Pae Ora (Healthy Futures) (Provision of Breast Cancer Screening Services) Amendment Bill

Thank you, Madam Speaker. The National Party is putting to the vote tonight that the—

ASSISTANT SPEAKER (Hon Poto Williams): Order! Order! I require the member to read the words about reading the bill for the first time. You should have that on your run sheet.

Dr SHANE RETI: Thank you. I move, That the Pae Ora (Healthy Futures) (Provision of Breast Cancer Screening Services) Amendment Bill be now read a first time. I nominate the Health Committee to consider the bill.

ASSISTANT SPEAKER (Hon Poto Williams): Kia ora.

Dr SHANE RETI: Thank you. The National Party is putting to the vote tonight that the breast cancer screening age be increased for New Zealand women. The National Party backs clinicians to do a better job with cancer management for New Zealanders, and we will give them the tools that they need. We agree with clinicians in the Breast Cancer Foundation that free breast cancer screening needs to be increased for women between 70 to 74 years of age inclusive.

Increasing the breast cancer screening age was the National Party’s first campaign 2023 health manifesto policy, and we were sending three signals: (1) that we care about New Zealand women, (2) that we care about cancer, and (3) that we care about preventative health. We want to lift our collective cancer game and start benchmarking ourselves against other countries that we want to compare ourselves to. For women in Australia, the screening age is 74, but not for New Zealand women. For women in Canada, the screening age is 74, but not for New Zealand women. For women in Australia, the screening age is 74, but not for New Zealand women.

Increasing the breast cancer screening age is estimated to save 65 New Zealand women per year, and we value every single one of those lives saved; this Labour Government does not. The Breast Cancer Foundation writes, “One woman a month will needlessly lose her life to breast cancer thanks to the Government’s latest refusal to uphold its promise of lifting the breast cancer screening age to 74, says Breast Cancer Foundation NZ. The Government has just responded to a select committee’s investigation into breast screening, saying it is unable to immediately roll out free mammograms to women aged 70-74, despite committing to do this in 2017. Parliament’s Petitions Committee recommended in March that the Government should consider extending the screening age from 69 to 74, after receiving a petition by Breast Cancer Foundation NZ signed by 10,600 people.” I will talk more about this petition further.

We agree with the Breast Cancer Foundation. This Labour Government does not support women with breast cancer. In 2016, Jacinda Ardern received a 10,000-signature petition to extend breast cancer screening. She stood there smiling, shaking hands, and taking photos. She committed to extending breast cancer screening and then did nothing—even worse, she didn’t even bother to advocate for increased screening.

I know that from a ministerial question from 27 October last year to the Minister with delegated responsibility for women, Ayesha Verrall, the current Minister of Health. To Minister Ayesha Verrall, October 27 2022: “Has she received any written communications … from the Prime Minister advocating for increased breast cancer screening amongst women aged 70 to 74”? Answer: “No.” Jacinda Ardern had the photo moment. She smiled; she waved. She had the power of Prime Minister, and then she did nothing.

In 2017, it was one of the five health priorities for the coalition Government, and still they did nothing. Breast cancer screening is a broken promise for this Labour Government, broken many times over. In 2021, Ayesha Verrall is still the Associate Minister for women’s health responsible for breast cancer. She received a memorandum on 13 December 2021. The memorandum is from the Cancer Control Agency titled “Summary Evidence for Breast Screening amongst women aged 70 to 74 years.” The memorandum states, “Extending breast cancer screening to women aged 70 to 74 is reasonable.” I will repeat that. The Government’s own memorandum states, “Extending breast cancer screening to women aged 70 to 74 is reasonable.”, and they do nothing.

The memorandum also talks about prioritisation, which this Labour Government then clings to as a safety net in an attempt to excuse and forgive lazy and incompetent decisionmaking in this matter. Put simply, this Labour Government buried and refused to act on the evidence that increasing breast cancer screening for New Zealand women is not only reasonable but important. We know they buried it, because on 4 November last year, I again asked the Minister for women Ayesha Verrall a question: “In what written communications with officials or colleagues, if any, did she express a need to progress breast cancer screening to include 70-74 year olds”? Answer: “I have not written to the Ministry of Health, [Health New Zealand, or the Māori Health Authority.]”—she did nothing.

This Labour Government has received all the evidence that increasing breast cancer screening is important and saves lives and is reasonable, and they’ve buried it. They don’t understand cancer; they simply don’t care.

Even their own select committee in February this year, in response to a petition to increase the breast cancer screening age, said this: “Health New Zealand accepts that international evidence confirms that the eligible population for breast cancer screening should be extended to include people aged between 70 and 74 years.” With the Government’s own agency, Health New Zealand, accepting the evidence for and recommending breast cancer screening be extended, surely there is nothing more to say or do? However, the Government are desperately trying to justify their lack of interest by hiding behind the screening IT system and the need for an IT upgrade. This is a poor excuse and can be easily exposed for the sham that it is.

There are three points to talk to: firstly, increasing breast screening from 70 to 74 years deals with an already known audience. They’re already on the register, and all that’s being captured is a further two mammograms, two years apart. This is not a redesign.

Second, in May 2021, Ayesha Verrall announced $55 million for the proposed screening IT upgrade and committed that it would be up and running in two years. Well, here we are, and where is it? It was never going to happen. The Minister confessed in written parliamentary questions that only $5 million of the $55 million has been spent—barely 15 percent of the funding for breast cancer upgrade—and why? Because this Labour Government spent the money elsewhere, because this Labour Government decided health reforms were more important than breast cancer, because this Labour Government decided cycle bridges were more important than breast cancer, and because this Labour Government decided a warehouse storing expiring rapid antigen tests was more important than breast cancer. They are wrong. The four-year costs for this programme are in the order of $30 million. Compared to this Government’s wasteful spending, it should be a priority.

The third point, around the IT upgrade, is a revealing Cabinet paper released a few weeks ago, confirming that the IT upgrade was actually never going to include breast cancer screening anyway. The business case in the Cabinet paper makes it very clear that the IT upgrade was never going to go beyond “45 to 69”. The purpose of the $55 million IT upgrade is “maintaining mortality gains and early cancer detection for women 45 to 69 who participate in screening”. The IT upgrade was never going to include expanded breast cancer screening anyway. It is a poor excuse. I don’t buy it. The Breast Cancer Foundation doesn’t buy it. New Zealand women don’t buy it.

In conclusion, I challenge any party here tonight to vote down increasing breast cancer screening for New Zealand women. If Labour MPs vote against this bill tonight, then I say to New Zealand women who care about breast cancer: take a position, pull on a jersey, and take this Labour Government to the polls in October and vote them out.

Breast cancer is too important to be left behind. National backs New Zealand women, and we back their fight against cancer. Thank you.

Well, goodness, that was an unnecessarily cross speech I’ve just listened to. I rise to take what is probably going to be the last time I stand to make a substantial call in this term of Government to speak on the Pae Ora (Healthy Futures) (Provision of Breast Cancer Screening Services) Amendment Bill, which has been brought to the House by Dr Shane Reti, as we heard earlier.

Madam Speaker, I’m going to just ask for your indulgence, as this is possibly my last substantial speech for this term, because I want to just spend a very short amount of time this evening just thanking the many, many people that actually stand behind us as we stand here and do our job in creating the best possible legislation that we can for Aotearoa New Zealand. I want to just acknowledge “Team Ilam” first: Nellie McIntyre—

Nicola Grigg: Is this a valedictory?

SARAH PALLETT: —Hannah Long; Alex Seren-Grace; Casper Howell, my executive assistant; and Beth Walters. I’m beyond grateful to them for their dedication to the people that they serve.

No, I’m not giving a valedictory speech, Ms Grigg, but I am going to take some time to explore the virtue of gratitude. I’m going to explore the virtue of gratitude towards the people who were—

Nicola Grigg: How about the bill?

SARAH PALLETT: —I’m going to get to the bill; please bear with. We’ve got 10 minutes; you can spare me a few seconds. I’m going to spend a few seconds just acknowledging and thanking, with your indulgence, Madam Speaker, the people who work so hard here in the House: Jenny, Peter, Ivan, Kelly, and the team, the amazing people in the Office of the Clerk, our security teams, ICT, cleaners, Parliamentary Service, translators, and interpreters. There are so many people that stand behind us, as I said, as we do this, and I apologise for taking my time to do this. But I do want to address the bill, which I’m going to come to now.

The Labour Party supports the extension of the age range of breast cancer screening from the current upper age of 69 years to 74 years. So I just want to start by saying that we support this bill.

We’ve heard some really disparaging comments from the Opposition about the work that we’ve done already towards making sure that this age extension doesn’t come at the cost of adverse impacts to the rest of the population, because this is a really significant problem that we need to avoid. Breast cancer is, basically, the most common cancer affecting New Zealand women. It affects about—well, we’ve got 3,550 cases diagnosed and 600 deaths from breast cancer each year. Breast cancer screening in New Zealand is an extraordinarily important part of our healthcare provision because it has reduced breast cancer mortality by 30 percent for the women screened, compared with women who have never been screened.

This is where things get personal for me, because I lost my mother to breast cancer. My mother was diagnosed with breast cancer when I was eight years old, and it came back when I was a little older. She died when I was 21 years old. She didn’t have breast screening when she was asymptomatic. She discovered a lump in her breast, and that’s how the cancer was detected.

When my first daughter—my eldest child—was eight years old, I found I had breast cancer, but I was lucky. I was actually much younger than whom the screening programme in Aotearoa actually covers, but I fell into a high-risk category and I was part of a screening programme that was completely separate from the one that we’re exploring this evening. But I was extremely fortunate. I had no symptoms. I had no lump in my breast. But when my eldest child was eight years old, the same age that I was when my mother was diagnosed, that mammogram that I had as part of the screening programme that had been created for my high-risk situation—that screening process discovered that I had very early stages of breast cancer.

Because I had that mammogram when I was asymptomatic, because I was fortunate enough to be able to have that screening process before a lump was large enough to be felt—to be palpated—I was lucky enough to have cancer detected early enough to have successful treatment. I was 36 years old when I was diagnosed with cancer, and I’m 56 now. I have been 19 years cancer-free—I am extraordinarily fortunate. So for me, this isn’t just about population health; this is personal, as I said.

The Labour Party is doing a great deal to ensure that that screening process is available for women. But one thing we need to bear in mind is that Māori and Pacific women have lower rates of screening participation and the last time we extended the age of screening, what happened was that the gap between Māori and non-Māori extended from 11 percent to 20 percent reduction in screening. There was a significant negative impact, and that’s something that in our intention to do the right thing, we need to make sure doesn’t happen.

We know that Māori people have cancer at a higher rate, and to address the accusation that Dr Reti made that this party doesn’t care about cancer—well, it’s kind of funny that we set up an entire Cancer Control Agency to look precisely at what is going on in New Zealand with this disease that takes so many of us too early, and to give us the tools and give us the information that we need to make sure that we do the right thing. In addition to Māori and Pacific people, women living with disabilities, gender-diverse people, and women who live rurally are also going to have distinct barriers to breast screening.

So what are we doing already? Whilst we do recognise that this needs to be done, and although we’ve heard an impassioned speech from the other side, the science is not as clear as it might be. In the UK, for example, screening ends at age 70. In Scotland, which is obviously part of the UK, screening ends at age 70. When I sat on the Petitions Committee, we read and heard some compelling evidence to show that actually screening cannot necessarily bring benefit for those older women, but we have come to a position of accepting the evidence on the other side. With these things, often things aren’t necessarily clear-cut, but we accept that this screening needs to happen. So what are we already doing? We’re tackling this problem from three points: workforce, ICT, and screening equity, as I’ve already outlined to a small degree earlier.

The current capacity for delivering mammograms is constrained by our shortage of medical imaging technologists and radiologists, so we’re addressing that through the health workforce plan and the BreastScreen Aotearoa Workforce Development Strategy 2022 - 2032. The overarching aim is that we have a sustainable and diverse workforce, and that population-based register that we heard Dr Reti be scathing about, the one that cost $55.6 million of Government investment—the current register does not have the integration, flexibility, or scalability required to provide a modern breast cancer screening service and to be able to provide and support these programme changes, so we desperately need this. We desperately need this investment, and that’s why this Government has stepped up and provided it.

Once the current ICT rebuild is completed, there will be 122,000 additional women aged 45 to 69 years old who are eligible for breast screening but who are not currently enrolled with Breast Screening Aotearoa. We’re going to be capturing as many women as we possibly can, which is going to be critical to saving lives, and screening equity—the quality improvement review of clinical quality and safety was commissioned in response to the identification that a large number of people had been waiting longer than they should have to be offered their appointment for their first mammogram, and 26 recommendations were made on the need to improve equity. One of the review’s recommendations was to establish Pae Whakatere for three years to oversee and ensure the implementation of these recommendations.

We recognise the value in extending screening; we are already doing the work that we need to do it, but we will commend this bill to the House. Tìoraidh an-dràsta.

I rise on behalf of the ACT Party tonight in support of the first reading of the Pae Ora (Healthy Futures) (Provision of Breast Cancer Screening Services) Amendment Bill.

I will keep my contribution relatively short but I wanted to congratulate the member Shane Reti on having his member’s bill pulled. It is always quite wonderful to be able to debate an issue that is dear to each member’s heart, and one that people have backed enough to put into the biscuit tin for themselves, and so congratulations on having it pulled.

The ACT Party wishes to send this bill to the select committee so that we have the ability to have a fulsome debate about the analysis of breast cancer screening for people between the ages of 69 and 74. I also want to acknowledge the countless hours of work and advocacy that members of our community have put in, allowing for this bill to get this stage. I know many, many women throughout New Zealand have been advocating for an extension of the breast cancer screening age, with a lot of passion. I’ve met many of them in the community, myself, so congratulations for all the hard work from these many women who have been championing this cause, and to Shane Reti for bringing it to the House.

Yes, I apologise, members; I should have said the question is that the motion be agreed to.

Thank you, Madam Speaker. So breast cancer is the most common cancer affecting New Zealand women, and around 3,500 cases are diagnosed each year. Unfortunately, around 600 women pass away as a result of breast cancer each year. That’s why early detection and screening is so important, because what the New Zealand evidence suggests is that breast cancer screening can reduce mortality by about 30 percent when you’re comparing those who have been screened to those who have never been screened.

So as we’ve already heard in the House, Labour supports the extension of the upper age range of breast cancer screening from 69 to 74 years, but it’s also important that we do it in a way that ensures those that are currently eligible for screening are not adversely impacted. I think my colleague Sarah Pallett talked about some of the work that’s already been under way to ensure that occurs. Why that’s important was because when the age range for screening was last extended back in 2004, and it was in the context of constrained capacity, what we found was that participation for Māori women was negatively impacted. What we saw were inequities between Māori and non-Māori women increase significantly. This is something that we really want to avoid happening again.

So what the Government has been doing is making a number of substantial changes and efforts to improve national breast cancer screening. Just going through a range of these things. I mean, the first one is significant work to regain the participation rates that fell during the COVID-19 pandemic. So there’s been work—things like Saturday clinics and after-hours screenings—just to make sure that people have got every opportunity to get screened and to get caught up. Also working with primary health organisations to make sure that they’re actively following up people that are unscreened or who’ve fallen behind in terms of their screening.

We’ve also heard about some of the significant investments in the new IT register, because it’s important that we’ve got the IT and the tools to back up the delivery of a modern screening service. So in Budget 2021, significant funding was allocated over four years to replace the existing IT infrastructure so that it can support that innovation and change, which is critically important.

There’s also some of the constraints around workforce. So work is also under way to address workforce shortages, particularly for medical imaging technologists and radiologists. And making sure that as we look at expanding, we’ve got the workforce there that can support that. Also addressing inequity issues, because, basically, we still have significant inequities, particularly for Māori and Pacific women, so making sure that we can get those inequities addressed in a very meaningful way.

So what we’ve done is we’ve got a lot of work that’s already under way to make sure that if we go through and roll out that age extension, then there are not going to be those capacity constraints which result in the impacts that we saw back in 2004 when they extended it last time, and to make sure that we can maintain our current screening rates for all those who are currently eligible.

So while we support the extending of the upper age range to 74 years, we do have a number of concerns, just particularly around this bill. So we’re quite keen to see that a significant amount of work happens at the select committee process to address these. I think the first one is just the uniqueness of prescribing something so specific in the primary legislation around screening, but also particularly the age range. Because what it means is as the evidence underpinning the screening programme changes or technology changes, best practice changes, the question is do we really want to have to come back and address the primary legislation each time?

It’s also not clear why we’ve gone into that very, very specific level about a particular age group without thinking about other aspects of the screening programme more broadly in terms of quality and in terms of mechanisms to ensure informed decision-making, clinical quality, and safety. So thinking around if you’re going to put something in legislation, which bits do you put in versus why are we so specific on this element.

I think there’s also concern around the same level of specificity in the women’s health strategy, so talking about one particular intervention, but it’s potentially precedent setting because then there’s a whole range of other interventions that may well be very relevant to New Zealand women and why aren’t we including those? But if we do, do we lose the ability to have that high-level strategy? So we’re happy to support this to select committee process, where I think significant more work will need to be done. Thank you, Madam Speaker.

Thank you, Madam Speaker. I rise on behalf of the Greens to speak to the Pae Ora (Healthy Futures) (Provision of Breast Cancer Screening Services) Amendment Bill, and I want to commend Dr Shane Reti for putting this bill forward and having it drawn. As has been canvassed by other members, what this will do is extend the age range which allows people to access free breast cancer screening from 45 to 74, so adding an additional five years.

We want to acknowledge that, in an ideal world, everybody should have access to free breast cancer screening when they need it and that we have to do more to expand the age ranges. So we are supporting this to select committee because it’s important that we are able to hear from submitters and officials around what impact it will have on life expectancy, what are the other considerations we need to have around additional resourcing that may need to go to make this happen in a way that meets the needs of the community both in terms of workforce and equipment, and also for advocates who have been calling for an expansion of the age range.

I think, from a Greens perspective, we should always be looking at both ends of the age range and actually expanding it also on the lower end of the age brackets, because some of the research that we’ve seen does show that that can have a really meaningful impact in increasing life expectancy and quality of life. But I do think this bill provides the opportunity to have a really robust debate and we do think there are merits in this bill. The select committee process could also help illuminate and inform Parliament and what else the Government needs to do to make this work so that we’re not just expanding the age range but actually making sure that people who need to access free breast cancer screening are able to do so in a way that is also culturally competent, that reaches our rural communities, etc. The Green Party is happy to support this bill to select committee and have a conversation there.

Members, it is time to leave the Chair. This House is suspended until 9 a.m. tomorrow when we will resume for the extended sitting to consider the Parole Amendment Bill. Pō mārie.

Sitting suspended from 9.55 p.m. to 9 a.m. (Thursday)