O'Connor Simon: Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill — First ReadingText is incorporated into the Bound VolumeO'Connor Simon: Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill — First Reading[Sitting date: 23 July 2015. Volume:707;Page:5314. Text is incorporated into the Bound Volume.]SIMON O’CONNOR (National—Tāmaki): I would like to thank the honourable member who has just taken her seat the Hon Annette King for what was an excellent contribution and also for her very kind words and compliments. I am always a bit worried though as my colleagues might be when Labour is giving me accolades and what that might signal. But no I am very pleased to work on the Health Committee with the Hon Annette King. In fact in beginning with this bill I want to acknowledge the entire Health Committee and the work that it is undertaking across a whole range of topics at the moment. This will be another one we add to it as we discuss the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. I thank the Minister of Health for introducing this into the House.I think genuine questions have already been raised around the timeliness—why has it taken so long? I think there is a hint of it in the last few minutes of the Minister’s speech when he noted all the various groups that had to be engaged and consulted with from the likes of the nurses unions through to the Ministry of Business Innovation and Employment obviously the Ministry of Health and a whole lot of other groups. Although this is a relatively simple bill it is a bill that has significant implications. So I thank the Minister for bringing it to the House and although it is predictable that it would come to the Health Committee I think it is something we are looking forward to being part of.This bill is very similar to a number of others that we have had of late. In the committee we are just finishing up the work on the Radiation Safety Bill and we finished work a while back on a bill that looked around the use of solaria and around contact tracing. What links all of those together is that they are playing into the Government’s focus in this space around health care that is sooner faster and more convenient and that this is ultimately about inefficiency and the updating of the statutes. This has been something that has required a long time in coming but in this space we are also trying to be responsive to the changing nature of health care in New Zealand.The terms “medical practitioner” and “health practitioner” are often used interchangeably but they are actually quite distinct terms and I might take the liberty to go through it a little bit for the edification of the House and for those listening but also to put it into context. A medical practitioner as currently defined is effectively a physician or a surgeon. We would classically just think of that as someone who is a doctor or a specialist. So your GP your dermatologist your plastic surgeon your general surgeon and your vascular surgeon—that is whom we are talking about. One of the examples that the Minister used a little bit earlier was around the use of death certificates. Part of this bill is actually going to reword what they are called but at the moment you need a medical practitioner—in other words you need a physician or a surgeon—to sign off on that document. We are saying that actually there is another group of people who can be involved and those people we call health practitioners.You will excuse me if I have to read this part because health practitioners are those who fall within the ambit of the Health Practitioners Competence Assurance Act of 2003 that very well-loved and well-known Act I am sure. Section 5 of that Act defines a health practitioner as a person “who is or is deemed to be registered with an authority as a practitioner of a particular health profession”. So obviously a doctor a physician or a surgeon falls within that but there is a whole range of other groups that fall within that. Just to give some examples—I do not intend to go all the way through them—midwives would fall under the definition of a health practitioner. Obviously that is the profession and it sits under the Midwifery Council. You have occupational therapists. They are health practitioners and come under a therapy board there. Those working in optometry osteopathy pharmacy physiotherapy—again these are people we are quite innately aware of who work in the health space.So primarily what this bill is doing is saying people within these professions within the correct scope of practice can actually begin to help us in the health care space. Again using the death certificate as an example why should it only be a physician and surgeon who can sign one when in fact we can ask as the bill suggests a nurse to have that power? A big part of that for those of us who have worked in the health care sector is that we know that it has changed we know that there are a number of people now who practise within the health space whose core competencies or scopes of practice are such that they can do things that we may not have thought of in the past.The best way to illustrate this is the change from the tertiary to the primary care sector. So when we talk in health about tertiary care we are talking about specialists. Think about elements say of dermatology plastic surgery. Think of the likes of endoscopy. Now they are primarily being done by specialists. If you had a skin cancer in times past you would pretty much if not exclusively go and see a dermatologist a plastic surgeon and a general surgeon to get that done. But actually the scope of practice of general practitioners over time has increased. Their skill levels have increased the technologies and the advances have increased so that you can now go to a general practitioner to have that done. It can now be done in the primary care sector. There are advantages to that not only financial but also it is just more convenient. So again if you have got a lesion you can go to your GP. He or she will take it out rather than having to send you down to a specialist.To further illustrate what has happened it is actually nurses now who are able to begin to act in this area. We still have some steps to go but nurses also have the necessary skills to work within this space. I think the Hon Annette King alluded to that and the great work that she introduced years ago as the Minister of Health to allow nurses the scope to expand. The same is happening in the endoscopic space—do not think about this too much but it involves cameras going down one of two areas. Again it has always been the domain or primarily the domain of specialists but actually now nurses can be trained to do this service. Again it can be done more cheaply and that is a real win for the taxpayer but it is also again more convenient. You can go down to a local surgery wherever your nurse or GP is and if they are suitably trained you can obtain their skills.So that is just an illustration of I suppose the background of why we can update these definitions through this particular bill why we are saying it is quite safe and prudent for us to allow health practitioners to work in a space that was traditionally just medical. So I think that is a positive. I think it is prudent and something I have certainly heard out in the community.It was alluded to earlier that some were doing a bit of a trip to the rural health practices—something I have been doing as well. In fact I was down at Gore Health recently and hearing about what they call a physician assistant. It is effectively a person who acts as a doctor in all but title. A physician assistant is a role that has been around—I think—about 30 years in the United States and we are trialling it here in New Zealand through the health workforce. It is a postgraduate level degree. Obviously it is not a doctor’s degree as we would understand it here in New Zealand but a person who has postgraduate training in a very particular clinical space and is able to do probably about 80 percent of what we think a doctor could do. That is being trialled in Gore Health.Again how do we increase the workforce and get them involved? So how that is going to manifest itself—it will be in a number of areas: one quite key one is in that multi-disciplinary area. Here are two very quick examples. We already know that within ACC if you need help obviously you are going to have a GP involved. You may be seeing a specialist if say you have got a back issue. You are going to be seeing an osteopath probably around that if not an orthopaedic surgeon. You are going to have occupational therapists involved and so forth. A lot of the paperwork at the moment still must be done by the medical practitioner. We are saying that we can make some changes through this bill that will provide that the lead person who is helping you through ACC can sign some of those documents.Similarly one of the announcements in the Budget was around the introduction of pain teams. In other words for those people in our community particularly in the orthopaedic field who are in pain we are going to bring multi-disciplinary teams together—nurses occupational therapists doctors. At the moment and without this bill only the doctor can sign off on forms. Through this bill it will actually be the lead provider in those pain teams. So it may be that the occupational therapist will be enabled to do the documentation required.So I think it really fits in as I said at the start to services in health that are sooner faster and more convenient. I think it is what New Zealand wants and I say that with some confidence not only as the chair of the Health Committee and obviously from going out in the community but from the fact that so far we have heard—I wait for the other parties but I am pretty sure—that we have got widespread support in the House. I can see nodding from New Zealand First. I know Labour is going to support it and the Greens. I assume therefore that everyone is going to support this bill. We as the New Zealand Parliament see that this is something important something that Kiwis will understand and will find appropriate which will make for better health care for them.Chris Hipkins: Why is it taking so long then?SIMON O’CONNOR: Finally the most excellent Chris Hipkins wonders why it is taking so long. Well we do have about eight other speeches to go. We can always just forgo those and go to the vote and call it a close for a Thursday. Thank you very much.