Health (National Cervical Screening Programme) Amendment Bill

Thank you, Madam Deputy Speaker. It’s a pleasure to rise and speak on behalf of this bill and to speak in support of this bill, which effectively makes cervical screening and the register a better tool. Why does it do that? How does it that? It allows cervical smear takers to eventually take up electronic look-up and to access the cervical-screening register. Why is that important? Well, I think it’s important if you can understand the workflow of what happens when you take a smear.

I think what’s important here—Minister Genter, when she first introduced it, said that the cervical-screening history was most important so that you didn’t over-screen. I want to contest that—that’s not actually the most important reason. When a woman comes in for a smear, you want to know their cervical history beforehand, not so you don’t over-screen them, but because it changes the way you do the smear.

Now, most of the time, you’d use a spatula, which is like a little sort of iceblock stick, if you like, but if a person has had an abnormal smear history, you actually are going to change it. You might still use a spatula, but you’re actually going to also use a brush, which is sort of like a little toothbrush, if you like, because—sorry to be so anatomical here, but it’s important to note that the real part of the history, it changes what you do. It gives you a more effective result if you know that something was amiss.

Furthermore, when you’re doing what you’re doing, sometimes you don’t see what you expect to see and you think, “Oh, goodness, this isn’t so good. I need to do something urgent.”—for example, if there’s scarring—but if you know from their history that they’ve had a colposcopy, it’s totally explainable. That’s why they’ve got scarring, and you can proceed as normal. So I think it’s very important to know that the reason that we want the cervical history is because it changes what you do in the moment.

OK, so how do you go about getting that history at the moment? Well, you call the local District Health Board (DHB) coordinator, and he or she then calls the coordinator and they look it up. I understand, as I’ve been speaking with them over the past few days, they’re happy, if you’re authenticated, to give you a verbal result. That’s a good thing—one can proceed. If not, what they’ll then do is fax it to you, as was mentioned. It’s been explained to me that sometimes a cervical smear history can be 20 pages long, and they’re doing dozens of these a day. You can see the cumbersome sort of process that this entails. When I spoke to the registry coordinator here in Wellington, she said that this is a common occurrence across a number of DHB cervical smear coordinators—so clear efficiency gains here.

What’s broken in the current Act? Section 112J is what’s broken. It wasn’t clear around disclosure in the Act when it was first created. This new legislation meets current privacy codes, it meets the Privacy Act 1993—more specifically, it deals to access, it deals to use and retention, and it also deals to disclosure.

Now, when we pass this bill, as has been noted, efficiency will improve, but the real efficiency is getting the electronic look-up for a smear taker—to be able to go straight there without going through coordinators. Now, there are some problems associated with that at the moment, because the cervical smear register is an old register. It was actually formed in 1990, and if we go back as to why, as has already been mentioned, it comes out of the Cartwright inquiry of 1988, and the screening register was established in 1990. Why is that relevant? It is relevant because you can’t do look-up today because it’s old technology. From your GP desk, you can’t do direct look-up into the cervical-screening register. Now, from what I understand, the hope is that the bowel-screening engine—the platform to that—is actually going to have the cervical-screening register embedded into it, so you will be able to do direct look-up, and then I think we’ll have the maximum efficiencies that this Act is entailing.

So it’s a good Act. I’m very pleased to support it. I think our colleagues who are smear takers will be very pleased with the efficiencies that this entails. It is primarily procedural. It’s not clear to me why it’s not in an omnibus bill, but maybe the Government can speak to that. Either way, it is a good piece of legislation, and I commend it to the House.

Thank you, Madam Deputy Speaker. I want to first put on record my appreciation of the technical knowledge of that member in his contribution to the House. I think it is actually really helpful to have, for those watching at home, a good explanation of the practice that is being supported here. It is an important contribution to our screening programme across New Zealand, which is vital in saving lives across a range of interventions, and it draws attention to the importance of a debate where you have people with expertise in different areas bringing different things to the conversation. So I just want to place on record my thanks to Dr Reti for that contribution.

The most significant amendment in this bill is the repeal and replacement of section 112J in Part 4A of the Health Act. Currently, section 112J covers only disclosure of information from the register. What the replacement section 112J does is that it explicitly covers the activities of the register—so, the access to the register, the use of register information, the retention of information from the register, and the disclosure of information from the register. As the Hon Julie Anne Genter mentioned in her contribution, the Privacy Commissioner has given this sign off—provided the existing set of criteria applied—and the Attorney-General’s New Zealand Bill of Rights Act check has been signed off as well.

So those who will now be able to get direct access to the register will be the staff working in district health boards who undertake the day-to-day administrative tasks associated with the register—the smear takers, laboratory and colposcopy providers and associated administrative staff, and screening support service providers. So this will, hopefully, provide for more timely result-sharing and will mean that the right people can get the results at the right time. It’s about bringing the legislation up to date with—

I’m sorry to interrupt the member—and before I say anything further, can I apologise. I did hesitate because I wasn’t sure whether you were the “Hon Dr”, so I acknowledge your proper title. I’m sorry to interrupt the member. The time has come for me to leave the Chair.

Debate interrupted.

The House adjourned at 10 p.m.