Turner Judy: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
Turner Judy: Health (National Cervical Screening Programme) Amendment Bill — Third Reading 
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JUDY TURNER (United Future) 
: 
 I rise on behalf of United Future to speak in support of the third reading of the Health (National Cervical Screening Programme) Amendment Bill. The bill has arrived at its final reading having started with a crisis at National Women’s Hospital then another in Gisborne two inquiries—the more recent being the inquiry into the under-reporting of cervical smear abnormalities in the Gisborne area—and then a very thorough legislative process geared towards enhancing the operation and evaluation of the National Cervical Screening Programme. It has also had to weather a raft of concerns about informed consent set in a climate that seems at times to have been obsessed with privacy. 
The bill is an initiative where the tension between the privacy rights of the individual needs to be balanced against the success of a screening programme that relies heavily on a commitment by those who participate to the common good. It is not that the participants have to choose between privacy and common good. Rather it is that the challenge has been to develop a bill that can wisely navigate a path between the two so that both the programme and the women who participate are safe. 
The programme is hugely reliant on numbers to ensure its overall success and safety. One recent development that has improved programme outcomes has been the change from an opt-on to an opt-off system. Without automatic enrolment the programme is seriously impaired in its attempt to decrease the incidence of cervical cancer in New Zealand. I reiterate the quote given by the Minister from the Gisborne inquiry because it is extremely important: “The choice for the Programme is stark. Effective evaluation can not be guaranteed if women’s consent is required; if the right of an individual to consent to access to her now-protected information is to predominate the Programme cannot effectively evaluate its effectiveness and therefore the safety of all women participants is potentially at risk.” 
United Future welcomes the inclusion of an independent review committee. The opportunity to review the programme regularly in its entirety in contrast to the work of the evaluators who will be monitoring specific aspects of the programme is a healthy development. Overall efficacy is always vital if we are to avoid the programme deteriorating and becoming a feel-good service that makes no measurable difference to the health outcomes for New Zealand women. It is also important that New Zealand women be kept informed about the findings of this committee. The all-important issue that we in United Future have kept before us in the consideration of this bill is the fact that screening programmes are not fully diagnostic and are therefore open to a range of errors and false readings. The misbelief that this screening programme is fully diagnostic undermines the importance of the programme evaluators. Evaluation is an essential part of a cervical screening programme not a feel-good add-on. The whole programme is rendered ineffective and even dangerous without it. 
Beyond the issue of early detection and treatment of cervical cancer is the issue of prevention. Cervical cancer raises a lot of extremely sensitive issues about lifestyle choices. United Future believes that we do women a huge disservice when we fail to communicate successfully the clear facts to both men and women about the importance of safe sexual practice. I commend National’s Judith Collins for being direct in her speech to the House during the Committee stage about the importance of addressing this issue. Ignorance is not bliss when dealing with sexually transmitted infections and the health consequences. In our war against cervical cancer we need to send out clear and unmistakable messages about the risks of casual unprotected sex so that we are not relying exclusively on the screening programme to reduce cancer incidence. Unlike Ms Collins however I do not think that the inclusion of the Kaitiaki provisions in this bill means that Maori women will somehow be prevented from having communicated to them the message on prevention. That provision stops data on Maori women being used in some aggregate way for purposes other than for what it was collected because no identifiable group wants that to be the case. 
This bill has been developed to correct the systemic problems highlighted by the Gisborne inquiry and to streamline and clarify for all New Zealanders how the National Cervical Screening Programme works what the intentions of the programme are and to make it easier to review the safety and effectiveness of the programme. United Future is very happy to support the passage of this bill understanding that screening programmes require a different set of ethics and standards than diagnostic services. Screening programmes invite an otherwise healthy population to participate in procedures that include a level of discomfort and therefore the balance must be struck between benefits and cost to the participants. The programme is completely reliant on large numbers of enrolments for its safety and success. With this in mind I challenge those involved in the promotion of better health outcomes for women to rally behind this screening programme for the good of those they claim to serve.