Coleman JonathanHEALTH PRACTITIONERS (REPLACEMENT OF STATUTORY REFERENCES TO MEDICAL PRACTITIONERS) BILLSecond ReadingHon Dr JONATHAN COLEMAN (Minister of Health): I move That the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill be now read a second time. In April of this year the Government announced the launch of the New Zealand Health Strategy which is all about delivering better care closer to home so that more people can get access to the services they need more conveniently. Part of that is using all the skills that we have right across the workforce to their fullest extent. We have a highly skilled nursing workforce highly skilled pharmacists and many people in the allied health professions are obviously trained to a very high level but there are a number of functions that by statute only doctors can perform. So the purpose of this bill is to improve access to services for the New Zealand public and to increase workforce flexibility. I will go through a range of the different provisions but essentially it looks at a range of Acts and removes the barriers to patients accessing the healthcare they need. A number of functions previously able to be performed only by doctors will now be able to be performed by an appropriately qualified medical practitioner who is a member of some of those other professions—for instance the nursing profession. It covers areas such as sick certificates some clinical assessments and the issuing of death certificates. The purpose of the bill is to remove legislative barriers so that competent health practitioners can perform a number of statutory functions previously limited to doctors under existing legislation. Barriers to innovative models of healthcare and making the best use of our workforce were identified in a number of Acts and seven of those Acts were prioritised by the Government for amendment. The Government also intends to review unnecessary restrictions for statutory functions for health practitioners in further Acts as they are revised. To improve efficiencies in the health system removal of legislative barriers will reduce unnecessary costs and time for the public who must often wait and pay to see a medical practitioner. This bill allows the public to be examined clinically assessed and if required issued with certificates such as sick leave certificates by suitable health practitioners in a much more timely and cost-effective manner. Changes to the statutory provisions in this bill will allow competent health practitioners to use their qualifications knowledge and skills for the betterment of consumers. The bill will improve health practitioner accountability by making practice more transparent. Currently health practitioners already undertake clinical assessments but the law requires a medical practitioner to formally authorise the assessments. This double handling is unnecessary and will be addressed by the bill. Delays for consumers in access to care will be reduced. The bill will also allow nurse practitioners with the primary responsibility of patient care to be able to certify the cause of death. This will address the issue of delays for families when doctors are unavailable for certification. In terms of the work of the Health Committee it heard submissions totalling 28 from interested groups and individuals and it also heard 10 oral submissions. Most submissions gave full or qualified support and I would like to thank those who did take the time to submit and of course I thank the Health Committee for the work that it put into this bill. As members might expect for a bill of this type the submissions considered by the committee were largely from professional organisations and individuals with an interest in the nature of the legislative tasks undertaken by health practitioners. On the whole health professional groups such as nursing pharmacy and physiotherapy supported the bill. Most medical group submitters including some medical colleges also supported the bill but a few medical submitters questioned some aspects. The committee considered the concerns raised. One aspect raised in those submissions was accountability for health practitioner competence. Committee members sought additional advice on the adequacy of the Health Practitioners Competence Assurance Act 2003 to assure themselves that the safety of the public is maintained. The committee was assured that responsible authorities regulating health practitioners have sufficient safety controls. The Health Practitioners Competence Assurance Act includes mechanisms to ensure that practitioners are competent and fit to practise for the duration of their professional lives. I would like to emphasise that the principal purpose of the Health Practitioners Competence Assurance Act is to protect the health and safety of the public. Having a single legislative framework allows for consistent procedures and terminology across the regulated health professions. The accountability regime that ensures health professionals are practising safely is unambiguous under the Act. Those not deemed competent will not be able to perform statutory duties. Health practitioners must be registered with the relevant responsible authorities and hold a current annual practising certificate. The responsible authority determines the scope of practice for the practitioner. It prescribes the qualification for scopes of practice and it ensures that practitioners are fit and competent to practise within their scopes of practice. It is also responsible for reviewing practitioners' competence and if needed has the power to suspend a practising certificate. It also has responsibility for referring complaints against a health practitioner to a professional conduct committee or to the Health and Disability Commissioner for investigation or sanctions as required. Several submissions requested changes to Acts other than those identified in the bill. These were considered by the committee and several further amendments were made to the bill including an additional amendment to the Medicines Act 1981. The committee has recommended the bill be passed and proposed several improvements. The reported-back bill will now amend eight statutes to enable a wider range of suitably qualified health practitioners to undertake activities currently restricted to medical practitioners. Some additional changes were also made to improve consistency of definitions across the amended Acts and to enhance the provisions of several Acts. I would like to provide some examples of the bill's contribution to improvement in the health sector. Amending the Medicines Act 1981 allows regulation-making powers that enable nurse practitioners to supervise designated prescribers clarifying the current provision in the Medicines Act with regard to the supervision of designated prescribers. Where there is a shortage of medical practitioners available in certain areas nurse practitioners will be able to supervise designated prescribers. This will enhance training opportunities for health practitioners working towards qualification as a designated prescriber. With the Government agreeing to regulate designated registered nurse prescribers this supervision will facilitate the delivery of health services in rural and hard-to-staff areas including nurse-led clinics. The bill includes improvement to the Misuse of Drugs Act 1975 to allow nurse practitioners and registered nurse practitioners working in addiction services to be able to prescribe controlled drugs as part of the team treating a person for drug dependency. The committee further recommended that designated prescriber pharmacists be allowed to prescribe controlled drugs to a person with a drug dependency when working in drug dependency treatment teams. A further amendment to the bill was also recommended to add the requirement for compliance with applicable guidelines issued by the Director-General of Health for those treating drug dependency. This change will enhance access to treatment services for drug addictions and ensure that there are adequate controls of those allowed to prescribe for drug dependency. To respond to the changing burden of disease in the future there will be greater emphasis on working in a collaborative fashion right across the various health professions and partnering with individuals their whānau and communities. The health and disability workforce must be freed from statutory barriers in order to be deployed in new ways to ensure that services are delivered by the right practitioner to meet the needs of the public. This bill will contribute by creating the environment where statutory functions can be delivered by a wider workforce. I commend this bill to the House.