Hague Kevin: New Zealand Public Health and Disability Amendment Bill — Second Reading 
Hague Kevin: New Zealand Public Health and Disability Amendment Bill — Second Reading 
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KEVIN HAGUE (Green) 
: 
 I begin as others have done by thanking the officials who assisted the Health Committee in our consideration of the New Zealand Public Health and Disability Amendment Bill. I thank the submitters who I think it would be fair to say put in 13 splendid submissions and I thank my colleagues from the select committee. I share Ruth Dyson’s praise for the role that Paul Hutchison as chair played. I also want to single out given the circumstances this afternoon one of our colleagues from the Health Committee the Hon Luamanuvao Winnie Laban and say to Winnie a big fa‘afetai lava to thank her for everything that she has done and give her best wishes for her future. 
The Green Party supported this bill at first reading and will continue to support it. In particular we support the underlying intent of the bill but we do so with some reservations. Enhancing quality and safety through the creation of the Health Quality and Safety Commission is a good idea and enhancing the effectiveness of the New Zealand health care system through greater collaboration is also an important idea that everybody shares. In relation to the Health Quality and Safety Commission if I could begin there I had the good fortune to represent district health boards on the Quality Improvement Committee so I was part of the development of a number of these quality improvement projects and I certainly welcome this exciting development—a great enhancement of this area of work. 
There are two reservations I want to voice in this debate. The first of those picks up on a point made by the IHC in its submission to the select committee. One of the things that has happened in the field of disability in particular in the field of intellectual disability is that we have focused on what the goal of disability support services might be. A groundbreaking report from the National Advisory Committee on Health and Disability called  
To Have an ‘Ordinary’ Life  
set out a goal for intellectual disability support services of ordinariness—ordinariness is the goal of those services. IHC was saying to us that a residential service that has the intent of providing an ordinary living situation for people with intellectual disability is a very different kind of service from a clinical service intended to repair illness. So I think it will indeed be a challenge for the new commission to think through what quality and safety means for a service that has such a different goal from that of the clinical services that will make up the bulk of its work. That is one reservation. 
The second reservation is a more deep-seated one and will be the subject of an amendment from the Green Party in the Committee stage: it concerns the intent set out in clause 13 of the bill for the Health Quality and Safety Commission to become self-funding. We believe that that is fundamentally wrong and that although the argument for self-funding which is that this will increase the relevance of the commission’s work and buy-in to that work from the health sector is an admirable argument and one that we would support the danger is also great. The danger is that if the commission is set up to become self-funding it will pervert and change the actions both of the commission and of service providers so that the commission will focus on those projects that lend themselves most readily to generating income and providers will tend to pick up those projects that are free or do not incur a cost. Neither of those behaviours is necessarily what we want so the Green Party will move an amendment to remedy that situation. 
I come to collaboration. I enjoyed Paul Hutchison’s journey through the changes in the health sector over the last several decades. I had the dubious pleasure of living through most of them while in positions in the health sector and that history shows us several things. First of all for me it reinforces the adage that structure should follow function. In the health sector we have seen a lot of structural change that has not been driven by that principle but is instead the result of ideological change or ideological belief. I think it would be disappointing if we were to see more of that kind of change in the sector. So what kind of function or service do we require in the New Zealand health sector? I suggest that public health services which Iain Lees-Galloway has talked about and primary health services lend themselves to highly localised structures whereas other services such as tertiary and quaternary services the most specialised services lend themselves to much bigger units of organisation. I have previously in the House set out my view that that suggests that what we need for structure is an intelligent network of locally organised structures that are able to aggregate where function determines that that is a sensible thing to do. I think we are moving towards it. 
I do not agree with Paul Hutchison’s view that collaboration has not been occurring in the sector. It has been occurring. There have been important gains. But it has been limited by a few things. It has been limited by what I call asymmetry of need where smaller district health boards have required collaboration and larger district health boards in general have not. It has been limited by an interpretation of the principal Act that suggests that each district health board should act only in its own interest and so there has not been a driver that it is in the interest of the overall New Zealand public. 
We support the idea of greater collaboration that can be directed by the Minister which is in this bill. We think that is the appropriate way to go. But we share the concern set out by Labour members about the other thing this bill does which was not signalled in the first reading debate: it diminishes the requirement for consultation imposed on district health boards. Certainly we will be talking with our Labour colleagues about the Supplementary Order Paper they intend to put forward and we intend to work for a change to the legislation in the Committee stage. There are a couple of reasons really. One is that the approach outlined by the Minister of Health in this debate of setting out the requirements for consultation through regulation is bad law. It is bad law. The consultation requirement ought to be set out in the Act itself and the interpretation of the Act should guide the proportionality of the consultation that then occurs because this is what the Government members say. They say that if we have the consultation requirements spelt out in the Act then district health boards will be forced into consultation that is out of proportion to the issue involved. In fact that is not the case. The Court of Appeal has already set out the law that applies here and it imposes precisely the kind of proportionality we would want to see. So there is no good reason for not including it in the Act and we will be working for that in the bill. 
In summary the Green Party will support this bill until its Committee stage but we will be working for some significant changes to the bill in the Committee stage. We hope that it will be possible to eventually pass a bill unanimously in the House. Thank you.