Intellectual Disability (Compulsory Care and Rehabilitation) Bill — Instruction to CommitteeCWH In Committee 
Intellectual Disability (Compulsory Care and Rehabilitation) Bill — Instruction to CommitteeCWH In Committee 
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Intellectual Disability (Compulsory Care and Rehabilitation) Bill 
Instruction to CommitteeCWH 
Hon RUTH DYSON (Minister for Disability Issues) 
: 
 I move  
That it be an instruction to the Committee of the whole House on the Intellectual Disability (Compulsory Care and Rehabilitation) Bill that it take the bill part by part and consider any schedules as one question. 
Motion agreed to. 
In Committee 
Clause 1 Title 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 It is with pleasure that I take a call on the title which has been changed to the Intellectual Disability (Compulsory Care and Rehabilitation) Bill with the term “rehabilitation” having been added. I have to say while the term “rehabilitation” is used it is difficult sometimes to see how rehabilitation fits in with intellectual disability which is a permanent ongoing condition. What really fits in is support services putting structure and scaffolding around a person’s life so that that person can then behave in a more appropriate manner. 
 I am not sure that that is called rehabilitation; I always think of rehabilitation as helping individuals to engage in new and enriching ways. I suppose that if the amount of support structures necessary can be put around somebody then rehabilitation may be an appropriate term if behaviour can be changed. We know that— 
The CHAIRPERSON (Hon Clem Simich) 
: In this debate could we stick strictly to the clause under discussion? It is the title clause clause 1. Unlike other debate over the last 2 days when we have ranged fairly widely this debate is narrow and must be kept narrow. 
Dr LYNDA SCOTT 
: Yes I have heard that from Chairpersons before who then go on to let everyone else have a wide-ranging debate but I will stick to the title. I am sticking to the title because “rehabilitation” has been added to it. I am talking about the new title of the bill and whether it is appropriate to have “rehabilitation” added by the Supplementary Order Paper to this bill. The title was Intellectual Disability (Compulsory Care) Bill which was very appropriate because that is what this bill is all about. 
The legislation covers those people who have an intellectual disability—I do note that the Minister has changed that definition even though we at the select committee spent hours and hours talking about the definition so we will be asking why it has changed—who are people born with an intellectual disability or who suffer a birth trauma and have an intellectual disability but it does not apply to people who suffer a brain injury for example a traumatic brain injury. They are not covered by this bill. So people with an intellectual disability are covered by this bill and the specific title for this bill needs to cover that. It needs to cover those with intellectual disability because the Mental Health Act no longer does. 
The title is the Intellectual Disability (Compulsory Care and Rehabilitation) Bill. The words “compulsory care” are important because that is what this bill is about. It is about taking those people who have an intellectual disability and who offend. We have taken out the non-offender group which was originally in the bill but these are people who offend and who therefore need compulsory care. It is very sad—extremely sad—to have people who have an intellectual disability being hounded by a community or coming before the law and being put in jail. So the whole point of this bill is to give compulsory care for people who have an intellectual disability in specific circumstances in specific facilities designed for them and with a care package that will be wrapped around them. 
Adding “rehabilitation” to the title relates to the parts of the bill where we have added needs assessment and rehabilitation plans. So having a rehabilitation plan for people can mean that they will be able to be released into community care rather than being in 24-hour permanent locked care. But as we know with the David Stephens case there are some people for whom that will never be able to be the case. Because of their behaviour their lack of anger management and the fact they do not understand the consequences of their actions they will have to be in permanent ongoing compulsory care as identified by the title of this bill. 
I do not think that we should in any way change the title. I have not moved any amendments or substituted anything for this title because it does determine in a clear and defined way what this bill is about. Compulsory care imposes limits on individuals and limits their freedom so that is why a specific Act of Parliament is needed. 
HEATHER ROY (ACT) 
: 
 I will take a short call to back up what Dr Lynda Scott said about the word “Rehabilitation” in the title. I think rehabilitation is a word that is often misunderstood and that in this case we are asking for trouble in a way by including it in the title. In fact I am going to propose an amendment to have the word “Rehabilitation” removed from the title. We will amend the amendment— 
Dr Lynda Scott 
: You are going to amend the amendment? 
HEATHER ROY 
: That is right—so that we move back to the title being the Intellectual Disability (Compulsory Care) Bill which I think describes the intention of this bill much better. Rehabilitation I notice is not defined either in the bill itself or in the Supplementary Order Paper. I would have thought that with its inclusion in the title it should perhaps have been defined. That would have made a good deal of sense. It should have been defined so that we know exactly what it is. 
Intellectual disability of course is a lifelong condition. It is a description of somebody’s intellectual capacity. Rehabilitation implies that somebody can improve from a set position. We know that that is not the case with intellectual disability. When people are disabled the measurement of their disabilities cannot be improved upon. The implication is that people’s behaviour can be improved and that indeed is sometimes the case despite the fact that these people are often functioning at a very low level throughout their lives. But the base from which they operate will never be able to be changed with treatment. Although their behaviour may be modified in a positive way their base condition will see no improvement at all. 
With regard to the title clause we will put an amendment forward; indeed it will be an amendment to amend the amendment. But it is important that in the interests of stipulating what the bill is truly about the word “rehabilitation” is removed from the title. I do not mean by that that we should make no effort with these people. I believe the opposite. These people should be put into facilities that are there specifically to cope with their particular problems. The word “rehabilitation” in the title is a misnomer. 
Dr PAUL HUTCHISON (National—Port Waikato) 
: 
 I am speaking to the title of the Intellectual Disability (Compulsory Care) Bill now to be known as the Intellectual Disability (Compulsory Care and Rehabilitation) Bill. I must say that for slightly different reasons this addition to the Supplementary Order Paper of the term “Rehabilitation” needs to be approached. 
Let us have a look at the “Intellectual Disability” part of the title which was the nub and one of the most important definitions to get right. When we think of that as being the important part of the title we look to the Supplementary Order Paper where there is a change in the definition of “Intellectual Disability”. I go back to the commentary of the Health Committee whose members went to huge efforts to ensure that the meaning of intellectual disability was defined. 
So we need the opportunity of having the Minister in the chair willing to explain the meaning of intellectual disability and why the committee has changed it. It is very important that she does so. The select committee said on the one hand that it had concerns regarding the standard of testing to be used specifically given the narrowness of the definition of intelligence quotient—originally set at 70 or so—but on the other hand it said further that it had considered submissions and that it would be very important effectively to have a margin of error of 5 which would mean a cut-off at an IQ of 75. We go to the Supplementary Order Paper which is highly relevant to the title and we see a change. So it will be important that the Minister does indeed give the Committee an explanation why the select committee has made this fundamentally important change. 
 After all this bill is about being able to define diagnose and care for those with intellectual disabilities which is absolutely related to the title. This is nub of it. The difficulty is that we have a Supplementary Order Paper that has amended the title and that has also amended the definition of “intellectual disability”. 
With regard to the addition of “and rehabilitation” and the amendment to the amendment by Heather Roy of the ACT party I think that in many respects if we go back to what the select committee said about the emphasis on rehabilitation then on the one hand there is no need to have “rehabilitation” in the title—and I agree in that respect—but on the other hand it would be a little churlish of me not to recognise the importance that the select committee placed on rehabilitation. The select committee said there should be explicit recognition of the importance of rehabilitation where possible to ensure that people do not receive custodial care only. 
We have a slight dilemma there. On the one hand we have the Labour Government adding a Supplementary Order Paper under urgency to a bill that has been around for 4 years. Not only has the Government changed the definition of the key words “intellectual disability” in the Supplementary Order Paper but it has also added in the term “and rehabilitation”—quite redundantly and quite unnecessarily because the emphasis has been placed on that in the select committee commentary which points out how absolutely fundamental that is. 
Speaking on the real nub of the title which happens to be the question of the definition of “intellectual disability” I have grave concerns as to the process followed by the Labour Government in bringing in the Supplementary Order Paper without consultation under urgency and changing something that is so fundamentally important. Over many decades there has been a huge debate as to how to accurately define “intellectual disability”. 
PITA PARAONE (NZ First) 
: 
 I want to take a short call to say that although New Zealand First recognises the inclusion of the word “rehabilitation” in the title we accept the comments made by the select committee in its report. One concern I have about its inclusion although I welcome it as part of the title and therefore as part of the bill is that “rehabilitation” as such is not defined. It is certainly not defined in the Supplementary Order Paper. I must commend the Government—given that we have challenged its process so far in terms of the way it has dealt with the amount of legislation this week and in particular the fact that the last debate concerned a Supplementary Order Paper to the tune of 40-odd pages—for this one being reduced to 10 pages. So one can only presume that the Government is starting to see the light and that the introduction of such lengthy Supplementary Order Papers at such late notice is being considered a little bit out of order. 
Even though other parties in the Chamber may want to prolong the debate in looking at the Supplementary Order Paper and at the title in particular I think it is relevant that the word “rehabilitation” be included. If that issue is not addressed—and some people may argue that “rehabilitation” should not be included in this particular bill—I think we are doomed to retain the attitude we have had for far too long in this country and to condemn those who are the subject of this bill to a lifetime of enduring the illnesses they have been afflicted with without any care or concern expressed by the community. Therefore I welcome the inclusion of the word “rehabilitation” in the title. 
SANDRA GOUDIE (National—Coromandel) 
: 
 As I look at the title “Intellectual Disability (Compulsory Care and Rehabilitation) Bill” I think: what about making it the “Intellectual Disability (Compulsory Care and Rehabilitation or Not) Bill”? It must be remembered that rehabilitation will not always be possible. Earlier on I talked about Barry Ryder whose case was a key one in helping to bringing about this bill. It was recognised that Barry Ryder could not necessarily be rehabilitated and the judge said that without doubt he was most likely to reoffend. The first question asked by the parents was about why experts thought that he could ever be rehabilitated. Rehabilitation will not necessarily be an option. Therefore the bill could be called the “Intellectual Disability (Compulsory Care and Rehabilitation or Not) Bill” or the “Rehabilitation Where Applicable Bill”. Rehabilitation is not absolutely always something that can be achieved. I would like to acknowledge our concerns about “rehabilitation” not being defined. I think definition is absolutely necessary and I acknowledge the words of Pita Paraone in recognising that. It is to be hoped that the Minister will ensure a definition is provided perhaps in the form of a Supplementary Order Paper before the bill goes too much further. 
Pressing on with regard to whether “rehabilitation” should be in the title—I see you leaning that way Mr Chairperson—I will stick to the title and explain about rehabilitation not necessarily being achievable. Justice Chisholm in his prognosis for Barry Ryder said: “In my assessment you represent an extremely high risk of reoffending.” When Ryder was unaccompanied and not being supervised he was caught by an adult with a boy in a secluded area by a school with a knife a tube of lubricant and a book about anal intercourse. Ryder has ruined the lives of four boys and the judge has said he will likely reoffend and that it is likely he cannot be rehabilitated. 
I bring members back to the title which is about rehabilitation. That may not necessarily be achieved and I think we need to be realistic about that. Much as we might all like to see people being rehabilitated when they are a danger either to themselves or to the public through no fault of their own but through circumstance bringing it about rehabilitation as identified in the title is not necessarily always achievable. I raised another case earlier about a woman aged 33 who went into violent rages. Because she went into those rages her parents could not find an agency that would care for her. This was a real concern and a problem. I do not know whether that person can be rehabilitated but in terms of the title possibly not. Who knows? The one thing that was of real comfort to the parents was that she did find a secure and safe environment at the Kimberley Centre. That was something they were most appreciative of. They were also appreciative of the expertise of the services that were provided at Kimberley. Any rehabilitation that may have been able to take place would have been provided for at Kimberley and in that case it was a positive but in the case of Barry Ryder it was definitely a very clear negative. Having the word “rehabilitation” in the title is a bit of a concern but because we are so supportive of this bill we will not agonise unduly over the title. As I said before it is to be hoped that a definition for the term “rehabilitation” will be provided in the bill by the Minister before it goes much further. I think it is absolutely necessary that we do have a definition of rehabilitation and we look forward to that being the case. 
STEPHEN FRANKS (ACT) 
: 
 Throughout this bill the Health Committee has inserted references to rehabilitation so that at least the title does reflect what the bill now contains. The reason why I support my colleague Heather Roy’s amendment to omit the word “rehabilitation” from the bill is relatively simple. I am a humble man. I do not like to see Parliament pretending to do something that science and doctors tell us is impossible. It is a little bit like Wellington City setting up a sign outside the airport that says “Earthquake-free Zone”. It is just as useful. Although “rehabilitation” may be a word that everyone likes—and it makes a warm fuzzy feeling for a select committee that was busy sticking warm fuzzy bits into the bill—as I understand it the key thing that distinguishes people who are to be subject to this Act from those who are insane and subject to other provisions is the realisation that they are not capable of rehabilitation and that their illness is a permanent disability. Of course the symptoms can be ameliorated and of course behaviour modification may improve the way in which they are cared for but the criterion has been set because they simply are not capable of rehabilitation or under current medical knowledge there is no prospect of rehabilitation. They will stay with whatever quotient they are given that categorises them in these forms. 
Parliament should not be legislating a scientific nonsense. Of course if we accept the amendment and restore this bill to the more realistic objectives in its title and reject the wishful thinking that has gone into it then there are a number of provisions that would have to follow through. But they too would make the bill more honest. If we take the word “rehabilitation” out of the title we can then go through each of the five or six places where I have seen the word “rehabilitation” inserted and we would no longer have the prospect of some poor caregiver or institution at some stage being required by a judge to give effect to a provision that is incapable of being given effect. As we go through we will see that the plan for care which previously was a care plan now has to be a care and rehabilitation plan. The title is the first place where this nonsense appears. There are a number of clauses where that ridiculous word should be taken out. It is not defined. From my understanding the select committee did not know what it was talking about. It just thought it would be very nice to look pious and well intentioned so it stuck in some references to rehabilitation. 
The select committee’s comments under the heading “Emphasis on rehabilitation” on page 7 of its report are about programmes to meet needs and the recognition of the importance of rehabilitation. We can recognise the importance all we like but if the whole bill is founded on a view that these people are not curable that rehabilitation is not what is done—or maybe it is. This is one of the words that Labour members like to redefine from time to time. It is a little bit like the principles of the Treaty of Waitangi or any of those other slogan words that mean whatever they want them to mean. Rehabilitation once was a respectable word that meant to restore people to the living state that they had previously. These people are going to be restored or rehabilitated to their former condition but the fact is that their former condition was probably worse. They have never had a good state to be rehabilitated to. The word “rehabilitation” is a nonsense and it should not be in this bill. It simply makes the title longer. It is inserted only to make people with woolly minds feel better and it will cause legal problems if anyone takes it seriously. The provisions in which the word “rehabilitation” have been inserted throughout the bill where it is added after the word “care” can mean nothing if this bill is truly to distinguish the state of these people from those who are— 
Edwin Perry 
: What’s your solution? 
STEPHEN FRANKS 
: My solution is simply to take the word out. If we want to have something nice in there we can put in a substantive provision that says people are entitled to all the care programmes that can ameliorate their condition so far as is reasonably practical with the resources available. That is what I think members of the committee probably wanted it to mean. But they did not say that. Instead they plucked out of the air a word that they thought sounded nice stuck it in the title and stuck it throughout the bill. Interestingly in all the criteria for care and rehabilitation plans nowhere does it actually say that a care and rehabilitation plan has to have a plan for rehabilitation. It is just stuck in as a title matter. 
JILL PETTIS (Junior Whip—Labour) 
: 
 I move  
That the question be now put 
. 
A party vote was called for on the question  
That the question be now put. 
Ayes 82 
New Zealand Labour 52; New Zealand First 13; Green Party 9; United Future 8. 
Noes 35 
New Zealand National 27; ACT New Zealand 8. 
Motion agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 160 in the name of the Hon Ruth Dyson to clause 1 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 109 
New Zealand Labour 52; New Zealand National 27; New Zealand First 13; Green Party 9; United Future 8. 
Noes 8 
ACT New Zealand 8. 
Amendment agreed to. 
The question was put that the following amendment in the name of Heather Roy to clause 1 be agreed to: 
to omit the words “and Rehabilitation”. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 8 
ACT New Zealand 8. 
Noes 109 
New Zealand Labour 52; New Zealand National 27; New Zealand First 13; Green Party 9; United Future 8. 
Amendment not agreed to and clause 1 as amended agreed to. 
Part 1 Preliminary provisions 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 This part contains some substantial provisions including definitions interpretations and the commencement dates. I want to talk about clause 7 “Meaning of intellectual disability”. We spent a great deal of time discussing this in the Health Committee. We did not want the definition to be too narrow. A definition that is too narrow would mean there were people who were not captured under the provisions of this bill. 
I had amongst my select committee papers an article from  
Truth 
 dated 26 March 1999 that has the headlines “Handicapped flasher hounded” and “Townsfolk gang up on village idiot”. I think that shows us how far we have come in the way we treat people with an intellectual disability because I do not believe those headlines would be used today. The article was about the pretty sad case of a chap called Peter McCallion who had a quite significant intellectual disability. He ended up in prison where he should not have been was accused of all sorts of things he never did and was beaten up severely. The people who had cared for him said: “There just aren’t any places for the Peters of this world.” That is what this bill is all about—making sure there are places for the Peters of this world who have a significant intellectual disability and who come before the law because of behaviour they are not responsible for or who have no anger management and just act out. 
The select committee came up with a new definition for intellectual disability. Rather than defining a person as having an intellectual disability if he or she has an IQ of 70 or below the committee tried to expand the definition by stating under clause 7(1): “A person has an intellectual disability if the person has a permanent impairment that—(a) results in significantly sub-average general intelligence as measured by standard psychometric tests generally used by clinicians; and (b) results in significant deficits as measured by tests generally used by clinicians in at least 2 of the skills listed ...”. The reason that was added to the definition is that somebody may have an IQ that is higher than 70 but be very deficient in certain skills especially social skills. If that happens that person may not be captured in a rigid definition that uses just an intelligence quotient and if that is the case this bill will not be able to be used to have him or her placed in compulsory care or in a permanent facility. Certainly in the case of Peter that is where he needed to be. He needed to be in a place where he could be cared for appropriately. 
Clause 7(2) states: “For the purposes of diagnosing under subsection (1)(a) a person’s general intelligence as significantly sub-average—(a) an intelligence quotient of approximately 70 or less ...” but we said under paragraph (c): “a possible quotient of 75 is the effective maximum at which a person’s intelligence can be diagnosed to be of that kind.” The Minister has a Supplementary Order Paper that takes that quotient of 75 back to 70. Amongst the people I spoke to who work in the intellectual disability and mental health areas there were those who thought it was of concern if the definitions were too rigid. The skills subclause that the select committee put in refers to the ability to communicate self-care home living social skills use of community services self-direction health and safety reading writing and arithmetic and leisure and work. We are talking about people who can actually function in society. I am sure there are quite a few people who do not function in society who do not have an intellectual disability but we are trying to confine the definition under this bill to those who do. So there is concern about that under clause 7. 
Clause 6(2) refers to special-care recipients meaning a person who is liable to be detained in a secure facility under an order made under the Criminal Justice Act. We have just debated the amendments to the Criminal Justice Act from which a new bill was developed—one that we did not support. 
Dr PAUL HUTCHISON (National—Port Waikato) 
: 
 Part 1 does indeed have some very substantial components to it. One has only to go to clause 5 to note that the term “care recipient” is once again defined. I recall Stephen Franks from the ACT party saying that this bill is absolutely inculcated with politically correct terms. One has only to go to the dictionary to note that the noun “patient” means “a person receiving care or treatment”. But oh no the terminology here has to be “care recipient” which is using two words for the price of one. That is very indicative of this Labour Government which is so keen on adding compliance costs and verbiage that signifies very little. 
It is also interesting that the adjective of the term means “having or showing patience”. Certainly when it comes to Part 1 the community has had to show extraordinary patience because after all it was back in 1997 that the courts were saying it was urgent that this bill be progressed. In 1999 under the National Government Wyatt Creech quite rightly introduced the bill to Parliament but under the Labour Government it has taken these many years before finally we have it back before us today. The terminology is highly important and it is once again a reflection of how this Labour Government will use two words instead of one when there is an opportunity to do so. It will sure as hang do exactly that rather than use the time-honoured word that people know and understand—such as “patient” meaning a person receiving care or treatment. 
I too want to focus for a moment on the meaning of the term “intellectual disability”. Once again if one looks at the Supplementary Order Paper the Associate Minister of Health Ruth Dyson has brought in without collaboration and without the consultation that did occur so well in the Health Committee one notices an anomaly. The officials might like to prick up their ears here because I see that the explanatory note of the Supplementary Order Paper talks about the change to the definition of “intellectual disability” and it goes on to say “(that is an intelligence quotient that is expressed as 70 or less and with a confidence level of not less than 75%)”. When one goes to the words in the bill—which I have temporarily mislaid—I think one finds that they talk about a confidence level of not less than 95 percent. Which is correct? 
Hopefully the Minister in the chair the Hon George Hawkins will take a call and sort out what this anomaly is all about. This is a hugely important definition. It is one of the nubs of the bill. In the depths of the night the Government brought in this Supplementary Order Paper which quite clearly has the words “a confidence level of not less than 75%”; yet when we go to the words of the definition in the bill we see that they talk about a confidence level of 95 percent. The Minister cannot have it both ways. It is time he observed proper process particularly when it comes to bills as important as this one. I hope he will take a call on this hugely central definition “intellectual disability” and confess that once again a mistake has been made because he has been sloppy—often there is sloppiness when a Supplementary Order Paper of this substantial note is brought in without consultation—or he will give an explanation of what it means. 
HEATHER ROY (ACT) 
: 
 It gives me pleasure to rise to speak on Part 1. I want to back up Paul Hutchison’s comments about the change to the definition of “intellectual disability”. Although I was not part of the Health Committee which considered this report I am concerned to hear that the committee spent a long time debating what determines whether somebody is intellectually disabled—I suspect the committee had very good advice from the medical profession—yet the definition in Supplementary Order Paper 160 goes back to the original definition. The Government had obviously made up its mind that the definition would be narrow rather than allowing the flexibility that the committee obviously felt was necessary. 
I am pleased to see that Ruth Dyson the Minister responsible for the bill is now back in the chair because I want her to define “rehabilitation”. She will have heard my concerns about the inclusion of the word “rehabilitation” in the bill not because I am opposed to rehabilitation but because it is important particularly for the public and for public expectations to have “rehabilitation” defined so that unrealistic expectations do not become widespread within the community. It is unrealistic to expect the disabled condition of “intellectual disability” to be rehabilitated; obviously that is an impossible task. But if the Minister is talking about behaviour modification of the intellectually disabled to whom the bill is referring that is quite a different matter. As confusion could exist not only among the public but also with some in the medical profession and with judges having to rule on these cases it is important to define clearly what we mean by “rehabilitation”. I ask the Minister to take a call and explain or better still to put forward an amendment so that “rehabilitation” is clearly defined in the bill. I do not think that is an unreasonable request. 
The increasing use of politically correct language in legislation was an issue raised by my colleague Stephen Franks and also by Paul Hutchison just a moment ago. It is appearing more and more in legislation put forward by this Government and is very obvious in this bill. I pick up on Paul Hutchison’s point about the definition of “care recipient”. Once upon a time we talked about “patients”. Somebody receiving medical care of some kind was defined as a “patient”. Certainly the patients seemed happy with that and everybody knew that meant somebody who was receiving treatment or care. That term was changed to “client” and I noticed that Judy Turner used that term when speaking in the second reading. The term “client” in the area of intellectual disability has become the norm of late. When I worked in the medical field as a physiotherapist the people I treated were always “patients”. I never considered them to be “clients”. The word “client” implies the handing over of money in some way the getting of something in return. Now we have moved on to “care recipient”. Again that term has sort of been defined but for the life of me I just cannot understand what was wrong with “patient”. 
Then we see a provision in the Supplementary Order Paper that replaces the term “care recipient” with “peoples”. We seem to have done a complete loop—going from “patient” right through to “peoples”. Likewise clause 6(2) defines “special care recipient” whereas in the past the term was “special patient”. Again I do not know what was wrong with that. It is the terminology used by everybody in the field. To be politically correct we have changed all these terms. 
Another confusing and totally unnecessary term that has crept in is “seclusion”. Supplementary Order Paper 160 amends subclause (5)(c) of clause 4 by omitting the word “isolation” and substituting the word “seclusion” and that change is made in other parts of the bill. Those two words are frequently used intermittently in the health sector. Isolation and seclusion really mean the same thing. The term “isolation” has been used for an awfully long time. I ask the Minister to tell us why we are changing the term “isolation” to “seclusion”. 
SANDRA GOUDIE (National—Coromandel) 
: 
 I am very pleased to stand to speak to Part 1. What comes to mind for me is what these particular parents are thinking as they grow older and as their children grow older. These parents start to worry and become anxious about what they can do to make sure their children are protected when the parents can no longer do that when they are no longer capable of ensuring their children’s ongoing care protection safety and security in a secure and caring environment. When we talk about “children” we are talking about grown children who may be 45 years of age 6 feet 2 inches tall and hugely strong but who have the mental capabilities of a 5-year-old. The overriding concern of those parents is that their children have a safe and caring environment. 
I am looking at the meaning of “facility” and “secure facility” in the bill. Those facilities are what some of the parents are seeking for their children. They want a secure environment for them. It need not be a secure facility in the terms we know such as a hospital; it could be a residential house. But it has to be secure in the terms of this bill. But is that enough? Is it enough to know there is 24-hour care for someone like Barry Ryder when one knows that the system can fail? For those sorts of persons who can be a risk to themselves and to others but more particularly to others the system has failed to ensure that they are in a secure environment. There is the danger of that secure facility not necessarily going to the nth degree. But this bill is here and it is providing a degree of comfort for parents who do have that growing sense of anxiety as they themselves get older. It is a very real concern. I have talked to some of these parents. 
I put some questions to the Minister about what services would be in place to provide secure beds for intellectually disabled people with high and complex needs and for persons who might come within the ambit of this bill. The first 10-bed hospital-level secure unit Te Huia has been established in Wellington and others are going to be established in the main centres. But will that be enough? I put it to the Committee that given some of the speeches we have heard today it will not be enough. For example foetal alcohol syndrome is becoming a recognised problem particularly in prisons. So are 10 beds at Te Huia and maybe eight beds here and 10 beds there going to be enough in the terms of the facilities and secure facilities identified in this bill? How many are we going to end up having and will they be enough to meet the concerns of parents with regard to the provision of a secure and safe environment for their children as they grow older? 
Those parents wonder how their children will fit into these placements. They are somewhat hopeful given the passage of this bill. They are also hopeful about their other concerns around caregivers and care providers—that they will be better paid better trained and better supported. That is a huge concern. It is as important to the care and protection of their children as the provision of secure facilities. We need to have provision for within those facilities care providers and caregivers. It is necessary that there is a holistic approach if one likes to meeting the needs of the individuals within those secure facilities or secure environments. 
I would like to recognise the Hauraki Lifestyle Supported Trust which is in my electorate. It does an excellent job in providing a secure and safe environment for the people in its care. I am incredibly heartened by the heartfelt way in which it provides for the people in its care. I see it as a model and it has been recognised as a model. I want to acknowledge the people involved with it. It is to be hoped that the secure facilities that are identified in this bill do have that sort of support. 
JOHN CARTER (National—Northland) 
: 
 I just want to make a small contribution on this bill. 
Simon Power 
: Nothing this member does is small. 
JOHN CARTER 
: Well OK I want to make a significant contribution. In particular I want to ask the Minister a question. In the dealings that I have as the member of Parliament for Northland I have found that when we come across cases like this often part of the problem is that there are just not enough trained people and resources to provide the services that these people need. I know that the Government has put significant funding aside—and good on it for doing that. We hope that the funding will be enough; I guess we will find out in time whether it is. The Minister may be able to indicate whether she is satisfied that we have enough trained people out there to do the job. When we deal with these people that is often the area where we are limited. If that is the case—and maybe it is not but I suspect that it may be so—how will we go about getting sufficient people into the system to be able to help with regard to these issues? 
Often the resources that are needed to provide for the needs of these people are significant. It is a great shame in some of the dealings that I have that where the argument comes that people need support and help it is actually an issue of going through the system and getting people who are able to give that assistance. The problem is that as a local member of Parliament one makes representations on behalf of somebody gets something looked at get involved with it and makes some progress for that person to the detriment of someone else. That is the sad issue with regard to all of those sorts of things. The question is whether we have sufficient resources. I wanted to make that point—that is do we have enough people with the ability to deal with those issues? I suspect that we do not. I also suspect that we need to put a whole lot of emphasis into making sure we have people who are properly trained to be able to deliver the services that we require as we put this legislation together. I draw to the Minister’s attention that it is one issue that I would like to think we will put a whole lot of focus on as we pass this bill through. We need to make sure that we are not just trying to paint over something and say we have done something so it will all be OK because it may not be. If we just pass a piece of legislation that certainly does not mean it will fix the problem. There is a wider issue out there and I wanted to make that comment. 
The question was put that the amendments set out on Supplementary Order Paper 160 in the name of the Hon Ruth Dyson to Part 1 be agreed to. 
Amendments agreed to and Part 1 as amended agreed to. 
Part 2 Principles and general duties 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 This part covers the principles and general duties. Clause 14 talks about interpreters having to be provided. That is very important when we are talking about someone with an intellectual disability who may have difficulty in communicating anyway. I think that provision brings us back to talking about a definition of normal behaviour and the cultural setting in which it takes place. When any of us travel we are always struck by the different cultural and religious beliefs of the other countries that we travel in. It is important that interpreters are provided to try to get appropriate information. 
We can imagine the situation that occurs if someone is maybe involved in say a car accident and the police turn up and see someone in the car behaving in an unusual manner. That could be because of a head injury that that person has sustained or it could be because he or she has an intellectual disability or has used drugs. The police at the roadside cannot determine what the reason for that behaviour is and people in such situations can sometimes end up in police care where the police have to determine what is causing the behaviour. If we add a language problem to that as well then we have severe difficulty in being able to sort out the cause of somebody’s behaviour. So it is really important that interpreters are provided. 
Under clause 13 we have the statement that the powers are to be exercised with proper respect to a person’s cultural identity and personal beliefs. I am not too sure about the personal beliefs one but certainly the cultural context in which somebody works with his or her language religion and ethical beliefs needs to be taken into account because that may create behaviour that may be unusual to someone of a different cultural belief. Those are some of the clauses that are in this bill. 
We have to look at the individual cases that we have had. I have talked to the police down in Marlborough about the problems they face. The police and our judges deal with the front line and that may also include ambulance staff although ambulance staff probably have more knowledge about intellectual disability than the police sometimes do. But in those situations it is quite difficult to understand why someone is behaving in the way that he or she is. If that person has an intellectual disability then this legislation has to immediately begin to be implemented and that means providing an appropriate assessment of the person and developing a care plan for him or her. 
Under Part 2 we also see the principles governing decisions affecting children and young persons. In the case of people who have an IQ of 70 their intellectual ability remains completely stunted so they do not develop the maturity or social ability to manage in society. It is far easier to be able to manage their care when they are children. It is when a child of 6 then becomes a 6 foot 2 inch man who is extremely strong but remains with the intellectual capacity of a child of 6 that we have had some of the sad cases we have seen in the past that have led to the development of this bill—people like David Stephens and the problems his parents had in coping with him. It is important that decisions affecting children and young persons should where practical be made and implemented within a time frame that is appropriate so that families can move ahead and get a care plan for them. 
Clause 9 talks about secure facilities. 
HEATHER ROY (ACT) 
: 
 I want to take a brief call on this part which is actually quite a small part. Having not been part of the select committee process that went through the whole bill very thoroughly I would like to ask about the area of interpreters. I am not sure what the intention of clause 14(2)(a)(i) is. It states an interpreter is to be provided if “the first or preferred language of the care recipient is Maori or another language other than English;”. The thing that worries me is the use of the word “preferred” particularly as in New Zealand there are people who are obviously very fluent in both English and Maori. I am concerned in particular about the cost that could be incurred especially if an interpreter is required for quite some time. I worry that health dollars may be diverted from where they perhaps should be spent and be spent instead on something like the use of an interpreter when people who are quite capable of being understood in English say that they would prefer to be heard in a completely separate language. I wonder what thought the Health Committee gave to that when it was processing this bill. 
We see that in other areas particularly in the mental health areas where patients under compulsory care—[ 
Interruption 
] Perhaps the Minister would like to take a call and tell me what went behind this measure. I was not part of the select committee process. 
 It was before my time in Parliament. Also I still have not had an answer to my query about the term “rehabilitation”. It is all very well for the Minister to sit there and pass comments to other members of the Committee yet she is not happy to stand up and answer valid queries that I think should be clarified. 
My concern is about the spending of health dollars. I was about to say that in the compulsory care of people with a mental illness the patients are able at every step of the way to appeal the process and use district inspectors to represent them when in fact the doctors presenting the other point of view usually do not have a lawyer representing them. Yet the money that is used for that comes out of the health budget. It comes out of the individual district health board budget for the appeal process when the intention is that the money is to be spent on treating those patients and not on legal bills. 
Clause 14(2)(a)(i) raises a similar concern and all I am asking for is clarification of that small provision. I do not object at all to subclauses 2(a)(ii) and (iii); they seem to be perfectly reasonable. But when somebody who is able to speak English perfectly well says he or she would prefer to be heard in another language I just wonder why that is acceptable. Perhaps the Minister could answer that question for me. 
Dr PAUL HUTCHISON (National—Port Waikato) 
: 
 Part 2 deals with principles and general duties. Once again I cannot help but note in clause 11 the term “care recipient”. I think it is referred to four times in about six lines—which is double the number of words we need. It is good to see the Minister in the chair and she may be able to take a call and explain the genesis of the somewhat redundant and wordy term “care recipient” rather than the use of the term that most people in New Zealand—in fact the world—know which is “patient” to mean a person who is receiving care or treatment. I would be very interested to hear what the Minister does have to say in that regard. She is nodding her head so as she is one of the leaders at the forefront of the politically correct brigade it will be very interesting to hear what she has to say. 
I will go on to clause 12 “Principles governing decisions affecting children and young persons”. Those principles do indeed seem thorough and on the whole I concur with them. There is the point that wherever possible the family whanau hapu iwi and family group of a child or young person should participate in the making of decisions affecting that child or young person and accordingly regard should be had to the views of the family whanau hapu iwi and family group. There is absolutely no doubt about that. The tragedy down in the South Island arose when there was a lack of involvement by the family. It was simply not listened to and a subsequent tragedy occurred when the young man killed his parent in that situation. So undoubtedly that is highly important. 
But one of the questions that hopefully the Minister will take a call on is how practically she will ensure that those ideals are lived up to in reality. How does one provide the service realistically? The Minister was one of a group that in the 1990s called shrilly time and time again for appropriate mental health services and facilities. Yet the reality of today is that we hear every day of the absolute mental health crisis in New Zealand and the lack of facilities. It is indeed an example of the forethought of Wyatt Creech who brought this bill into the House that provision was made for $50 million for both this bill and the Criminal Justice Amendment Bill (No 7) so that there would be money earmarked to ensure that appropriate facilities were there. However in reality we do not see that and I would be very interested if the Minister would take a call on that point. 
I move on to clause 13 “Powers to be exercised with proper respect for cultural identity and personal beliefs”. Again it is fine and appropriate to say that it is vital that proceedings are conducted with proper respect for the care recipient’s cultural and ethnic identity language and religious or ethical beliefs. I remember very well when I was a consultant at one of the hospitals and a woman from Iraq came in. She was a doctor and there happened to be a senior doctor from Iraq in attendance. As a male gynaecologist I deferred to that individual to take the woman’s history and carry out the treatment—something I normally do not do. As it happened the Iraqi senior doctor said the woman should be taken down to an operating theatre but just beforehand she called me to say that she was caught up in the emergency department and to ask me to do the operation. I went in only to find that a totally inappropriate operation had been ordered and the woman was anaesthetised. That operation was ordered by an overseas senior doctor whom I had organised to look after another Iraqi doctor. So in practice the reality of ensuring that cultural sensitivity does take place is very difficult. 
JOHN CARTER (National—Northland) 
: 
 I want to take a call in order to ask the Minister to take a call with regard to clause 12 “Principles governing decisions affecting children and young persons”. 
Hon John Tamihere 
: I raise a point of order Mr Chairperson. My point of order is with regard to Standing Order 35(1): “A party must inform the Speaker of—(b) the identity of its leader and other office holders”. We are led to believe that there has been a change in the leadership of one political party and we ask whether the Chair or the Speaker has been advised. Could you confirm that the leader of the National Party has changed this afternoon? I think members are entitled to know. 
The CHAIRPERSON (Hon Clem Simich) 
: That is not a point of order. 
JOHN CARTER 
: If Mr Tamihere is trying to be humorous he should learn how to be humorous. People like me can be humorous but some people cannot. 
The issue that concerns me is that when I look at clause 12 I think it is probably a take-off. Someone who is more familiar with the bill than I am may be able to help me. The structure in the clause is the same sort of structure we have with the Department of Child Youth and Family Services for example. I guess it is our consultation structure. I imagine that if the wording is not exactly the same it is probably similar to the wording we have in other legislation. 
I come back to the point I made earlier on in Part 1 about how we will provide services and facilities to make sure that consultation happens. If the Minister is going to be relying on the Department of Child Youth and Family Services for example to make sure that those consultations etc. take place with families whanau hapu and iwi then I have serious concerns. We all know both currently and indeed from history going back over a number of months and years that the service is not so flash. So the Minister might care to take a call to assure the Committee that she has in mind some other department organisation or system to provide the service set down here under clause 12. We want to be assured of that because as the Minister knows we are supporting this bill. 
Sitting suspended from 1 p.m. to 2 p.m. 
Debate interrupted.