reduce the mortality—and that occurs both in cervical cancer and in breast cancer. But I am sure that most men in New Zealand are really hoping that a test will be developed in the future that has that sort of specificity for prostate cancer as that is one of their leading causes of death. 
We will be supporting this bill today. We were pleased to see the changes that members of the Health Committee made as we worked together in the select committee and then as we met with the Minister of Health afterwards to continue to raise the concerns that our caucuses had and to negotiate further arrangements to make changes to this bill. Those changes have been made and we support the passage of this bill today.