Hague Kevin: Medicines Amendment Bill — First Reading 
Text is incorporated into the Bound Volume 
Hague Kevin: Medicines Amendment Bill — First Reading 
[Sitting date: 28 February 2012. Volume:677;Page:608. Text is incorporated into the Bound Volume.] 
KEVIN HAGUE (Green) 
: 
 I rise to indicate that the Green Party will be supporting this Medicines Amendment Bill at least as far as the select committee and will be very interested in the submissions that the select committee receives. Like other colleagues who have spoken in this debate I am a member of that committee and will take a keen interest in what people have to say as unlike some of those who have spoken I am not that impressed with the degree of consultation that has occurred to date. I will elaborate on that in a moment.  
The New Zealand health sector is facing a barrage of problems that will be driving up the need for health services. We have a growing population; more people need more services. We have an ageing population and the evidence is pretty clear that the older we are in fact the more health services we tend to need. We have a more diverse population and different population groups bring with them different health needs that our system needs to respond to. As Iain Lees-Galloway has just been speaking about we face a tsunami a virtual tsunami of chronic disease. And chronic diseases—diseases like cardiovascular disease diabetes depression and many others—tend to bring with them very complex and enduring needs for health services. It is a more complex picture than even that because people tend to have not just one of those diseases but several of them at the same time which creates in their interaction with each other fresh needs.  
We also have in this country an ever-widening gap between rich and poor and there is extremely strong evidence that the pattern of inequality that we are seeing of growing inequality is itself driving even greater health needs. Inequality is probably the single greatest driver of health needs. Whether it is communicable disease or motor vehicle crashes the pattern of inequality is the single greatest determinant of the pattern of health needs that we face.  
So that is a pattern of complex and increasing health needs and our system needs to respond to that. As Paul Hutchison has alluded to in his contribution to the debate the ways in which we are able to respond to those problems are quite constrained. We have seen certainly new medicines and therapies being developed and they are an important component of how we will respond to that need. New technologies more broadly than medicines are also an important contributor. In the House today there was a question from a New Zealand First member about the technologies available for people with diabetes for example. It is an important question. We are also seeing increasing specialisation in our health workforce so that in the profession of medicine for example we are seeing the discipline of general surgery becoming not just general surgery but sub-specialisations within general surgery. Colorectal surgery is now a specialisation and a surgeon who is not a colorectal surgeon is going to be pretty iffy about doing colorectal surgery. Even within colorectal surgery there is now some specialisation within that discipline.  
Increasing specialisation is meaning that we are able to devote more specialised skill to a person’s particular need. But that in itself raises problems. It raises problems of the centralisation of health services to particular centres because not every place is going to have the colorectal surgery that is required. For rural health services and provincial health services in particular there are some very particular problems of how we ensure that people that live in those areas get good access to the kinds of specialised services to which they are entitled as citizens. That is one of the defining problems and defining questions to which we must provide some answers.  
All of that has got to be accomplished within reducing dollars in real terms. While certainly the Government has been putting more dollars into health services those dollars have not been keeping pace with inflation and that is a major problem. So it is appropriate that legislation in other parts of the regulatory framework for the health sector is overhauled to facilitate the responses of the health sector to those problems that I have described. Certainly the description of the bill sounds great—you know updating modernising improving effectiveness and flexibility and reducing barriers. It is all good is it not? Indeed there are some aspects of the bill that are unquestionably good—for example facilitation of electronic prescribing. Smart use of information technology is vital to increasing our efficiency of resource use and also reducing error and risk. That is something that is unquestionably good.  
But there are other aspects of the bill that are not so clear. There is a new definition of “medicine” for example. The new definition broadens the definition of medicines. I am pretty experienced in the sector but I am not able to tell what that new definition is actually going to mean in practice. So I am looking forward to hearing what submitters have to say. What I fear is that by broadening the definition of medicines we may actually be opening up some of the overreaching aspects of the previous bill that several members have alluded to. That overreaching is what caused the problems that led us to not be able to progress those issues at that time. So I am suspicious and interested to hear what the submissions say.  
It is essential given the crisis in our workforce—and we do indeed face a crisis—that we use the skill sets of all of the professional groups in our health sector to the maximum extent that we possibly can. I have had considerable experience of working with rural nurse specialists for example and these are highly skilled nurses with extremely broad experience and expertise who do an extraordinary job in isolated rural areas. And the areas that I know are those on the West Coast of course. So using all of the skills of that professional group will result in better services to the people of the West Coast—was that my buzzer Mr Assistant Speaker—and better services to rural and provincial people throughout the country. That is a critical component of what we need to do. Certainly I think other speakers have talked about the professional skills of pharmacists and using those to the maximum extent possible.  
But I have some doubts. What for example is the point of a delegated prescriber when we already have a regulatory framework in the Health Practitioners Competence Assurance Act? I do not get what the new category does in addition to what is already available and I will be interested to see what that says.  
On the consultation on the bill I think there has been a bizarre choice of those to consult. Certainly the regulatory agencies the councils have been consulted but I do not see there the College of General Practitioners or indeed any of the other professional colleges. The Medical Association the New Zealand Nurses Organisation—some of the key organisations that ought to have been consulted have not been and I am worried about that and keen to see what they have to say.  
I am also finally worried about the rationale that is given for the bill—and I quote: “remove … unnecessary ineffective or excessively costly” requirements. For me that strikes a bit of a chill note in that that is precisely the formulation that was used to justify all of the deregulation we experienced through the 1990s. I do not want to go there again and I would be very interested to see what the submitters have to say at the select committee about that issue too. Thank you. 
The ASSISTANT SPEAKER (Lindsay Tisch) 
: Before the member speaks I am sorry about the buzzer. It may need some medicinal help.