Health (Protection) Amendment Bill — First ReadingText is incorporated into the Bound VolumeHealth (Protection) Amendment Bill — First Reading[Sitting date: 06 November 2014. Volume:701;Page:725. Text is incorporated into the Bound Volume.]Health (Protection) Amendment BillFirst ReadingHon Dr JONATHAN COLEMAN (Minister of Health):I move That the Health (Protection) Amendment Bill be now read a first time. I nominate the Health Committee to consider the bill. This bill will amend the Health Act 1956. That Act is a very longstanding piece of legislation but although excellent in many respects in some areas it has not kept up with the times. In October 2013 the Government decided to improve the range of measures in the Health Act in two areas: measures to protect the public from the risk of spread of some infectious diseases and in the case of people under 18 years of age measures to protect them from the harm associated with artificial UV tanning. The bill will protect people from these preventable harms. It will do so through measures proportional to the risks faced.As we know some infectious diseases can spread very quickly and sometimes with alarming results. New Zealand has recently experienced another preventable measles epidemic. We all recall the tragic outcomes associated with outbreaks of meningococcal meningitis. New Zealand and indeed the rest of the world is also deeply concerned by the unprecedented outbreak of Ebola virus disease in West Africa.We should never take highly infectious diseases lightly. Fortunately the Health Act does already provide for a range of measures to address serious disease threats such as Ebola. These include in particular the quarantine powers for use at the border and the special powers. These latter provisions which have never been used are effectively the Act’s emergency powers. The Health (Protection) Amendment Bill does not amend these quarantine or special powers. Rather the bill provides for a greater range of intermediate but still potentially significant interventions to assist with the day-to-day management of endemic infectious diseases in the community.The bill has three broad objectives designed to strengthen protection measures for New Zealanders. Firstly the bill adds new provisions for the surveillance and management of infectious diseases. These measures will improve the availability of information for certain conditions of public health significance provide for more effective management of behaviours that put others at risk of infection and strengthen legislative provisions for contact tracing. Secondly the bill streamlines the legislative framework for all infectious diseases by including tuberculosis in schedule 1 of the Health Act “Infectious diseases notifiable to medical officer of health and local authority”. Tuberculosis will be treated in the same way as all other notifiable infectious diseases. This measure allows the historically separate Tuberculosis Act 1948 to be repealed and the Tuberculosis Regulations 1951 to be revoked. Thirdly the bill prohibits for health reasons the commercial provision of sunbeds and other artificial ultraviolet tanning services to those under 18 years of age. These measures have been carefully considered to balance health protection and individual rights. For example the bill will protect people from infection risk while protecting privacy to reduce the risk that people will not seek treatment.The bill provides for the notification on a non-identifying basis of three additional infectious diseases: HIV infection gonorrhoeal infection and syphilis. None of these are notifiable at present despite their serious long-term implications for health. The bill provides for a series of incremental steps when people do not change their behaviour voluntarily to reduce the risk of spreading an infectious disease of concern. New management options include directions issued by a medical officer of health and court orders. Voluntary compliance is our preferred first approach. In the majority of cases people do comply. However in a few cases each year people do not agree to modify their behaviour to reduce the risk of harming others by passing on significant infectious diseases.The provisions in the bill allow for incremental interventions that are appropriate to the circumstances of each case consistent with human rights protections. Directions for example may require an individual to undertake counselling or testing or to accept restrictions on travel or place of residence. In very serious cases courts may issue detention orders to detain a person in a health facility or other place of quarantine until they no longer have an infectious disease and in some instances to order a case to accept treatment. However the bill makes clear that mandatory treatment is not to be physically enforced.Contact tracing is an important and internationally recognised public health strategy as it helps reduce the risk that an infectious disease will spread. The bill strengthens the legislative basis for contact tracing by establishing obligations in respect of contact tracing. Currently contact tracing is voluntary and relies on the consent of the individual with the infection. Some people do not cooperate unfortunately and that can place other people at significant risk of serious harm. The bill places on people who have or may have a notifiable infectious disease the obligation to provide information on their contacts if requested by a contact tracer. Such a provision is essential for effective public health protection measures. This is because people who are contacts but who are not yet showing symptoms of illness may still have the infection and be able to pass it on so posing a risk to others. This situation is already recognised and provided for in the Health Act where people may be detained whether or not they have a confirmed infection.To protect against the harm of tanning services for those most at risk the bill introduces a ban on the commercial provision of artificial UV tanning services or sunbeds to people under 18 years of age. Although this provision in the bill discriminates on the basis of age international evidence of harm justifies the Government’s position. Artificial UV tanning is associated with an increased risk of developing skin cancer and evidence shows that younger people are more vulnerable to this risk. There is strong evidence that people who use sunbeds increase their risk of malignant melanoma and other more common skin cancers. The greater the exposure the greater the risk of skin cancer. Voluntary standards and guidance on operating sunbeds exist. However repeated surveys have consistently found variable compliance with those voluntary steps designed to minimise harm despite considerable effort to educate operators and to encourage their compliance. The Government considers that the evidence of health harm gives sufficient justification for intervention particularly in respect of controls to protect young people from exposure to sunbeds.Finally the bill also streamlines current legislation by including tuberculosis as a notifiable infectious disease under the Health Act. This allows for the repeal of the historically separate Tuberculosis Act 1948. I consider that this bill provides a balance protecting individual rights while still protecting the health of the wider public from risks arising from significant infectious diseases and from risks from sunbeds. It gives me great pleasure today to speak on this important piece of health legislation. I commend this bill to the House.Hon ANNETTE KING (Acting Deputy Leader—Labour):Labour will be supporting this legislation today. Can I congratulate the Minister on bringing forward his first piece of legislation as the Minister of Health and in fact on holding the position of the Minister of Health. It is one that I was privileged to hold for 6 years and I have to say that of all the portfolios I had in my 10 years as a Minister it was my favourite and that remains still the case today. In congratulating the Minister I have to say there have been many Ministers associated with amendments to the Health Act 1956. In fact these amendments were first proposed in work that I did as the Minister way back when. The Public Health Bill that contains these changes was introduced into Parliament in November 2007 by my former colleague—Hon Ruth Dyson: 2007?Hon ANNETTE KING: In 2007 it was introduced into Parliament by the Hon Pete Hodgson. We had the first reading on that bill in December 2007 and it was referred to the Health Committee which reported back to Parliament in June 2008. So since June 2008 the Public Health Bill which amends the old Health Act has sat gathering dust on the Committee table with no action at all. So 6 years on congratulations Minister on getting some of the amendments through. There is still more work to do and I think perhaps this is going to be done in episodes because it appears to be—Iain Lees-Galloway: A continuing story.Hon ANNETTE KING: It is a continuing story—an ongoing matter it appears. But good on you for bringing forward these changes and they are ones that are necessary. I think it is appropriate that we have them now although as the Minister said we do not need them—with Ebola now in the media and of great concern to many people we have very good measures available now—but the measures that have been proposed in the Health (Protection) Amendment Bill will help strengthen the existing measures that we have.The old Act that we have got is a very fragmented one and it does need to be updated. It is outdated and one of the things that was very clear in it was that it needed to have greater provisions around contact tracing and I will talk a little more about that in a moment. When you look at the regulatory impact statement that the Ministry of Health has put forward it has made it very clear that it wanted these sorts of changes over a long—or in fact it calls it a sustained—period of time and it has been concerned that we needed to include these new measures. It recommended that we improve notification of infectious diseases and also the framework for notification. It pointed out that this is of interest to main stakeholders who are of course the public but also to doctors to laboratories and to district health boards. And it made it clear that this is not an issue of cost so it was not ever going to be a problem in terms of cost. It said that the cost of these changes is relatively minor. The regulatory impact statement also shows that the ministry has had a look at the bill in terms of the New Zealand Bill of Rights Act and it has found that the provisions in this bill on balance “represent justifiable limitations on rights and freedoms under the Bill of Rights Act 1990 given the importance of protecting the public from significant infectious and the safeguards provided.” So it has had a pretty good passage in terms of looking at the clauses that are to be changed and at whether it meets obligations.The problem with what we have got now in the current Act is there is a risk that the members of the public who are infected with an infectious disease spread this disease and that it remains unknown and is not able to be managed and of course that is of great concern to New Zealanders. It would also probably be of great concern to the person themselves if it was unknown to them. Also currently the comprehensive and timely information on the rates and trends of sexually transmissible infections is lacking and I found that really interesting—that we do not collect good information on some very old infectious diseases such as syphilis and gonorrhoea or of course on a newer one HIV. So it is interesting that for these diseases—and HIV has been around for quite some time now—we have lacked comprehensive and timely information on the rates and trends. Collection of this sort of data is incredibly important in managing infectious diseases and also for looking at trends and at where it is happening—age groups and so on—in making policy decisions. The other limitation of course is in tracing and contacting people who may be the source of the infection.This bill goes into three main areas. The Minister has set them out pretty clearly and I will just quickly go over them. The first area is the tracing of contacts as I said who may have an infectious disease or who may have been exposed to one. It is called contact tracing and what it does is move from the current reliance on a voluntary involvement to specific measures on contact tracing which will improve the public health ability to be able to identify isolate and test the sources of infectious disease in the community. What it says is: “Where voluntary consent is not gained the Bill introduces a duty on a person who may have an infectious disease or may have been exposed to one to provide prescribed contact information. The Bill also places a duty on public health staff to keep patient and contact information private to the fullest extent possible.” and I think that is really important. Throughout these changes protecting private information is one of the requirements and often it can hamper information if people are scared that things are known about them that will be provided in a public way. The bill also has an offence: “An offence is introduced of failing to provide the prescribed contact information. There is a fine of not more than $2000 upon conviction” and there is an ability to appeal those convictions.The second area of the bill is that it increases the range of infectious diseases that are notifiable and I have already talked about them. They are gonorrhoea HIV and syphilis. So that is the second area where changes are being made. The third area of the bill “provides a series of incremental options for the management of individuals with significant infectious diseases whose behaviour puts other people at risk of contracting a disease.” and it puts in place additional management provisions within a human rights framework using principles of risk management and proportionality.The fourth part of this bill is measures to ban the “commercial provision of artificial UV tanning services to young people under 18 years of age.” and I think the Minister set it out pretty clearly that this is a risk to a small group of people but it still is a risk. Also it does not stop with the approval of a medical practitioner the use of UV tanning services should that be prescribed. So it is not an offence if a practitioner was to prescribe it for medical purposes but for those operating commercial artificial UV tanning it will be an offence.Finally this bill does streamline a number of administrative changes as well and the Minister mentioned that at the end of his speech. The most notable is the inclusion of tuberculosis as a notifiable infection in the Health Act as opposed to it being in its own Act where it was for so long when we had high levels of tuberculosis in New Zealand.The bill goes to the Health Committee. We are very short of work there in the Health Committee so we will be looking forward to having a bill to get our teeth into and we will be looking forward to hearing submissions from the public. The Labour Party supports this bill.SIMON O’CONNOR (National—Tāmaki):I am very pleased to take a call on this bill. As the member who has resumed her seat Hon Annette King has noted this will be a piece of legislation coming strangely enough into the Health Committee meeting. I am happy to report to the House that 3 weeks in I think there is a collegial conviviality and we are working very hard on the matters in front of us although I will not illuminate the House on some previous matters we discussed. Although they may be of great importance I am not sure that everyone will want to necessarily know about particular prophylactic elements that we have been exploring. This is a very important bill and I am very pleased that the Minister of Health has brought this to this House for its first reading. I am also very pleased as the chair of the Health Committee to be working with a fine team of people on both sides of the House in order to help facilitate this bill through. As this is the first bill I do want to acknowledge Barbara Kuriger who is the deputy chair and Scott Simpson Jacqui Dean and Shane Reti from the National side whom I am very much looking forward to working with and of course led by the previous speaker and others in the House on the other side I think we will make good and productive work of this bill the Health (Protection) Amendment Bill.There are three broad areas to the bill. The first which was noted is around the whole Tuberculosis Act and integrating that into another piece of legislation. I think that reflects the National Government’s approach to keeping things simple and not having multiple bills when you can put them into one.The second area is around UV rays particularly through the use of these tanning beds. It has been a discussion point for a while. In fact I think the previous chair of the Health Committee Dr Paul Hutchison was quite keen on this topic. It is one that strikes me as quite important and it is very prudent too that the Government is targeting particularly those under 18 in order to assist them in their decision making. When I worked within the health sector prior to coming into Parliament I used to do quite a bit of work around the plastic dermatological side when it came to melanomas and other skin cancers. Although I would not know whether those were caused directly or indirectly by sunbeds the damage that UV rays can do is very very clear so it is really important that this bill provides some structure and guidance around that.The most important aspects of the bill though are of course around infectious diseases and the notification thereof. This bill is increasing the number of those infections that can be notified. The Minister has mentioned those and they are around gonorrhoeal infections the human immunodeficiency virus or HIV as we most commonly know it and syphilis which is still around in society. Up until this bill basically there has been a voluntary system or obligation of notifying. We are basically ramping up this in a series of steps where a duty is rightly and positively imposed to use a technical term on the person to provide their details to their doctor or to their health professional. In turn actually as well those health professionals—nurses doctors caregivers—are under a duty too now to collect that data. So this has been discussed around contact tracing. Those who are familiar with epidemiology will know that tracking down the source of a disease or infection or some health issue is vitally vitally important not only for that person and their immediate family but for us as a society as well.This bill is a response to those exceptions where as the Minister was referring to people refuse to give over their information. Their choices around their infectious disease have a consequence for the rest of us. We have heard from the Minister as to how that will be a graduated response. Again we want people to voluntarily provide their details and to notify the fact that they have an infectious disease but where necessary we will impose a positive duty that that must be done. Where people then refuse to take the treatment that is required—be that something as simple as counselling discussion or testing—more and more pressure can be applied for what is basically the common good of society.So there are three very important aspects brought into this bill—a triumvirate of factors if you will. I am looking forward to this bill coming before the Health Committee. As I said at the start it is a hard-working committee and we are going through quite a range of petitions at the moment. All are quite important. I think it was quite striking the other day that we had people come before the committee to share their personal stories and it was important for us to hear and acknowledge that. In acknowledging them I will also acknowledge the work that will happen through this Health (Protection) Amendment Bill and I commend it to the House.POTO WILLIAMS (Labour—Christchurch East):Kia orana. It gives me pleasure to rise to take a call on the Health (Protection) Amendment Bill in its first reading. It will come to the Health Committee for discussion which is great. I am also a member of that committee and I look forward to doing some further work on it.Firstly I just want to talk about the timeliness of this bill. Obviously there is a lot of public interest around the notification of infectious diseases with the recent events that have happened overseas around the Ebola virus. So I think it is very timely that we are looking at the Health (Protection) Amendment Bill which I understand from my colleague the Hon Annette King was really a piece of work that started some 7 years ago. So it is great that we have finally got this into the debating chamber.I want to start by looking at the increase in the range of infectious diseases that are notifiable. I spent a little bit of time today looking through the Ministry of Health’s website for the current list of notifiable infectious diseases. Obviously on that list are things like H5N1 or avian flu the severe acute respiratory syndrome virus and Ebola in terms of the viral haemorrhagic fevers. It is really interesting that this is obviously a list of notifiable diseases that changes and grows as the needs demand.On this list it is very interesting that it talks about hydatids disease. I do not know whether many of you know this but I recall as a younger person—a much younger person—that we used to have to take our dog to the dosing centre to have it treated for hydatids. I was talking to a young colleague of mine today Kurt McLauchlan about hydatids and having to take the dog along to the hydatids treatment centre to get him dosed. He did not have a clue what I was talking about. It was quite bizarre. My point about that is that times change and the way we treat diseases and the treatments available change as well. So I am very pleased to see that this bill makes provision for allowing the notification of other infectious diseases as we become aware of them as they become apparent in our communities and as our ability to treat them occurs.I ask myself the question: what is the purpose of updating this list of infectious diseases that are notifiable? And it is obvious that the reason is that as we become a more global society as we travel the world more the issues around diseases becoming more problematic for our populations and progressing around the globe become more apparent. We do need some other tools to deal with ensuring our population stays safe and healthy. This bill makes a very salient point around the traceability of contacts of people who are exposed to infectious diseases or who have contact with others. It gives some very clear directions to medical officers of health to make public health orders through the District Court.In light of the recent events that have occurred in the United States for example discussion about what is required for public safety has to be balanced against what is reasonable in order for people to be able to carry on with their lives normally. I know that in terms of what has happened around the recent Ebola events of course many of the issues that have occurred have been around breaches of standard infection control procedures and the measures that are required for specific diseases. This bill talks about the medical officer of health being able to give certain directions and those directions of course are that the individual who is infected must participate in counselling and must refrain from carrying out specific activities. There are restrictions about where the individual may go and with whom they may associate where they are specified to reside and who may be required to supervise them.The bill also provides for adding some other notifiable infectious diseases to the list. We have already heard that that includes gonorrhoeal infection HIV and syphilis and that means that we will also be able to collect information on and track the prevalence of these diseases better. Also under the provisions of this bill around the contact traceability of folk exposed to these diseases there is a very important provision around ensuring that the information of the individual is kept private because one of the barriers to people coming forward when they are infected is the fact that they will be exposed to public scrutiny. So it is really important to note that one of the important provisions is around ensuring that the information on these individuals is kept private.The third aspect of this bill which is very important relates to the use of artificial tanning providers and services. We are talking about sunbeds and other UV tanning services not being able to be provided to people under the age of 18 unless by a specific prescription. We have had voluntary regulation in place up until now and that does not seem to have had an awful lot of uptake. Many of the services have not complied. Given our attitude in this country to the outdoors we would do well to ensure that when we are exposed to sunbeds and tanning clinics which provide a very heavy dose of UV light in a short period of time—it is quite an intense light. In this country given that so much of our recreation is in the outdoors we are exposed to an awful lot of UV light anyway.I am reminded of a story that a friend of mine talks about where every summer he exposes his children to at least half an hour to an hour of sunlight in the summertime before he puts sunblock on them because he wants them to brown up before they go out and play. I think our attitudes in this country towards exposure to sunlight and UV light are not in line with the detrimental effects that overexposure can cause. We do spend a lot of time in the summer outside in the sun. Often our children are running around with their unprotected skin. We often do not think to put sunblock on. We have a culture in this country around it being permissible to tan and even to burn and that is not good in terms of our rates of skin cancer.In Australia on a visit recently I had the chance of visiting some health organisations that talked about what employers have in place in terms of their employees who work out in the sunshine. They provide personal protection equipment for their employees that includes long-sleeved shirts and long trousers. If those employees were here in New Zealand they would generally be out in the sun working in all sorts of weather in shorts and T-shirts. So the Australians have taken a much more useful approach I believe to supporting workers and just being really smart about being out in the sun. We should match that real attention around being out in the sun and exposure to UV light. It would be really useful in terms of going to sunbeds and tanning clinics if we make some regulation around ensuring that our young people are not overexposed to UV light.Just to sum up Annette King was involved I think in the introduction of this legislation in 2007 and it has taken the Government a long time to get this bill into the debating chamber. I am sure that the Government takes infection control seriously. I believe that responding to pressure from Kiwis in relation to recent events regarding Ebola has potentially pushed this bill into the House but I look forward to having this bill come to the Health Committee. Thank you.BARBARA KURIGER (National—Taranaki - King Country):Where health risks are identified and voluntary measures are not working it is important that more effective actions are taken to protect people from harm and that is the underlying purpose of the Health (Protection) Amendment Bill. As we have heard the bill has three broad objectives to strengthen a range of health protection measures for New Zealanders.The bill will add new provisions for the surveillance and management of infectious diseases. As previously noted these measures will improve the availability of information for certain conditions of public health significance. They will provide for more effective management of behaviours that put others at risk of infection and strengthen legislative provisions for contact tracing. Also the bill streamlines the legislative framework for all infectious diseases by including tuberculosis in schedule 1 of the Health Act “Infectious diseases notifiable to medical officer of health and local authority”. This measure allows the separate Tuberculosis Act 1948 to be repealed.Really importantly the bill prohibits for health reasons the commercial provision of sunbeds and other artificial UV tanning services to those under 18 years of age. The provision of artificial sunbeds and tanning services such as commercial solaria or sunbeds will clearly impact on the rights of these younger people to access such services. However there is strong evidence that people who use sunbeds increase their risk of melanoma and other common skin cancers. The greater the exposure the greater the risk of skin cancer. Studies have suggested that using a sunbed before the age of 35 almost doubles the risk of melanoma compared with those who have never used sunbeds. There is also further evidence that children and adolescents are more sensitive to UV light from any source.So although voluntary standards and guidance on operating sunbeds exists repeated surveys by Consumer New Zealand and health authorities have consistently found variable compliance with these voluntary steps designed to minimise harm. Compliance is improving only very slightly over time. On balance officials consider that the evidence of health harm gives sufficient justification for intervention particularly in respect of controls to protect young people from exposure to artificial UV tanning devices. The bill provides a balance on all of these matters protecting individual rights and privacy while still protecting the health of the wider public. Thank you.KEVIN HAGUE (Green):I would like to start off where the previous speaker Barbara Kuriger left off on the issue of balancing rights or balancing harms because all law is in some way a restriction of personal liberty. That is the point of law. When we pass a law we have to be confident that that restriction of liberty is justified by the protection of the person whose liberty is thus constrained from harm or detriment or harm or detriment to some other person or people. In this House what we need to consider is that balance between the protection from harm and the restriction of liberty. So I want to pass that test over the various provisions of the Health (Protection) Amendment Bill at this point.I want to come first of all to this issue of UV tanning. Paul Hutchison may well be watching this debate and if he is I extend my best wishes to him. We could actually frame this clause in the bill as the “Paul Hutchison clause”. I was going to say “memorial” but that would be wrong. The provision in this bill is at the most timid level imaginable. I was intrigued to hear Jonathan Coleman in his contribution to this debate saying that the age limit of 18 was struck because there was evidence of disproportionate harm to persons under the age of 18. I would be very interested indeed to see that evidence at the select committee. I was intrigued that there was not—as we usually have actually in the case of age limits on behaviours—a case made based on maturity or otherwise to make a decision about the harm that is being incurred with an activity. That was not the Government’s case. It was instead a case based on disproportionate harm. So I am going to be very interested to see that.I would argue that the evidence actually is that there is significant risk of harm at every age. That is the evidence I have seen and that would also be consistent with the point that Jonathan Coleman made about the fact that the voluntary code of practice that his predecessor put in place has not worked. The industry has not complied with the voluntary code—what a surprise. That is usually what we experience with these voluntary codes of practice. The fact is that people who use these UV tanning beds or salons incur significant risk of skin cancers. They do so in a situation where the information that is available to them is insufficient for them to form a reasonable view and make an informed decision about the level of risk that they are incurring. That is a case for not allowing these to exist at all. I will be very interested to hear the evidence at the Health Committee. It is particularly important because at least three states in Australia are now banning these things altogether from the end of this year. What that means is that a substantial problem we currently have which is that some of the equipment that is available in these tanning salons is already second-hand and of substandard quality is going to get worse because there will now be a glut of second-hand machines from those states in Australia that are banning this altogether. We will get the cast-offs from those Australian states which will pose a greater risk that the New Zealand public and the customers of those salons will be unaware of and uninformed about.I will come now to the communicable disease provisions in the bill—the obvious companions to UV tanning facilities in this bill. These are around contact tracing notifiable diseases and the restriction of liberty. Members may be aware that these are provisions that I have considerable familiarity with in relation to my previous work with the New Zealand AIDS Foundation. Again there are various balances to be struck. When contact tracing becomes compulsory as it does under this bill then there certainly is a restriction on the liberty and rights of the person who is being required to for example reveal who their sexual contacts have been.There are potentially also some problems with revealing who those sexual contacts have been—one that is familiar to contact tracers in the public health field—but in relation to the balance that this House must strike there is an issue also with whether in fact we enhance or inhibit our ability to actually contact trace by making it mandatory. A previous speaker has already alluded to that that if someone knows that they may be required to reveal who their sexual contacts have been they may not present for treatment. They may not present to health services; that has been our experience. Striking the balance correctly is going to be very important. Also making a disease notifiable—clearly that can be useful. But again if a person knows that this bill provides—as it does—for the medical officer of health to be able to require a testing laboratory to reveal the identity of the person who has just tested positive for HIV syphilis or gonorrhoea what may happen in that situation is that the person may not present. I believe—and I would be interested to hear the evidence—that it may be better to provide for anonymous testing as we do for AIDS which is a notifiable disease. The select committee needs to consider that.The balance around the restriction of liberty and the public good that is gained is particularly apparent in the new powers of medical officers of health to compel various levels of behaviour. As I say I was at the AIDS Foundation and had to use all of these provisions from the existing 1956 Act an Act that came into place largely reflecting the experience of New Zealand in managing tuberculosis. We needed to deal with modern disease and modern circumstances such as the HIV epidemic with powers that were created for a different bygone era and a totally different kind of disease. We found them all to be inadequate for the purpose. That is why we were strong supporters of reform of the Health Act back in 2001 when I had to deal with the Christopher Truscott case which some members of this House may recall using these archaic powers.The AIDS Foundation has been a strong supporter of the Public Health Bill and I am grateful to Annette King for outlining some of the history of that bill. Annette King did not mention that the bill introduced in 2007 was merely the latest attempt to have a public health bill and that previous attempts had also foundered. As she said this bill which was reported back from the select committee to this House in 2008—and members of the public have already had a chance to express a view about many of the provisions in relation to that public health bill—has languished near the bottom of the Order Paper since that time.It would have been much better to simply advance the Public Health Bill further up the Order Paper. We would have had cutting edge legislation that was able to deal with these issues much more quickly than we will have with this bill had we done that. Why have we not done so? We have not done so for the reasons that National outlined in its minority view in the select committee’s report back of the Public Health Bill. Essentially it opposed the provisions in that bill that dealt with non-communicable diseases and it opposed them because of its proximity to the very industries that drive the epidemics of non-communicable disease in New Zealand. The conflicts of interest that were apparent in National’s opposition to the Public Health Bill are the very conflicts of interest that are now coming back to bite it over its management of the Katherine Rich - Health Promotion Agency issue. It has to figure out where it stands.BARBARA STEWART (NZ First):I rise on behalf of New Zealand First to take a call on the Health (Protection) Amendment Bill. New Zealand First supports this bill. We believe that the changes that the bill makes are very timely. The bill makes a great number of changes that are needed to the public health system. We knew that there were concerns about the way the current legislation was not meeting the needs that health professionals were identifying so this is very timely. Of course like others on the Health Committee I am looking forward to working further on this bill.Firstly I would like to speak to the first section of the bill which deals with tracing people who have an infectious disease or who may have been exposed to one. There is nothing surer than the fact that we need timely data on this. It will reduce the need for people to wonder about whether or not they have actually contracted a disease. We know that the voluntary involvement in reporting is not really good enough. We know that people are travelling far more than they ever have and if there is a disease that they may have been exposed to or have picked up and brought back to New Zealand we need to know fairly quickly. We have got the example of the Ebola disease. We appreciate that the Ministry of Health is focusing on this and taking measures to try to ensure that New Zealanders are not exposed to it and that if somebody comes into the country who has contracted Ebola we have got some system in place to actually deal with it. That is what needs to happen.Previous speakers have listed the wide range of diseases that are contactable to the Ministry of Health. We believe that some people may consider these rules too strict but they are essential to the health of New Zealanders which we totally support. In particular the bill requires that medical health professionals keep private the details of all of those with infectious diseases to the fullest extent possible. We believe that this will be a real challenge but we appreciate that New Zealanders definitely need certainty with their health care. So we will be interested through the select committee process to see exactly how this is going to happen. In New Zealand First we support preventative measures rather than reactive measures and this is really a good start in this field. We are pleased that this bill is one of the first on the Order Paper—or pretty soon in the first bracket of Parliament—because action needs to be taken.Again we are very happy to see that the Government has decided to take some action on tanning salons tanning services and sunbeds. We can credit that to Dr Hutchison and timely written questions from New Zealand First. We believe that it is timely to ban sunbeds for people under the age of 18. I recall a few years ago going to a tanning salon trying to get the golden tan that New Zealanders like. The lady told me that no I would not get the tan that I thought I was going to get; that I would stay instead with my vegetable tan—red as a beetroot and peeling like an onion. I did not expect to get that from a tanning salon. So we think that this is a small step forward and we welcome it but we do not think it really goes far enough because every Australian state has now either banned or is planning to outlaw these commercial sunbeds. We know that Australians have one of the highest rates of skin cancer in the world.We previously asked the Hon Tony Ryall whether or not he planned to follow the Australian example. The answer that we got back was no he had no plans at that particular time. So we are very happy to see this coming through. We know that there is absolutely nothing in New Zealand that checks and regulates these sunbeds apart from voluntary guidelines. We know that there needs to be monitoring of sunbeds as to the intensity of the light that the beds are emitting and the length of time that people actually spend in them. But nobody has ever measured the light so whether or not they are at the recommended rate or higher than that rate is totally unknown.The total registration rate for melanoma has decreased in New Zealand by 13.4 percent between 2001 and 2011 but unfortunately the mortality rate has increased by 12.3 percent. We know there needs to be more action to reduce this number and banning sunbeds would be a very significant step towards that. Skin cancer is one of the most common cancers in New Zealand and we all need to be taking action to help reduce that particular rate. I know that when we were over in Australia as a previous speaker has mentioned we were surprised to see that all of the workers outside were totally clothed. There was no bit of skin exposed to the sun over there. It is something that perhaps we may need to consider here in New Zealand.The bill also makes a number of administrative changes that will streamline legislation. Most noticeable of course is the inclusion of tuberculosis as an infectious disease under the Health Act 1956 and the consequent repeal of the Tuberculosis Act 1948. The facts show that cases of multidrug-resistant TB have been trending upwards for some years—the last 15 years in fact—largely driven we believe by the increasing number of migrants who are coming into New Zealand and the fact that there is no real check on whether or not they have this multidrug-resistant TB. So we would be most interested to see whether streamlining and repealing the Tuberculosis Act have any positive changes on the TB rates in New Zealand.In New Zealand First we have always been supportive of ensuring the best possible health care for New Zealanders. We believe of course as I said earlier that preventative measures are better to achieve this than the reactive measures that we have come to expect from successive Governments. So New Zealand First will be supporting this bill as it is working towards protecting the health of all New Zealanders and we look forward to hearing the submissions at the select committee and working further on this particular bill. Thank you.SCOTT SIMPSON (National—Coromandel):It is a pleasure to take a very brief call in this introductory debate on the Health (Protection) Amendment Bill. As a returning member of the Health Committee it will be very good to sit on the committee and get into the two main issues that the bill confronts. These issues are to do with the spread of infectious diseases and as other speakers have noted the UV tanning issue for those who are under 18. One of the interesting things that we found when the committee toured to Australia late last year was that although Australians have a higher rate of skin cancer than New Zealanders do we have a much higher mortality rate so there is clearly something that the Australians are doing better than we are. I hope that by introducing a measure to prevent those under 18 participating in the use of UV tanning clinics and things of that nature this bill will help in some way. I commend the bill to the House.MEKA WHAITIRI (Labour—Ikaroa-Rāwhiti):Tēnā koe Mr Assistant Speaker. It gives me great pleasure to take a call on this bill. Can I start too by acknowledging the newly appointed Minister of Health the Hon Dr Jonathan Coleman. I wish him well in his tenure as the Minister of Health. Health for many of the people whom I represent from Ikaroa-Rāwhiti is very very important along with education jobs and housing so I am happy to stand in support of this bill in its first reading.I want to acknowledge the origins of this amendment bill which came from the Public Health Bill introduced by the Hon Annette King some 7 years ago. I want to acknowledge the fine role the Hon Annette King has played as a Minister of Health. There is not a place that I travel to up and down Ikaroa-Rāwhiti—be it hospitals community health providers or Māori and Pacific communities—where the people do not know and acknowledge the work that Annette King did in her time as the Minister of Health so I do want to acknowledge and mihi to Annette.I am glad even though it is 7 years on that we have this bill before the House. Of course the problems that this bill is attempting to address have been canvassed by previous speakers: infectious diseases and UV tanning devices. I want to talk about the problem around infectious diseases and what this bill is attempting to do in mitigating how we deal with that. There is a risk that members of the public are affected by serious infectious diseases and that the spread of these diseases remains unknown and is not able to be managed. So that is clearly the intent of this bill.We are also trying through this bill to create comprehensive and timely information on rates and trends of sexually transmitted illnesses which is lacking and which hampers appropriate policy development for reducing and managing these sexually transmitted illnesses. We also through this bill are trying to address the lack of immediate options for effective case management—that is either voluntary compliance or detention—which means that in practice usually only limited action is able to be taken to manage and assist people whose behaviour puts other people at risk. Fourthly we are also trying to trace and contact people who may be sources of infection and who require treatment. If treatment is not undertaken in many situations it will result in the infection further spreading. Again we do not want this in our communities. As such the Government needs to do more to help stem the spread of infectious diseases and I acknowledge that the introduction of this bill is clearly attempting to do that.There have been comments on the UV tanning. As some of us start approaching the warmer months of summer some of us do not need to be tanning perhaps as others feel the need to but it is a serious matter. Tanning does cause harm particularly to young people and to perhaps many people in this House bar some of us. I guess it is both a privilege and an advantage of being of a certain ethnic background—we celebrate that some of us do not need to use tanning. But to get back to the serious nature of it there are people who suffer severely through UV tanning and this bill is attempting to make sure that we are managing that in order to prevent further harm particularly as previous speakers have mentioned to under-18s.So what is the bill about? It is trying to give effect to the Government’s decision from October 2013 to improve the range of measures available to protect the public from harm associated with both infectious diseases and with artificial UV tanning. Improving like I mentioned the tracing of people who have infectious diseases seems pretty reasonable. It sounds pretty straightforward. But the end point for me is the fact that we need to protect our communities from the further spreading of infectious diseases and therefore we need to make sure that we have a facility that registers people with those types of diseases.It is important that we create the opportunity to ensure that people are registering. I see in the bill that there is an expectation that all information will be confidentially held. That is perhaps one of the scary points that some of the previous speakers have made but I also know that it is vital for many many people. We have read stories in papers about people having maliciously gone on to spread infectious diseases and the harm that has been caused to many innocent people throughout the country. I just want to ensure that when we are putting this through the select committee process people who may have a concern—and I do want to acknowledge the Green member talking about getting the balance right between liberty and public good—can raise their concerns and I think the select committee process is where that can happen.As a member from one of the largest electorates I do need to pass on some comments to members of the select committee. In relation to a lot of the health policies and health legislation that we pass in this House I do want to put in a plug for rural communities and I do want to put in a plug for isolated communities simply because they do not have access to a lot of the services that those who live in more metropolitan and larger provincial towns enjoy. There are communities up and down my electorate—just the logistics of implementing a registration like this and managing the unintended consequences of UV tanning devices. Can I leave it to the great members of the Health Committee to ensure in their deliberations that in passing this bill we are able to ensure that all New Zealanders no matter where they live no matter how far they live from centres are able to access the benefit of this legislation and the intent behind it.I do join with others in this House in standing in support of this bill. I look forward to the report back that will come from the Health Committee. Kia ora.Dr SHANE RETI (National—Whangarei):I had the privilege of practising dermatology for 20 years in Northland so I have seen some of the damage that sunbeds can do. I commend this bill as a timely and important bill.The Health (Protection) Amendment Bill is about protecting health. Previous speakers have set out clearly why the provisions in the bill are necessary and I want to discuss matters of compliance. Failing to comply with an infectious disease direction failing to comply with a public order and failing to provide contact tracing information is an offence. In all cases a person committing an offence under the infectious disease provisions of the bill is liable on summary conviction to a fine not exceeding $2000.The bill also introduces an offence for providing UV tanning services to a person under the age of 18 years. The offence would also apply to the owner of the business as well as to staff who undertake the supply of services. This is a strict liability offence. In other words the bill reverses or modifies the usual burden of proof for an offence or a civil pecuniary penalty proceeding and requires the defendant to prove they did not commit the offence.Again this has been reviewed by the Ministry of Justice against the New Zealand Bill of Rights Act requirements and has passed the test. A person or a body corporate has a defence against the charge of providing UV training services to a person under the age of 18 if they can show that the contravention occurred without their knowledge and that they took reasonable precautions and exercised due diligence to prevent that contravention. For example a person who sold a sunbed session to someone under 18 years of age may have a defence if they can prove that an approved evidence of age document was provided prior to the service being provided.This is an excellent piece of legislation in totality. I commend its referral to the Health Committee.IAIN LEES-GALLOWAY (Labour—Palmerston North):I am very pleased to support this legislation because I always support Labour policy. This is a good bill that implements Labour policy that has been around for a very very long time. Other speakers have referred to the fact that the bulk of this legislation comes directly out of Labour’s Public Health Bill but of course the National Party vehemently opposed it. I believe it got reported back from the select committee sadly on 26 June 2008 which was right before the 2008 election and of course the National Party could not help but play politics with a piece of legislation that was designed to improve the health and well-being of New Zealanders. Of course what term did National use? Well it was nanny State—nanny State nanny State nanny State.What I found really interesting was reading through the minority report that the National Party wrote on the Public Health Bill—probably written by Chris Bishop. He is having a good old grin. I do not know whether he was in a National MP’s office at the time but it certainly looks like it was written by a communications person not by a member of Parliament sitting on the Health Committee.I read the section entitled “Not so voluntary codes of practice” in which National Party members wax lyrical about their concerns about how voluntary codes of practice that could be used to ask different industries to adopt practices that support the safety and well-being of New Zealanders could ultimately turn into regulation or even legislation. Of course you have just got to grin when really that is exactly what this legislation does. It takes a voluntary code of practice that the people who operate UV tanning devices were asked to implement. They spectacularly failed to do anything that was in the interests of the health and well-being of New Zealanders and so this National Government is in fact doing exactly what it warned the terrible Labour-led Government back in 2008 it was going to do by implementing voluntary codes of practice.I see the former medical practitioner over there—sorry I have not learnt your name yet; I will eventually. But he is having a wry grin. He knows what I am talking about. Usually the medical practitioners in National side with Labour on this stuff. I remember when Paul Hutchison crossed the floor of the House to vote with Labour on its tobacco legislation. The medical practitioners in the National Party always get this stuff. It must be painful being in the National caucus having to deal with the silly political rhetoric that those members engage themselves with when it comes to health legislation.We could have been doing this. We could have got this in place 7 long years ago but thankfully because of the Ebola crisis in West Africa the National Government sees fit to pass this legislation at this point in time. I have to say it is a little bit disappointing that National has chosen to use the Ebola outbreak as the catalyst for introducing this legislation. The bill itself says that National made the decision back in October last year to pursue these regulations but it seems that it sort of waited until there was an appropriate moment in the media to say that it is doing something to protect the health and well-being of New Zealanders.I attended a briefing with ministry officials that the Minister of Health organised for Opposition health spokespeople to talk about what the response is to the Ebola outbreak. One of the things that they were at pains to get us to understand was that the last thing they wanted to do was for people’s vigilance to suddenly improve during the outbreak and then fall away again if and when the outbreak is finally over. Actually there are real risks to New Zealand of people carrying communicable diseases into the country from overseas every single day. In fact even today we are more at risk from malaria than we are from Ebola because malaria is much more communicable much more infectious and actually people coming in—the chair of the Health Committee is looking perplexed and bemused. I encourage the chair of the select committee to talk to the health officials about this. They said that people coming into the country with a heightened temperature from West Africa are more likely to be carrying malaria than they are Ebola.But of course there is a range of other diseases as well that could be brought into the country by people from elsewhere so these provisions actually are necessary all of the time and have been necessary for the entire last 7 years since National made politics out of the provisions of the Public Health Bill. It is really good that National is finally charging ahead with this now but we could have done it much sooner.Speaking of “much sooner” I note that the World Health Organization recognised tanning beds as a significant carcinogenic threat back in 2009 and recommended that Governments should implement legislation to do exactly what this bill does—to ban the use of tanning beds for people under the age of 18. With its usual haste and enthusiasm a mere 5 years later we see this Government finally implementing the recommendations of the World Health Organization on UV tanning beds.This is the problem with National. It is slow to act. National usually lets Labour Governments take the progressive stance to actually do things. National members jump up and down and squeal at the time they tell everybody how their rights are going to be taken away from them and then when they do get into Government of course they do not repeal any of it; they just carry on with business as usual. But it is always left to this side to make the positive change that actually improves the health and well-being of New Zealanders. The sky is always going to fall when National is in Opposition and then when it gets into Government of course it repeals absolutely none of it. So it is no surprise that it took it a mere 5 years. In fact we should be really quite impressed that it took it just 5 years from when the World Health Organization first recommended legislating against the use of UV tanning beds for under-18s to when the National Government finally gets to the point where it legislates for them.I do take the point the Green member Kevin Hague made that the evidence that the age of 18 is the appropriate age is probably not strong. I heard from one of the members opposite—the deputy chair of the select committee—that the recommendation is not to use them before the age of 35 but there is always a balancing act with these things. I think that most of the evidence tells us that the use of alcohol before the age of 25 probably is not that good for the development of the young developing human brain yet we have made 18 the purchase age for alcohol. Again I actually applaud the Government for achieving what is probably an appropriate balancing act by finding that age and 18 is of course the age of eligibility for a range of things that we deny to young people. It just seems appropriate that that would be the age at which you become able to use a tanning bed if you feel so inclined despite the fact that the evidence against doing so is getting stronger and stronger every day.It is important to be able to improve the tracing of people who have or who may have an infectious disease or who may have been exposed to one. Certainly the measures that are already in place for tracing people who are identified as being at a risk of carrying Ebola or any other infectious disease from overseas are quite sound and I think New Zealanders should feel satisfied that their Government and the Ministry of Health are taking appropriate action to ensure that the community at large is kept safe and that the risks are managed. In fact the current legislation really does allow for that and I am pleased that in this country we have not really seen too much fearmongering around the risk associated with Ebola and other communicable diseases because that risk is very real every single day. Just because we have got an issue that is getting a lot of media attention does not mean actually that our vigilance should go up. We should remain vigilant at all times.This is good legislation. It implements what has been long-held Labour policy. We look forward to the discussions at the select committee and a robust and constructive debate around some of the finer points. We commend this bill to the House.Dr PARMJEET PARMAR (National):What a great contribution on the National Government’s Health (Protection) Amendment Bill from all members. It is my pleasure to rise to conclude the debate by commending the bill to the House. Thank you.Bill read a first time.Bill referred to the Health Committee.