Health (Screening Programmes) Amendment Bill

Implementation of several key recommendations from the Ministerial Inquiry into the Under-Reporting of Cervical Smear Abnormalities in the Gisborne Region is a step closer, after the Health Committee reported the Health (Screening Programmes) Amendment Bill back to the House today.

The bill amends the Health Act 1956 by inserting updated provisions to govern the operation and evaluation of the National Cervical Screening Programme. The screening programme was established in 1988 in response to a recommendation in the Report of the Cervical Cancer Inquiry 1988 (the Cartwright Inquiry).

Committee chairperson Steve Chadwick notes the high degree of agreement amongst members over the committee’s recommended changes to the bill. “We all agree that the provision of an outstanding cervical screening programme is important for the health of women in New Zealand. The strengthened evaluation procedures in this legislation will work to ensure the programme meets the highest possible standards,” Mrs Chadwick said. Evaluations are necessary for the continuous improvement and quality assessment of the National Cervical Screening Programme. They provide valuable information on the competence of health professionals and act as a safeguard to ensure the accuracy of cervical screening reporting.

The committee recommends limiting the bill to cervical screening programmes only. The bill as introduced allowed for the provisions of the bill to be extended to other screening programmes by Order in Council.

“We were concerned that the mechanisms in the bill for extending the legislation to other types of screening programmes contravened the constitutional principle that matters of policy are set out in an Act of Parliament and the details of those matters are left for regulation. Most of the provisions in the bill are very specific to the cervical screening programme, and we expect further legislation will be developed that contains policies and principles that can be applied to other health screening initiatives,” Mrs Chadwick said.

The bill as introduced provided for screening programme evaluators to have access to relevant information about individual women on the register held by hospitals or laboratories, but required an additional consent process for access to primary care records. The committee recommends that this consent process be removed. This change meets the recommendations of the ministerial inquiry.

“We are aware that the idea of access to primary health care records concerns some women,” Mrs Chadwick noted. “However, we believe there are adequate safeguards in place to ensure screening programme evaluators are permitted access only to necessary health information. It is essential that evaluators have access to such records to carry out effective internal and external evaluations, and ensure the screening programme does its job of ensuring high quality cervical screening, assessment and treatment services, and continuous quality improvement.” The Green Party opposes removing the additional consent process, as it is concerned this undermines the privacy of personal health information and the confidentiality of the general practitioner-patient relationship, and could cause a backlash against the programme.

The committee considered carefully the provision in the bill that establishes the National Cervical Screening Programme as an ‘opt-off’ programme. Under the opt-off system, a woman is automatically enrolled in the National Cervical Screening Programme when she has a screening test or if she undergoes a colposcopic examination. She can then choose, at any time, to be removed from the programme, which will result in her information being removed form the register, and any information held by the programme in hard copy being either returned to the woman or destroyed.

“Most of us agree that this is the appropriate way to operate the programme, to ensure high rates of enrolment and participation. Without automatic enrolment, the programme cannot achieve its aims of decreasing the incidence of cervical cancer in New Zealand,” Mrs Chadwick said. The Green Party would prefer to see an opt-on programme, with women giving their explicit consent to be on the programme at the time of their first smear test.

Other recommended changes include: requiring public reporting on the effectiveness and quality of the National Cervical Screening Programme; making access to information one of the objectives of the programme; extending the powers of screening programme evaluators to access certain specimens and information held by private specialists; and amending the procedure for screening programme evaluators to report concerns about practitioner competence.

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