Roy Heather: Health Practitioners Competence Assurance Bill — In Committee 
Roy Heather: Health Practitioners Competence Assurance Bill — In Committee 
[Volume:611;Page:8067] 
HEATHER ROY (ACT NZ) 
: 
 I will look firstly at the commencement of this bill. The commencement is staggered: some parts of bill come into force on the day on which the Act receives the royal assent but the bulk of the bill comes into force on the day that is 1 year after the date on which it receives the Royal assent. That gives particularly the larger groups the medical practitioners and the nurses in particular just 1 year to sort themselves out particularly with regard to the scopes of practice. I agree with both of the two previous speakers’ comments about scopes of practice. They are untried and untested and New Zealand patients will be the guinea pigs. It is the larger professions in particular that will have a lot of decisions to make about scopes of practice. They will be very difficult to develop and we will have only 1 year in which to sort them out. 
I suspect that the Government thinks that scopes of practice will make New Zealand and the New Zealand health scene in particular a world leader but nothing could be further from the truth. Lynda Scott said that public safety will be eroded and she is quite right in that. That is my main concern too. My fear is that rather than enhancing protection for the public public safety will be eroded as a result of scopes of practice coming into being. 
Going back briefly to the comment about New Zealand being a world leader if we just think for a moment about what it is that holds our health system together at the moment we will see that it is the health professionals. It is the doctors and nurses who have to hold things together at the coalface in very difficult circumstances. This legislation will do nothing but make things worse for them. The self-regulation that health professionals have been subject to so far is the professionalism that we see in our hospitals and general practices today and which we see our health professionals exhibiting whenever we go to visit them. The scopes of practice will make life very difficult for them. 
We have much longer waiting lists than elsewhere in the world and we have much longer waits for radiotherapy and chemotherapy which put patients under stress. When one asks patients what exactly is good about New Zealand’s health system the thing they say is the care that they receive from the doctors nurses physiotherapists occupational therapists and other health professionals whom they visit. Instead of accepting that that is the part of our health system that is good and which works well and effectively we are now going to turn the whole lot on its head and change those things for the health professionals. 
If we move further on to the definitions in this part we see that the definition that is noticeable by its absence—quite apart from the definition of the principles of the Treaty of Waitangi which the New Zealand First member talked about—is the definition of competence which I talked about in the debate on the title. Where is the definition of competence? It is not there. Why? Because it was too hard to define but our health professionals will still have to be subject to competence. It will be impossible for them to try to work under that. 
Let us now move on to the definition of medical practitioner. Part of my Supplementary Order Paper 111 is to omit the definition of medical practitioner throughout the bill particularly in this part and to substitute the following definition “medical practitioner means a person referred to in section 139 of the Medical Practitioners Act 1995”. Members might ask why I am having that omitted; it is because doctors do not want to be part of this legislation. They can see that it is not going to work for them. They feel that their concerns have not been adequately addressed and that this legislation will not enhance safety for the public so they do not want to be part of this bill. Likewise we have heard that optometrists want to be removed from the bill. They too have grave concerns about quality assurance scopes of practice and in particular the ministerial control that will result from this bill being made law. 
On 22 July the Minister of Health said in the  
New Zealand Herald 
 that this bill is like “doctors knowing best” all over again. Well we are not going to have that. We are not going to have doctors knowing best despite the fact that they are meant to diagnose problems and that they have had 6 years’ initial training and then significant training afterwards. No instead we are now going to see the “Minister knows best”. The Minister of Health knows best and she will tell health professionals what they are supposed to do. Ultimately she will make the decisions about how they go about their practice and how they put themselves into practice rather than allowing self-regulation which has worked very effectively particularly with doctors. If other professions were given that same opportunity it would work well with them.