Health Practitioners Competence Assurance Bill Health and Disability Commissioner Amendment Bill Medicines Amendment Bill — Third Readings 
Health Practitioners Competence Assurance Bill Health and Disability Commissioner Amendment Bill Medicines Amendment Bill — Third Readings 
[Volume:611;Page:8621] 
Health Practitioners Competence Assurance Bill 
Health and Disability Commissioner Amendment Bill 
Medicines Amendment Bill 
Third Readings 
Debate resumed from 10 September. 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 The Health Practitioners Competence Assurance Bill was 272 pages but has now been split into three bills. It was comprehensive legislation that failed abysmally to measure up to the standard that it should have reached. The bill originally sought to have 11 Acts of Parliament included under one Act to ensure the competence of health practitioners throughout New Zealand to be able to practise safely to protect the public and to assure quality assurance in the ongoing education and credentialing of people involved in health practitioner competence. The bill did not achieve that. In the Health Committee we worked very hard to try to make improvements to it. 
But it should not have been a political bill. It should have been the sort of bill that everybody round the select committee table could agree on and work on but that did not happen. One has to ask why. One has to sheet it back to the Minister of Health. The Minister of Health had not asked the ministry the hard questions in the development of the bill. She should have sent the bill back to the select committee. She should have sent it back for the ministry to go back to those people who were so concerned about the bill until she got it right until the ministry got it right and until people were happy with it. 
Some of the people included under the bill—physiotherapists occupational therapists and dental technicians—have Acts of Parliament that are very old dating from 1947 and 1956. They were very pleased to get new legislation. But the doctors the medical practitioners in this country absolutely opposed the bill. They work under an Act that was brought in by the National Government—the 1995 Medical Practitioners Act. The bill was supposed to be modelled on that Act of Parliament. Initially the doctors said that was fine because they are very happy with the 1995 Act. They think it has solved about 30 years of problems. They were happy for the bill to go ahead based on that. But that was not what happened. What happened was some very new things were introduced. 
One of those things was scopes of practice. They were not defined on paper. There were no academic pieces of work that people could subject to peer review to decide what exactly scopes of practice meant and how they would affect health practitioners in this country. There was no intellectual rigour applied to this concept. It is not practised anywhere in the world. The only place in America that thought it might go down this line has not implemented it because it has been too difficult. Scopes of practice have been described as cutting edge and as enabling legislation. The last time we heard that was on the Resource Management Act and members know what a mess that turned out to be. People do not know exactly whether scopes will be broad or narrow or how they will be interpreted. Only through case law when people turn up before the Medical Practitioners Disciplinary Tribunal and other disciplinary tribunals will we actually get some strong concepts about what scopes of practice are. 
That is one of the major concerns that medical practitioners have. They want out of this legislation. Heather Roy and I worked to try to get medical practitioners out of the Health Practitioners Competence Assurance Bill but we failed because United Future would not support us. Otherwise we could possibly have moved ahead. 
The other concerns in this legislation are the powers of the Minister and there not being elected representatives on registering bodies. That is of major concern to bodies like that of the doctors who previously have been able to elect representatives. It is about professional competence and professions actually feeling they have some control of their profession; they are very unhappy that that is occurring under this legislation. 
One part of the original legislation will now become a separate Act when it is passed—that is the Health and Disability Commissioner Amendment Bill one of the three bills that this major piece of legislation has now become. We agreed with that. That was a good part of this legislation. We worked hard on it in the select committee to make changes. We agreed with this part because it is based on the Cull report and develops a one-stop shop gets rid of the complaints assessment committees and ensures that all complaints about health professionals go to the Health and Disability Commissioner’s office. That is a very good advancement. We know from the Parry inquiry that it was the complaints assessment committee and the process of getting through it that caused most of the problems. I will never forget Colleen Poutsma’s husband saying: “If you are not very determined and very articulate you cannot get through this process.” That was not good enough and we do have to help people through the process. We welcome this change and we are pleased to see it. 
The other changes that have occurred are now in the Medicines Amendment Bill. At the moment the pharmacists are absolutely reeling because stat dispensing has come in and Pharmac has gone back to 3-monthly dispensing. This has seen a 30 percent reduction in the income of pharmacists. We are seeing rural pharmacy closures already. We are seeing interns having to do a fifth year to get placement to be fully registered. Half of them cannot get places now because the pharmacists cannot afford to have them. We see rest homes that had their medicines dispensed in blister packs now facing the costs of paying for stat dispensing—a significant increase when rest homes and continuing care units have had no increase in funding from this Government and have had massive increases in costs. In this situation pharmacists will be partly deregulated. They can own up to five pharmacies and up to a 51 percent shareholding. The Minister has an exemption clause that allows her to allow other ownership if it will improve health services within an area. 
Another area that the doctors were particularly concerned about was quality assurance. Over the last 8 years probably since the Medical Practitioners Act came in quality assurance has improved markedly in hospitals around the country. Complaints procedures and doctors nurses and other health professionals getting together to engage in quality assurance activities have seen a marked improvement from the 1980s when I first began practising as a doctor. Thirteen percent of people who are admitted to hospital suffer iatrogenic harm which means harm that comes from the treatment they receive—either from medicines from getting a hospital-acquired infection or from the treatment they have somehow harming them. It is absolutely essential that when one has a near-miss or something goes wrong or some unexpected event occurs in a practice the practitioner can actually sit down with people and look in a protected way at what went wrong so that he or she can improve those services so that he or she can say: “This was the problem. Let’s do something about it. Let’s make it better. Let’s improve the systems.” 
If quality assurance is not protected—and we did make some changes in the select committee but many feel we did not go far enough to protect quality assurance activities—then people will not voluntarily offer up information about what has happened or what has gone wrong. One case at Waitemata hospital—the Lachlan Jones and Malcolm Beggs case—was used as the reason that we now have to open up quality assurance. There are lots of different avenues for people to take a complaint—through the hospital complaints system and through the Health and Disability Commissioner’s complaints system. If a practitioner on the front line cannot look at his or her practice and do case reviews then that will be very significant. I do not wish to see a reduction in quality assurance activities. 
National has not supported this legislation not because the concepts were not right and not because we do not want all health practitioners in this country to practise safely but because the legislation was not consulted on properly and because there are things in this legislation that the practitioners especially the doctors are very unhappy with and they should know because they are practising on the front line. 
JUDY TURNER (United Future) 
: 
 This legislation has had a long and varied journey—that is a petition in 1999 a member’s bill in 2001 and the Cull report all of which have set the stage for what we support in the House today. This has been an adventurous legislative project. To create legislation that would provide an effective regulatory regime to protect the public from harm and that would endure well into the future is no mean feat. One of the strengths of what we now have is that it establishes a framework for practitioners who are currently not covered by law to meet a raft of regulatory standards and to gain professional credibility. Among those now waiting in the wings to be included are psychotherapists acupuncturists and a number of natural health-care practitioners. 
One of the most welcome aspects of this legislation is the new one-stop complaints structure. The old system involved multiple agencies undertaking separate investigations into the same incident with huge time delays difficult access for patients to the complaints process no centralised database to detect repeat poor practice and no powers to suspend practitioners when the public is at risk. This legislation addresses all those concerns and is consistent with the recommendations of the Cull report. 
The power-base of this legislation has been of concern to some submitters. There was of course a difference in those concerns depending on whether the submitter was a professional or a consumer. What we have ended up with is a series of provisions that empowers professional authorities and a balancing set of provisions that involves consumers and central government. After passing this legislative framework the Minister will after appropriate consultation and through Order in Council allow new professions to be added to the list of those covered by the legislation and will determine which activities should be restricted to certain practitioners. Professions will be able to appoint the members for each registration body but there is provision for elected members. 
That option is important as different professions requested different outcomes from that provision. Some did not want to have elections and others did. The either/or nature of this aspect of the legislation is a good compromise. The Minister can instigate an audit of an authority’s policies and procedures if it is concerned about its processes and the Minister can give directions to resolve disputes between professions regarding overlapping scopes of practice. It is hoped however that where overlapping scopes of practice exist the professions involved will work maturely through any issues themselves. 
Central controls on registration authorities are that each authority must have two lay members and that each authority must be separate from the association that represents a particular profession. It is interesting to note at this stage that while the doctors association had concerns about the legislation the doctors’ regulatory body the Medical Council did not and has supported it. 
The powers and responsibilities of registration authorities include setting the scopes of practice that everybody is so worried about; the power to set those is with the regulatory bodies and the professions themselves. Determining competencies and qualifications is their responsibility as is certifying individual practitioners and setting standards of clinical competence cultural competence and ethical conduct. 
There has even been some mocking of the inclusion of cultural competence as if this is some sort of new imposition on health practitioners. Hospitals have respected cultural considerations for years and no health professional wants to alienate patients through unintentional insensitive practice that leaves them feeling vulnerable or worse violated. Of course the registration authorities also ensure that professionals maintain their competence. 
United Future is pleased to support the third reading of this legislation and is pleased that there is a review clause ensuring that any tidying up that may be needed will be given due consideration. At the end of the day the best gauge we have as to the appropriateness of this legislation is feedback from some of those who are most affected by its implementation. During the Committee stage of this legislation I referred to recent communications received from many of the health professionals who immediately come under this legislation: the Dental Council the Nursing Council the Occupational Therapy Board the Dietitians Board the Psychologists Board the Opticians Board the Medical Radiation Technologists Board the Medical Laboratory Technologists Board etc. They have all supported the intention of the legislation. 
United Future is also pleased to hear of the hard work that is already well under way by professionals immediately affected by this legislation and looks forward to seeing the ongoing development of health practices not yet covered by it. 
PITA PARAONE (NZ First) 
: 
 As a first-time member of Parliament I have often been amazed at the scope of some of the legislation that has passed through this House. The range of legislation illustrates how regulated and legislated we are as a country. It also illustrates that perhaps there are too many people in here who have completely lost touch with the real world where most people live—people who just want to have a happy life and to get ahead people who are contributing to our presence in this House through their taxes and people who I suggest are getting more and more frustrated at the red tape and bureaucracy that they have to endure in order to run their businesses. In fact I know people with good business ideas who run a mile from that once they realise the course they have to run. But I digress somewhat. 
The record will show that New Zealand First opposed the legislation. But I also want the record to show the reasons for that opposition and to reassure the public of New Zealand that we in New Zealand First are not against legislation that ensures the protection of health consumers and the regulation of health practitioners as some people in this House would have others believe. 
As I mentioned during the early part of the debate the intention of this legislation is good. In fact any legislation that has the intent of assuring patient safety has to be good. However there has been a great departure from what was originally introduced. It looks good on paper to have legislation that brings all health practitioners under one umbrella with the safety of patients as its overriding goal. But I do not think enough consideration has been given as to how it will work in practice. Too much of it is theoretical and untested and I am not the only one who has serious misgivings about it. We can witness the distancing of medical practitioners from it. They want out and for good reason and I ask why? Perhaps herein lie some of the answers. They will have to work it all out on a daily basis and dare I say it define and apply the often referred-to principles of the Treaty of Waitangi which are conspicuous by their absence from this legislation yet are included in a number of other pieces of legislation. 
They are the ones who will have to comply with bureaucratic demands. They will have to figure out how scopes of practice and registration authorities will work in reality while there remains the possibility of political interference. They will have to deal with the issue of cultural competence conspicuous by the fact that no definition is given in the bill. They want out because they can see clearly that the bill does not do what it was originally presented to this House as doing. 
The passing of the legislation is a signal to them that the Medical Practitioners Act widely held to be workable and robust legislation is no longer good enough. They say that it is and we know that it is. If it ain’t broke why fix it? More appropriately if it needs only a spark plug why replace the engine? Without the support of the medical profession I suggest there will be difficulty ahead. I further suggest that we should heed the profession’s call before it is too late. 
Of course the irony of all that is that the legislation was to be modelled on the Medical Practitioners Act so that health-care professionals would be covered by more effective legislation. Medical doctors’ concerns about this legislation say it all. This legislation has completely lost any common ground it may have once had with the Medical Practitioners Act. Instead it has become a tangled web of bureaucracy with unprecedented powers afforded to the Minister. 
To say that some people within the health profession hold concerns with regard to those increased powers would be an understatement. The possibility for considerable political interference into matters of a professional nature provides the potential to undermine the very intent of this legislation—that is the safety and quality of health services to patients. 
Last night the Associate Minister in response to the many criticisms already expressed from those within and outside the health profession alluded to the fact that scopes of practice were not something new as they already exist. I tell the Minister that what is new about them is that this legislation now makes them a legislative concept. The lack of any wide discussion or consultation is the cause of much of the criticism. As the chairperson of the New Zealand Medical Association mentioned with the numerous alterations made during the passage of the legislation it is clear that the focus will be on narrow codified descriptions of each individual’s practice. Already it is not hard to imagine that narrow restrictive and bureaucratic individual codes of practice will influence employment contracts with district health boards. It is quite telling that doctors were originally amenable to the concept of the legislation. I cannot say that that is now the case. 
I urge that we reconsider the position in which we now find ourselves and take heed of the voices of experience and reason that are coming at us from all directions. As the Association of Salaried Medical Specialists recently mentioned the passing of the legislation would be the first time for a very long time if ever that legislation covering the registration and competence standards of the medical profession has been passed against the advice and despite the express opposition of the medical profession itself. 
The association also expressed its concern at the increased degree of political and bureaucratic control as an interference in the registration and standards of medical practitioners at the expense of professionalism. As a member of the Health Committee I was approached by many health-care providers and consumer groups that were deeply concerned about the implications of this legislation. I also heard and read submissions from many groups and individuals who will be affected by this legislation. I would be failing in my duty if I did not say in this forum that a lot of apprehension is out there. People are concerned about the implications of the legislation together with compliance costs and how scopes of practice will work. If this legislation is about the protection and safety of the general public then they are quite right to say that it should then be robust enough to earn the support of those experts in the field. They also note the irony in that much of the controversy surrounding the legislation could have been avoided had there been acceptance of some of the practical amendments offered consistent with the intent of the legislation. 
I also note that a number of health practitioners are yet to be included in the legislation not least acupuncturists from whom a large number of New Zealanders are able to have their health concerns addressed. I further note that the ministerial advisory committee on complementary and alternative health mentioned that there are in excess of 60 different alternative health services all of which will need registration if they are to be covered by the legislation. The bureaucratic obstacles afforded by this legislation will not provide any encouragement for those professions to want to be covered and could lead to possible undercover operations. However during the debate on the legislation New Zealand First expressed its opposition to much of it. We also supported certain parts of it; one particular part has given rise to the Health and Disability Commissioner Amendment Bill. In keeping with that support New Zealand First will be supporting that particular bill. Essentially it deals with complaints about health-care providers and disability service providers and ensures that each complaint is appropriately dealt with. 
Finally I reiterate that both patients and providers must be confident in the processes in place to protect them. The Health Practitioners Competence Assurance Bill does little if anything to inspire that confidence. Quite the contrary I maintain that health-care consumers should be at the centre of a bill that purports to protect them yet nowhere are patient outcomes shown as a major focus. Accordingly New Zealand First will oppose the Health Practitioners Competence Assurance Bill and the Medicines Amendment Bill and will support the Health and Disability Commissioner Amendment Bill. 
HEATHER ROY (ACT NZ) 
: 
 I rise to speak to the third reading of what was the Health Practitioners Competence Assurance Bill. That bill has now been divided into three bills: the remaining Health Practitioners Competence Assurance Bill the Health and Disability Commissioner Amendment Bill and the Medicines Amendment Bill. Like my colleague in New Zealand First ACT New Zealand will be supporting the Health and Disability Commissioner Amendment Bill but will oppose the other two bills. Our concerns certainly have not changed as the legislation has progressed from the bill that was initially brought to the House to the three bills that it now is. 
I have to say that this is a very sad day for New Zealand. It is a very sad day for health professionals whom the Government insists on calling “health practitioners” because in fact they are very professional and I think they deserve to be called “health professionals”. It is a very sad day for the health professionals of this country for several reasons. The first is that the Government has not listened to them. Many of the groups that came to the Health Committee—and we had slightly more than 250 submissions I think—had very similar concerns about scopes of practice quality assurance provisions the great amount of ministerial control that this legislation will allow and about elected members of authorities. The Government was unwilling to listen to those concerns and make the significant changes that would have made it much more palatable for medical professionals in particular—but some others too—to accept the provisions within this legislation. 
When the Ministry of Health issued its discussion paper in 2000 the Health Practitioners Competence Assurance Bill was welcomed because the underlying principle behind the bill—of using the most modern health occupational legislation the Medical Practitioners Act as the basis of developing new umbrella legislation—was a very good idea and most of the professional groups agreed with that. However as time progressed things changed significantly and the Health Practitioners Competence Assurance Bill that was finally presented to the House at the Committee stage was so far removed from the Medical Practitioners Act that in parts it was barely recognisable. 
It is a sad day also because medical practitioners are very unhappy with this legislation—so much so that they asked to be removed from it. They have made their concerns very well known and I put forward a Supplementary Order Paper to have them removed from it. The National Party and New Zealand First both supported my Supplementary Order Paper because they could see the damage that will be caused as a result of medical practitioners having to abandon modern up-to-date and very well-working legislation and change to the Health Practitioners Competence Assurance Bill. It really is a retrograde step both for themselves in their practices and most important for patients when it comes to safety concerns. 
It is also a very sad day for the Pharmaceutical Society. The Pharmaceutical Society is an organisation that has existed for over 100 years. It has built up a great number of assets and operated very professionally over those 100 years and there has been a great deal of emotional attachment to the society as time has evolved. Certainly pharmacists are very sad to see that go. As time has gone on and it has become apparent that they will have to disband their society they have been making provision for that. But there will certainly be a great deal of sadness because of the emotional attachment they have felt to it and that is not necessarily a bad thing when we are talking about medicine and the care of patients. 
The legislation has been described by Ian Powell of the Association of Salaried Medical Specialists as an ambitious dog’s breakfast and I think that sums it up quite well. It is certainly ambitious legislation. It will see the repeal of 11 Acts relating to different professions so that there will be one huge omnibus piece of legislation. It is hugely thick and hard to lift and it will not cover everybody’s concerns as huge umbrella pieces of legislation seldom can. Some groups were very pleased to see the introduction of the Health Practitioners Competence Assurance Bill. Physiotherapists and occupational therapists for example have been working under 1949 legislation. Practice has certainly moved on in that time. The legislation relating to dietitians has been in existence since 1950. For those professional groups it is time to move on and have up-to-date legislation. Although the Health Practitioners Competence Assurance Bill is not perfect it will serve them better than the legislation they have at the moment. I myself feel that they would have been better to hold out for amendments to their own Acts but it is a move forward for them. 
One of my great concerns which I mentioned several times during the other reading debates and the Committee stage was the lack of a definition of “competence” in the legislation. Here we have legislation that is all about competence and patient safety yet competence cannot be defined. We were told at the select committee that it was too hard to define. If something is too hard to define how can it be in the title of the bill? How can it be a yardstick by which people must be judged? I say that it is near on impossible and for that reason I feel very sad that we are progressing with something that does not even have a definition. 
The concerns I mentioned that most of the professional bodies had were very similar. Firstly I want to talk about scopes of practice. Scopes of practice remain unresolved in the minds of the professional bodies. In particular there is concern about the intention of broad scopes of practice and there was much discussion about that. The professions were told that scopes would be broad but in practice they have been watered down by other wording that in effect implies narrow or personal scopes of practice. For some professions that will not be too much of a problem. Occupational therapists have already worked out their scopes of practice. In fact they have decided to have just one scope of practice so for them things will not change. For groups like medical practitioners who have lots of vocational branches that they work through by educational means the scopes of practice will be extremely difficult to determine and they will be extremely difficult to bring into practice. 
Another area of difficulty with scopes of practice is when there are overlapping scopes and several professions might perhaps perform one function. I think in particular of acupuncture. There are acupuncturists who want to be part of the Health Practitioners Competence Assurance Bill. I am told that there are physiotherapists in outpatient clinics for whom 70 percent of the time acupuncture is involved in the practice. Also many general practitioners these days perform acupuncture. So scopes of practice will be a nightmare to determine for areas such as those. 
I move on to quality assurance activities. In particular we are concerned about protected activities. The medical profession in particular and also increasingly other professions have operated very good quality assurance activities which have enabled the groups to learn from the mistakes that have been made. They have been able to do so in a protected environment and they are very worried now that this will not happen. If they cannot be offered protection those very valuable discussions will not continue because people will be fearful of the result of those discussions. That affects not only the professions themselves but also in a very large way—and I do not think that the Government has looked at this properly—patients whose safety will be compromised. The ministerial control in this legislation is very great and many of the professions are quite rightly worried about that. I will not go deeply into the issue because we discussed it at length during the Committee stage. However it is a justifiable worry for the professions. 
Elected members of authorities are also going. The Minister has made it very clear that she is not in favour of those even though the provision is in the legislation that they could possibly exist. She has said on several occasions that she in not in favour of them so the doctors the pharmacists and the dentists who elect members for their bodies at the moment will no longer have the ability to do that. This sad day I think needs to be noted. Today we need to say goodbye to professional self-regulation. What other professions do not have professional self-regulation? There are many. [ 
Interruption 
] Mr Cunliffe may well clap but he should wait until he next goes to see his doctor. The fact that professional self-regulation is going is a very sad thing. Elected members of authorities are going and that too is a retrograde step. It is the professions themselves that know which of their members are best to govern them. It is not as though they have a majority holding on each of these things; it is just that these people are there to represent them. Today we are also saying goodbye to some of the improvements that came in under the Medical Practitioners Act—most particularly the improvements relating to patient safety. 
SUE KEDGLEY (Green) 
: 
 The Green Party will be supporting this legislation but it does so with some very serious misgivings. The best amendment made to the legislation was the requirement to review the Act in 3 years’ time—a proposal I might add put up by the Green Party. As will many others we will be waiting very eagerly for that review. I am sure that some very important issues needing to be reviewed will be raised when that time comes. 
Certainly we agree about the need for a consistent transparent framework for the registration of health professionals and for robust consumer-friendly and streamlined disciplinary procedures that apply to all health professions. We acknowledge that consumers—or many of them—are disillusioned with the health system in particular the complaints system and that perhaps hundreds of men and women have been frustrated and humiliated and have suffered anguish and distress as they sought to pursue complaints through the health system. Many have suffered intolerable delays in trying to get their complaints through the system. It is extraordinary that in the past up to 14 different agencies have been separately able to investigate the same medical event. So there is an urgent need to streamline the complaints system and we hope that the creation of a one-stop shop recommended by Helen Cull and certain specific things such as the 3-week time frames will help to streamline the investigation of complaints in the health system. 
We also acknowledge that in the past some practitioners have been unfairly taken through the complaints system and that there is a need to protect health professionals from vexatious complaints which can be traumatic time consuming and cause them huge stress and financial loss even if they are eventually cleared of the charges. We believe that the ability of the Health and Disability Commissioner to dismiss vexatious complaints will help to protect practitioners from having to go through unnecessary trauma and stress. 
There are some very positive aspects to this legislation but other aspects of it cause us serious concern. Our particular concern is the degree of control this legislation gives any Minister of Health in this or any future Government over all the health professions in New Zealand. It gives the Minister the right personally to appoint up to 14 members of every governing authority established under the legislation and that power will give the Minister considerable control over the members of all the governing bodies in the land. Every member of an authority who is appointed by the Minister will be in a very real sense beholden to that Minister for his or her reappointment and that will act as a strong incentive not to rock the boat to toe the line and so forth—just as it does with all the appointed members of district health boards. We have noted how the personally appointed chairs of district health boards around New Zealand have sought to keep controversial or difficult issues out of the media and to try to control the members of those boards. That is a very real concern as is the fact that the Minister has the power to resolve any contentious or unresolved issues to do with scopes of practice. The Minister also has the power to decide what will be and what will not be a controlled activity. All those things will have very significant and far-reaching effects. The Minister—and the Minister alone—will make those decisions. 
We were very surprised that United Future did not support our amendment to establish the democratic right to allow up to 50 percent of members of a health profession to elect members of their authority. Electing members of the authority would give members of a profession some sense of ownership over that profession. It would also mean that its elected members would not be beholden to the Minister of Health for their appointments so the amendment would have given the health professions some important independence. 
I am astonished that United Future did not support that amendment as all parties in the House apart from Labour did. The Green Party managed to get an amendment through the Committee stage that says that the Minister may come up with regulations to allow some practitioners to be democratically elected. We will be watching that very closely and looking forward to the Minister promulgating those regulations. That is one of many measures we will be scrutinising in the review to make sure it has happened. 
Like others we have huge concerns about scopes of practice becoming narrow and restrictive. In acupuncture for example—as the previous speaker mentioned—how does one decide on scopes of practice where three different professions are practising acupuncture and how will that issue be resolved without it being to the detriment of acupuncturists who are outside of this bill? That is something else we will be watching extremely carefully. 
One of our overriding concerns is that this bill leaves virtually all the detail of the system to be decided by regulation after the bill has been adopted. It basically gives no parliamentary scrutiny to all of the serious issues that have been addressed today. We have this parliamentary mechanism called an Order in Council which I do not think the public fully understands. It may sound nice but it is a secret mechanism that involves no parliamentary scrutiny. All of these things will be able to be decided by Order in Council without any parliamentary scrutiny and we have enormous concerns about that. 
We are delighted that pharmacy was not deregulated. There was an attempt to deregulate all pharmacies in New Zealand but the Green Party used its influence to oppose that as did all the pharmacies in the land. That provision was contained in the original bill but has been dropped and we are enormously pleased about that. 
Finally we are extraordinarily concerned that acupuncturists—who have been seeking statutory recognition for 20 years and who made very strong recommendations on this bill—are not covered in this legislation. If this bill were focused on consumer protection acupuncturists would have been one of the professions covered. I believe the decision not to include acupuncturists was a purely political decision just as it was a political decision to include osteopaths. Osteopaths were given an assurance at the last election that they would be included and we are delighted that they are but there is no reason not to include acupuncturists. Arguably acupuncturists have a much stronger case than osteopaths because acupuncturists who poke unsterilised needles into people can cause huge harm to the public of New Zealand—more harm than most. Acupuncturists are very aware that unregulated persons can set themselves up as acupuncturists and bring the entire profession into disrepute not to mention the risk of harm to others in New Zealand. 
Steve Chadwick 
: They will get there. 
SUE KEDGLEY 
: The chair of the Health Committee Steve Chadwick who has been very supportive in trying to get acupuncturists together assures me they will get there. I hope she is right and I can assure members that I will be watching this issue very carefully. I am worried that medical acupuncturists who are already covered by this bill will seek to keep out in a patch-protection way those acupuncturists who are not covered by it. 
STEVE CHADWICK (NZ Labour—Rotorua) 
: 
 I am proud to be given an opportunity to speak in this third reading debate. It was difficult to sit quietly and listen to the cant and misinformation of the Opposition during the previous two stages. As the Health Committee chair I was responsible for the select committee stage and we were always aware of the task ahead and the long-term implications of the bill for over 73000 health practitioners in New Zealand. It is those practitioners that I would like to thank today. They worked collectively with us on the need for one consolidated piece of legislation that covered 11 health professional groupings. I also wish the 23 other health groupings good luck with the work they will need to undertake in order to be included in the legislation by Order in Council. 
Our commitment to get this legislation passed completes a policy undertaking in 1999 to review health occupation legislation. This has been an exciting and a long—not rushed—journey with representative groups communicating together over this issue for the first time in decades. There has been a genuine sense of goodwill in finding common issues of professional practice and then working on the points of difference under the framework of this bill. 
I thank the officials from the Ministry of Health for their commitment to this task. I will not name them—the approach has been a collective one under the leadership of Karen Poutasi and Gillian Durham. They have ironed out the varied challenges of interpretation and misinformation with the registration bodies the colleges and the councils. Consultation and the development of this law have not been rushed as the Opposition has suggested. The ministry met with professional groupings for 3 years after the discussion document was put out and work will begin in earnest with groups such as acupuncturists once this bill is passed. The ministry will then lead this work and the ongoing discussions acting as a resource to the professions. 
I would also like to acknowledge the leadership of the Minister Annette King. Unlike previous Ministers she has had an open-door policy for the professions to work through commitments such as pharmacy ownerships and the establishment of professional councils for dentistry midwifery osteopathy and pharmacy. She has stuck by her word and her commitment. 
Pharmacists are not disappointed. They are delighted with this Government. Aspects that do require more work such as the protection of quality assurance activities were resolved with the appropriate groups such as the clinical advisory group of District Health Boards New Zealand. They were the experts we worked on to get those aspects ironed out. It was critical for us all that the sector worked on wording that gave practitioners confidence about the role of clinical audit review and protection of significant-event case reviews as opposed to commissions of inquiry police investigations or inquiries under the Mental Health (Compulsory Assessment and Treatment) Act. 
I appreciated the members of the committee who worked with us collectively to make this legislation as robust as we could. The legislation has to be sustained for many years even though there is a 3-year review provision. I am pleased to see it there and thank the Greens for that. I want to thank the members of the committee who gave their input and who do understand how health professionals think behave and enact the intent of the law in their relevant spheres of professional practice. This legislation is also about public safety and cultural competence to practise in very diverse clinical settings. Those on the committee familiar with professional aspects brought a balance; others brought a valid consumer counterbalance to a dominant medical view. 
Many other health professionals who want to be deemed valid practitioners in an ever-expanding health environment will now work towards inclusion in this legislation. It is a tool that will bring practitioners together through registration competency oversight and the management of professional complaints. That is unprecedented and it is exciting for the field of clinical practice in New Zealand. That approach will also ensure public safety and some of the members of the Opposition from the medical profession have forgotten that that was one of the key principles of this legislation. 
I would also like to thank the office of the Health and Disability Commissioner for its work and Ron Paterson. His was a major contribution towards ensuring that we made the one-stop shop provisions for complaints as robust as possible. That system is now so much more streamlined than the 14 agencies that currently deal with complaints. I want to get to those health practitioners who worked with us and then in June announced that they were withdrawing their support for this legislation. 
Patients have asked me to explain the difference between a nurse a midwife and a doctor. Under this law there are very few differences because the relevant registration bodies remain as they were under the previous registration authorities for those professional groupings. The dominant right to self-regulate is something that we have been determined to break down and it goes into this legislation. We are pleased to see that consumers are included which will provide a counter-balance to those medical practitioners. As a Government we were not prepared to compromise that view. On reflection even though the two groups concerned previously said that the Medical Practitioners Act was an imperfect beast they have at least remained consistent in their concerns about the extent of the Ministerial powers proposed in this legislation and their assertions in favour of professional self-regulation. 
In 1999 we undertook a review of the Medical Practitioners Act and those concerns were addressed then as well as part of the review and rejection of the Medical Practitioners (Foreign Qualified Practitioners) Amendment Bill. We then built on the robustness of the Act. What Opposition members fail to understand is that 110 of 167 clauses in the Medical Practitioners Act are carried over into this bill. They should relax—making good legislation takes time and Professor John Campbell the president of the Medical Council of New Zealand says just that in the latest doctors’ magazine. For over 2 years through each stage the Medical Council has been involved in the development of the Health Practitioners Competence Assurance Bill and the resulting legislation. I am sure that we will be able to move on with those professionals. The Minister has always had an open door. 
When this legislation is passed it will have to sustain future Ministers of Health and administrations and during the Committee stage we were all acutely aware of that. This legislation was an ambitious task but I remain very optimistic of its outcome after today and I am well aware of how leading-edge it is considered to be in terms of the health practice field in New Zealand. I am proud to support this bill. 
DARREN HUGHES (NZ Labour—Otaki) 
: 
 I rise to take a brief call and support my colleague Steve Chadwick who ably chaired the legislation in the Health Committee assisted by officials from the Ministry of Health. I also recognise the fine leadership in the health portfolio of my friend and colleague the Hon Annette King. She has done a fantastic job on this bill and I welcome its third reading in the House. 
Dr PAUL HUTCHISON (NZ National—Port Waikato) 
: 
 What a case of denial the Government has on this legislation. The Health Practitioners Competence Assurance Bill is hugely important and has now had two additional bills split off from it—the Medicines Amendment Bill and the Health and Disability Commissioner Amendment Bill. I appreciated the Associate Minister of Health the Hon Damien O’Connor’s complimenting me on my work on the Health Committee when he spoke last night. However he is so much out of touch that he failed to recognise that I was not a member of the committee. That is a reflection of just how much out of touch the Labour Government is and the Associate Minister of Health is in terms of managing the resolution of this legislation. His lack of touch and knowledge absolutely reflects the summation of the Association of Salaried Medical Specialists when it commented on this legislation by saying in essence that: “The revived HPCA Bill continues to threaten the capacity to ensure standards of care and safety through a major encroachment on professional self-regulation and a major enhancement of political and bureaucratic control in this area.” 
One of the major themes that should have occurred today was that finally a Government managed to get agreement from the various health practitioners and parties involved with the evolution of this legislation so that it would truly support the health services of the New Zealand people well. I absolutely agree with my colleague from ACT Heather Roy that it is a tragedy that the Government has failed in that and while Stevie— 
The ASSISTANT SPEAKER (H V Ross Robertson) 
: The member may not use personal names. I refer to Speaker’s ruling 6/1 (Supplement). 
Dr PAUL HUTCHISON 
: I had not quite finished my reference but I take note of your comment. While the honourable member for Rotorua Ms Chadwick has mentioned that there is something in the order of 73000 practitioners in this country she has failed time and time again to recognise that medical and surgical specialists take on some of the most onerous responsibilities in the field of health. The fact that neither the New Zealand Medical Association nor the Association of Salaried Medical Specialists has supported this legislation is a huge indictment on the fact that the Labour Government has continued not to listen to them. I reject Ms Chadwick’s comments when she started to quote the Medical Council which indeed has been in contact with the Government over the last 2 years. But the other bodies have lamented that there has not been ready access to the Minister of Health. Time and time again she has ignored what they have said and brushed them off. I would agree with those headlines; making good legislation does take time. This Government has failed to achieve that. 
There is almost a sense of déjà vu because there was a possibility of that some 4 weeks ago in the second reading of the Health Practitioners Competence Assurance Bill when I held up the bill and said that I did so with considerable dismay. That dismay was first at the fact that the bill had not achieved the unity that it should have—that opportunity was lost—and second at the fact that it was of immeasurable size. Much to my further dismay this legislation is no longer 272 pages long but is now about 291 pages long—again an absolute morass of the bureaucratic complexity that this Labour Government seems to feed on wherever it possibly can. That was indeed the case when it brought in the health and disability bill 2 years ago which heralded the most complex health system New Zealand has ever seen with its 21 district health boards. 
We should not lose sight of the main purpose of this legislation which is said to be to protect the health and safety of members of the public by providing for mechanisms to ensure health practitioners are competent and fit to practise their professions. I say again for the record that it is vital to remember the summation of the medical specialists: that in essence the revised legislation continues to threaten the capacity to ensure standards of care and safety. 
On the more positive side the National Party has indeed supported Part 8 of the original bill which encompasses the Health and Disability Commissioner Amendment Bill. Again I think all parties recognise that there have been some horrific tragedies over the last 15 to 20 years in New Zealand: firstly the National Women’s Hospital cervical cancer inquiry followed by the Gisborne inquiry with regard to Dr Bottrill and more recently the Parry inquiry. The Parry inquiry in itself was a huge tragedy and it exemplified the fact that there were so many different agencies dealing with health matters and reporting that the situation was totally out of hand. So we all recognised the useful suggestions made by Helen Cull in terms of the one-stop shop and the very strong work that Mr Paterson the Health and Disability Commissioner did in helping to evolve this very useful Health and Disability Commissioner Amendment Bill. I believe that it will stand the test of time in its usefulness. 
Again as an indictment of the lack of insight of the Minister of Health I just recall that  
New Zealand Herald 
 article where Sandra Coney brought up the huge concern about the reflex reaction of the Minister of Health when she wanted to dob in incompetent health workers. Fortunately the Minister did listen to that and she did respond but it seems incredible that we have a Ministry of Health where the deputy director Dr Gillian Durham said the legislation would make it a statutory requirement for health workers to report colleagues if they felt they were working below standards. She said a complaint would prompt a competency review of the practitioner. The aim was to tip the balance in the mind of health professionals from their duty to a peer to their duty to the public to ensure that the safety of the public was their primary consideration. Undoubtedly a “blame and shame” environment was being suggested. Fortunately that has been revised to a certain extent and that has to be a great relief. But it did take a lot of pressure on the Minister of Health before she was prepared to do even that. 
I also want to comment again on the lack of consultation recorded by the New Zealand Medical Association. It said: “Quite simply we have no confidence in the policy development process or the consultation process behind this bill. We believe that the lack of adequate consultation has led to a number of major deficiencies within the legislation.” It went on to say this regarding professional self-regulation: “The opportunities for greater concern by the Ministry of Health and by politicians are substantially increased to the extent that it is doubtful that effective self-regulation can continue.” I brought in an amendment to the Committee suggesting that one of the major purposes should be the recognition of professional self-regulation as the basis of health practice in New Zealand and the Government rejected that. I believe that that is a sad indictment on the failure of this Government and this bill. 
MOANA MACKEY (NZ Labour) 
: 
 I rise to pay tribute to my colleagues Annette King the Minister of Health and Steve Chadwick the chair of the Health Committee for all the work they have done on these bills and for all the consultation that they have undertaken with the relevant parties to ensure that this legislation is robust and acts in the best interests of the people of New Zealand who are the consumers in this industry. These bills clearly do that. I support the third reading of these bills. 
JUDITH COLLINS (NZ National—Clevedon) 
: 
 This is the sort of legislation that we in the Opposition would like to be able to support and we will support the later part of the original bill today which is now in the Health and Disability Commissioner Amendment Bill because that deals with the disability provisions and we are in complete agreement with those provisions. 
However the chair of the Health Committee Steve Chadwick is so lacking in leadership that she could not get up here today and thank the members of the select committee in the proper way. She wanted to imply that some of us were not cooperative which is a lot of rubbish but we certainly were cooperative. She said she wanted to thank those of the committee who had worked with the Government in a constructive way yet we worked constructively all the way through the process on this legislation. It was a long process and if Steve Chadwick does not have the gumption today to thank those people I will do so. I now thank Pita Paraone Heather Roy Dr Lynda Scott Sue Kedgley Judy Turner Nanaia Mahuta Dianne Yates Anne Hartley Dave Hereora and Steve Chadwick—and I do that because the leadership of that select committee is so lacking. 
What did Steve Chadwick do in her speech? She grovelled to the Minister dear Annette King and said she was wonderful. We had another speech from young Darren Hughes and what did he do? He grovelled too. Then what did Moana Mackey the very very nice young member of the House and the select committee do? She got up and had a grovel too. So that was three grovels. That was all that those members had to say and that is probably about right. They also insulted everyone else who did not agree with them. 
The United Future party is voting for this legislation and I accept that. It is in bed with the Government and that is fair enough. However United Future has said that it has a couple of concerns about the legislation. Every Opposition party shares those concerns but unlike United Future we are not all rolling over and cuddling up to the Minister. One of the concerns is about the Minister’s powers. Even United Future has concerns about the powers of the Minister because this Minister is so far from talking about professionalism among health professionals that she is actually all about putting them down. She does not like health professionals to be a stroppy educated lot; she wants them all to be nice appointed people who owe their position to the Minister and that is not right. 
I note that the Greens have expressed their concerns about that as well. I would like to pay tribute to the speech that Sue Kedgley gave in which she clearly said that. Those of us who sat through the hearing of the huge number of submissions on this bill along with all the hearings held during the adjournment and all the time spent out of the House on this legislation all felt that we were really really working well together. Of course we cannot all agree on everything but at least on the Opposition side of the House we can be decent about it and do not insult someone for disagreeing with us. 
The Minister does not like the provision in the Medical Practitioners Act that allows medical professionals to elect some of their members. Why is that? It is because they might think they are representing some doctors or because they might be elected by doctors because they actually know something and we cannot have that. It is shown in the papers that despite our many many attempts all we could get out of the Minister was that if she feels like it she may decide at some stage to allow medical practitioners and all the other health professionals to elect one member—or maybe more than that if they are very very good and constantly say how good the Government is to them which just will not happen—out of a total of 14. That is just sheer arrogance. 
This Minister does not respect health professionals—so much so that she will not even allow them to be called “professionals”; they are now to be called “practitioners”. Those people who give their time and effort in undergoing many years of training in all the different areas of health are now to be called “practitioners” and not “professionals”. The best way to get professionals to act in a professional manner is to treat them as though they are professionals. If we treat people as though they are professionals the chances are that they may actually be professional. But this Minister cannot risk doing that because if people are professional they will be independent and robust and they will certainly sort out that Minister. We can see why the doctors’ magazines state that 48 percent of the doctors surveyed want Dr Lynda Scott to be the Minister of Health with 8 percent saying that they want the current Minister of Health. That is something—8 percent. 
Heather Roy 
: And 8 percent want Dr Paul Hutchison. 
JUDITH COLLINS 
: Oh and 8 percent want Dr Paul Hutchison! 
Heather Roy 
: And others. 
JUDITH COLLINS 
: And others? That must be Heather Roy! 
One of the other areas that we are concerned about is that the Minister is the final arbiter on the scopes of practice. What could that Minister possibly know about scopes of practice? We have a situation where scopes of practice are untried in a country; we are to be the guinea pigs. One of the constituents in my electorate rang in the other day and said she wanted to stop this legislation because it had nothing about patients in it. So I told her to contact Annette King before the end of today. But I do not think that will make a scrap of difference because I do not think the Minister really cares about it. Nor does the chairperson of the Health Committee; she really does not care about it. 
One of the other things that the Minister will be able to do is to state what “restricted activities” are for professional groups. How would she know about that? The professional groups are the right people to decide those things because they are the people who know their own competencies know the stresses they work under and know their conditions of work. They do not need a bureaucrat and her other little bureaucrats to tell them how to do that. 
Let me go on to an area that has given me a tremendous amount of interest: the cultural competence area. Every time I mention that in the House I get a barrage of abuse from the Government side and I must say I do quite enjoy it that the Government members show their colours—finally. Every health professional who will now be called a health practitioner must be registered and must show not only that he or she is ethically and professionally competent—and we have no problem with that—but also now that he or she is culturally competent. That term is not defined and when an area like that is not defined it raises serious concern. I can see that provision being used to stop overseas health professionals from coming and working in this country. The midwives association has already said it will be able to use it to stop the terrible midwives coming in from overseas who are not culturally competent. When asked in the select committee which ones they were talking about they said the Australian midwives. That shows the level of pathetic political correctness that this bill is all about. It is all about sucking up to political correctness—sucking up to the Minister and giving her all the jobs forgetting the poor old patients and the poor old people who actually do the work and giving everything to the Prime Minister and her mates. 
DAVID BENSON-POPE (NZ Labour—Dunedin South) 
: 
 I am delighted to rise in support of this bill. 
A party vote was called for on the question  
That the Health Practitioners Competence Assurance Bill be now read a third time 
. 
Ayes 70 
Labour 52; Green Party 8; United Future 8; Progressive 2. 
Noes 45 
New Zealand National 25; New Zealand First 13; ACT New Zealand 7. 
Bill read a third time. 
Health and Disability Commissioner Amendment Bill read a third time. 
A party vote was called for on the question  
That the Medicines Amendment Bill be now read a third time. 
Ayes 70 
Labour 52; Green Party 8; United Future 8; Progressive 2. 
Noes 45 
New Zealand National 25; New Zealand First 13; ACT New Zealand 7. 
Bill read a third time.