Scott Lynda: Health Practitioners Competence Assurance Bill — In Committee 
Scott Lynda: Health Practitioners Competence Assurance Bill — In Committee 
[Volume:611;Page:8065] 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 This is a very large comprehensive piece of legislation and we must remember that significant amendments have been made to it. Also there are a large number of Supplementary Order Papers. Many health professionals out in the community are very concerned about the bill. It should not have been a political bill. It should not have had the number of people voting against it that it has tonight in the Chamber. If it had been better organised if it had been better consulted on that would not be the case. There are many times around the table at the Health Committee that we do not vote on party lines; we vote on what is in the best interests of the country. We work together. We have had a very good working team. But this bill has seen a large number of members in the Chamber voting against it. Why is that? The reason is that there are significant concerns. 
One of the major concerns in Part 1 is about scopes of practice and the fact that they are ill-defined. Setting out to protect the public when health practitioners are dealing with them is a very valuable concept and everybody wants to see that happen. But we may see public safety eroded not improved by this bill. We do not know what the term “scopes of practice” actually means. Are scopes of practice to be so broad that they will be meaningless? Are they to be so narrow that there will be an individual scope for every single person? In the past we determined what health practitioners could do based on the exams they passed. People passed an exam passed a registering authority and then were able to do a set number of things. Under this bill we have a thing called scopes of practice but nobody is too sure what that means. Because of that doctors do not want a bar of this bill. The Association of Salaried Medical Specialists does not want a bar of it. The New Zealand Medical Association does not want a bar of it. They understand. They have been working in here and the scopes of practice—[ 
Interruption 
] 
The member opposite continually chips in. She has no concept of what this bill is about. She does not understand what scopes of practice are—nor does anybody else. It is about time she stood up and took a call to show us she has actually read something and understands something about health care in this country. It is extremely important that we protect the health and safety of the public but this bill will not do that. It brings in too many new concepts. It tries to be too ambitious. It tries to bring too many practitioners together under one bill. The Medical Council of New Zealand now has to determine scopes. Will it do that for every individual who comes into this country from overseas? Will it have to determine his or her individual scope of practice? That is a huge task to ask of the registering board. 
We also have to look at what will happen if there is a dispute. What will happen when there is a dispute about scopes of practice? The Minister will have the right to determine what happens with overlapping scopes. Scopes are to be quite narrowly defined and the example used that was of immense concern was nurse anaesthetists. So if we have medical anaesthetists and nurse anaesthetists how do those scopes interrelate? The Minister in two of her speeches has already endorsed nurse anaesthetists. She has already said it is a great concept that it is a really good thing and that it should happen. As the Minister has endorsed the concept I would like her to take a call and tell us how she is going to determine the way these overlapping scopes will be differentiated and how the nurses and the doctors will be able to determine the way a nurse anaesthetist will practise in this country. 
I am in a pretty unique position because I have been both a nurse and a doctor. I can tell members that as a nurse I sometimes thought I had more knowledge than I actually did. When I trained as a doctor I realised that my diagnostic skills as a nurse were not as great because in nursing it is often done on pattern recognition. One gets to see a lot of people who have certain conditions. But when things are not quite as they seem then figuring out a diagnosis requires more knowledge.