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 third time.

It’s a pleasure to see this bill through to its third reading. This legislation is needed to enable the National Cervical Screening Programme to take advantage of modern information technology and also pave the way for HPV primary testing, which causes 99 percent of cervical cancers.

As we’ve discussed previously in relation to this bill, the current situation is that when a woman presents to a provider for cervical screening, if the provider isn’t her regular general practitioner, the provider will need to request by fax access to that person’s screening history. This happens via outdated technology, including fax. So this bill clears the way to allow health practitioners to have direct look-up access into the screening histories of participants in the screening programme, which will be secure by log-in and read-only access. This is the same as many other information systems used throughout our health system.

And if we just reflect for a moment on the importance of cervical cancer in countries without a cervical cancer screening programme, cervical cancer is one of the leading killers of women in the middle of their lives. And our cervical cancer screening programme does a good job of preventing that type of impact; however, we must improve it so it can continue to be a world-class system.

We have covered at length, during the second reading, some of the technical aspects of this bill, so I thought I would like to take the time during this third reading to cover some of the history of this screening programme to contextualise the present changes. The National Cervical Screening Programme was New Zealand’s first population-based screening programme, and it led the way for all our other screening programmes. The programme was established in 1990 after the Cartwright inquiry in 1988, which investigated allegations concerning the treatment of cervical cancer at National Women’s Hospital and several other related matters.

As a result of the inquiry, there were also important changes in other areas of health, which I’ll come to later. That inquiry arose out of a groundbreaking article in Metro magazine, written by Sandra Coney and Phillida Bunkle about allegations of women under the care of Dr Herbert Green at National Women’s Hospital. Women with carcinoma in situ, so early cancer, weren’t informed that they were the subject of cervical screening research. Dr Green had been monitoring them and not treating them. This went against the current practice at the time—it’s not a case of treatment standards evolving during the period of his practice; it was against practice at the time. As a result of this mismanagement, a number of women developed cancer and subsequently died.

I want to acknowledge some of the people that contributed towards the sweeping changes as a result of the inquiry. Firstly, Sandra Coney and former MP Phillida Bunkle, who were authors of the groundbreaking article and were also involved in the setting up of the Cartwright Collective: a women’s health advocacy group for cervical screening. Of course, Dame Silvia Cartwright herself—the judge who chaired the inquiry—and survivors like Clare Matheson, who spoke out to the media about their experiences, sharing their story publicly so that the public and the country could understand the very human impact of what had happened.

There were also medical advisers to the inquiry who subsequently had long roles in advising the development of the National Cervical Screening Programme. These include Professor Charlotte Paul, a specialist in public health and epidemiology; colposcopist Dr Gary Fentiman; and Dr Peter Sykes. Another person who was instrumental in the setting up of the national screening programme in the years after Cartwright was Professor David Skegg, an epidemiologist who continues to help the Government with many of the COVID challenges we are facing—recently serving on the Epidemic Response Committee.

Early on, the programme was regionally based—it wasn’t initially a national screening programme, and women across the country worked hard to encourage others to be screened, nurses took up roles as smear takers and trained as smear takers, and very dedicated women in health administration set up their own registers and set up measures to make sure that women were followed up.

After the Cartwright inquiry, the National Cervical Screening Programme has gone on to be nationally linked up and a number of positive developments in the quality of the programme have occurred over time, but it has not been without controversy, including when women in the Tai Rāwhiti region had errors in their slides being read and legislation was subsequently passed to ensure that the deficits in the programme then were addressed.

But Cartwright had wider impacts beyond just the impact on the cervical screening programme, and I think it’s worth going into those further as well—not just in New Zealand, actually, around the world. I entered medical school a decade after the Cartwright inquiry precipitated a range of improvements in our health system. The Health and Disability Commissioner framework was set up in response to that, and that’s the cornerstone of our patient rights practice in New Zealand. Our health ethics committees make sure we didn’t have the same problems with research without consent—informed consent practice improved in both research and clinical settings. I was very lucky as a medical student to be lectured on these changes by Professor Charlotte Paul. Charlotte’s teaching on these issues was informed by her firsthand involvement in the Cartwright inquiry as an expert adviser. And she also brought to that a deep knowledge of the complexities of screening and a moral clarity on the harm done to those women and the changes we needed to make to ensure that that never happened again.

Another important point about the inquiry that’s relevant to the changes we’re making in cervical screening now is the experience of Māori women. The inquiry was a turning point for Māori women’s health, because they had the opportunity through the inquiry to express deeply felt cultural beliefs about the sanctity of te whare tangata. And it bears repeating that the barriers for Māori in accessing cervical screening are not new. We have known about them since Cartwright, and we have struggled to address them for a long time.

So following on from the inquiry, legislation to ensure the protection of women and Māori data by way of the Health (Cervical Screening (Kaitiaki)) Regulations in 1995 was put in place. And the National Kaitiaki Group, mandated as part of the regulations, was established in 1995. Until these regulations came into force in 1993, the first interim National Kaitiaki Group representatives were women including Dr Erihapeti Rehu-Murchie, Dr Irihāpeti Ramsden, and Dr Lorna Dyall, and they were joined by Ramari Maipi and Keri Wikitera. Many other wāhine Māori have been guardians of Māori data on the National Kaitiaki Group since that time. The National Kaitiaki Group is important for being the first group in New Zealand mandated to manage Māori data governance. So I’d like to acknowledge all of the women who have served on the National Kaitiaki Group over this period.

In more recent years, wāhine Māori, particularly Dr Bev Lawton, have led research on cervical screening and Bev’s focus has been on the use of the HPV polymerase chain reaction test and self-swabbing in New Zealand. And we know from her hard work that self-swabbing, which is partially enabled by this bill, is a really much more acceptable way for Māori women to have their samples collected.

So following on from the Cartwright inquiry, it was felt that it was really important to legislatively mandate all aspects of the cervical screening programme, and Part 4A of the Health Act puts this into practice. No other screening programme is regulated in this way, but I think you’ll understand from the history why that is the case.

So by way of conclusion, this bill enables direct look-up access for practitioners to participants’ screening histories. It’ll make cervical screening more efficient, and it enables smears in a wider range of settings. Along with investments announced by this Government in Budget 2021, it enables HPV screening. This bill will enable the use of information technology and diagnostics to ensure we have a high quality and modern screening programme. A world-class screening programme takes constant work, and I am grateful to the many doctors, nurses, screening experts, health officials, and women’s health advocates who have brought us to this point. But more than that, these changes will enable screening to be performed in conjunction with the developments we’re making in HPV screening at home or in the community. HPV testing will also enable women to collect their own samples.

My view is that the women at National Women’s Hospital were harmed and experimented on because they were disempowered and discounted in the medical system. That’s why I’m leading changes that will take cervical screening out of the clinic into settings where women feel more comfortable, from something that is done to us to something that we can do for ourselves. This Government will also ensure that wāhine Māori find the procedures acceptable and that they trust that their information will be used sensitively. I commend this bill to the House.

The question is that the motion be agreed to.

Thank you, Madam Speaker. Far be it from me to get in the road of what was initially a National Party bill, which made sense then and makes sense now. It’s sort of a small concern that it’s taken us this long to get to this point, and we can talk about that, but this was a pragmatic approach to solve a couple of problems.

The problems we had were that only a limited number of people could access the database—administrators—and for some reason still to be determined, faxing was the mechanism to input data and, actually as I recall from getting a consent form to get information out, they fax the information back, not at all suitable to the electronic age. Really, we were missing the opportunities that we could have had with modern technology. This was a pragmatic approach to solve those two problems, and I think this bill most adequately does that.

If I did look back and think about why it’s taken so long to get here, I think I’d probably reflect on the fact that the anticipation was that the cervical screening register would be updated and that it would be put on top of the bowel screening engine; that was sort of the mechanism—we do the core screening IT, and then each individual screening programme, be it breast, be it cervical, or coronavirus as it is here now, would sit on top of that core platform, and so most of the work would be done. As we found, it took a while—in fact there was an 18-month delay—to get the bowel screening programme out because that core engine took a little bit of time to develop. I think that partly explains why it’s been a number of years to get to this place tonight where we’re signing this through.

The select committee process was very fulsome and, as invariably happens with select committee, it added to this bill. The advice that we received from submitters was meaningful and useful, and helped us to make recommendations and changes. I want to acknowledge Louisa Wall, who was the chair of that select committee, and she particularly brought useful information around data sovereignty for Māori and particularly the National Kaitiaki Group. I was speaking with Louisa earlier around this bill, and reflecting back on the time we had through select committee, and the discussion was along the lines of how she was keen to see Māori as members of the Kaitiaki Regulations Rōpū, translating the information to data that Māori communities can actually use. She was thinking that the kaitiaki group can contribute so much more than what was originally intended. As we brought the thinking out of select committee, the Supplementary Order Paper that came through in the committee of the whole House was actually to backtrack some of the recommendations we had, because it turned out in the time frame from when we reported back to the House to now that the ministry had looked at what those recommendations were and decided some of them were not manageable for the outcomes we were looking for. We looked at that, we had that background knowledge that came through select committee, and decided that, yes, we could understand that position so we supported it in the committee of the whole House.

I also want to commend—I think in my second reading I erroneously attributed HPV to Bev Walding when, in fact, it’s Professor Bev Lawton. Bev’s done a marvellous job bringing cervical screening through into the HPV which we’re now going to roll out as a new screening mechanism. Disappointing it was turned down as a Budget bid in 2020, but here we are now, and that will improve the uptake in cervical screening for Māori, for non-Māori, and for women as a whole, as has been the precedent set internationally. This is why we were so enthusiastic for HPV to be the new screening mechanism, and I want to congratulate her and her team for continuing to press us, continuing to press policy-makers, with rational, reasoned thinking as to the benefits and the urgency around human papillomavirus screening.

While we’re talking HPV, we should just keep our eyes on a few things related, in as much as that we’re so consumed by coronavirus at the moment that the normal year 5 community vaccination of children in schools has been stood down because we don’t have enough community nurses to deliver that programme. Let’s remember the vaccines they give in year 5, in schools, is the HPV vaccine, as well as diphtheria, tetanus, and pertussis. So while coronavirus is an umbrella, all the other stuff that needed to continue on, all the other stuff we needed to do, we mustn’t take our eye off that, or there will be a tail of consequence of the course we did. And while we’re talking HPV and cervical screening, HPV is the year 5 vaccine we give in schools that has been stood down due to coronavirus, and we need to keep an eye on that.

In summary, this was a good bill when it started, it’s been made better by the select committee. We’ve supported the Supplementary Order Paper because that made sense, and we believe this will improve the access, the data analysis, and what we can actually do with cervical screening to improve the outcomes, particularly for Māori women, who disproportionately have worse outcomes, worse access, and later diagnosis for cervical cancer. We’re particularly keen to see if what we’re putting in place tonight can improve that in some way. This is a good bill, very glad to see it here. Thank you.

Thank you, Madam Speaker. It’s a real pleasure to be speaking here on the third and final reading for this bill, the Health (National Cervical Screening Programme) Amendment Bill. Just like the previous speaker, Dr Shane Reti, I sat on the Health Committee, and we heard a number of submissions on the bill. It was great to hear just the support people had for the changes that were being made. Even though some of the changes are just very technical, and it might seem that the changes are quite small, I think this bill has huge potential to, basically, improve uptake of cervical screening and to reduce inequalities and to save women’s lives.

I want to focus on just three areas tonight, and I think the first one is just something that seems to be quite small and technical, and that’s the change in definition to a screening test. What that change does is pave the way for HPV testing, which, obviously, as we’ve heard talked about tonight, has the significant potential to increase women’s uptake of screening. So what the new definition is: basically, it says, “a test, such as a high-risk HPV test or a cervical or vaginal cytology test, designed to identify women who may have, or are at higher risk of developing, cervical cancer or a precursor to cervical cancer”. I think what that does is futureproof the definition. So we’ve got HPV but we’ve also got some of the changes in terminology that are current right now.

I think, combined with the Government’s $53 million investment in this year’s Budget that’s going to pave the way for HPV testing, what that means is that, from July 2023, women will be able to access the HPV test. And I think that’s going to make a huge difference to many women’s experience. I think, first of all, embarrassment was seen, in many research articles, as one of the key barriers to cervical screening, in a lot of the literature. And I think, when you talk to people, that’s quite clear. I think the ability to self-test will make a huge difference for many women’s lives. I think, basically, being able to turn up to a healthcare professional and be able to take your self-test, your own swab, in privacy will make a real difference. Or women still can have a health professional take the vaginal swab if they so choose, but you don’t need the whole procedure that currently cervical screening needs at the moment.

I think the other thing with the HPV testing is that then screening needs to happen less often. So, if a woman has a negative test, she can be reasonably reassured that she’s very unlikely to get some of those changes that lead up to cervical cancer within the next five years. And so what that means, from a screening perspective, is that women can be screened every five years rather than the current three, which will make a huge difference as well. Initially, women will still need to obtain their swabs via a healthcare provider even if they’re self-testing, but what the ministry is doing is looking at ways to make screening even more accessible, and that’s things like mailing out self-assessment kits and making sure that they work safely for women.

So, basically, what the research suggests—there’s been some recent research that’s looked at the impact that HPV testing would have in terms of screening uptake. And, in a recent study, that found that an offer of HPV self-testing could increase uptake of cervical screening by almost three times in under-screened Māori women. That’s a huge impact in terms of reducing inequalities and reducing barriers to screening. So I think one of those simple changes in the bill, changing the definition, has the potential to really make huge differences in people’s lives.

One of the aspects, though, that’s also been talked about is improved access to the information that you need as a screener, in terms of being able to look up the data on the register rather than having that information faxed through. I think there’s been quite a lot of conversations and people noting the old system of having their data faxed through to a smear taker, having to wait for that, and then moving forward. But I think, if you look at some of the inequalities, again, in our cervical screening rates, and making sure that those staff that are working for the ministry or DHBs who have been hired to follow up women who are, basically, not responding to their screening recalls and just seeing if they can get in touch and talk through that with them—and I think being able to do that work, a lot of that work in terms of trying to contact people, is basically happening in the evenings or after hours. And so being able to have the flexibility to be able to use the look-up access functions of the register is quite important in that respect, rather than having to wait for somebody else, who may or may not be on duty at the particular time, sending you that information through. So I think that again offers quite a big improvement in terms of reducing barriers to screening and access.

The direct access will be expanded also to include those who are undertaking research and evaluation, but just making it quite clear that those privacy protections—that protection of the register—will still be in place; so, basically, privacy requirements preventing unauthorised access and preventing publication of any information that identifies individuals. But also that level of protection in that the national screening programme manager still contains control over who’s granted access to the register, and it’s also got access as an auditable activity. So it means that those protections are in place. And there’s also, basically, an offence if you amend the register without the national programme manager’s authorisation. So I think there’s a range of protections in the bill so that, while we are expanding access to be able to look up data on the register for particular purposes, those protections are there.

Just in the final few minutes, I’d like to focus on the Supplementary Order Paper (SOP) that the Government has put through, and that relates to some of the changes around the regulations in the National Kaitiaki Group, and this was something that we spent quite a lot of time on, as a select committee discussing, because it’s really important, in terms of governance, when we’re looking at data that’s identifiable in terms of Māori data, that the kaitiaki group has approval of what happens to that data. What the SOP looks at is how we can make sure that those working within the screening programme can get on and do some of those more routine, mundane data updates without having to seek that approval but, at the same time, making sure that, if you are going to be publishing information which is identifiable in terms of ethnicity, in publications, then you do need to get approval from the National Kaitiaki Group in terms of the way that that occurs. Also, if you’re compiling statistics on other issues, the same thing applies—but, just in terms of the day-to-day functions, making sure you can do your data refreshes, your data back-ups, making sure staff can get on and do that at pace with the usual business of the work that goes on within the screening programme.

So, basically, what we’ve spent time on in the SOP is just clarifying those functions and what does need approval and what doesn’t, which is incredibly important because, where we’ve got larger inequalities in terms of access to screening, in terms of screening uptake, it’s really, really important that the National Kaitiaki Group has approval and has involvement in the publication of data that relates to Māori. So that’s crucial. And the kaitiaki group members and the ministry will be continuing to work together in partnership to strengthen Māori governance around the data within the programme. So that’s incredibly useful.

What I’d just like to conclude with, though, is just talking about some of the changes in the bill—not in the bill but in the way that the bill will then lead to—and particularly the use of HPV screening, because this is the research I quoted earlier. This was a study that was taken up in Northland, looking at women who hadn’t been screened for some time, a group of Māori women. What they found was, with the offer of self-screening with HPV then following through to who actually took up screening, 59 percent were screened, whereas, if they were just offered the traditional cervical smear, what they found was only 21.8 percent of those women were screened. That’s a huge difference. So what that was was, basically, 2.8 times more likely to be screened if you were offered this HPV rather than the standard cervical screening. So that’s the huge potential that we’ve got to reduce inequalities in cervical cancer by improving our cervical screening rates.

So, just summing up what this bill does, it does a whole range of things, but, basically we’re updating the definition of screening so that that does allow for HPV screening. It provides secure login access to those that need to use the register for a range of purposes, and also, with the Government SOP, it provides clarity around the role of the National Kaitiaki Group in terms of providing approval for the use of identifiable data where people are identified as Māori. So a really important bill—

Order! The member’s time has expired.

I’m acutely aware that I’m following on in my commentary from a Dr Verrall, a Dr Reti, and now a Dr Craig. I won’t be able to comment on the clinical aspects of this bill, but what I can comment on, on behalf of the National Party, as our spokesperson for women, is the benefits that the Health (National Cervical Screening Programme) Amendment Bill will bring to women across Aotearoa New Zealand. We in the National Party do have a long and proud track record of going into bat for, and ultimately creating and changing law that ensures improvements to, women’s health.

It was, after all, our party that instigated this amendment bill and, indeed, was in Government during the early 1990s when the National Cervical Screening Programme (NCSP) was rolled out. It seems that while the screening programme itself has grown and evolved since the 1990s, the technology unfortunately has not, which is why we are here this evening supporting this bill into law. It makes small, technical changes that will deliver big results. Who would’ve thought that in the 30-odd years that this screening programme has been in place, the dedicated health professionals like Dr Craig would still be relying on the same technology that they did all those years ago when it was first launched, and, indeed, a fax machine.

The amendments, that have been traversed and canvassed around the House, will allow health providers and staff to look up information directly using secure login via the internet. So it will, essentially, bring clinical information processes into the 21st century. I note in reading from submissions from those that have spoken to the Health Committee that district health boards particularly have submitted on this and they welcome the direct access to the NCSP Register, and they’re considering the amendments positive. Nurses, too, are saying that access to the full history of any woman will ensure recalls are not too often or too few and will allow HPV testing if and when required.

I thought interestingly, Family Planning provide about 19,000 cervical smears a year, and access to the NCSP Register will support greater efficiencies in cervical screening recall by being able to check directly to determine whether an individual on their recall list has had samples taken elsewhere since they last saw the patient.

While it will speed up the process for smear takers in primary care, importantly, it does not compromise patient privacy. On that note, some submitters have raised concerns that the access to confidential information is in breach of privacy law, but it is comforting to see the Privacy Commissioner has said that he sees no outstanding privacy issues. I would like to acknowledge Minister Verrall for sharing her thoughts as we traversed this issue during the committee of the whole House stage. I did ask about the robustness of the platform and the testing that has taken place around protecting data security, and she has confirmed to this House that it will be equivalent to the IT systems used by DHBs for other national programmes, so she believes it is robust. So while this platform isn’t unique, what is unique is how very specific this legislation coming through this House is and that it will also enable future upgrades and improvements both to the IT and the screening programme itself.

So, all in all, we on this side of the House support changes that will allow easier access to primary healthcare for women, therefore improving the lives and welfare of New Zealand women. I commend this bill to the House.

Kia ora e Te Mana Whakawā. It’s an absolute privilege to speak on the Health (National Cervical Screening Programme) Amendment Bill.

I have fond memories of this bill because this was the first select committee I was a member of when I entered Parliament. So I want to acknowledge the team that worked this through.

As Dr Shane Reti has alerted us to and reminded us of how this bill has started in this House, I’m just going to give a summary of the points I’m going to talk about, because sometimes I talk for so long that I forget to cover the main points. So I want to give a summary of the bill. So the summary is that this bill will strengthen and improve the National Cervical Screening Programme. It puts in place rules that allow specific health providers to have direct access to participants’ screening history held on the cervical screening register, information which helps determine or recalls screening referral pathways, as the last member has alerted us to, changing the technology because the current law refers to fax machines. So this will enable a new IT system is placed to ensure access is secure to the register.

The Minister, Dr Verrall, had acknowledged that—in her contribution had taken us through the story and the history of how we came about it today. I want to acknowledge her leadership in telling that story, because it reminded us of exactly why this is needed. So the Supplementary Order Paper (SOP) that was provided made it practical to ensure the changes to the National Katiaki Group can continue. The National Kaitiaki Group can continue to have oversight of the Māori data. I want to quote Dr Verrall, because she did say a quote: “A turning point for Māori women’s health about the sanctity of the whare tangata.” That’s where the Government’s SOP came about to ensuring that the National Kaitiaki Group can continue to have a good oversight of Māori data while at the same time ensuring the programme’s in tune with data, and information management activities can continue at pace.

Why is this important? This bill is important because it saves lives. One hundred and sixty women develop cervical cancer every year, and, sadly, 50 women die from it. This is sad. It’s just sad because almost all cases are preventable or can be treated if found at an early stage. So that’s why this bill is important.

The bill will improve services provided by health providers. When I made mention to access to information being faxed, that in itself sets us back decades, and a great barrier to access to information. So for health providers who provide cervical screening—which includes the medical practitioners, Family Planning as mentioned before, and sexual health clinics—nurses and midwives working in primary healthcare can have access to the data. Also having access—well, we all know, I’m not a doctor, but knowing my health history will help my doctor provide treatment for me. So access to a participant’s screening history information is crucial in terms of clinician decision-making when a cervical screening test is undertaken.

I want to also refer to the National Cervical Screening Programme and how it plans to develop a new register. So the new register can, amongst other things, provide, as I’ve said before, secure information, secure computer direct look up, access to the register for health providers working in primary healthcare. The legislation changes will ensure that secure computer direct look up access to the register for health workers is explicitly and directly authorised by this legislation.

One of the concerns that one of the groups that submitted, the national Māori Women’s Welfare League—their concern was about privacy of information and about the ability of the kaitiaki group to maintain the access to data of Māori women, and this can still happen in this bill.

As much as I hate and it’s sad that I refer to 50 women dying from cervical cancer each year, the majority of those women are Māori, are Pacific, and are Asian. So this bill will, in its journey, help save lives. So the services provided by Māori and Pacific providers are primary health organisations. Some DHBs, one Whānau Ora commissioning agency, a non-Government agency—those services that provide the services will have secure access to information to be able to support women as they go through this.

We talk about in this House that it is a cervical screening programme. We talk about it in just words but for women it’s a journey that takes a lot of thinking to get done. But I just want to, if I forget in my contribution, remind women that it is a long journey to think about getting your screening done. It’s challenging for us to think about ourselves first, but really do make this a priority in your life. I want to challenge the men in women’s lives to make it a priority for yourself, because if your partner is a woman and you have daughters, it’s you—well, it is everybody’s responsibility to ensure that women get the help they need.

So also this bill, what the bill does, it clarifies the meaning. Like I said before, I’m not a medical practitioner, but we call it the “smear”. The words, the definition of “smear” is now no longer applied under this bill. The bill amendment has proposed the definition of “screening test” within; the phrase “smear” is removed so it’s no longer a “smear test”, that it’s a “screening”. So one reason for the amended definition, as I said I’m not a practitioner, moving away from using the term “smear”: sometimes it’s not a positive word to use.

I did mention before in terms of protecting the Māori data and how that will be protected in terms of clause 6A and the National Kaitiaki Group. The reason why it’s important to—why we should legislate this response in terms of 6A is because it is important. The National Kaitiaki Group is a group established under the health, cervical screening, regulations since 1995—that is important. In my second contribution, and I think today I mentioned it once is the whare tangata, which in Tongan we call it the fonua which is whare tangata. In terms of my understanding of how I translate my Tongan views, aligning it with Te Ao Māori, it is the “house of humanity”, and the data of Māori woman should be treated that way, that it is sanctity, that it is information that you would—because of the history that Dr Verrall had taken us through in her opening statement of how women weren’t informed about their information, how they weren’t informed that they were being used in a clinical test without them knowing, that’s why it’s important that the role of the kaitiaki group continue. The role needs to be still in legislation to keep that important in this bill.

In my last seconds of this bill, I want to acknowledge those who have lost their lives due to cervical cancer. Perhaps if we removed the barrier earlier we could have saved a few lives. But on that note, I commend this Health (National Cervical Screening Programme) Amendment Bill to the House.

Kia ora. I stand on behalf of the Green Party to be in support of this bill. At its heart, it makes information more easily available to the staff on the national screening programme so that they can do their work better on behalf of the people who need it. So on that reason alone we support it.

Throughout this process, as Minister Verrall has guided it through the House, we’ve consistently raised two issues, and so we want to just recap those and see where’s it got to through this process. So the first one is about inclusiveness, the acknowledgment that even though we couldn’t make the language in this bill inclusive, one day we’ll change all the language in all the bills and all the Acts. But we have been assured that this service is open and will be open to all the people with a cervix and vagina, the whare tangata—a much more beautiful language. That includes trans men, intersex, and non-binary people. Minister Verrall has also indicated that in the programme, with all the new technology that it will have, that people using that service will be able to self-identify their gender. There are very few places where takatāpui and rainbow people are able to do that. So while I have the floor I would like to do a shout-out to Minister Tinetti in the upcoming work on the Births, Deaths, Marriages, and Relationships Registration Act, which will follow up from that already world-leading legislation on self-ID for drivers’ licences and passports with being able to identify gender on birth certificates.

In ngā kaitiaki group it was actually really lovely to hear Minister Verrall give that whakapapa of the group and of the screening programme, and it resonated for me in two ways. One of my aunties was one of the women affected when those mistakes were made in the Tai Rāwhiti, and she passed away after being misdiagnosed by the programme. Also, Erihapeti Rehu Murchie, who was one of the first people on the first kaitiaki group, a staunch advocate for Māori women and children for her entire life. She is someone that I mentioned in my maiden speech as having been an early mentor for me and I’m sure many, many other people through her incredible work. Also, the late Irihapeti Ramsden.

Over the years, though, the function of ngā kaitiaki, I think, became less and less important. And as the early papers show, there were several years there where no reference was made to them at all. I am really hopeful and confident with the new work around this and making more of an emphasis on that group, clarifying the parameters of their work, that that will become a staunch group advocating on behalf of Māori women and takatāpui. So everything we do to support this screening programme and every other programme like it will save lives. I’m very, very happy to come in this bill to the House. Kia ora.

On behalf of the ACT Party, I’d like to stand in support of this Health (National Cervical Screening Programme) Amendment Bill. It’s a very important bill. A lot of women out there fail to get their screening each year because they don’t get their notifications or they ignore their notifications, and it’s a very sad occurrence. And it’s also very sad to hear that faxing is still around. I’m one of the old generations. I still remember faxes and having to put that beautiful, heated paper into the fax machine where a lot of the younger ones will only know faxing by our beautiful new printers that we’ve got with a fax option that you put through the computer screen.

This amendment makes it a lot easier for data to be able to be sourced through modern technology. And we can keep a better track of where women are at with their lives. It’s very important that we have this modern technology in all our screening areas, just not this, and it’s really sad that it has taken us 30 years to get to this stage—it’s sad that it hasn’t been recognised beforehand and it’s taken this time.

My biggest thing—while we’re here, also as colleagues across the House—is actually to remind women not to ignore the messages that they received for reminders, because three years does come very fast when you’re busy and you tend to forget that that is up. Now also with the screening programme including HPV, the human papillomavirus, and that’s a huge thing. For me also, being an ex - lab technician, and how technology has changed even from when I was there as a lab technician.

But the biggest thing of all is that we’ve got to remember that we’ve got to make sure that we have services that are flexible, that will deliver what the customer needs in mind. That’s the biggest thing of all—that we are a service, even in health. It is a service, and we’ve got to make sure that we are giving the best service that we possibly can give.

Now, the biggest thing of all is ACT does support these changes in updating the technology as it will lead to efficiency, but it is better for both patients and those carrying out these screening tests, because it makes life easier for those nurses and our GPs to be able to get that information faster. We also know that it’s even difficult when we do move cities and towns to get into new GP practices—that sometimes our information does not follow us. So I’m only taking a very short call, because the majority of the people have gone through all the technical side of this bill. Most of all, we would like to commend this bill to the House. Thank you, Mr Speaker.

Thank you, Mr Speaker. It’s an absolute pleasure to rise to speak in favour of this bill. Many of my colleagues across the House have spoken about the importance of this screening programme and of the improvements that are being made, but I’d just like to refer back to my colleague the Hon Dr Ayesha Verrall when she was referencing the origins of this particular screening programme and referring back to the Cartwright inquiry. I’d just like to add my voice to hers in gratitude for the work of Sandra Coney, Phillida Bunkle, and, of course, Dame Silvia Cartwright. When I was studying midwifery was the first time I came across the Cartwright inquiry, and it’s deeply shocking to hear what happened, for the first time, to the women in this country and also to acknowledge that it happened against the current medical practice at the time. Unfortunately, obstetrics and gynaecology and maternity care historically have some dark areas, and that’s one of them. Another area of darkness would be the development of the Sims’ speculum that was done on the, obviously unconsenting, enslaved people. So there’s an awful lot of work and an awful lot of history that we have before us.

You’ll understand, when you hear about the Cartwright inquiry and of the experimentation that took place without the consent of the women involved, that this has generated in me a lifelong commitment to informed consent and also to advocate for the best possible provision for all, but for women in particular. In saying that, I’d also like to acknowledge the words of my Green Party colleague on the Health Committee, Dr Kerekere, who was speaking of the importance of inclusive language. It is really important. Though I would acknowledge that the majority of people who are affected by this bill would probably define themselves as women; obviously, not everybody with a cervix and vagina would do so. It’s really important that we do use inclusive language when we’re referring to these screening programmes.

So we’ve established that 160 women a year, so far, develop cervical cancer, and 50 of those will die from it. As my other colleague said earlier, this is just a tragedy. We, obviously, want to do everything we can to ensure that those numbers are reduced and that cervical cancer, if it exists, is detected early.

We’re changing one of the words in this bill so we’re actually referring not just to the cervix but also to the vagina, because the programme screens for vaginal cancer as well as that of the cervix. So I would acknowledge too the women and other people who experience vaginal cancer, and acknowledge the importance of diagnosing that early too.

The National Cervical Screening Programme has reduced the incidence and death by cervical cancer by half since 1990, which is an extraordinary achievement. We still have more to do; unfortunately, only 61 percent of eligible wāhine Māori have been accessing the programme, and we have explored the reasons for that, which, of course, backs up the rationale behind this bill.

I’m, obviously, delighted that Budget 2021 has put up to $53 million into implementing a new test for human papillomavirus, because this causes 99 percent of our cervical cancers. What we’re moving towards, in two years’ time, is a simple and quick swab that people can choose to do for themselves. As we said before, we’re moving away from the language of “smearing”, because what we’re doing currently isn’t smearing those cells on to the slide ourselves but actually using a soft brush to get some cells from the cervix and then put them into a medium before they’re looked at under a microscope.

To make the changes that we’re hoping to make, we do need new legislation. The key amendment addresses how we’re going to do it and for what purpose. What we’re going to be doing is improving services that are provided by health practitioners, and what we’re going to be doing is to enable them to access the records of participants in the screening programme more easily. At the moment, and certainly historically, we have had to do that via fax. My colleague Toni Severin was talking about being old enough to remember faxes. Well, I’m not just old enough to remember faxes; we’ve actually been using them in the health service for a very long time, and it’s good to see us moving forward. They’re horribly unreliable, and it’s really not the best way for us to be transmitting health information. So what we’re going to be doing is allowing health practitioners who are providing cervical screening to be able to access this information, and I’m looking forward to us being able to do so in a more effective way.

Some people have concerns when they’re looking at a direct access computer-based system around privacy, and that’s a completely legitimate concern and one that we have had to address, obviously, consistently moving forward from this bill. So just to reassure people, we are looking at only a read-only look-up access, so the people who are entitled to look at this information are not, by and large, going to be able to change it. It’s going to be very secure access, with a secure user name and password, and everybody that’s moving forward into being able to access information will also be subject to the Privacy Act 1993 and, of course, their relevant health professional regulatory constraints and employment and contract laws. All of their use will be subject to audit, which is something that we are, as health practitioners, really aware of as existing currently. It’s important to know that just because you are a health practitioner and providing that cervical screening yourself doesn’t necessarily mean that you have access to the information for anybody that isn’t one of your patients or somebody you’re providing care for. And it has to be in relation to the provision of that care. There’s very strictly defined access, and there is going to be, obviously, a consistent application of disciplinary processes if those are breached.

One of the other smaller changes that we’re looking at in this piece of legislation: as I said, we’re going to be referring to the vagina as well as the cervix because of the vaginal cancer risk, but we’re also using a wider definition of “screening test” rather than “smear”, as I explained a little earlier.

I think that we can all agree, across the House, that this bill is an important piece of legislation, and it’s really reassuring to see the agreement that I have seen and heard from all of my colleagues on all sides of the House. I would like to commend this bill wholeheartedly to the House. Thank you, Mr Speaker.

This is a split call. I call Harete Hipango—five minutes.

E te Māngai, thank you. Look, this evening there’ve been a number of doctors in the House that have made “house calls”, which is something that I recall from my childhood days. So it’s been somewhat reminiscent particularly to listen to the expert contributions from those of you in the health sector. I acknowledge you for that; thank you.

I also recollect that I had the privilege of standing to address the House on the first reading of this bill. The House was full at this time. It happened to coincide with the Hon Bill English’s valedictory speech, and in taking that call I was cut short. I have a brief call this evening—again, soon to be cut short—but that does not in any way lessen the significance of this bill being passed into law with its third reading.

I reflect that at the time I addressed the House, I spoke about the vein and vernacular of a smear and disclose campaign, which was related—and I recall very vividly, back in 1987 and 1988—to the Sandra Coney and Phillida Bunkle Metro article “An Unfortunate Experiment”. We have moved fast forward in time where having heard about the unfortunate experiences of many women who have suffered the affliction of cervical cancer—and my thoughts this evening also turn to Tale Morrison, who was the champion for our women and our Māori women. Before she died—it was almost three years ago to the day—Tale was on a crusade. That crusade, I think many of us will remember, was one of “Smear your mea”. And hearing in the House tonight the kōrero that that terminology “smear” is no longer used, but that resonates with many of us and that was part of Tale’s tohu in what she left for us.

In talking about “Smear your mea”, I say that it is also important that there is no mea culpa, as a result of that, that we learn from those experiences. It just happens to be also—talking about cervical cancer and the old terminology of the smear and the smear campaigns—somewhat ironic that I address the House this evening, speaking to that subject, but I think it’s significant. This, importantly, is about where we’ve moved forward today and the information technology. Again, it’s very fresh in our minds what happened at the Waikato DHB with the technology and the flaws that come about. This legislation will ensure it’s not only expediting and making more efficient the access to information technology but about the protection of that also.

So, look, I was around in the 1980s—I was around a little bit longer in the days of the house calls from the doctors that were made as well. But it impressed upon me very significantly the impact of that unfortunate experiment and the investigative work that was done. Here we are today as a result of the intrinsic forensic examinations that have gone on, and this legislation will ensure the protection, because it is about the information on the National Cervical Screening Programme that is to be accessed, used, retained, and disclosed in the most efficient, effective, appropriate way. I, with privilege, commend this bill to the House. Kia ora.

Tēnā koe, Mr Speaker, and thank you for the opportunity to take a short call in relation to this important bill. I want to begin by recognising the words of Minister Verrall in the House this evening, but also recognising her work in shepherding this important bill through the House. I also want to recognise the important message that our Minister the Hon Kiri Allan sent earlier this year when she shared her story. The impact of her story has in many ways been a ripple that’s created a wave—a wave of conversations but also a wave of action, as many New Zealand women around the country have spoken to each other and made the trip to have their cervical smears done as well. Several weeks ago, I attended an event run by an organisation called Empower Her, which was an ethnic women’s empowerment event at the Fickling Convention Centre in Auckland. There were about 40 women attending the event who recognised the importance of Minister Allan speaking up and the impact it had had for them, as well. I have no doubt that her words have had an impact on several.

I had an opportunity to speak to this bill at second reading, as well, when I spoke about the fact that Māori, Pacific, and Asian women have lower rates of participation in the National Cervical Screening Programme. It’s a real priority, in terms of ensuring screening equity, to raise the number of women in those groups who are getting screened, and that’s the part of this bill that I’m really excited about: looking at how the bill will enable improvements to community-based screening support services. The way in which that will happen is that the fifteen district health boards will be undertaking community-based screening support services, contacting participants who aren’t responding to recall for breast or cervical screening. I do think we should never underestimate the power of a reminder. Sometimes it’s a reminder just for busy women who need a reminder to set their appointments, but other times it’s an opportunity to touch base with a healthcare provider, someone who knows their information, to ask all those questions that only that group of people can provide. It is hugely significant.

There are a lot of cultural changes we still need to navigate through to ensure that we see equity across screening stats, but if we are to tackle those really horrific numbers around cervical cancer, then we need a multi-pronged approach. We need to approach it with a scientific approach, with an education approach, but also with a cultural approach that recognises and doesn’t deny that cultural context exists. We need to capably walk through those cultural doorways and reach out with information, support, and options, and I do believe what’s exciting about this bill is that’s exactly what it does. It recognises cultural context by allowing things like being able to screen at home, in your community. It recognises cultural context by removing words that are seen as not encouraging people to turn up to those smears, to those cervical tests.

Finally, I just want to comment on the broad support across the House, which I think speaks tremendously to the importance of this bill. I commend this bill to the House.

Tēnā koe, Mr Speaker. It’s a pleasure to take a call tonight on the Health (National Cervical Screening Programme) Amendment Bill, and like my colleague before me, Vanushi Walters, I want to begin by briefly acknowledging our colleague in this House, Kiritapu Allan. Last week, I spent two days in Kiri Allan’s electorate alongside my colleague Dr Tracey McLellan, and it was obvious to us how loved Kiri is by the people in her electorate, who wanted to wish her well everywhere we went.

This bill is for all the women of New Zealand who are at risk of cervical cancer, and especially those women who have lower rates of participation in the National Cervical Screening Programme, as has been pointed out: Māori women, Pasifika women, and Asian women. This bill will address those lower rates of participation by removing barriers to participation. This bill will save lives, and I just want to note Kiri’s words to not be whakamā and to get it done.

I want to thank and acknowledge the various Ministers who have worked on this bill—Dr Ayesha Verrall, the Hon Julie Anne Genter, and Dr Jonathan Coleman—alongside our current Minister of Health, Andrew Little, for the measures announced in Budget 2021 that will assist with the implementation of this bill. I’d also like to acknowledge the Health Committee and the officials for the high quality of their work on this bill, along with all the people who made submissions. I thank you for your participation in our democratic process, especially on such an important topic.

This bill removes barriers to participation in the National Screening Programme in two ways. The first, that many have mentioned tonight, is around improving the cervical cancer screening register and the IT systems in place to enable access to the register for health practitioners. The need for consistent, secure, and patient-focused IT systems is one of the reasons why we are implementing the health reforms necessary to ensure more consistency across all of Aotearoa and ease of access to health records for medical professionals.

Last week, I was speaking to a group of nurses in my electorate of Nelson about some of the IT systems they use and don’t use when they are supporting patients in their care. It’s quite common practice for patients to be transferred between Nelson and Christchurch, and sometimes those notes that they use are based on an IT system, but sometimes they’re handwritten notes. It’s been mentioned tonight that for the cervical register that we currently have, it uses a fax system. I actually am old enough to have used a fax system, in a number of my roles, actually, including a recent one when we all, kind of, couldn’t quite understand, those of us who joined the organisation, why faxes were still being used. But it just goes to show that in many parts of our health IT systems, we do have work to do to ensure that they are modern and fit for purpose. So by using a centralised register, it will ensure that our health practitioners have access to current information that they can access quickly to ensure they can support their patients to get the healthcare that they need.

The register will put controls in place to protect the privacy of participants on the register, which is very important. It will give look-up access that is read-only for practitioners, and a new offence has been added under section 112J of the Act which would make it an offence to amend the register without authorisation. As a user of health services myself, I have often been quite surprised that my own health information is not always shared between the health practitioners who support me, and I imagine a number of New Zealanders would also be surprised at that. We do need to balance the need for privacy with the need for sharing health information across providers, and I think this bill is an excellent example of striking that balance perfectly.

One example is the amendments that have been included that relate to the National Kaitiaki Group, and that has been mentioned tonight, about the importance of ensuring that data that is shared through the system doesn’t identify individuals, and those types of protections that we put in place when using the data from the register for research purposes, to ensure that we’re also protecting the privacy of patients.

I’ve just gone through the first main way that this bill removes those barriers, and that is around the incorporation of a new IT register, and in doing so ensuring that we can have a proper and accurate tool to use to know who is actually in need of receiving their cervical screen. But the second way, and another important way that this bill removes those barriers, is through expanding the definitions and processes used for screening. Some of the biggest barriers to cervical screening are those barriers that are deeply personal to people. Those of us who’ve had cervical smears know that it is a highly necessary procedure but that it can be difficult, awkward, embarrassing, and uncomfortable. For me, it’s been a procedure I’ve had to prepare myself for. I’ve sometimes been at a GP visit and been offered a smear; sometimes I’ve said yes, sometimes I’ve said no because it felt awkward—not the right time—and I’ve declined and made another time. For people who have survived sexual assaults, the idea of having a smear can be incredibly difficult. I want to acknowledge the women in this situation, one of whom is a friend of mine, and the doctors and nurses who do a wonderful job every day supporting women while they have these important and crucial tests. I’d particularly like to just reference my colleague Dr Leavasa from his previous, I believe, second reading speech when he talked about the care he takes as a male GP to undertake these screens for women. I just want to thank him for the care and sensitivity he approaches this with.

This bill makes changes to the definition of “cervical screening”. As my colleague and chair of the Health Committee, Dr Liz Craig, pointed out in her speech, the bill removes the phrase “smear test”—and I think this is a good thing—based on the feedback that the word “smear” can be perceived negatively. The bill makes a small amendment to the definition of “screening test” to now include an HPV test. Budget 2021 invests up to $53 million to complete the design of this new test. This will allow women to self-administer an HPV test, removing a lot of that awkwardness and that difficulty that we face. It’ll take away some of those challenging times when you know you need to have a test but perhaps didn’t feel like it was quite the right time, if you know it’s something you can actually do privately and do yourself.

The bill will save lives, many of whom will be Māori women. The clinical modelling shows that it will save around 138 additional lives over 17 years. I’d like to reiterate the call from my colleague tonight, Anahila Kanongata’a-Suisuiki, that, women, we need to be screened. It’s a step we can all take for ourselves and for our families.

I’d like to finish by acknowledging the support across this House for this important bill that will improve women’s health and save lives. I commend this bill to the House.

Thank you, Mr Speaker. I’m pleased to rise to speak in support of this Health (National Cervical Screening Programme) Amendment Bill in this, its third and final reading. In doing so, like my colleague I acknowledge the medical professionals that have spoken and given considerable technical expertise in their speeches. Throughout the passage of this bill, it has been noted that the changes are largely administrative changes and updating for all of the technology advances. Again, I’d like to acknowledge the health professionals involved in the National Cervical Screening Programme and, in particular, the nurses who have had to put up with the constraints of the lack of use of technology in the screening programme. As many of us have said, it’s almost unbelievable that the fax is still being used for something as important as conveying information to health professionals who provide services in the cervical screening programme. When we think of the potential issues around the use of faxes—the privacy, the lack of productivity as people stand around waiting—it’s just incredible that we’ve still been imposing this on our health professionals.

I do want to acknowledge though the submissions that came in that were obviously concerned about privacy issues—as they should be. It is really important to note that the relevant provisions of the Privacy Act 1993, the Health Information Privacy Code, the health professionals regulatory constraints, and the employment and contract law are unaltered by the amendment, and that should give comfort to those who particularly submitted on the issues of privacy.

As my colleague Dr Reti has already spoken about, this bill picks up on the work that was initiated by the previous National-led Government, and it’s pleasing that this Labour Government has continued the work of the previous National Government on this bill, when in so many other areas it would have been sensible to do that—and I think of the very topical areas such as mental health and roading initiatives where they chose not to do this. And so we compliment Minister Verrall on being much more open to that bipartisan approach.

We have been looking at the benefits that the bill will bring to the cervical screening programme. And of course, we’ve talked about the benefits of privacy, increased speed of the information, and also the futureproofing around IT upgrades and supporting the register and improvements to the screening programme through the use of technology over the coming years. But we also need to talk about those very real improvements that will come in, we hope, the very near future with the HPV testing and that is where we are likely to see real improvements in breaking down the barriers to accessibility.

I’m very appreciative of the very fulsome history that Minister Verrall gave us on the National Cervical Screening Programme, going right back to the catalyst for the inquiry, “The Unfortunate Experiment”, a phrase actually coined by Professor David Skegg from Otago University. So while it was incredibly important for us to recognise and acknowledge the history behind this bill, one of the most exciting and important parts is looking forward with this bill. I know that in my own region, the rates of screening are less than 65 percent for both Māori and non-Māori woman in the eligible 20- to 69-year age range and, really, we should be looking at 75 percent or better. So certainly there is the hope that the HPV testing, and, indeed, particularly the self-testing, will improve those rates and that accessibility is going to be particularly welcomed. So National certainly supports this Health (National Cervical Screening Programme) Amendment Bill at its third reading and we commend the bill to the House. Thank you.

Thank you, Madam Speaker. It is great to have this opportunity to speak on the third reading of the Health (National Cervical Screening Programme) Amendment Bill, and also to be the last call for this particular bill.

Before I speak to this bill, I just want to take this opportunity—this is my first time during this sitting block—just to acknowledge, as a former sports doctor for the Blues rugby franchise, just to say congratulations to the Blues rugby team who won against the Highlanders over the weekend, in the Super Rugby Trans-Tasman final.

ASSISTANT SPEAKER (Hon Jacqui Dean): Order! Order! The “almighty” Highlanders.

Also, just as a former sports doctor for the Manu Samoa team, who will be playing the Māori All Blacks this Saturday, I wish both teams all the best as it’s going to be a close session. So I’m looking forward to that match as well.

💬 Hon Member: Cricket!

Cricket? Oh, smears—let’s talk about the smears now. When we look at this bill, it is about strengthening and improving the National Cervical Screening Programme. Look, as a GP I am glad that this bill has come through the different stages and will be passed tonight. It is about not only having the access to, I guess we would say “new” technology; it’s pretty much old technology, to get rid of this whole faxing of results because we need to futureproof our system, and it’s about time that we did the same with looking at these results coming through. It’s about being quicker, it’s about being convenient, and also streamlining care—removing the frustration of our administration that are trying to get these results on hand.

Also, looking at the Supplementary Order Paper as well, and looking at the National Kaitiaki Group having good oversight in continuing this, because of Māori data and data sovereignty—as many of our colleagues have mentioned tonight, and it’s only about using what you need, read-only access, and making sure the process is much more efficient. When I look at the testing for the HPV virus, which is the cause of 99 percent of cervical cancers, the definition of the screening test changing to include the test itself, and also the Government acknowledging the $53 million in the Budget as well, enabling this HPV testing to go ahead—this will remove massive, massive barriers.

Again, I guess I mention what the member Rachel Boyack has mentioned before, and as I spoke in what I think was the committee stage—as a male clinician it is really hard when I do consult with our women patients who come through; I can see the dread on their face when I call their name and they’re coming in specifically for a cervical smear, that they would cancel, postpone, or—

💬 Hon Member: Try being the patient!

Ha, ha—yes! But this testing, this self-test, is going to be a huge game-changer for the system. Where I practise in South Auckland, Māori, Pacific, a lot of our religious and faith-based population—culturally, as well—it will bypass those two barriers and provide better access for our women to get that test for HPV.

We’ve heard about the stats—about 50 women dying from cervical cancer in the last year, about 160 women developing cervical cancer. That’s 50 families, 50 whānaus that have had their family member taken from them. It could be for various reasons, but one of them, high on the list, is getting a late diagnosis and late treatment, and having this self-test for HPV will definitely improve on ready access to intervention at the right time.

I also want to mention the preventative measure of the vaccine itself, the HPV vaccine. It’s also known as Gardasil 9, and I acknowledge what many other colleagues have said across the House of the nurses, the healthcare workers, that try to recall our young children to make sure that they get the HPV vaccine in order to prevent cervical cancer, as well. This is on the immunisation schedule for 11- to 12-year-olds, but it is recommended for between nine- and 14-year-olds, and the vaccine is given as two doses, at least six months apart. I just want to mention this because I know that many may not even know about the immunisation schedule for our young folk, and making sure that they get access to this HPV vaccine, as well. Those who are older, in the older bracket above 15 years old, will need to get three doses of the vaccine, spaced out within 6 months, but it is that key area between 11 and 12 years old that we try to target. Again, I mention the GP clinics and nurses. We usually have this dashboard that comes up on our computer screen that tells us where we sit on our targets to make sure that we are recalling these women, and also our young folk to get the HPV vaccine. It’s tremendous work, and again, going back to the results, getting faxed results, getting that upgraded to a new system would definitely help improve our recalling system, improve our intervention at the right time.

We’ve heard about the different populations in Aotearoa—Māori, Pacific, and Asian women—that have lower rates of participation, and this will definitely help target those different populations in order to get that earlier testing, earlier results, and earlier intervention, therefore reducing the risk of cancers. These are all the things that I did want to mention, but I also want to acknowledge my own GP college—Dr Samantha Murton, Dr Bryan Betty, the Māori and Pacific chapters of the GP college that do tremendous work, and not only them but also the nursing college, as well, that does great work in this space. Those are the people I want to mention and acknowledge.

That’s why I support this bill passing through. This is going to make a huge change for our wāhine in Aotearoa. Thank you.

Motion agreed to.

Bill read a third time.

I declare the House in committee for consideration of the Gas (Information Disclosure and Penalties) Amendment Bill.