Roy Heather: Health Practitioners Competence Assurance Bill — Second Reading 
Roy Heather: Health Practitioners Competence Assurance Bill — Second Reading 
[Volume:610;Page:7545] 
HEATHER ROY (ACT NZ) 
: 
 I welcome this opportunity to rise to speak to the second reading of this bill. ACT New Zealand will not support this bill for the reasons outlined by both the National member and the New Zealand First member. We have outlined these reasons in some detail in our minority view in the commentary which was a joint one. 
This is a huge piece of legislation that the officials tell us and have told us often has been 3 years in the making. However it was pushed through the Health Committee with a great deal of urgency despite the fact that it is 272 pages long and covers 11 professional groups. Those groups are medical practitioners dentists pharmacists physiotherapists occupational therapists nurses dieticians psychologists chiropractors medical auxiliaries and optometrists and dispensing opticians. The bill will repeal the eleven Acts that currently govern those professions. Some of those professions have been working under outdated legislation for far too long. If I were still working in my field as a trained physiotherapist I would currently be working under a 1949 piece of legislation as do the occupational therapists. The dieticians are not far behind working under law that was passed in 1950. For those groups change is long overdue. Practice and technology have moved on significantly in the intervening years. 
However I want to raise my concern that that reason alone does not justify our accepting this legislation which I feel is inadequate to cover those professional bodies as being the best that can be done for public safety. Many of the smaller professions that are very keen on the legislation going ahead would have benefited from more time having been taken over this legislation in an attempt to get the various parts absolutely right for their professional practice. The commentary on the bill under “Background” states: “The Health Practitioners Competence Assurance Bill is intended to provide a framework for the regulation of health practitioners in order to protect the public where there is a risk of harm from the practice of the profession.” The reason that ACT New Zealand does not support this bill is that we do not believe that it will achieve that. 
It concerns me—and the New Zealand First member raised this concern too—that there is no definition of “competence” in the bill. Here we have a piece of legislation that hinges on competence and we were told that the term “competence” was too hard to define. If it is too hard to define how can health professionals be reasonably expected to meet this standard? What standard is it? If it cannot be defined how can it be met? What are they to aspire to? What level of practice should health professionals meet? If “competence” cannot be determined how can judgments be made about individual health practitioners’ performance? The answer to this question of course is that it cannot. 
I have two Supplementary Order Papers in relation to this bill. We have heard that both the New Zealand Medical Association and the Association of Salaried Medical Specialists are not at all happy with this legislation. They have had concerns for some time and they have attempted to be heard. They say that for the professional groups the consultation was not adequate; the registration bodies had adequate time with the officials they said to discuss concerns but the professional bodies were given only a cursory amount of consultation. They are very keen to pull out of this bill. One of my Supplementary Order Papers is introduced for that very reason. It is to remove medical practitioners from the Health Practitioners Competence Assurance Bill. 
The New Zealand Medical Association said that the Health Practitioners Competence Assurance Bill was clumsy bureaucratic and laden with scope for political interference. The Government as I have said claims that the bill aims to protect the public but in reality it will not encourage professionalism—it will work against it. When professionalism is not encouraged is the very time that the safety of the public is at greatest risk. 
The Association of Salaried Medical Specialists said that it had many concerns about the bill. In fact the association wrote to several health spokespeople of the various parties. It said that it had many concerns but that the following were the most critical in terms of the health and safety of the public and in terms of the deficiencies of the bill when contrasted with the higher standards of the Medical Practitioners Act. The New Zealand Medical Association it should be noted also voiced the very same concerns. 
The first concern was conformity of scopes of practice with the registration provisions of the Medical Practitioners Act. We have heard a lot about the scopes of practice and I will not go into a lot of detail because I agree entirely with what the National Party member and the New Zealand First member have said about scopes of practice. They are new untried and untested and despite the assurances that the Associate Minister of Health Ruth Dyson tried to give us nobody is fooled. We in New Zealand will be the guinea pigs who try these. In particular where there are overlapping scopes of practice between various professions it will be very difficult to determine who should be responsible for what and to find the common ground so that good practice is able to be ensured and leading on from that of course the safety of the public. 
The second area of concern was quality assurance. The Medical Practitioners Act which is a much more modern piece of legislation than those that many of the other groups are working under sets out good quality-assurance provisions. The medical practitioners have over the last decade in particular made huge gains in relation to dealing with the public examining their own practice and really updating their codes of practice. They feel that it would be better to stick with the Medical Practitioners Act particularly its quality assurance provisions. They feel that those in the Health Practitioners Competence Assurance Bill are unworkable and will not encourage good quality-assurance. 
The United Future member spoke about the protection that is provided for medical practitioners. In fact this is not the case. The medical practitioners are very worried not only for themselves but for other professional bodies that the protection is not there. When that does not exist the experience is that the professions do not participate fully and in an honest and upfront manner in terms of quality assurance. If we want good-quality safety and practice from our health practitioners then we must allow them that scope—that room—to deal with mistakes that have been made not in a shame and blame way but in a no-blame environment. The Health Practitioners Competence Assurance Bill does not provide for that. 
The next area is the setting of codes of ethics. The Associate Minister of Health Ruth Dyson mentioned the codes of ethics. The medical practitioners in particular are very worried that this right is being taken away from them. Medical practitioners have always been able to determine their own code of ethics. They are the people working in the area; they know what is necessary. Instead the officials and the Minister of Health in particular will have a large say in codes of ethics. 
The other thing that is very important to the medical practitioners but also to the pharmacists and the dentists is the ability to have elected members on their registration boards and their professional bodies. Under the bill this right may well be taken away from them. The bill does say that scope is there for them to elect people whom they can nominate to go on their professional bodies but in fact the decision is to be made by the Minister of Health and she can easily override those nominations. In a press release that we saw in the  
New Zealand Herald 
 of 22 July—a very recent one—Ms King said that she did not favour elections for such bodies. So although there is provision in the bill for nominations to happen it is most likely that medical practitioners dentists pharmacists and any other profession that wants to have elected members will not in fact be able to do so. 
Another area of concern which has also been mentioned is ministerial control. I have alluded to this several times throughout my speech. The scope for the Minister to have overriding control in many areas of this bill is great and all the medical professions should be very worried about this. It depends of course on one’s Minister of Health but the bill leaves the field wide open for any Minister to come in and make decisions that these professionals should be able to make for themselves. 
For these reasons ACT New Zealand will be opposing this bill and opposing it vigorously.