King AnnetteHon ANNETTE KING (Deputy Leader—Labour): Labour as it has throughout this legislation's progress supports it at its third reading. I want to begin by saying that I would have thought the Minister of Health could have shown a little bit more enthusiasm about this legislation which makes quite a significant—Hon Dr Jonathan Coleman: I used it all on your question today.Hon ANNETTE KING: You certainly did Minister. You used it all on the questions today; it is just a shame you never answered any of them. But it is a shame that the Minister did not sound so enthusiastic and sounded a little bored by it all because certainly the Health Committee did not find it boring at all. In fact I want to begin by saying that the Health Committee took the legislation very seriously. We did a very good job on the legislation and reported it back once we got our hands on it.The biggest problem with this legislation is the time that it has taken for it to get through this Parliament and to make the changes that are needed. I have raised this in the first reading in the second reading and in the Committee stage so you will not be surprised that I am raising it again in the third reading. You see sometimes really good ideas under this Government seem to be put on the back-burner and come second third or last in some of its priorities. Unfortunately they are often very good health ideas and that may reflect the energy of the Minister—I am not sure.This is legislation that was needed and has been needed for some time because of the complexities that we now have in our health system and our need to have a range of health practitioners able to provide a range of services when they meet those competencies. The very first piece of legislation that was going to enable others to prescribe for example happened a long time ago—in fact it happened in 2005 when I was Minister of Health. I introduced something 14 years ago and here we are making a little improvement all these years later.So I do say to the Minister when we have got legislation like this use your muscle to get it up the Order Paper. I am sure the Leader of the House if he was approached—being a very approachable man—would listen to him and say: Yes this is important." I think it is more important than some of the legislation we have and certainly more important than worrying about lost luggage and things like that.This legislation as the Minister did say is from an omnibus bill. It does amend eight statutes and it does increase the range of functions that can be performed by health practitioners under those statutes. In those old statutes they made reference only to "medical practitioners"—in other words doctors—so they restricted what could be done by any other practitioner. By amending that and changing it to "health practitioner" it widens the range of who can carry out those functions. Actually as the Minister pointed out health practitioners are carrying out some pretty important functions under this legislation. For example the Misuse of Drugs Act is being amended so that a qualified nurse can treat addiction patients. Changes to the Burial and Cremation Act will allow nurse practitioners to certify the cause of death. As the Minister said that is not easy so you need to have people who are trained in doing it but they do not have to be medical practitioners. We will also amend the Land Transport Act with this legislation and it is being amended because at present it states that only medical practitioners—doctors—and optometrists can provide medical reports on a person's fitness to drive. Then if you look at the Children Young Persons and Their Families Act it restricts medical examinations of children to medical practitioners whom the court considers qualified for the purpose. So the legislation amends as I said eight statutes and allows other health practitioners to undertake those roles.In a changing health system those roles as I said do require us to use the expertise and training of every health practitioner whom we can use. We can augment the work that is done by medical practitioners when others are involved in the provision of health services so this legislation widens that ability. It is going to give greater scope and I can see real use for it particularly in rural New Zealand. It is often hard to recruit medical practitioners there but in our rural areas we have extremely good nurses with high levels of skill nurse practitioners those who are involved in emergency responses and those who are involved in rural health practice. I can see great use of them to carry out these functions. Imagine if you were in a small town and you had to wait for a medical practitioner to arrive to declare that a person was dead. It is great stress on a family waiting for that certificate to say that a person has died. Now in that community there can be a person with the appropriate training who can undertake such a function. I think it is going to be very valuable. I notice that the member Barbara Kuriger who does represent a rural seat is nodding her head. She understands the practicality of this change as will many out in our community.There is one fear I have with this legislation—I raised it at the committee and I raised in other readings of this legislation—and that is what has been said by the Minister which is that there is no cost to doing this. Well I think there has to be a cost to doing it because if a person has greater skills be they a nurse or any other health practitioner—if they have got greater skills and they have got greater qualifications they do need to be paid more. They will not be doing it at the same price as a practitioner who has lesser skills. There will be a cost and one of my worries and fears is that if we think there is no cost we will fail to fund those practitioners to carry out the role.One of the problems that we have had with nurse practitioners is that district health boards (DHBs) have not funded those who are qualified to be nurse practitioners because of the higher costs. Where there could be hundreds and hundreds of nurse practitioners—we have got thousands of nurses who have got Master's degrees and above in their qualifications not being used because DHBs have to pay more for their skills and they do not. They have not used that capacity and skill that we have in New Zealand because of the cost. That is my fear—that we will pass this legislation and little will change. Little will change even though there are those who have the skill to do it unless DHBs are prepared to pay for that skill.We have just gone through a junior doctors' strike seeking to ensure that they are properly rewarded but also treated fairly when it comes to rosters and so on. We cannot ask another workforce to carry out the greater duties that we need without ensuring that it too has proper working conditions and the remuneration that goes with it. I just hope that I am wrong but I have seen what has happened.The first nurse practitioner was actually registered in Hamilton back in about 2002 and I thought that we would have seen thousands by now. That has not been the case and it does as I have been told get down to money. I hope that at our select committee we do not have to bring this up with the Minister during Estimates hearings and at other times because he has got it right—I hope I have got it wrong and he has got it right—that there does not need to be any extra money. But one of the things we ought to do is monitor the impact of this legislation over time to ensure that all the things we think will happen by amending these eight statutes actually will happen for the provision of health services in New Zealand.We do commend this legislation to the House. I am glad that it has finally reached the end of a very long process. I too think the Health Committee is a very good committee and I am being very objective in this—you know I could be highly political. But I do think we have an extremely good Health Committee and I will say of Simon O'Connor he is one of the best chairs we have had of a select committee.Grant Robertson: Is he going to get into Cabinet?Hon ANNETTE KING: I think he should be in Cabinet. In fact he would probably make an extremely good health Minister. He is informed he is reasoned he knows a little bit about it and he is interested and none of those qualities you could—Grant Robertson: That puts him well in front.Hon ANNETTE KING: That puts him well in front. None of those qualities our current Minister has. I have just done him to death; he probably will not get a job now. But we support this legislation and I am very glad it is going through the House.Grant Robertson: Oh good timing."