Health (National Cervical Screening Programme) Amendment Bill

I move, That the Health (National Cervical Screening Programme) Amendment Bill be now read a first time.

I nominate the Health Committee to consider the bill. It gives me great pleasure to speak on the introduction of this bill, because it supports improvements to the National Cervical Screening Programme. In my view, the National Cervical Screening Programme does not receive sufficient recognition for the contribution that is made to the lives of New Zealand women, to their whānau, and to the wider community. A significant number of New Zealand women have received follow-up treatment in response to abnormal smear tests, and, as a consequence, have enjoyed the significant benefit that earlier detection provides. I would like to acknowledge those who work, or who have worked, in the National Cervical Screening Programme for their contribution in this regard.

We have a National Cervical Screening Programme because of the unfortunate experiment carried out on New Zealand women that resulted in the Cartwright inquiry. New Zealand women led the charge to better protect patient rights and to ensure we get the health services that we are entitled to. Cervical screening has a much higher degree of scrutiny than other programmes because of previous failings from Government and the medical profession. We, this Government, are committed to deliver and improve cervical-screening services in Aotearoa, and to honour the important legacy that feminist health activists have delivered, often at painstaking cost.

This bill will enable immediate improvements to be made to the way access to the information on the national cervical screening register is authorised. The register holds clinical information on all women enrolled in the screening programme, and this clinical information is crucial for health providers to perform their work. The bill will also enable future upgrades to the information technology that supports the register and how it is used, as well as future improvements to the screening programme itself. To achieve this, this bill makes technical amendments to Part 4A of the Health Act 1956. This part of the Health Act governs the National Cervical Screening Programme and the register.

The most significant amendment is the repeal and replacement of section 112J in Part 4A of the Act. The current scope of section 112J covers only the disclosure of information from the register. However, what the replacement section does do is that it now explicitly covers the activities of access to the register, the use of register information, the retention of information from the register, and the disclosure of information on the register. The replacement section retains the current general approach of prohibiting the disclosure of information from the register unless that disclosure is expressly authorised under this section.

Also, the replacement section 112J explicitly states to which people, and for what purpose, this section will apply. Therefore, the amendments ensure that the full range of activities that could be conducted in relation to the register, or any future upgrades to the register, are properly captured in legislation. In the amended section, people granted direct access to the register will be staff working in district health boards (DHBs) who undertake day-to-day administrative tasks associated with the register: smear takers, laboratory and colposcopy providers and associated administration staff, and screening support service providers. The ability to provide register information on a case by case basis is retained in the new legislation—namely, for the purposes of research and statistics, to a screening programme evaluator or a review committee, and for the purposes of enabling results from the tests to be followed up and notices sent to women enrolled in the programme.

The current formulation of section 112J means that the express authorisation of the Director-General of Health under sections 112C and 112ZE of Part 4A of the Health Act can, in some cases, be a requirement for some people to perform their functions within the screening programme pathway. Therefore, directly authorising these people to perform their specified function in legislation will remove this inefficiency.

These amendments also capture the concept of direct access to the register. This concept has been introduced to explicitly cover the activity of making look-up access to the register available to a remote-site computer using a browser and a secure log-on. Using this type of information technology for this function is widespread in the health system and beyond. The National Cervical Screening Programme manager will still retain administrative control over secure log-on access, and access to the register will remain an auditable activity. The bill creates a distinction between having read-only direct access to the register and being able to amend information stored on the register. Amending information stored on the register will only be allowed under the express authorisation of the National Cervical Screening Programme manager. A new offence has been introduced for amending the register without this authorisation. The existing offence provisions under Part 4A of the Act will be amended to match the changes to section 112J.

Some minor and technical amendments are also being made to support the amendments. As I have already alluded to, these changes leave the original intent of section 112J intact, as well as leaving the rest of the strict controls outlined in Part 4A of the Health Act unaltered. The only existing regulations made under Part 4A of the Act, the Health (Cervical Screening (Kaitiaki)) Regulations 1995, are retained as a result of this bill, and their provisions will continue to apply. In addition to the controls I’ve outlined, the people provided with direct access to information on the register would also remain subject to the Privacy Act 1993—including the Health Information Privacy Code 1994—relevant health professional regulatory constraints, and relevant employment and contract law.

The work of screening support service providers is a good example of the benefits of providing direct look-up access to the register. Some of these providers are contracted to undertake outreach work to make contact with priority groups of women who are not responding to recall for breast or cervical screening or who are not attending colposcopy or mammography clinic appointments. Women referred to this type of support service include Māori, Pacific, and Asian women who may experience barriers to screening. Health workers in these services often work after hours to make contact with women, or hold cervical-screening clinics outside working hours to make the clinics more accessible. Look-up access to the register will provide these health workers with critical, on-the-spot clinical information about the women they are engaged with, as it is common for women to be unsure about their screening history or when they last had a cervical smear. For a screening support service provider, knowing when their last smear was taken is important to avoid women being over-screened. If this information is not on hand, the woman may be asked to come back and the opportunity for cervical screening is potentially lost.

I am also aware the planned upgrades to the register could allow direct look-up access to women’s screening histories for smear takers in general practice. Currently, women’s screening histories are faxed to general practices from DHB register staff because the current register does not allow for this type of direct access, and email is not considered a secure way to transfer confidential patient information. It is planned to build look-up access for general practice into the future development of a new register. This will be much more efficient for clinical users of register information.

I alluded earlier to authorising people to amend information held on the register. This type of access is needed for a small number of DHB administration staff who are employed to undertake administrative tasks that support the National Cervical Screening Programme register for their DHB population. These people work on the register on a day-to-day basis and have permissions to amend demographic and other information on the register, such as updating contact details and amending their recall status.

I’m advised that some consultation was undertaken on the early policy related to this proposed amendment, and support for the changes was received. The bill has received the support of the Privacy Commissioner and other Government departments, subject to the ongoing adherence to existing privacy controls and practices. In addition, the Attorney-General has concluded that the bill appears to be consistent with the rights and freedoms affirmed in the New Zealand Bill of Rights Act 1990. No regulatory impact statement was prepared for the early policy for this bill, as the bill is largely a reformulation of the existing law.

I am well aware that the previous Government approved the development of this bill, and I commend them for doing so. I consider that the bill retains the strong controls over the register and how it is used that were originally intended by the enactment of Part 4A of the Health Act. The National Cervical Screening Programme is a significant contributor to New Zealand and the lives of New Zealand women, and this bill will enable improved services to be provided for women participating in the National Cervical Screening Programme. For these reasons, I commend this bill to the House.

Debate interrupted.