Health (National Cervical Screening Programme) Amendment Bill

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.

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.

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.

I move, That the question be now put.

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.

The House adjourned at 9.56 p.m.