Health (National Cervical Screening Programme) Amendment Bill

I present a legislative statement on the Health (National Cervical Screening Programme) Amendment Bill.

ASSISTANT SPEAKER (Hon Jacqui Dean): That legislative statement is published under the authority of the House and can be found on the Parliament website.

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

This bill will strengthen and improve the National Cervical Screening Programme, a programme that protects the health of women throughout our country. It will enable the programme to take advantage of modern information technology. The new rules are needed because Part 4A of the Health Act did not anticipate the information technology that is available now. The bill also paves the way for the screening programme to move to human papillomavirus (HPV) testing, which causes 99 percent of cervical cancer. As we have discussed earlier today, in Budget 2021 we included investment of up to $53 million to complete the design and implementation of human papillomavirus screening. The new test will replace the current smear test for the 1.4 million eligible women aged 25 to 69 years old. It is a simple and quick swab that women in the future will be able to do themselves and does not require an invasive speculum exam. We anticipate, based on trials that have occurred here in New Zealand, that this will greatly reduce the barriers to getting screened.

Tonight, in my remarks, I want to discuss the purpose of the Health (National Cervical Screening Programme) Amendment Bill, outline the recommendations from the select committee, and then describe a tabled Supplementary Order Paper to address the unintended consequences of some of the select committee recommendations, and a remedy to them.

So, first, the underlying bill: currently, clinicians who want to access the screening record of a participant have to request and receive that information via fax—via fax. Fax should have been abolished ages ago in the health system. They are unsafe, unreliable, and have a privacy risk attached to them. This bill clears the way for a move to direct, secure, log-in access, just like all the other information systems used across our health system. This is a standard that we should aspire to for every programme, particularly a vital public health programme. This will mean that healthcare providers have the most up-to-date clinical information when a participant attends an appointment, either for cervical screening or follow-up, and it’s crucial information because, if you don’t know the past history of a woman in the screening programme, you can’t decide what to do next—

ASSISTANT SPEAKER (Hon Jacqui Dean): Order! Not the Speaker.

—one can’t decide what to do next and how that woman should be referred. As a result, there can be delays, and women who present for what should be a simple matter are asked to come back once the information has been sent via fax from the screening programme, meaning, in some cases, an additional appointment is needed.

You can imagine that this is troublesome enough in the type of settings where screening usually occurs—say, in a general practice clinic—but if we want to be more innovative, and we could be in the future with self-sampling, then perhaps we’d want to be able to do this in different settings as well, and being able to use direct log-on with mobile information technology would mean we’d be able to move the screening programme into the community in a way we haven’t been able to previously. So we can and should be doing better for participants in the cervical screening programme, and this bill will allow us to.

I’d now like to turn to the second matter: the Health Committee’s recommendations, and there were four I’ll canvass. The Health Committee reported the bill back to the House on 19 September 2018. I’d like to thank the committee for its consideration of the bill and everyone who took the time to make a submission. The committee unanimously recommended four changes to the bill, and I’ll go over them now.

Firstly, minor changes have been recommended to the definitions of “diagnostic test”, “screening test”, and “specimen” for the purposes of the programmes. Members will find these proposed changes in clauses 5(1AAA), 5(3), and 5(4) of the bill. These changes would apply to all provisions in Part 4A of the Health Act. This will mean that we will move away from using the term “smear test”, as samples with the new HPV test are not smeared on to a slide, and the definition of “screening test” will now also include reference to the human papillomavirus.

Secondly, changes are proposed to the new section 112J(4)(d), which relates to the disclosure of information for the purpose of enabling compilation and publication of non-identifiable statistics from the register. So I stress: these are non-identifiable statistics. The change is to use the phrase “unless the disclosure is prohibited by” instead of the phrase “in accordance with”. This change is designed to make it clear that any regulations cannot authorise disclosure that is prohibited under another provision.

Thirdly, the consequential amendment is the recommendation to the kaitiaki regulations themselves. The kaitiaki group oversee the use of Māori women’s data by the cervical screening programme. Members will find this proposed change in clause 9(1A) of the bill. This change is recommended because clause 5(1) of the bill will amend the definition of National Cervical Screening Programme register to include “any part of the register that is replaced”. It therefore makes sense to amend the definition of National Cervical Screening Programme register in the kaitiaki regulations so that it is consistent with the definition used in the principal Act. I fully support the adoption of these recommendations.

The fourth change, and the one I propose to change through the Supplementary Order Paper, is a change to clause 6A. The Health Committee recommended the introduction of a new clause 6A to the bill. The clause provides that section 112ZE(1) of the principal Act does not override the requirements of the kaitiaki regulations. The regulations provide for the national kaitiaki group and give it a role in the protection of use of information on and from the register that identifies participants as being Māori. The committee has identified that section 112ZE of the principal Act enables screening programme employees to retain, access, and use and disclose any cervical-screening information to the extent necessary to perform their functions as employees. This provision, being the principal Act, overrides the kaitiaki regulations. The amendment will change the operation of section 112ZE so that all screening employees’ use of data would become subject to the kaitiaki group’s approval.

I accept the Health Committee intent in introducing clause 6A. However, the information that is likely to be captured by the legislation is necessary; it needs to be used on a daily basis for routine internal data analyses, data modelling, and data quality checking. I think this is an unintended consequence. It is also possible that clause 6A might be interpreted as requiring approval of the automated use and disclosure of data during even things as simple as electronic data uploads to existing electronic applications. It would be unworkable for the programme employees to be prohibited from accessing this information until approval was sought for their day-to-day work. This could impede the provision of timely data to the sector, used for monitoring and quality assurance activities, as well as having unintended consequences on the workload of the national kaitiaki group.

The timely execution of these internal processes is vital to the quality of cervical-screening programmes. As clause 6 was not considered in the development of the bill, an independent panel of reviewers with expertise on the screening pathway considered its impact. It also included expertise on Māori health, and it has considered that to both meet the intent of the Health Committee and mitigate the risk of unintended consequences, a legislative response is required. To this end, I’ve tabled a Supplementary Order Paper that would replace clause 6A as recommended by the Health Committee with a new clause 6A. The new clause will retain the Health Committee’s clear intent that the screening programme employees must gain the kaitiaki group’s approval for using programme information but only when that information is intended for publication. This would include annual reports, monitoring reports, cancer case reviews, parliamentary review committee reports, any public-facing component of a new electronic application, other publication of information captured by the legislation, and external requests for information captured by the legislation.

However, the new clause 6A would also require that the kaitiaki group’s approval will not be required for the programme’s internal processes that are not intended to result in a publication, nor would applications be required for data uploads to existing electronic applications or for existing publications. These changes would provide assurance that the programme’s internal data and information management can continue at pace and will not be subject to delays. I believe the Supplementary Order Paper goes a considerable way to addressing the select committee’s intent, and recommending clause 6A is necessary given the identified risks.

In summary, I am pleased with the very robust consideration that the bill has received since introduction, both at select committee and the independent review panel, and I look forward to the passage of the bill so that the improvements can be made—

The member’s time has expired. The question is that the motion be agreed to.

Thank you, Madam Speaker. National will be supporting the onward progress of this bill. This kind of makes sense. I mean, in one way it’s just addressing a very small administrative factor whereby anyone other than administrators couldn’t access the cervical-screening register, and if you weren’t the administrator you needed to, as I recall, fax in your request. It would be authenticated and then you’d get a fax reply back.

ASSISTANT SPEAKER (Hon Jacqui Dean): Not me. Order! Not the Speaker.

I’m sorry. Someone would. A provider would—I’ll get into the anatomical detail shortly, if you really wish. And this was cumbersome, although I may be able to—I mean, looking back, to think why we were using faxes, it is hard to explain. It could be that at that stage, we were following some of the American terminology around health information security. Their Health Insurance Portability and Accountability Act (HIPAA) regulations actually talk to this, because what happens is, in the US, if you’re HIPAA compliant, if you’re transmitting information in an electronic way—

ASSISTANT SPEAKER (Hon Jacqui Dean): Order! Not me. Not the Speaker.

Sorry. If one is transmitting information in an electronic way other than a fax, you have a whole range of compliance called HIPPA compliance, which adds on roughly a minimum of $20,000 of compliance to transfer that information. But for some strange reason, fax transmission is outside of HIPAA. So it may well be that when the legislation first—

💬 Hon Gerry Brownlee: I think you’re a very HIPAA person.

—ha, ha!—came into the House, we were following the HIPAA legislation. I don’t know. I’ve considered it as well and it just doesn’t make sense here now, so we’re trying to redress that so that providers, authenticated providers, can access the register.

This started off as a National Party bill years ago. It’s sort of hard to understand why it’s taken so long to get here, and yet if we think about it, the promise here was that the cervical-screening register would build on top of the bowel-screening engine. So when the bowel-screening engine was created, the engine was going to be the core to screening IT, and you’d put cervical screening on top and now, you know, purportedly coronavirus and other things. But, as we well know, the bowel-screening engine took so long—it was delayed by six to 12 months—and so I suspect that may be why this bill has taken so long. Because by the time it’s enabled—now, it will be after coronavirus, but it needed to be added on top of the core screening engine which came out of bowel screening.

As it came through select committee, there were some really good suggestions, some really good futureproofing suggestions, as one can see in the bill. It talked about increasing the anatomical area of pathology, relevant—that made sense. And as the Minister spoke, about futureproofing it for HPV, which absolutely is a good idea, and I totally support that. That’s a really important next progress for cervical screening. Disappointing that it failed the Budget bid 2020. I know Professor Bev Lawton and her team were very enthusiastic about it, but here we are now. I think this will do a huge service to women and certainly help reduce the inequities, particularly for Māori, that we all want to achieve. So I am very supportive of HPV screening.

I’m sort of hoping that Louisa Wall will be able to take a call, because the issue that we did spend a lot of time on in select committee was around the kaitiaki group and, more specifically, data provenance for Māori. The rest of the bill was quite easy. This became the most complicated part, as I recall, and that’s what leads us to the Supplementary Order Paper. Because we were mostly looking for that balance between appropriate provenance and management of Māori women’s cervical-screening data—is what was trying to be achieved—and there was some concern that this bill might override or, more specifically, that this bill might be used to strengthen up some of those kaitiaki regulations. That’s actually what was looking to be done. Having said that, we understood some of the difficulties, because officials did say to us that we could complicate or hinder the sole purpose of cervical screening by putting these regulations in. But at the time, and on balance, we thought it was reasonable.

Having said that, here we are with another set of views in the Supplementary Order Paper, which we’ll talk to later, which reinforce the point that, actually, officials think this could be unmanageable to have it in its current form as it was reported back. Having looked through this and seen it, we’re quite relaxed on that. We were relaxed in select committee, understood both sides of that argument, and there’s nothing at first blush that we see in this Supplementary Order Paper that gives us any reason to pause.

So in net summary, this is mostly an administrative bill. It makes a lot of sense—contemporises what we’re doing with cervical screening. The select committee did a lot of really good work to futureproof it to what’s now turned out to be the current protocols, and we’ll be continuing to support its progress through the House. Thank you.

Talofa lava, Madam Speaker. Since the National Cervical Screening Programme started, the number of people who have died from cervical cancer has dropped by nearly two-thirds and that’s incredibly good news. But the issue we’ve got is that inequalities still remain, and so we’ve got much higher rates for Māori and Pacific women, and that’s something that we really need to focus on moving forward in terms of reducing those inequalities. The good news, though, is that cervical cancer usually develops slowly and so it means that those pre-cancerous changes can get picked up by cervical screening, allowing for early treatment and, in most cases, a cure. But what needs to happen for that to occur is that you need to start screening early, and so the current recommendation is that if you’re between 25 and 69 years old, you’ve got a cervix, and you’ve ever been sexually active, then you should be having a cervical smear every three years—or even more often if you’ve had an abnormal smear.

What this bill does is it makes some changes to the current screening programme so that we can actually modernise it and make it more effective, and what I’d like to do tonight is just focus on two of those aspects. The first one of them is looking at how we improve access to the cervical screening register, because as we’ve heard tonight, at the moment, what we’ve got is we’ve got a register that holds the information on women on the screening programme, but it’s unduly restrictive, and so what needs to happen is that people request information. So if you’re a smear-taker working out in primary care, you have to request that information and then wait for a fax. I’m not even sure that many places still have faxes, but, apparently, that’s how it still happens at the moment. So, clearly, this needs to be sorted out.

The other issues are that if you’re laboratory or colposcopy staff, you still need the Director-General of Health to have approval. And so what this bill will do is it will make changes so smear-takers in primary care, colposcopy and laboratory staff, will be able to have look-up access, read-only access, to the register. And so what they can do is then access that information for authorised purposes about those that they are screening. But also a number of district health boards, the Ministry of Health, employ people to follow up on people who have been late for their smears, and this is where we are trying to make sure that we reduce inequities and inequalities in screening rates. So being able to contact people and invite them and remind them about their smear, and so having access and improved access to that, because a lot of this work happens in the evenings—and so, again, anything that’s there to reduce inequities will make a huge difference.

So one of the main things this bill does is just modernise the whole approach. We’re not relying on faxes. We’ve got look-up access, but it still protects all of those privacy provisions and makes sure that it’s only for authorised purposes—that’s closely monitored—and also making sure that no information is disclosed about identifiable individuals, so those protections remain.

One of the other aspects, though, we looked at in select committee is widening the definition, because “cervical smear” is relatively old terminology. And what we changed in select committee—there was a recommendation to expand the definition to include high-risk HPV tests and also cervical and vaginal cytology tests, just to reflect more up-to-date approaches to screening. So what that does is it clears the way for human papillomavirus—HPV—testing, which is thought to cause about 99 percent of cervical cancers, the HPV virus. As has been mentioned tonight, the Government invested $53 million in Budget 2021 to enable HPV testing to replace the current smear test. And what we’re looking at is a start date about mid-2023. What we’ll do then is we’ll change over to HPV testing as the main way of cervical screening.

What women will experience is quite an improvement, because instead of the traditional smear test, which requires a health professional to take the smear and a range of associated equipment, women will be able to self-test with a vaginal swab and, basically, do that privately themselves. The expectation, initially, is that they will still come to a healthcare provider for that screen. But what that saves is a lot of healthcare professionals’ time and equipment, and also, for the woman, a much better experience. And then, once women have had their test, if they have a negative HPV test they can be reasonably reassured that in the next five years they would be unlikely to develop any of those precancerous changes. And so what that means is they would only need to be screened once every five years instead of once every three. But they can still, if they’ve got any concerns, consult their healthcare provider in the meantime.

Then the Ministry of Health is looking at: can we even make that much easier in future? Possible options would include mailing out self-test kits if they’re found to be safe and effective for women. So what this bill does by changing the definition is allowing some of these changes to occur. So this is an important bill and what it will do is improve the cervical-screening programme. It’ll reduce inequalities and it will save lives. I commend this bill to the House.

Talofa lava, Madam Speaker. I’m pleased to speak in support of the Health (National Cervical Screening Programme) Amendment Bill in its second reading.

As previous speakers have said, this is largely an administrative change. The bill amends Part 4A of the Health Act 1956 to enable health professionals who provide services to women along the cervical-screening pathway and their support services staff to directly access this information from the National Cervical Screening Programme register. The key amendments are really ensuring that this information is available in a modern and timely manner. It’s almost unbelievable that, currently, the access to this clinical information occurs via fax. It’s incredible not only from a technology perspective but also from a privacy perspective that people are standing around waiting for something like this to be coming through on a fax, and so we certainly support this becoming a much more modern means of accessing this information.

It’s important that women understand or are assured that privacy is going to be well catered for. The amendments will allow providers to look up the information directly by using secure log-on access via the internet. It is important to note that the relevant provisions of the Privacy Act 1993, the Health Information Privacy Code 1994, health professional regulatory constraints, and employment and contract law are unaltered by the amendment. The National Cervical Screening Programme manager retains the administrative control over who they grant secure access to the information, and it remains an auditable activity. So all those privacy concerns are still catered for.

As my colleague Dr Reti has already traversed, this bill picks up on work that was initiated by the previous National-led Government. So we support this bill bringing this basic amendment in, which brings the clinical information process into a much more modern set-up.

It will certainly speed up the process for smear-takers getting this information and being able to discuss it with their patients without compromising their privacy, and of course we would support anything that makes it easier for women to access primary healthcare. We know that the National Cervical Screening Programme makes a fantastic contribution to the lives of New Zealand women, and so we, again, would want to support any improvements with that.

Cervical screening, as Dr Liz Craig has noted, is a key tool in maintaining the health of women across the country, and being able to get an immediate improvement to the way we access this information on the national cervical screening register is imperative to these improvements. The bill will enable also future upgrades to the IT that supports the register and how it’s used, as well as future improvements to the screening programme, but it retains that strong control over the register.

I wanted to just bring in some context from my own electorate, where WellSouth have been doing some research on their primary healthcare network. They analysed individual-level data from the entire WellSouth enrolled population as of 1 January 2019 on key health indicators, of which cervical screening was one of those indicators. WellSouth’s target for cervical screening of women with up-to-date smears is 75 percent. That’s in line with the current 2010 primary health organisation performance programme target of 75 percent or more of eligible women in that 20 to 69 years age group enrolled in their practice to have had a cervical smear recorded in the last three years. What WellSouth found was that they were not meeting that target for either Māori or non-Māori women, with 63.9 percent and 61.7 percent.

So the point was well made by the Minister that while this amendment will bring improvements in accessing information from the National Cervical Screening Programme through faster and better access to information, the real improvements will come when the primary screening for HPV occurs, and, again, Dr Liz Craig outlined how that will break down a number of the access barriers for women. So we consider it absolutely appropriate that this bill would make the amendment to provide for the new definition of “screening test” to include reference to the HPV test.

So, in conclusion, I speak in support of this amendment, and we look forward to the progress of this. Thank you.

Thank you, Madam Speaker. Talofa lava. It is a pleasure tonight to speak in support also of this bill at its second reading, the Health (National Cervical Screening Programme) Amendment Bill.

I’d like to start by acknowledging the Minister, the Hon Dr Ayesha Verrall, not only for her work but also for the fact that she prioritised this amendment bill. Listening to the Minister’s contribution earlier reminds us—on this side of the House, in Government—we are committed to improving outcomes for all New Zealanders, and this bill is yet another example of us doing that. I’m very pleased, also, to see colleagues on the other side of the Chamber also supporting this bill and the potential that it has to improve outcomes for women and for New Zealanders.

What this bill does is it, essentially, seeks to bring the National Cervical Screening Programme (NCSP) into the 21st century, progressing it from an outdated, bureaucratic, and laborious process into something that’s much safer and a much more efficient sort of system. It’s topical, I think, that we’re debating this bill following the recent Budget 2021—a fabulous Budget which included, amongst many other things, up to $53 million for the design and implementation of the new test that the Minister outlined earlier on, the new test for HPV to replace the current smear test. I think it’s fair to say that there’s no doubt this new test will save lives, particularly wāhine Māori lives.

So it is fantastic to stand here tonight and support a bill that will, firstly, facilitate the new test; and, secondly, strengthen the existing process in parallel—which currently, as noted by several of my colleagues, requires health workers to receive crucial screening history information via fax following an indirect authorisation process, which is also cumbersome. So, importantly, this bill enables the development of a register that provides secure, direct access to really valuable screening information. However, having said that, detail is also important, as is expert input, so I’d like to also acknowledge the work done at the select committee stage—the previous Health Committee—where, it should be noted, most submitters strongly supported the bill, the gist of which could probably be summed up by the submission by the Royal New Zealand College of General Practitioners when they said, and I quote, “The College supports this bill and views it as a significant improvement over the current situation where a fax is sent to the general practitioner. We consider the bill will result in better communication and outcomes for patients.”

Having said that, I think it’s also important to note that some people also raised privacy concerns, and these concerns, I think, should be alleviated both by what the Privacy Commissioner, John Edwards, subsequently submitted, and also the Minister’s Supplementary Order Paper (SOP), which she outlined. So the Privacy Commissioner stated, “I have no outstanding privacy concerns with the bill as introduced,” adding that although “Providing more people with access to the register comes with some increased privacy risk … I am satisfied the bill provides for this risk to be mitigated through appropriate operational controls—access to the register will be controlled by the NCSP manager, and the Ministry of Health has advised the activity will be auditable.” So in addition to that, as I said, the Minister also introduced an SOP which directly assesses concerns regarding privacy for Māori participants and should allay any of those outstanding concerns from the bill as was introduced.

So in summary, I think we are making important changes to the NCSP system, while maintaining the appropriate safeguards so that women in New Zealand Aotearoa trust the system and actually feel safe getting what could be a lifesaving test. We know that cervical cancer, as a couple of my colleagues have already pointed out, develops slowly and is both preventable and treatable. The latter is, of course, highly dependent on early detection. We must do everything within our power to assist those health workers responsible for the screening process. By improving the programme to expand information, accessibility, and to make the system more efficient, we go a long way toward facilitating prevention and early detection in a timely intervention.

The bill may seem technical in nature, but it is actually about decreasing bureaucracy, retaining trust in the health system, and ultimately improving those outcomes and saving lives. So I don’t want to hold up the progress of this bill any further except to say that it is an important contribution. With that said, I have no hesitation to commend this bill to the House. Thank you.

Talofa lava. This morning we greeted Matariki with a karakia on the top of Tangi te Keo or Mount Victoria, and then we visited the land occupation at Mau Whenua. Just when I thought my job couldn’t get any better, tonight I get to speak in the House about supporting the health and wellbeing of people with a cervix and a vagina. So while those people with a cervix and a vagina are predominantly cis-gender women, it also includes trans-men, intersex people, and non-binary people.

Now, cervical cancer is the easiest cancer to prevent. A simple pap smear, an HPV vaccine, will do that job. However, we have about 160 people developing it, and about 50 die from it every year. As the chair of our Health Committee identified, of course it is one of the many ways in which Māori and Pacific Island people suffer disparities. I fear we will see an increase in those numbers soon, because when our select committee considered and reviewed all of the DHBs, I noticed that many of them reported that in order to allocate resources and staff to deal with the pandemic, their screening programmes for cervical cancer and breast cancer were affected. I really, really hope not.

The national screening programme is hugely effective and has reduced the incidence of this type of cancer significantly. One of the ways that it tried to attract and make sure that Māori women would feel comfortable coming to do this, be screened, was to assure them of their privacy, that not just them as a person coming into this quite vulnerable position and situation, and having that done—and everyone here in the House knows what that feels like: it’s not fun. So they were assured that their privacy would be protected because of the national kaitiaki group that was established that said no information would go out that hadn’t been checked by them in certain circumstances. So they would protect that data by respecting the sanctity of te whare tangata and any data associated with that, making sure that nothing was published inappropriately or that would impact negatively on Māori, but that, overall, any information would be used to benefit Māori women.

So we absolutely support our employees in our screening programmes to have all the data they need to do their job, to make their lives easier for them as staff but also all of the people that they’re caring for. We have a concern, though, that the kaitiaki group doesn’t receive many applications for checking the use of that data. So we want to make sure, absolutely, on a day to day, that that gets done and people can do that. But there’s a big gap between that and something being published. So we just want to make sure that that kaitiaki group is still effective and still doing what it needs to do.

But the other issue I wanted to raise was about the particular ways that members of the takatāpui, trans, intersex, and non-binary communities suffer, and the discrimination they face in the health system. Unfortunately a big part of that description is a complete and absolute obsession with their genitalia. So when it comes to any encounter with our health system, especially to do with sexual and reproductive health, they suffer greatly. So I just wanted to make sure that when we’re talking about privacy, we’re not just talking about particular groups. We’re looking at a group of people who we should also be able to reassure that their information will not be used against them. I have been approached by people who are trans, non-binary, and intersex to talk and tell me the experiences they have had. So one particular example is because they have access to all of their data, they will then address them with a pronoun that’s not appropriate. We know that there are some employees who will use old names, what some of the community will call dead names, which are no longer how they identify and not who they are.

So in conclusion, we absolutely support this, but we want to ensure that all people, no matter their background, no matter what they were assigned at birth, the sex they were assigned at birth, if they have got a cervix and a vagina, their health and their privacy will be protected. Kia ora.

Thank you, Madam Speaker. I rise on behalf of the ACT Party in support of the Health (National Cervical Screening Programme) Amendment Bill at the second reading, because we believe that the amendments would provide our healthcare professionals with even better tools than they currently have, through enabling improved accessibility to the National Cervical Screening Programme register, and significantly streamline the process.

For context—and I can’t believe that I’m saying this—our current system uses faxes. You know, there is an entire generation of health practitioners coming through the system, coming through college, now in the workforce, who probably should never have used a fax. I have never used a fax. I can’t believe that people are being trained up to be using near-obsolete technology. So this amendment is about enabling our health professionals to access the National Cervical Screening Programme register without going through that whole rigmarole of the current process, the fax process.

It’s deeply concerning that health practitioners who take smear tests, whose job it is to provide services to our patients along a cervical-screening pathway, are forced to go through such an outdated and obsolete programme. Unfortunately, that’s just one way that shows the inefficiencies in our healthcare system. We have to acknowledge that the problem here is not with the health professionals. Our nurses and our doctors do a great job helping New Zealanders with their healthcare needs. It’s just a massive flaw in a system that they’re having to do it with such outdated technology.

I do admire the work that our health practitioners are doing to make sure that New Zealanders can get the care that they need, but we also have to admit that data efficiency and accessibility in healthcare is extremely important to make sure that people can get the care that they need in a timely fashion, and especially when it concerns issues such as cancer, because being able to directly access data on a patient’s screening history actually impacts how quickly people can get the care that they need and how quickly a smear can be carried out.

While we believe that this bill would make an important and necessary change in the short term, we also think, as the ACT Party, that there needs to be longer-term thinking from this Government, and we actually believe that the outdated IT infrastructure is of huge concern in New Zealand. I mean, we’ve just seen the Waikato DHB issue, and we had reports in 2019 and 2020 that showed that our DHBs don’t have the necessary data technology and security to make sure that they are protected from cyber-attacks.

We actually want to be committed to a modern healthcare system which empowers New Zealanders. We should be able to keep people’s information safe but, importantly, acknowledge that a lot of this problem is down to outdated technology, just like this is with faxes. So we believe in streamlining our bureaucratic healthcare system, reducing overheads, making better use of technology, ensuring better integration of our healthcare system, and focusing on patient outcomes, and so I commend this bill to the House.

E te Māngai o te Whare, talofa lava.

💬 Shanan Halbert: Talofa.

Talofa. Tuatahi māku, ka tīmata taku kōrero ki te mihi atu ki a rātou kua mate i tēnei mate pukupuku, momo mate pukupuku, kua pāngia hoki i tēnei mate pukupuku.

Tuatahi, ki a Talei Morrison. Ko ia tētahi o ngā wahine toa e hāere puta noa i te motu ki te kōrero ki ngā kapa, ki ngā whānau, ki ngā wāhine, ki ngā hapori katoa e pā ana ki tēnei mate pukupuku. Me te whakahau ki ngā tāngata kia hāere ki te rapa, ki te Smear i ō Mea.

Tuarua, e tuku mihi ana au ki tōku hoa mahi, arā, te Hōnore Kiritapu Allan. Kua pāngia e tēnei mate. Engari kei roto ia i te hohipera. Ko tēnei te wiki tuaiwa o te whiwhi rongoā mō tēnei nō reira e mihi ana ki tōku hoa, ki te Whare, i tēnei pō. Ka huri au ki tēnei pire.

[Firstly, I would like to begin my speech by acknowledging those who have died of this particular cancer and those who have been afflicted with this cancer. Secondly, I acknowledge Talei Morrison. She was one of the warrior women that travelled the country to talk with kapa haka, with families, with women and with communities about this type of cancer. She encouraged people to “Smear Your Mea”.

Secondly, I would like to acknowledge my colleague, the Hon Kiritapu Allan, who has been afflicted with this disease. She is in the hospital. This is her ninth week receiving treatment so I would like to acknowledge my friend and the House this evening. I turn to the bill.]

Every year, about 160 women develop cervical cancer, and about 50 die from it. This is a tragedy because in almost all cases it is preventable or it can be treated if it is found early. That is one of the real issues that we have and that this bill is trying to address by introducing new systems and processes that may make this screening more accessible to more women so that it can be identified early and, hopefully, treated, and therefore the deaths are preventable.

In my short mihi in beginning this contribution tonight, I acknowledged wahine toa Talei Morrison, who unfortunately was taken by this disease, but, in her journey, she shared with so many people the message about how important it is to Smear Your Mea and really encouraged kapa haka groups across the motu, communities across the motu, wāhine, and whānau to take up that challenge, to make sure that we look after te whare tangata and that we smear our mea. I also acknowledged—of course, known to everybody here in the House tonight—the Hon Kiritapu Allan, who is currently undergoing treatment, and today she reported being in week nine of that treatment, and giving us all a message of hope and saying kia kaha and aroha to everybody.

So it is really important, therefore, that this bill goes through the House and passes, because it will enable a more modernised system, which should make the opportunity for screening more readily available to people, and, hopefully, more user-friendly. But it does require legislative change in order to achieve that.

I thank the member from the ACT Party Brooke van Velden for her contribution just prior to me speaking. One of the issues for anybody listening tonight is that the current legislation requires the transfer of information to happen by facsimile, and I was just thinking then, “When was the last time I ever used a fax?” Now, I think my doctor says, “I’ll fax that across to the pharmacy and then you can go and pick it up and you’ll get a text message to tell you that it’s there.” I’m not sure that they are still faxing that information, but anyway that’s what they say. But when I thought about it, the last time I received a fax was when I was 16 years old and I was in Australia on a basketball tour, and my parents sent me a fax to Australia—I’m 38 years old now, and I haven’t received a fax since then. I think that we all agree, in the House, that the fax is something that is quite outdated. We need to modernise the technology that we can use so that we can be more responsive; we can do it in a much quicker manner.

This Government, in the latest 2021 wellbeing Budget, committed $53 million to improve our cervical- and breast-screening programmes. As part of that funding, there is an allocation there to upgrade our IT system and also to introduce the HPV testing. The legislation includes the HPV test, which is important because we are going to be funding that and phasing that in and phasing the other one out by 2023, and also funding for a new IT system. So it is important that this legislation is actually in place so that that funding that has been allocated will be effective.

I wasn’t on the Health Committee, but I did read their select committee report, and I did want to talk particularly to the issues raised around the kaitiaki regulations. I want to acknowledge Minister Dr Ayesha Verrall, who approached us as the Māori caucus to talk about the challenge that she had in terms of the advice that she was given about potentially how unworkable the current proposed clause 6A would be in the legislation, and how we could work through and get a balance of what the concerns were that were raised by the kaitiaki group and submitters who were submitting on that, as well as those of all of us who, I am sure, are very keen to see more Māori women, who, unfortunately, are overrepresented in the statistics, get access to cervical screening. I thank the Minister for coming to us and talking about quite a sensitive issue and how we get the balance right. I read the select committee’s report and heard what their concerns are. I have also read the Supplementary Order Paper (SOP) and listened to the Minister’s contribution and am thankful for the process that she followed with us in terms of it.

I’m satisfied that the new clause 6A will retain the Health Committee’s clear intent that the screening programme—employees must gain kaitiaki’s approval to use screening programme information where that is captured by legislation, but only when the information is intended for application. As she mentioned, that would include information that is used for annual reports, monitoring reports, cancer case reviews, Parliamentary Review Committee reports, any public-facing component of a new electronic application, any publication of information captured by the legislation, and external requests for information captured by the legislation.

However, the new clause 6A would also ensure that the kaitiaki group’s approval wouldn’t be required for the programme’s internal processes that are not intended to result in publication. The real practical effect of that is that, as it was, they would potentially have to go and seek approval every single time they were wanting to use that information, which would make it clunky and slow the process down. I don’t think that was what was actually intended by those kaitiaki regulations. If we look at why the kaitiaki regulations exist, as Dr Kerekere mentioned in her earlier contribution, they “must have regard to the … sanctity of Te Whare Tangata; the need for culturally appropriate protection for the taonga of the information covered by the regulations; [and] the need to ensure that the information is used for the benefit of Māori women.”

So I believe that the SOP proposed by the Minister gets that balance right. It allows those using the information on the day-to-day practical side of arranging and referring for screening to be able to do that without having to go and seek permission. However, if any of the information were to be used for any publication and specifically those that the Minister mentioned, then the kaitiaki group does still have its role there, and that is carried over not only into this legislation but to the legislation that empowers those particular regulations.

I have almost run out of time. I just want to thank the Health Committee for the work that they did on this. I heard Dr Shane Reti’s contribution earlier. So for those members who were on that committee, thank you very much for the process that you went through, for your consideration of that balancing that was required for the kaitiaki regulations, the protection of sensitive information, te whare tangata. I am pleased that there is cross-party support tonight for this very important bill and for the programme to be as effective as it can be for our wāhine Māori and those with a whare tangata. Nō reira, tēnā tātou katoa.

Kia ora. I call Erica Stanford. This is a split call.

Thank you, Madam Speaker. I’m pleased to take what will be a very short contribution. I spoke on this bill back in 2018 at first reading, and I remember a couple of things. Firstly, it was the Hon Jonathan Coleman who spoke for us—that’s how long ago this was—at first reading. He opened, I believe. Then I do also recall congratulating Julie Anne Genter for bringing this bill to the House and also on her pregnancy, I believe, and here we are again. So congratulations, Julie Anne Genter, on your second pregnancy. That’s how long we’ve taken to bring this bill back.

Look, I think that what needs to have been said has already been said by previous speakers, especially on this side of the House—the very capable Dr Shane Reti and also Penny Simmonds, who has taken up a role on the Health Committee very ably. And we have, sort of, digressed, I think, into conversations about who remembers when they got their last fax, which was quite amusing. I remember the last time we got a fax was from my father in a Boeing 747, 30,000 feet above the Pacific, telling us he’d left the water on in the glasshouse. You used to be able to send faxes from airlines, in the cockpit.

Anyway, when I do remember speaking on this bill early on, just the disbelief that it was still the case that doctors had to, firstly, ring up a registry to get results and also rely on the use of a fax. But the bad thing about that was it often meant that maybe they wouldn’t do that and then would potentially do the test in a different way which wouldn’t get the results that they needed if a woman had had a previous result that meant that a different type of test needed to be carried out. So that’s potentially quite dangerous.

So this really is a very small technical bill that does a lot of good things, dragging us into this century and allowing those practitioners to dial straight into the registry and get the information that they need. It’s going to improve women’s health, and I commend this bill to the House.

Talofa lava, Madam Speaker, and thank you for the opportunity to take a very brief call in relation to the Health (National Cervical Screening Programme) Amendment Bill. I am not a member of the select committee who considered this bill, but it is a huge privilege to speak briefly in its favour. I just wanted to begin by commending the work of Minister Verrall for shepherding this bill through the House. As the previous speaker mentioned, a lot of has already been traversed about the bill, and as I was listening to speakers, I was thinking back on a quote I heard from a cancer survivor who said, “Life is 10 percent what happens to us and 90 percent how we react to it.” I suspect that many people in this House know of and have had family members or friends who have lived with or passed from cancer. And there is a lot of truth to that quote. There’s a lot of profound courage and love and strength that comes from those survivors. But it’s my view that life is also about learning and doing a service to that strength and courage and really looking at the systems that we have in place in terms of providing cancer services to ensure that when people are fighting some of the most difficult battles of their lives, before they go on to those battlegrounds we’re providing them with the best odds possible, and that, for me, is what this bill is about. This is a bill that’s about saving lives.

My colleagues have quoted the number of women who are diagnosed every year and the approximately 50 who die from it—and this is really an avoidable tragedy, at the end of the day. I just wanted to note very briefly some of the stats that I saw from the 2017 National Screening Unit, which said at the time that there were 63.7 percent of Asian women who were screened—so under what the target was, which at the time was around 80 percent, and the changes made in this bill will really go towards addressing that. This bill is important as it will explicitly allow the people providing community-based services, as my colleagues have said, to be able to look up access to the register so that they can perform their work as easily as possible. I do think this is one step in terms of what we need to do. I referenced the numbers for Asian women who get screened, or rather those who don’t, and I do think that there are a number of steps we need to also take in terms of addressing the culture of women feeling comfortable across all cultures to go and get screened proactively to take away some of that stigma. I commend this bill to the House.

Talofa lava e te Mana Whakawā. It is an honour and a privilege to speak on the Health (National Cervical Screening Programme) Amendment Bill. I want to take this opportunity to acknowledge the Minister the Hon Dr Ayesha Verrall and her leadership now at the second reading here in the House.

I also want to acknowledge the submitters. I know that it’s been a while since it came to the select committee, but the Health Committee was one of the first committees that I was on and I remember the discussions on this, so I want to take this opportunity to acknowledge the 16 submissions received. I think it’s important that we say in this House—record—the names of those who’ve made submissions, because it is really important that we do, so if I can just read it out. I want to acknowledge the Māori Women’s Welfare League - Te Rōpū Wāhine Māori Toko I te Ora, who, when they gave their oral submission, had attended with Dame Silvia Cartwright; the Auckland Women’s Health Council; the Federation of Women’s Health Councils Aotearoa; the Cartwright Collective; Chris Berriman; Family Planning; Mrs Georgina McPherson; the National Council of Women of New Zealand; Mrs Uputaua Ioapo-Peniata; the New Zealand Nurses Organisation - Tōpūtanga Tapuhi Kaitiaki o Aotearoa; the New Zealand Medical Association; Jillian Lamb; the Office of the Privacy Commissioner; Southern DHB; Waipatu Karamu Māori Women’s Welfare League; and the Royal New Zealand College of General Practitioners. Of those 16 submissions, we had oral evidence of three submitters, and, of course, we heard many times from the Ministry of Health.

I referred to the attendance of the Māori Women’s Welfare League at select committee with Dame Silvia Cartwright. I think it’s important for the House to remember that the report of the cervical inquiry was in 1988—33 years ago. I want to read this excerpt from the background provided by the Māori Women’s Welfare League, because we are decades down the line and it’s still important that this is a focus, and I quote, “In her report of the cervical inquiry in 1988, Dame Silvia Cartwright recommended that a nationally planned population-based screening programme should be implemented as a matter of urgency. In relation to that recommendation, Dame Silvia [Cartwright] stated that a special duty was owed to Māori women who had three times greater risk of contracting invasive cancer, complicated by barriers to Māori women being screened which were identified as a ‘financial, cultural, and questions of accessibility.’ Dame Silvia Cartwright identified the need for a programme to be developed in consultation with Māori women”. It is 33 years down the line and we are still talking about this.

I refer to the Māori Women’s Welfare League because in their submission it was important that whare tangata and its sanctity is important and continues to be, but also in the information shared by the ministry. So we’ve heard from the Minister speaking about the definitions of bringing into technology of this bill—making it come to technology in terms of fax machines and whatnot, but, really, what remains the same is the concern about the sharing of information relevant to Māori women. One of the focuses of the group was about the sharing of data for research and for publication. So I’m glad to hear from the Minister that the fourth change that is recommended by the committee will introduce the new clause 6A to the bill and that the clause provides that section 112ZE(1) of the principal Act does not override the requirement of the kaitiaki regulations, and I think that’s important.

I really want to talk about the sacredness of the whare tangata. As a Tongan, we refer to the whare tangata as the “fonua”, which is one of our many words for fonua. It could mean land; in terms of Māori it means the whare tangata, it means the afterbirth, so it is important—this is really important. In terms of whether it’s invasive through sharing of information for publicity in terms of research, it must—and it must—go through the kaitiaki programme because of the importance it has for Māori. But when we talk about Māori, we forget that it’s important for New Zealand. So in the care that they provide for information for Māori women, we then follow on as new migrants to Aotearoa after Māori. So I really want to echo that care that it is important in terms of the act in itself of providing information in terms of cervical screening, and it’s also important in the sharing of the data, whether it be for publication or internally.

I just want to echo too the acknowledgment that our fellow MP, our fellow sister, the Hon Kiritapu Allan is going through a tough time, but with all the whole country’s prayers and all of this House we want to say, “Kia kaha wāhine toa.” In your experience, that experience itself has helped women come out to look at their health in a new way of achieving health for themselves.

It was said before that this is mainly a women’s issue, but it is actually all of us—it’s an issue for all of New Zealand. And when we do care about the whare tapa whā, the fonua, the woman, we protect our future. And in that case, I commend the Health (National Cervical Screening Programme) Amendment Bill to the House. Fa‘afetai tele.

Talofa lava. I cannot start my speech without acknowledging the Hon Kiritapu Allan. When New Zealand now talks about or thinks about cervical cancer, I’m sure many of us have her face in our minds. I want to take this opportunity in the House to commend and congratulate the Minister on her bravery in sharing her story with New Zealand, because I think it has had a powerful impact across our communities in terms of women’s willingness to have screening, to go and have those tests, and that is an incredibly powerful thing to do. I just want to put on the record for this House, Kiritapu, that we on this side of the House stand with you as you work on your recovery. We wish you every piece of wellness on the journey you are on now, and we wish you a very good recovery.

This bill is about making the technical changes that are needed to ensure we have modern healthcare services available in our society. It’s a great case of where technology and innovation have gone ahead and the law, unfortunately, hasn’t kept up. So National absolutely supports this bill for the practical changes that it makes.

I want to acknowledge the select committee, which I didn’t sit on, but which I understand has heard a number of submissions on this. I want to acknowledge Dame Sylvia Cartwright, who is the figure who stands in the background whenever we talk about cervical screening and the processes used. And actually, having now read this bill and looked at it in preparation for my contribution tonight, I want to acknowledge the healthcare workers and the clinicians and the people involved with the cervical-screening programme who have had to put up with a ridiculously outdated framework, governing Act, for far too long. I almost coughed on my coffee when I read that the status quo is that currently, when cervical screening providers need to access clinical information about individual patients, they do so by fax, that the National Cervical Screening Programme staff fax the information to them. So I just want to do a shout-out to those staff and the people on the other side of the fax; they should not have been having to put up with such outdated technology and such an outdated mode of communicating for so long. I am glad that Parliament is taking the opportunity to remedy that and allow them to move into 2021 and the technology and options we have available to us.

It’s my view that if we want to provide good modern healthcare to New Zealanders, then the things that we should be considering are: what can we do to make that healthcare better, to ensure people get it sooner, and to ensure that wherever possible they get it closer to home? What this bill essentially does is it makes it easier for people to get the screening that they need. It makes it more convenient. It will encourage more people to do it. Those are good things. It shows the power of technology to improve healthcare, because by having databases that are more accurate, that are more easily updated, and by ensuring that more people are able to access them for appropriate purposes, what we actually have is an end result for the patient, and the end result for the patient is that the healthcare people in their life have connected up the information about that individual’s health. That is, I think, what we should expect in terms of all healthcare practices—that, wherever possible, people are joining those dots on the patients’ behalf, so that they get the care they need as soon as possible.

I can’t help looking at this bill and thinking to myself “Doesn’t this highlight how far New Zealand has to go?”, but also what an opportunity we have to improve our health services by harnessing the power of technology, because this is just one area of our health system where things have fallen woefully behind. We are still in a situation where data sharing even between GPs and hospitals, even between hospitals in one DHB and hospitals in another DHB—even sharing information, accessing information about my own children’s health records is still overly cumbersome, too difficult. That is because we haven’t fully harnessed the power of the technologies that are available in our modern world. It’s my view that if we do that, we can actually provide much better care to people, fewer things get missed, and more people get the services that they need.

This bill deals with screening. Screening is a vital form of primary healthcare. If we get screening right, we are right at the prevention end of things. And I know that all of us in this House share a view that it is better to prevent things than it is to have to treat things down the line. So having a good framework for managing the national screening programme makes good sense from a primary healthcare perspective and will ensure that the screening programme is more accessible and is just simply more practical for more people.

One of the things that this bill does and deals with that we are having to grapple with across the board when we look at technological amendments, when we move from fax to computer, is this issue that there is the potential for privacy to be compromised, there is the potential for data to be compromised, there is the potential for individuals to have wide access to information that they could misuse or manipulate. So I am pleased to see that this bill sends a strong signal by creating an offence for those who might choose to amend the cervical-screening register without authorisation. That is something that modern technology may make easier to occur, but of course it would be a very grave offence in that doing that could compromise the health of not only individuals but many people but would also, I think, very importantly, undermine trust in this database, in this system.

That is something that we all need to protect here. Women need to know that when their most personal data is being held in a national register, it will be protected, it will be looked after, that it is there to look after their health, and that it won’t be compromised in any way. And I think offence provisions like this, while I very much hope they won’t have to be used in the sense that I hope there aren’t abuses of this register, they do allow for a very strong signal to be sent if that occurs.

Finally, I think in this bill what we see is the power of research and development innovation to unlock future ways of both preventing, screening for, and treating cervical cancer. Because what we see in the detailed provisions, for example, is the fact that we now are moving to screening for HPV, primary screening for the human papilloma virus—forgive me, medical people listening—rather than simply screening for examining cells. That reflects the fact that we now have better research, we have better information about what are the precursors to cervical cancer, but we also know that this bill will accommodate some of the new ways we have of screening that are easier for women, that are better for women, that potentially allow them to feel more mana and dignity in the testing process, and that I really hope—I really hope—will ensure more women do the testing we so need them to do so that they can live good long lives and so that if they have problems, we can catch them as early as possible.

I’m also hopeful that there will be further research and development, there will be further technological development that means that in the future, fewer women in this country die of cervical cancer, that fewer women in this country have to go through the trauma and sadness of what we now all know, as a nation, is a very extreme form of treatment for a very serious disease. Yes, this is a small and practical step, but it is important, and I say again, to the Hon Kiritapu Allan, I have you in my thoughts tonight.

Talofa, Madam Speaker. Fa‘afetai tele lava for the opportunity to arise today and take a call on this bill. But can I first acknowledge, please, like everyone else, including across the House, our colleague, the Hon Kiritapu Allan—and I have said before but, as a newbie settling in, she was very supportive, gave us a lot of tautoko, a lot of guidance, and for a new MP that’s huge and something we really value. I know I speak for all my other new colleagues when I say we’re with you, and kia kaha wahine toa. Thank you.

I wasn’t on—obviously, being a newbie, I wasn’t on the select committee that considered this, the Health (National Cervical Screening Programme) Amendment Bill, but I know they considered 16 submissions, three of those oral, and can I just say, thank you for that work. Because this bill isn’t just a bill—like others have said—this bill is going to save the lives of many of our women in Aotearoa. So thank you to those on that committee.

As other people have said, this bill is about modernising the technology and upgrading our systems. Currently, like others have said, when cervical-screening providers need to access clinical information about individual patients, they have to do so by fax. And although I look really young, with no wrinkles and no grey hairs, I also remember faxes, so now I’ve probably busted myself and am showing my age. But yes, I also remember faxes and how long that takes, and God forbid if there’s a power cut and the fax stops because the line doesn’t—it’s diabolical.

So to be able to be sure that we can modernise our system to make it easier to not only contact our patients but also look up our patients’ records—health professionals, of course—right there is obviously a lot easier, especially for women who are having to come in and talk about smearing our mea. And I feel more comfortable saying that rather than talking about other things—you know, cervical smear. So, yeah, we’ve also heard tonight that 160 women develop cervical cancer, and as has been said before, 50 die from cervical cancer. And we know that a majority of them, unfortunately, are Māori women. So this bill will come some way to making that less and less, and will save many more women, particularly Māori—and, can I say, Pacific as well.

Because, as a Pacific woman—and, as I said, I’d rather say “smear your mea”—and having a Pacific mum growing up, and, Madam Speaker, you may have also experienced this as well: things like this were never talked about in my household. That didn’t mean that my mum didn’t care about my health or what needed to happen to me as a women; it just was never talked about. So even for me—again showing my age—when I started to have cervical smears, it was my friends that took me along to that rather than my mum. I’m happy to say now that there is much more awareness and much more encouragement, and much more of an effort to make sure that we are messaging that out to Māori and Pacific women in the channels and the messages, and how we need to hear that, so then we’re getting a bit more of an uptake in our people “smearing their mea”, and that’s fantastic.

However, like I said, this—although it’s small—technical change will make a big difference to women who are feeling very mā when they come in to talk about having to get their mea smeared. So, and again, I know this is probably quite similar to many Māori women as well—you know, being close, Moana a Kiwa are cousins of the Pacific people—I can imagine that it’s a similar thing, having to go in and, first of all, talk to nurses and doctors that you don’t even know, or receptionists, to talk about why you’re there and then having to wait until they, back in the day—or, sorry, even now—fax away your stuff. It can be humiliating. So being able to now make those changes, again, is going to make that whole process—although I still can’t, kind of, talk about the whole process, it will make it a bit easier for many Māori and Pacific women.

I know I acknowledged Kiritapu Allan before, but can I also acknowledge the work that the Hon Kiritapu Allan is doing in this space at the moment. Again, I’ve just talked about how mā it can be for Māori and Pacific women and how we are getting better at messaging in the right way so that Māori and Pacific women understand and are encouraged to make sure they do their regular smear their meas. What Kiritapu is doing at the moment while going through her own wero to me is just an inspiration, that not only is she fighting the really good fight—and she’s strong and she’s young and she’s an inspiration in that field—but she’s also thinking about other women. And even on her really bad days, and you can see sometimes she might have had a really hard bout of chemo, she’s still talking about, “Hey, get out there. Smear your mea.”, and trying to save women’s lives, just like this bill is doing.

So while this bill is small, focusing on modernising the current system, this bill is actually mighty in what it actually does. Essentially, it saves women and it saves many of our New Zealand women, and for that, again, I am grateful, and I want to say fa‘afetai tele lava to the select committee who worked on this bill. I also want to acknowledge our Minister, Ayesha Verrall, who’s championing this cause—as well as many others—for women, and of course with her announcement around the cervical smear and breast cancer screening, as well. Can I just finish by saying it’s such an awesome time to be part of this Government when we are making massive changes for all New Zealanders, but certainly for our wāhine toa. So I just want to say thank you again, fa‘afetai tele lava, and I commend this bill to the House.

Motion agreed to.

Bill read a second time.