Wall LouisaLOUISA WALL (Labour—Manurewa): Tēnā koe e Te Mangai o Te Whare. It is my pleasure to speak on this the third readings of the bills divided from the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. I want to as always commend the work of the Health Committee. I think it is a committee that works diligently on behalf of New Zealanders and so I acknowledge its work on this particular piece of legislation. I just want to reaffirm for those who are listening that what these bills do is remove references to medical practitioners in eight pieces of legislation to allow other suitably qualified health professionals or health practitioners like nurses to perform tasks that they are skilled in that they are not empowered to do under current legislation. Some of those things actually I think should be highlighted. They are about for example the ability to sign death certificates; they are about the ability to take blood specimens from drunk drivers; they are about being able to declare people unfit to drive; they are about signing sick-leave certificates; they are about prescribing controlled drugs; and they are about issuing a certificate to accompany an application for a mental health assessment. Currently all those tasks are only able to be performed under legislation by medical practitioners. What this piece of legislation will do is enable nurse practitioners health professionals and other health practitioners who under their learning and under their scopes of practice have the competency—they too will now be able to perform those legislative functions. I want to acknowledge the fact that the first nurse practitioner graduated in New Zealand in 2001. And actually it was in 2005 under my colleague the Hon Annette King that we first started to look at expanding the legislative responsibility of nurse practitioners. We did that under a piece of legislation that enabled nurse practitioners to prescribe medication. What this piece of legislation does essentially is look at the whole nursing area—and there are over 50000 nurses in our country—and look at their skills and look at their ability to provide better services to the New Zealand population. At the heart of this piece of legislation it is about maximising the strengths of the health workforce. I particularly want to focus on the issue of pay equity actually within this whole area. I think it is really important now with the expansion of the legislative scope that our nurses have that we look at remuneration. For example practice nurses in New Zealand earn between $31000 and $45000 per annum. If you are a registered nurse you can expect to earn $65000. If you are nurse practitioner—who we have heard has to undertake a Master's essentially so it is an extra 2 years' worth of study—you can aim to earn over $90000. If you look at medical professionals or medical practitioners a junior GP—so this is someone who spent 5 years studying at university and at medical school and then takes another 4 years to qualify—can earn between $75000 and $90000 a year. I am sure that other people will be able to talk more specifically about the remuneration but a senior GP is someone who after 10 years of both qualifying to be a medical practitioner and then working in the field can look at earning between $180000 and $250000 a year. That is a huge difference between a senior GP and a nurse practitioner who you would say is a senior nurse. So a senior nurse earns $90000 a year; a senior GP earns between $180000 and $250000. I think some of the implications of this piece of legislation based on my quick research of how much people are remunerated are that I think in the future we are going to see that our nurse practitioners are actually hugely underpaid. If they are now performing a whole lot of statutory functions and statutory responsibilities that previously only our medical professionals—our doctors—have been able to do then actually there needs to be a reflection of that in their anticipated salaries. The reason I am bringing this up as quite a big issue for the House in the future is that obviously nursing has tended to be an area or a domain that women have chosen to study in and to practise their skills and contribute to providing the New Zealand public with the health services that they need. I am highlighting it now because I think it is something that in the future we are going to have to address. This has not been about being pragmatic. This has actually been I think about fully utilising the skills of our entire medical workforce. I certainly am—and I know after listening to Barbara Stewart from New Zealand First that it is something that is also now on their agenda. I only want to highlight the fact that there is overwhelming support for this piece of legislation. There were 28 submissions and only two opposed. One of those was from the medical practitioners themselves. I think that from their perspective obviously preserving their status within the whole medical workforce was something that they were particularly concerned about. That is probably the best way to describe it. I do not think that they were trying to undermine the nurses' position but I do not know. For people who have worked in the medical area doctors always seem to have been at the top of the hill or at the top of the tree and the nurses were seen as subordinate. Under this piece of legislation actually I see parity. I see our nurses and our doctors actually complementing one another and doing their job hand in hand and side by side—not one above the other. I think that in some of the roles that our nurses will play in the future—and particularly in rural communities they will be leading the provision of health services. I think that this piece of legislation is only really the beginning of another process and another evolution of how our health services are provided in our country. From the perspective of all nurses—the Nursing Council of New Zealand Nurse Practitioners New Zealand neonatal nurses mental health nurses—and from the pharmacy sector physiotherapy and even the unions who chose to make a submission on this piece of legislation there was widespread support and I think that support from the submitters is being reflected in the House. I will not take up any more time. I commend the bills to the House.