Roy Heather: Injury Prevention Rehabilitation and Compensation Amendment Bill (No 3) — Second Reading 
Roy Heather: Injury Prevention Rehabilitation and Compensation Amendment Bill (No 3) — Second Reading 
[Volume:625;Page:20168] 
HEATHER ROY (ACT) 
: 
 ACT New Zealand opposes the passage of the Injury Prevention Rehabilitation and Compensation Amendment Bill (No 3) for a variety of reasons which I will go into in a moment. First I will just say a word about the select committee process. It was very rigorous although a disproportionate number of the submissions heard came from the various acupuncture groups. There are four main groups in the country. Although many of the groups are working together very well and productively some are not entering into discussions as we would perhaps hope they might. It would be encouraging to see the discussions continue and to see those groups form a united front and as the previous speaker said come to be regarded as one body under the Health Practitioners Competence Assurance Act. I think that that would be to the benefit of everyone. As I said the bulk of the submissions came from the acupuncture groups and this took up a huge amount of the time for the submission process. 
As other members have outlined the bill relates to quite a few technical amendments to the original Act but the main reason for bringing this amendment bill before the House was to make changes to the medical misadventure provisions. ACT agrees that in theory the proposed changes to the medical misadventure provisions in the original Act are a good thing. But there will be many unintended consequences I think that have not been investigated fully and that will lead in particular to costing the country a good deal of money. ACT is concerned about the increased costs that will result from the removal of the rarity and severity definitions in relation to medical misadventure and about the likely increase in levies for the earners and non-earners accounts. At the moment they roughly share the cost of producing the funding for people who claim accident compensation. 
The Department of Labour gave us a lot of information. Some of it was about the cost of the bill. As the previous speaker said it is estimated that an annual cost of $8.69 million will arise from the changes to the original Act in this amendment bill with a one-off transitional cost of $12 million. Accident Compensation Corporation (ACC) actuaries estimated that in relation to these changes the ACC would accept around 1000 additional treatment injury claims each year with an average fully-funded cost of approximately $9000 per claim. That is where the $8.69 million increase in funding that the Department of Labour told us about comes from. However I have had representations from various health providers who are involved in the scheme as it exists at the moment. 
It was interesting to hear the Minister say there was a high level of satisfaction among medical practitioners about this. Certainly the ones who came to see me not just one or two but quite a substantial group were very concerned about the increase in costs they fear will result from this legislation. I think it is important that we look realistically at the costs to the country. The Department of Labour itself admitted that it would be very difficult to predict the increase in numbers of claims and their costs despite the fact that the ACC actuaries have in fact given us a rough estimate. The department said that it was very very difficult to try to estimate these things. 
The new definition of treatment injury could stimulate a large increase in the number of claims after the bill comes into being including unlimited retrospective claims for treatment injury as long as a previous claim has not been lodged with the ACC. That is something that I think no other member has raised yet—the retrospective nature that can occur. We believe that claims will be made for conditions that are not foreseeable and are not the fault of any party involved but rather the unintended but statistically predictable consequence of normal treatment. That is an issue that the medical practitioners have raised too. Normal treatment is very difficult to define. So there may well be those consequences. 
We are not arguing that ACC coverage should depend on fault but when the scheme is operating at the boundary between sickness and accident—and I will talk about that in a moment—the scheme will be vulnerable. It will be in the interests of patients and health providers to classify complaints as treatment injury. It is just human nature for everybody to want a good outcome for the patients; both the patients themselves and their health providers. When grey areas exist and there is no clear definition the boundaries suddenly become unclear and it is often easy to convince oneself whether patient or professional that somebody qualifies when perhaps the person should not. The removal of the disciplines could mean that the boundary will in practice depend on highly subjective decisions or even—sadly I might say—to some collusion. There is no provision within the bill as it stands at the moment to prevent that. So there may be some collusion with and loss in the integrity of the scheme. I believe that is something that nobody in the House would want to see. 
One of the main reasons ACT is opposing the passage of this bill is the division of treatment and that its funding depends on whether a condition is in fact due to injury or to illness. This is problematic. Anybody who has worked in a hospital setting and I think in particular of orthopaedic wards will know the difficulties that exist and the unfairness—the unfairness that New Zealanders do dislike—that exists between those with an injury and those with an illness. I can think of my own days of working in orthopaedic wards when I would have two patients lying side by side. One would be an older person who had worked right through from a young age had been a productive member of society and paid taxes but because he or she suffered from osteoarthritis and needed a hip replacement was not eligible for accident compensation. In the next bed there was frequently a young fellow who had had a motor vehicle or motorbike accident often of his own causing. There they lay side by side with completely different circumstances but often the same condition yet only one was eligible for compensation Although accident compensation has many benefits and largely removes litigation from the whole equation this unfairness between injury and illness exists in this country. ACT has always contended that accident-based insurance schemes are a very fair way of getting around this problem. 
I would like to back up the point made by the previous National Party speaker that choice is actually very important with regard to accident compensation. ACT contends that choice of insurer for both individuals and employers is imperative to the success of the scheme as it stands. If the scheme were extended beyond that it would manage to get around that barrier between injury and illness. We would like to see a return to the choice that existed for that brief period of 9 months in 1999. Of course when the Labour Government swept into power it swiftly changed the provisions. That was a shame because really it could only be considered as an experiment. There was not time for the changes to be totally absorbed by the medical area. That choice and the competition it provided both to employers and to workers was a very good thing. We saw a drop in the number of accidents and by and large a drop in the amount of claims. That was for the good. We believe that the private sector should be able to compete for this insurance cover. 
So to sum up ACT New Zealand does not support this bill although we acknowledge that the changes to medical misadventure provisions in the original Act in theory look good but we worry about the cost to the taxpayer and we worry significantly about the distinction perpetuated between those people who suffer from a condition and those who suffer from an illness. That distinction is not there. 
I look forward to the Committee stage where we can explore this amendment bill in more detail particularly the proposed costs which are very difficult to estimate as the Department of Labour has said. It is unfortunate to see another Supplementary Order Paper slip in. Submissions cannot be heard on those amendments so the public will not have their say. ACT will be opposing those amendments.