Reti ShaneDr SHANE RETI (National—Whangarei): It is a pleasure to take the last call on this excellent bill and I would like to also congratulate the Health Committee on working this through and the member Chris Bishop on working so hard at what became quite a substantive rewrite.As this came to select committee there were three major groupings that we were interested in: the policy intent income replacement and cost reimbursement. The question we were asking as it came to select committee around the policy intent was whether the narrative should change from removing barriers to live organ donation to cost neutrality. Regarding eligibility for income replacement and cost reimbursement—would that apply if people do not actually proceed to donation? Should time off work for the recuperating donor be covered? Should there be income replacement and cost reimbursement for overseas donors—and what about beneficiaries who also have income? We were also interested in asking questions around the types of transplant covered because kidney and liver were certainly in the scope of this bill—but bone marrow transplant is also very common and was also covered under a funding mechanism that we were considering.Income replacement was the second major area that we were interested in in select committee. We were interested in whether we would change from 80 percent initially to 100 percent of income replacement. What was presented to us was information showing that in fact the coverage under the current arrangement—current income assistance for recuperating live organ donors—is actually only between 27 percent and 66 percent. So we knew that if we were starting at 80 percent we were above what we are doing anyway.There was also the question of the cap which was a reimbursement up to a maximum of $120000. Under cost reimbursement this is currently covered under the National Travel Assistance Policy (NTAP) and Work and Income covers some childcare components. Some of the issues we were interested in there included the suggestion that maybe the cover under both of those schemes was partial—not full anyway. Certainly the NTAP covered travel and accommodation childcare and prescriptions but what was not covered seemed to be parking and maybe international phone calls for international donors. So these were the questions we were interested in as we went into select committee.In select committee we had 110 submissions. There were 14 oral including the Royal Australasian College of Physicians Kidney Health New Zealand the National Renal Advisory Board and Live Kidney Donation Aotearoa. The themes that came through those submissions included wide support for the bill. The risk to donors was real but remote and so some submitters said that donors should actually be prioritised into the health system if at some later date they subsequently develop a health issue. We looked at this very closely and it was considered that the risks were quite remote and that it would really significantly distort the prioritisation system within the health system. As for income replacement at least half—nearly half anyway—said the level of replacement should go from 80 percent to 100 percent. In fact the Royal Australasian College of Physicians said that low-income donors are particularly vulnerable to a loss of income and they are aware of many cases where donors delay making a donation to coincide with the Christmas break so that there was no income disadvantage. On cost reimbursement there was support for widening the cost base both in eligibility and administration.Subsequent to those submissions we landed and made some conclusions on these three major areas. The first was that the policy intent—the principle to the policy intent—needed to remain cost neutral. Secondly when we looked at income replacement it was increased to 100 percent. The reasons for that were that it was thought to be totally consistent with that principle with cost neutrality and because it has a different policy intent and purpose to say ACC or other social assistance funding which had set the 80 percent level in the first place. I think what also made it viable was that it had a well-defined time frame of 12 weeks and was thus quite different to ACC and other social assistance funding as well. The cap was removed. Again this is consistent with a difference from ACC with a 12-week maximum. The evidence we had from the UK where they do not have a cap was that there had been no substantial fiscal blowouts as a consequence of that. As for the final category cost reimbursement—there would be full cover of actual and reasonable travel and accommodation and also cover of costs during the work-up stage. That took us through the conclusions and then there was the really difficult piece of work—of how we implement that policy because a large number of agencies interface with the mechanics of actually implementing the policy. That came out as a whole second departmental report—Departmental Report Part Two. If we look at those conclusions the implementation stage looked to maintain cost neutrality. As for income replacement—the figure of 100 percent was written into the bill. It was written in on a gross basis it is taxable income and as I said the cap was removed. What we did for the cost reimbursement was that that was not written into the bill. Instead what we chose to do was to use the existing Ministry of Health mechanism under the National Travel Assistance Policy but to have the policy reviewed and any gaps identified subsequently. This bill has had solid consultation. It is well formed and important. I am pleased to be a part of the committee working with this and I commend it to the House.Bill read a second time.Name changed to Compensation for Live Organ Donors Bill.