Medicines Amendment Bill — Second Reading 
Text is incorporated into the Bound Volume 
Medicines Amendment Bill — Second Reading 
[Sitting date: 20 March 2013. Volume:688;Page:8798. Text is incorporated into the Bound Volume.] 
Medicines Amendment Bill 
Second Reading 
Hon MAURICE WILLIAMSON (Minister for Building and Construction)  
on behalf of the Associate Minister of Health: I move  
That the Medicines Amendment Bill be now read a second time 
. After looking at the bill I am pleased that the Health Committee has recommended that it should proceed with some amendments. The committee has worked hard and I thank all the members for their contributions. Before outlining the provisions in the bill I think it is helpful to review its purpose in order to understand what this amendment bill will do and what it will not do. 
This bill will amend some specific provisions of the Medicines Act 1981 to streamline the legislation. What this bill will not do is carry out a comprehensive overhaul of the Act. In June 2011 the Prime Ministers of New Zealand and Australia announced their intention to proceed with the establishment of an Australia New Zealand Therapeutic Products Agency under a treaty signed in 2003. The Minister of Health intends to progress a Therapeutic Products and Medicines Bill in 2013 to provide for the agency. That legislation and the Natural Health and Supplementary Products Bill currently before the Health Committee will comprehensively overhaul New Zealand’s therapeutic products regulatory system. This Medicines Amendment Bill pre-dates the Prime Minister’s agreement to progress the Australia New Zealand Therapeutic Products Agency. It should be seen as an interim measure before the agency is established. 
This bill firstly will modernise the definitions of “medicine” “medical device” and “therapeutic purpose”; secondly it will amend the medicines approval process to make the legislation less prescriptive instead specifying the detail in regulations; and thirdly it will amend the prescribing framework to name nurse practitioners and optometrists as authorised prescribers and make some minor changes to licensing requirements. The submissions on the bill were generally supportive of these proposals. The bill as introduced also added an enabling provision for a new category “delegated prescriber” and an enabling provision for temporary prescribing rights. 
There were mixed views from submitters on these provisions. A common theme was the need for further information on the process for gaining and implementing delegated and temporary prescribing rights. The bill has been amended in response to this and I will now outline for the House the feedback from submissions and key changes. Definitions—there was general support for updating the definitions of “medicine” “medical device” and “therapeutic purpose” to better align with international norms. The definitions in this bill have been developed to reflect New Zealand’s current regulatory framework. These definitions will be reviewed and updated again as part of the establishment of the agency. 
Prescribing—there are currently two categories of prescriber in the Medicines Act: “authorised” and “designated”. An authorised prescriber is a medical practitioner dentist registered midwife or designated prescriber. These prescribers must prescribe within their scope of practice for patients under their care. “Designated prescriber” is the term used for a restricted subgroup of authorised prescribers. Currently optometrists and nurse practitioners with prescribing rights and some registered nurses practising in diabetes health are designated prescribers. Designated prescribers are allowed to prescribe only certain medicines listed in regulation. The bill revokes the designated prescriber regulations for nurse practitioners and optometrists and names them as authorised prescribers. This will align their prescribing rights with those of medical practitioners dentists and midwives by enabling them to prescribe all medicines appropriate to their scope of practice rather than limiting them to being able to prescribe only from a limited list of medicines. This move acknowledges the safe and appropriate prescribing practice of these groups over the past 7 years. There was broad support among the submissions for amending the definition of “authorised prescriber” to name nurse practitioners and optometrists. A small number of submissions raised concerns about extended prescribing rights in terms of patient safety fragmentation of care and increased costs to the sector. This reflects in part a general opposition to the extension of prescribing rights to people other than doctors. 
The bill also creates a new category of prescriber the “delegated prescriber”. Delegated prescribers will be allowed to prescribe under a delegated prescribing order issued by an authorised prescriber. The competence training and qualifications required of delegated prescribers would be set in consultation with the responsible authority. The requirements for delegated prescribers would be set at a lower level than for designated and authorised prescribers commensurate with the more limited level of prescribing and the oversight of the authorising prescriber. Generally there was cautious support for the new category of “delegated prescriber” from medical and pharmacy organisations and opposition from nursing groups. The “delegated prescriber” category adds a prescribing option for professional groups beyond the existing categories. It will be for regulatory authorities to determine what form of prescribing rights if any they intend to seek for their profession. 
A common theme in submissions was the need for further information on the process of gaining and implementing delegated prescribing. The bill has been amended so that delegated prescribing rights will be made via regulation rather than by  
Gazette 
 notice. Requiring a regulatory mechanism will allow greater scrutiny and reflect the significant responsibilities that accompany any form of prescribing but it will still allow flexibility to tailor conditions and requirements to different groups of delegated prescribers. Further consultation and education on the details of the delegated prescriber provisions will need to occur during development of the regulations and prior to their implementation. 
The bill as introduced included a temporary prescribing provision to allow time-limited demonstration sites of new models of care that involve extending prescribing rights. Officials’ previous understanding was that designated prescriber regulations could not be time-limited. I have since been advised that the existing designated prescriber regulation-making power does allow conditions to be placed that specify a time limit. This would allow all the restrictions that would be imposed by a temporary prescribing provision to be imposed by designated prescribing regulations. Given this ability the temporary prescribing provisions are redundant and have been removed from the bill. 
This bill also amends the licensing provisions in the Act to enable a licensing authority to take into account previous convictions when considering an applicant’s fitness to hold a licence and to impose conditions either when issuing a licence or at any time while a licence is in effect. The bill removes the provisions in the Act that deal with medicines approvals and will replace these with regulation-making powers. The default commencement date is set at 1 July 2017. This anticipates that the medicines approval process provisions in the bill are likely to be superseded by the establishment of the Australia New Zealand Therapeutic Products Agency but provides a backstop should the implementation of the agency be delayed. 
Of the submissions that addressed the medicines approvals process there was general support for the removal from the Act of the detail about the application and process requirements for the new and changed medicines and related products. Regardless of where the approvals process for medicines is developed as a New Zealand - only scheme or as part of the joint agency scheme the regulations will be risk based and provide different approval pathways to cater for medicines in different risk categories. Each pathway will trigger the application of a level of scrutiny that reflects the risk of the medicine. For example in keeping with international norms more rigorous scrutiny will be applied to higher-risk prescriptions etc. etc. Medicines with known ingredients that can be purchased without a prescription would require less scrutiny. The regulations would be set out in the eligibility criteria for the different pathways and the validity requirements. They would also set out the process to be followed by the regulator and applicants to resolve or not technical queries. 
This bill provides an opportunity to amend some specific provisions of the Medicines Act in advance of the comprehensive overhaul of the— 
The ASSISTANT SPEAKER (Lindsay Tisch) 
: I am sorry to interrupt the honourable Minister. His time has expired. 
IAIN LEES-GALLOWAY (Labour—Palmerston North) 
: 
 It is a pleasure to follow such a fulsome contribution from the Minister for Building and Construction Maurice Williamson on the Medicines Amendment Bill here on a Thursday morning during extended sitting hours—a time for non-controversial legislation to be progressed through the House legislation that has broad support from parties around the House. What an appropriate place for this Medicines Amendment Bill to be debated and what an appropriate time because the issues dealt with in this legislation ought to be non-controversial. They ought to draw broad support from across the House but unfortunately to paraphrase Chris Auchinvole it ain’t always necessarily been so. 
The Medicines Amendment Bill does get broad support and it is supported by the Labour Party. We support the fact that the bill streamlines the Medicines Act and amends some specific provisions in the legislation. I think the thing that the public will take most notice of is the work towards establishing the Australia New Zealand Therapeutic Products Agency. Having a trans-Tasman authority to oversee medicines and therapeutic products is a sensible thing that we should be working towards. Of course we have been lurching towards it for some years now but progress has been held up and the politics of that I will address in a moment. 
The other thing that New Zealanders will notice the most is the broadening of prescribing rights. To be honest this is the thing that I am most interested in and most supportive of in this legislation. The ability for in particular nurse practitioners but also other health practitioners to gain prescribing rights I think is an important step towards improving the accessibility and availability of medicines and improving the flexibility of our health system. We know that it can be challenging for people to get access to appropriate health-care and that can simply come down to the availability of appropriate health practitioners. In the 21st century I think we recognise that that does not always have to be a medical practitioner. It does not always have to be a doctor. We received a number of supportive submissions particularly from the Nurses Organisation and other nursing representative organisations for the extension of prescribing rights to nurses and to other health practitioners. There was some opposition. Sadly but predictably it came from the GPs and from the medical fraternity who seem to think they are the only people qualified to deal in health and particularly in medicines. It was not exactly die in the ditch stuff from the medical fraternity. I think they realise that the world has moved on. It was not exactly a strident submission from them but nevertheless that is where the opposition came from. 
As I said this is a bill that is necessary and improves the regulatory framework for medicines. But everything contained in this bill the substance of this bill could have been progressed 5 years ago had the National Party not decided to play politics with this important issue. The National Party withdrew its support for the then Therapeutic Products and Medicines Bill which interestingly is the title of the legislation that we are working towards of course but the National Party saw an opportunity to put the Labour Government under pressure by withdrawing its support meaning that that bill could not be progressed. This was not in the interests of good health-care in New Zealand. This was not in the interests of good regulation of medical products. It was not in the interests of good regulation of natural health and supplementary products which we are also going to be dealing with this morning. This was pure politics. When I read last year that the Minister of Health Tony Ryall is in the media’s opinion the best politician on the National benches I thought: “You know what? They are absolutely right.” He is a terrible Minister of Health. He is ruining the health system. He is setting up all sorts of problems for future Governments to have to clean up but my goodness Tony Ryall is a very very good politician. Unfortunately politics does not always make for the best lawmaking or the best regulatory system or for improving our health system but it can make for good politicians. I know that Dr Paul Hutchison agrees with all of this. He will not say so of course because he is whipped by his party but Dr Paul Hutchison agrees with all of this. 
What did the National Party say that Labour had to do in order to keep its support for establishing good regulation around medicines? It was to take away the provisions in that original piece of legislation to do with natural products. Well what is the next bill that we are going to be debating this morning? What did we work so hard on Dr Hutchison to align this piece of legislation with? It was the Natural Health—and now—Supplementary Products Bill which actually shows how political National’s opposition is to actually achieving everything that is achieved in this bill. Five long years ago it could have been done. We could have had nurses— 
Hon Annette King 
: Along with folate. 
IAIN LEES-GALLOWAY 
: Along with folate as well Ms King says. We could have had a good regulatory framework for medicines. We could have had nurses prescribing. We could have had nurse practitioners particularly diabetes nurse practitioners doing more to deal with the tsunami of diabetes that this country is facing. We could have been tackling that 5 years ago but no National likes to play politics when actually the thing we are supposed to do is get on and govern properly and do the right thing by New Zealanders. This bill and the bill that is going to follow it are both excellent pieces of legislation. It is just such a pity that in this case when the National Government actually for once got off its backside and did something about this bill the thing is that what it did was completely contrary to the interests of New Zealand—it put politics ahead of the health of New Zealanders. 
Dr PAUL HUTCHISON (National—Hunua) 
: 
 It is indeed a pleasure to speak on this Medicines Amendment Bill. Contrary to what Iain Lees-Galloway the former speaker said this is yet another positive and continuing contribution by the National Government towards improving health in New Zealand and I must say that the health situation in New Zealand by objective measurements has only improved under the Minister of Health—the outstanding Minister of Health—Tony Ryall compared with a very miserable performance in the 9 years before. But I would like to acknowledge the work of the Health Committee on this important bill. We work as a very consensual committee and it was very positive and an excellent result has been formulated. Secondly I want to thank the 43 submitters amongst which again there were some thoughtful submissions and of course I thank the Ministry of Health staff who were extraordinarily helpful to us. 
This bill is reflective of the need to deliver high-quality safe modern public services within tight budgets. I must remind the former speaker that the facts are that since 1950 the cost of living has gone up by 152 percent but expenditure on health has gone up by 452 percent. That was totally forgotten by the previous Labour Government which increased expenditure on health from $6 billion to $12 billion over 9 years with no real increase in output. It was a failure. It totally failed to realise that it is important to expend every health dollar well and that has been reversed under this National Government. But I do want to acknowledge Health Workforce New Zealand and others throughout our health system that are continuously looking for innovative new ways to work that will lead to better sooner more convenient health care for all. 
Hon Members 
: Slogans. 
Dr PAUL HUTCHISON 
: No slogan at all. 
I do note that in the submissions the New Zealand Medical Association was understandably somewhat more conservative in its submission than others. It did support delegated prescribing under the supervision of a registered medical practitioner but noted that the bill could enable any authorised prescriber including nurse practitioners and optometrists to also be responsible for delegated prescribing. I think it is understandable that it has a conservative approach because at the end of the day the responsibility for mishaps—and mishaps will always occur and when it happens with prescribing indeed they will always continue to occur—does indeed fall at the end of the day on the medical profession. But on the other hand the submissions from the nurses the pharmacists and the optometrists were far more activist in wanting to extend their prescribing rights. I have no doubt that at the end of the day the bottom line is that of patient safety and again I welcome the initiative of this Government of forming the Health Quality and Safety Commission led by the very able Professor Alan Merry in ensuring that safety is absolutely at the bottom line of any legislation that may go to new and innovative measures. 
As was pointed out this legislation is an interim measure intended to address some problematical provisions of the Medicines Act in advance of a comprehensive overhaul. That overhaul is likely to happen by mid-2016 when a single regulatory regime will occur across both countries—Australia and New Zealand—and that of course will be an extremely satisfactory advance. I do note that the nomenclature around this bill is somewhat mind-boggling. It does require a Gilbert and Sullivan alliterative command as was so ably demonstrated by Maurice Williamson in his initial speech when it comes to these new definitions of authorised designated and delegated prescribers— 
Hon Maurice Williamson 
: I just read what I had in front of me. 
Dr PAUL HUTCHISON 
: But he read it so well—he read it so well. I will not go into further detail now other than to say that this is yet another step in the innovative continued work of the National Government in ensuring that New Zealanders are delivered better sooner and more convenient health care. 
Hon MARYAN STREET (Labour) 
: 
 I rise to speak on the Medicines Amendment Bill and I take some pleasure in doing so but I would have taken even greater pleasure in doing it 5 years ago. The member who has just resumed his seat Paul Hutchison who chaired the Health Committee—I have to say in an extremely able way and I have no beef with him about that at all—saw fit to take a flick at the previous Labour Government and its innovations in the health area which was completely unjustified and it would be remiss of me to allow that to go unchallenged in  
Hansard 
. So I would ask that member to recall the cut in prescription fees the cancer control strategy the breast-screening programme and all the other helpful innovations that the Labour Government undertook in the health portfolio in the 9 years that we had the privilege of being on those benches. 
In the course of those improvements that we were making to the health sector we proposed to bring in a Therapeutic Products and Medicines Bill which oddly enough is exactly the same name as the bill that this Government is going to move on to in due course. But I remember distinctly from that time—it was my first term in Parliament and I was on the Health Committee—Tony Ryall playing complete politics with the health of New Zealanders. He thought that he was on to a winning thing by joining with people under a series of red umbrellas out on the forecourt of Parliament to protest about natural supplements and the regulation of natural health supplements. In the process of his doing that the bill was split into two parts but even so the now Minister of Health could not at that time in Opposition bring himself to advance something that was going to be for the good of New Zealanders and this delay in managing innovative measures of prescribing and of using our health workforce lies absolutely on that Minister’s head. On his head lies the responsibility for the delay a good 5 or 6-year delay—6 years now—in bringing these innovations to this Parliament. So I do not want to hear any more about the wonderful Minister of Health when people realise that his siding with Sue Kedgley which he did only on the basis of politics and not on the basis of being committed to the issue that she raised—which had validity it is true. He engaged with the Green Party in a way we have never seen him do before or since and saw that this was a way that he could score some political points at that time at the expense of New Zealanders. I have no compunction about sheeting that responsibility home to this Minister who continues to call himself the Minister of Health when in fact he should be called the “Minister of Illness”. 
We are supporting this bill because it started with us and so we support it. We support the idea that there be regulated but extended powers of prescribing. When the Health Workforce New Zealand group started to look in the last few years at just how scopes of practice might be amended or adjusted to incorporate additional functions and tasks that was greeted with applause from us. That is a sensible thing to do. If we are looking to maximise the appropriation that goes into health and at the same time ensure that what is delivered through the health appropriation is for the benefit of the greatest number of New Zealanders then this is a good proposal. 
Extending powers of prescribing however must be done only with the imprimatur of this House and with regulatory oversight by this House. People in New Zealand must have confidence that if they are going to get a prescription from a nurse or a nurse practitioner or an optometrist or any other designated prescriber then that person is competent to fulfil that task. And that competence must be regulated must be monitored and must be scrutinised and in the end it becomes the responsibility of this House. We could have had this 6 years ago—6 years have gone by when people have still had to pay their $39 $42 $45 or sometimes $54 to go to a general practitioner just to get a script that could have been given to them by somebody who was appropriately qualified and regulated to do it. So for the last 6 years people have been paying unnecessarily for consultations with their general practitioner when quite frankly somebody else could have done that job and that is the responsibility of this National Government and the responsibility of the National Opposition before it. 
We undertook the development of the delegated prescribing protocol when we were in Government. We think there is strong support for the general proposal across health professionals and also across the New Zealand public who understand that they should not have to pay twice: once to go to an ophthalmologist and then to go to somebody who has prescribing rights to get the medication and the treatment they require. This will allow for more timely access for patients especially in some of our more diverse community and rural settings and that is really important. National could have delivered “Better sooner more convenient care” 6 years ago to people in rural communities and provincial areas had it not decided to play politics with it instead of recognising the merit of the bill that we were passing even when we divided it into two so that the issues around natural health supplements could be addressed separately and the Green Party’s concerns could be addressed properly in that regard. But no “Better sooner more convenient care” was not on their minds when Government members were in Opposition. Opposing was on their mind when they were in Opposition. 
So we support this bill. We welcome it. We think it is important that there is a more comprehensive overhaul of the Medicines Act. In fact it could have been done more comprehensively. This bill remains an interim measure. I think that that is also a sign of inadequacy. In fact the whole thing should have been done at once but now we are passing an interim measure that will have to be revisited again shortly and that is a shame. It is kind of a waste of Parliament’s time but hopefully the Government will sort itself out and we will get there in due course. Both this bill and the one that follows it the Natural Health Products Bill have our support and we wish only that we could have voted for them some years ago. Thank you. 
KEVIN HAGUE (Green) 
: 
 It is my pleasure to take a call on this Medicines Amendment Bill and begin in the traditional way by thanking the officials who worked with the Health Committee on this bill. The arcane nature of some of the material in the bill I think meant that officials had to work particularly hard on this one and their work was appreciated. I also thank my fellow members of the Health Committee. It is a committee that works very well together under Paul Hutchison’s chairmanship and it did a great job on this bill. We actually made some substantive changes. Also I thank of course the submitters. It was I think difficult for submitters to get to grips with the nature of the bill because although some consultation had been undertaken some years previously with a limited set of stakeholders many submitters were coming to the bill for the first time because of the inadequacy of that earlier consultation process. The submissions we received were I think uniformly well thought through and appreciated. 
It is a long time ago that we were considering this bill. The Health Committee was considering submissions on this bill about a year ago and one has to wonder I think—picking up on Maryan Street’s point that this is an interim measure—why on earth it would take a year for this bill to come back to the House. If the measures were needed for the interim surely they were needed a year ago. There seems no reason at all why it could not have been progressed at that time. 
Maurice Williamson has covered some of the detail of the bill and I pick up on Paul Hutchison’s perhaps backhanded compliment to Maurice Williamson—describing it as “Gilbert and Sullivanian” perhaps. “He read all the speeches with a voice so clear that”—I am not sure what the second line would be but maybe he is deserving of a promotion within Cabinet. The revised definitions were welcomed by all. I just note the need that will arise to align the definitions of medicines in other Acts with the one that is incorporated into the Medicines Act by this bill. 
The principal change made by this bill is to extend and elaborate the framework for prescribing rights reflecting the creaky nature of the existing framework for prescribing. I think there was general support for the extension of authorised prescribers and I note in particular the change made to nurse practitioners which I think is very broadly welcomed across the country. Regarding designated providers the changes made to this category are important for the flexibility of our prescribing framework and I will come to that in a little more detail in a moment. And then regarding delegated prescribers as Maurice Williamson has set out this was not altogether uncontroversial and Iain Lees-Galloway has also spoken about that. 
I think we are cautiously of a mind still to accept this extension into delegated prescribing. I say “cautiously” because to our way of thinking this category of prescribers still does not sit easily with the Health Practitioners Competence Assurance Act. That I think is one of the matters that as we move to the permanent resolution of these issues in the Medicines Act as opposed to the interim one will need to be addressed by the Government—probably by a Government that is less supine about the need for regulatory reform in the area of health. Regarding the category of temporary prescribers as Maurice Williamson has said it was good that the select committee recognised that that further category was not needed and it has been scrapped in the bill. 
The point of our regulatory regime around medicines has got to be threefold. It has to ensure timely access to medicines. The changes that we are making in this bill to the categories of prescribers adds to our ability to provide New Zealanders with timely access to medicines and that is a good thing. Secondly the regime must provide for the safety of New Zealanders. That I think is clearly what was at the heart of some of the concerns expressed by doctors about extending prescribing rights to other categories of health professionals and I am satisfied that the provision exists for us to ensure safe prescribing of medicines. The onus now falls on the Director-General of Health and the Minister to ensure that that is carried forward. 
The third purpose is one that is not normally articulated but is I think very important in the light of this bill and that is to ensure that we make the best possible use of the health workforce that we have. This bill certainly makes a contribution in that regard. It is very important for the reason I outlined in my first reading speech—and Iain Lees-Galloway again has spoken about it—and that is the growing need for health services. A growing population an ageing population a population with more complex health needs all says our health system needs to do more and more. Against that backdrop we have a Government that has chosen to reduce health services funding in real terms and within that sinking lid for health funding to prioritise some particular areas that are of short-term importance and optical value for political gain at the expense of everything else. 
I think everyone in this House ought to be sobered by the research that was published just a couple of weeks ago from the University of Otago showing actually that one in four New Zealanders over the age of 15 either has type 2 diabetes or has pre-diabetes. That is a rate much higher than was previously thought and it is indicative of the kind of load that our health services are going to need to shoulder. Against that backdrop we have a Minister who comes to the House week after week making a smug claim about 1000 extra doctors in response to questions about senior doctors about our specialist workforce. We know that what he is doing is conflating certainly some extra senior doctors—fewer than are needed to maintain parity against the growing health need in fact—along with junior doctors and a bunch of other people. That is what he is doing. He is conflating categories to provide a politically useful answer. 
I think we also need to start drawing attention to the contribution of Health Workforce New Zealand one of the Minister’s initiatives which is still producing a programme that is hopelessly poorly geared to the need that we actually have of serious workforce development in the health sector. Its programme is chaotic haphazard and clearly inadequate for the need. 
So when we look to the extremely slow progress of this interim bill it is emblematic of this Government’s approach to health. In stark contrast to the growing extremely serious need for a comprehensive overhaul of our regulatory regime and our systems to enable this nation to cope with that tsunami of health need this Government is choosing instead to work slowly and to make cosmetic changes that are in its political short-term interests rather than grappling with the serious long-term challenges that New Zealand faces. We have a health Minister who is clearly not up to the task. 
BARBARA STEWART (NZ First) 
: 
 On behalf of New Zealand First I rise to support the Medicines Amendment Bill. Like the previous speaker Kevin Hague I would like to thank the officials for their hard work. There were some parts of the bill that did need a lot of clarity for members and the officials worked hard to ensure that we had that clarity. I would also like to thank the chair of the Health Committee Dr Hutchison for his patience and I thank fellow members of the committee. 
This bill has taken a long time to get back to the House. Why? We are totally unsure. We have had no reasons for the delay in this bill. New Zealand First supports this bill the Medicines Amendment Bill in view of the global advances that are happening in medicines and the changing role of medical practitioners. We in New Zealand First have always believed that decisions regarding health have to be timely and this bill is one way with the burgeoning disease burden that is now approaching New Zealand that we can ensure that timely decisions are actually made. 
By altering the definitions of “medicines” and “medical devices” and further defining where various health professionals fit in on the prescribing framework this bill will help to achieve the goal of timely decisions. What is the slogan we hear in this House quite often? Is it “Better sooner faster care” or is it “Better sooner more convenient care”? We hear it daily and we would like to believe it. 
Hon Simon Bridges 
: Why does Maryan Street oppose it? 
BARBARA STEWART 
: We are not opposing it; we are supporting it. We believe that this bill will actually enable New Zealanders to have a greater flexibility to get the most out of our health system. 
When one goes to an optometrist or a pharmacist or a nurse practitioner and some ailment is diagnosed identified and prescribed for it makes sense to have that prescription written out at that time rather than going to the general practitioner at some later time and having to arrange the appointment. We all know that attending work is one of New Zealanders’ greatest considerations and the greatest percentage of New Zealanders try to take the minimum of sick leave. 
One of the purposes of this bill as the Hon Maurice Williamson said is to modernise definitions to align with international norms. This tells us a lot. Where New Zealand was once considered one of the world’s leaders in health information and health technology advances we are now playing catch-up with our legislation but it is an important step if we are ever going to get ahead. We do live in a time now when technology is accelerating advancements in health and medicine. As such it is no surprise to find that the definitions of “medicines” “medical devices” and “therapeutic purpose” need adjusting from what is currently set out in the Medicines Act 1981. Realigning these meanings with the products that we find ourselves buying time and time again is timely. Over-the-counter products for self-medication have advanced in recent years. The number of advances in over-the-counter products like contact lens solution eye drops headache remedies self-testing pregnancy kits and nasal sprays cannot be considered by anyone to fall under the category of medicine and they should not be classified as such—and no doubt there is a whole list of other things that should be mentioned. 
In fact technology has advanced significantly and it is inevitable that “technology” in the regulations would need to be amended. We want these advances to continue as we are the recipients and we need to see the definitions of medical devices and medicines aligned with international norms. We live in an international world and we basically cannot afford to shut ourselves away in our corner of the world and ignore what is happening elsewhere. 
Whom we see for a routine check-up or a repeat prescription has also changed quite markedly. Pharmacists optometrists dentists and nurse practitioners are often the first port of call for minor ailments or for ongoing condition maintenance. Where would we be without the trusted community pharmacies that can provide a wide range of advice and remedies for a wide range of ailments from coughs and colds first aid for a wide range of sports injuries and everything else in between—warts nits lice everything? We have all been there and used those services and sometimes bought those products ourselves. It is an excellent service that the pharmacists provide instead of people actually going to the doctor. Pharmacists always provide a very valuable professional service to a very high level. It is instantly available and people appreciate that. So we in New Zealand First were very pleased to see their prescribing regime actually changed recently and we wish them well and hope that it continues. 
Of course we have to recognise too the increase in the amount of training that is actually given to pharmacy staff by various organisations. This has really given the pharmacy staff and the customers the benefit of the wider experience of those working in the pharmacy industry making everyone’s understanding of minor health ailments so much better and allowing them to more ably select the self-medicating products that we rely on. With these subtle changes to the health model that we currently have the legislation needed to catch up to accurately represent our experience within the health system. 
While working on this bill in the Health Committee it became apparent that submitters generally supported the new regime and the new definitions. I am confident that the work done on the bill has resolved the queries of the various groups that discussed their submissions regarding the prescribing framework. It did take some work for all of us to understand the differences between an “authorised prescriber” a “designated prescriber” and a “delegated prescriber”—all of those terms that the Hon Maurice Williamson waxed lyrical about this morning. So we believe that we can support this part of the bill with confidence. 
Delegated prescribers are very important and a valuable step away from “health by postcode”—a problem that we really do not want to have. It is a good option beyond the current prescribing practices that people currently have. When this role is totally established it will help ensure that all New Zealanders have more convenient and efficient access to medicine. We believe these changes will also help bridge the gap between the rural and the urban experience. 
New Zealand First supports the passing of this bill as it allows for greater flexibility where medicine and health changes are happening at an incredible rate. We believe it is in the interests of our health outcomes to keep up with the changes. Safety however is a priority for New Zealand First. We will watch as the regulatory authority is created and carefully monitor what problems are arising in this particular faction. Given we are seeking to increase the flexibility of our health system we will support the bill right through all stages. Thank you. 
Bill read a second time.