Hutchison Paul: Health (Screening Programmes) Amendment Bill — First Reading 
Hutchison Paul: Health (Screening Programmes) Amendment Bill — First Reading 
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Dr PAUL HUTCHISON (NZ National—Port Waikato) 
: 
 National supports this bill into the House. It is considerably concerning that the bill was last debated in October 2002. That suggests the Government is not being assiduous with many of the details that are important in relation to the issues of the day. Along with that is the fact that the 6-monthly audit report that was expected at least as long ago as that has not occurred. That is also a great worry.  
There is no doubt that cervical cancer is a very significant cause of mortality in New Zealand for women and that a well-run screening programme can save lives. It is estimated that something like one in 97 women in New Zealand can expect to develop cancer before the age of 75. An expert analysis has indeed shown that without an adequate screening programme there would be 340 new cases and 116 extra deaths a year. Since the screening programme began in New Zealand cervical cancer deaths have fallen significantly. From 1987 to 1996 the incidence—that is the number of new cases reported per year—has dropped by 22 percent and the death rate by 43 percent. However cervical cancer morbidity and mortality trend rates can be very misleading. In fact cancer rates were trending downwards in all developing countries prior to screening programmes having been initiated in the 1960s. That phenomenon has been confounded by the cohort of post-war babies who have sustained a higher rate of cervical cancer for a variety of reasons.  
This bill has laudatory objectives to achieve. They are the delivery of high-quality cervical screening and treatment services the provision of information to women and the facilitation of continuous quality improvement in the national cervical screening programme. However there are warnings and lessons to be learnt. Because New Zealand has gone through substantial scandal and horror relating to cervical cancer it is absolutely vital that the legislation surrounding cervical cancer screening is indeed made as good as possible. I was heartened when I spoke to Professor David Skegg some months ago to learn that he believes the major features of this bill are appropriate. However probably one of the most important factors relating to the success of the scheme is its practical management by the ministry and by the Minister. While National supports and welcomes this bill going to the select committee it is absolutely essential that it is well scrutinised. It is vital that submissions are carefully heard and if necessary changes are made to the bill particularly in the area of patients’ rights and informed consent.  
Sadly New Zealand history reveals that our own Ministry of Health has not run an ideal cervical cancer screening system from the very beginning in 1990. A leading question is whether it would be better to have an audit unit separated from the ministry. I think the speaker from ACT has asked that question also. Wherever the unit is I say it must be under careful transparent and continuous monitoring.  
Because of the controversy surrounding cervical cancer and its early detection it is important to go over some of the more recent landmarks that have occurred in New Zealand’s history. I quote from a relevant article in the  
New Zealand 
Herald 
 that appeared on 7 November 2001. It stated that in 1998 “Judge Silvia Cartwright reports on the ‘unfortunate experiment’ in cervical cancer treatment at National Women’s Hospital … She recommends a national screening programme with a centralised register. The register would keep cytology … and histology … lab results together to ensure a reliable database.” However in 1989 Health Minister Helen Clark set up the programme in 14 locations. Instead of following then Judge Silvia Cartwright’s recommendations those locations were based on the then new area health boards. To quote the  
New Zealand Herald 
 “Because of the political haste to begin screening cytology and histology results were not combined until 1996” some 7 years later.  
Between 1990 and 1994 it came to light that women who saw Gisborne pathologist Michael Bottrill for cervical smears—like many others seen by Dr Bottrill between 1990 and 1996—were told their smears were normal. It was not until 1999 that the tests showed Dr Bottrill might have missed 129 out of 150 slides with high-grade abnormalities for cervical cancer. Former Minister of Health Wyatt Creech announced a ministerial inquiry. That inquiry took place in Gisborne between September 2000 and March 2001 and a separate report recommended the creation of one super-agency with a central database to deal with medical complaints.  
The  
New Zealand Herald  
report went on to state that in April 2001 the “273-page Gisborne cervical cancer report blames both Dr Bottrill and the national cervical screening programme. It finds Dr Bottrill under-reported smear tests but that the Ministry of Health had failed to design an effective programme for a decade which allowed Dr Bottrill’s mistakes to go unchecked. The report says health officials need access to women’s medical records without their consent to check if other labs have under-reported smears. But it surprises experts by not recommending a separate cancer control agency.” It also stated that on 3 October 2001 “Health Minister Annette King says the Government will implement the inquiry’s key recommendations. Researchers will have access to women’s records. Women will be able to opt out at any time if they do not want their details revealed.”  
It is highly relevant that the Gisborne report stated that ultimately it was the flaws in the national cervical screening programme that permitted Dr Bottrill to practise as he did. For every reason this cervical screening programme bill must be developed through the select committee process in the most optimal possible way. There are some fundamental questions to be asked of the ministry and the Minister. Already there has been a delay in the 6-monthly report from the Minister of Health. Only nine of the 46 recommendations in the report of November 2001 concerning the screening programme have been completed. I call upon the Minister to explain why the second 6-monthly summary report has not been completed. I understand that Dr McGoogan was due to make her report but that has just not happened. Clearly there have been problems within the ministry and within the unit responsible for dealing with completing the recommendations of the Gisborne cervical cancer inquiry.  
It is extremely important that the Minister of Health ensures that all information is available to the select committee so that the bill will be adequately scrutinised and optimally evolved. It is also important that the Minister and the ministry manage the screening programme far better than they have in the past and far more expeditiously than they have demonstrated over the last 6 months. National welcomes this bill being referred to the select committee.