Dyson Ruth: Health Practitioners Competence Assurance Bill — Second Reading 
Dyson Ruth: Health Practitioners Competence Assurance Bill — Second Reading 
[Volume:610;Page:7536] 
Hon RUTH DYSON (Acting Minister of Health) 
: 
 I move  
That the Health Practitioners Competence Assurance Bill be now read a second time 
. The Health Practitioners Competence Assurance Bill is about public safety. It is designed to protect the health and safety of the public by providing mechanisms to ensure the lifelong competence of health practitioners. 
The bill has been in preparation for over 3 years and has been the subject of much consultation and debate—in fact so much so that at a recent conference on legislative drafting the Parliamentary Counsel Office used it as an example of a process involving sound policy development and policy decision-making. Such an extensive consultation process provides the foundation of good legislation. 
The Health Committee has now reported the bill back to Parliament after receiving and considering 265 public submissions. That was the final stage of the consultation process and many of the recommendations made by submitters were accepted by the committee and have been incorporated into the legislation. I am happy to recommend to the House that it accept the committee’s amendments subject to some technical changes. For example the Health and Disability Commissioner recommends that only 3 weeks not 3 months is an appropriate period for a practitioner to respond to a complaint. 
Issues are raised in the minority reports that cannot be substantiated and in some cases even contradict previous stances. There is a focus on the concerns of the professions with scant regard for consumer concerns. There is a claim that the bill is not based on the Medical Practitioners Act which is acknowledged as a very successful piece of legislation. In fact the Medical Practitioners Act was used by parliamentary counsel as the basis for drafting the Health Practitioners Competence Assurance Bill. There are 110 clauses out of a total of 167 relevant clauses and the schedules that are based directly on the Medical Practitioners Act. All the major concepts of the Medical Practitioners Act have been carried forward into the Health Practitioners Competence Assurance Bill and have been adjusted where necessary to generic terms in order to provide a framework that can apply to all health practitioners not just doctors. The basic principles of ongoing competence separation of the registration process from the disciplinary process and the declaration of quality assurance activities have all been carried through. 
The Medical Practitioners Act required the Director-General of Health to review the quality assurance provisions after a 2-year period. The Health Practitioners Competence Assurance Bill incorporates the recommendations made as a result of the review in 1999. Also taken into account were the recommendations of the Health Committee in 2001 after considering the Medical Practitioners (Foreign Qualified Medical Practitioners) Amendment Bill in the name of the Hon Ken Shirley and the petition of the Hon Nick Smith and 828 others. Both Mr Shirley and Dr Smith expressed concern about the operation of the Medical Practitioners Act. The Government undertook to address their concerns in the Health Practitioners Competence Assurance Bill and we have delivered on that commitment. 
There is a claim that the scopes of practice concept is new and untested. The Medical Practitioners Act however is based on scopes of practice. The Health Practitioners Competence Assurance Bill simply adapts the concept to express broad scopes of practice in generic terms that can apply to all health practitioners. 
It is also claimed based on the response to an Official Information Act request from the New Zealand Medical Association that the Ministry of Health did no background work on scopes of practice. The response from the ministry actually was that it had no written papers but all the background papers had already been made publicly available during the consultation process. 
In a discussion document released in September 2000 the ministry sought comment on the concept of scopes of practice. Ninety-four percent of respondents supported the concept provided that there was consistency between professions and clarity on overlapping scopes of practice. These issues were addressed in the paper seeking Cabinet approval for the concept and the Cabinet paper with the background discussion document were placed on the Ministry of Health’s website over 2 years ago. In its 2002 publication  
Nurse Practitioners in New Zealand 
 the Ministry of Health included a section “What is a scope of practice?” much of which discusses the development of scopes of practice for nurse practitioners. 
 The Health Committee included a section on scopes of practice when it reported on Nick Smith’s petition in 2001. In this section Dr Smith is quoted as believing that “specialist registration as a dermatologist in New Zealand is effectively a closed shop”. The committee expressed the view that the proposed Health Practitioners Competence Assurance Act which would override the Medical Practitioners Act could address the issue of highly specialised medical practitioners not being able to practise. The Health Practitioners Competence Assurance Bill provides for broad scopes of practice in most cases; however after Mr Shirley and Dr Smith expressed concern about the inability of some overseas-trained doctors to register in order to practise in New Zealand the Government undertook to introduce legislation that would allow a clinician with a limited scope of practice to practise in our country within that limited scope. The Health Practitioners Competence Assurance Bill delivers on that undertaking by allowing for a scope to be tailored for an individual in some circumstances. 
To allow flexibility under the Act to accommodate future changes in technology and the delivery of health services clinical decisions are the responsibility of the registration authorities and may be adjusted through a transparent process without the need for legislative change. But the purpose of the bill is to protect the public. In return for the increased powers of professions in respect of clinical decisions there are checks and balances to ensure that registration authorities are held accountable for complying with the Act through the Minister of Health directly to Parliament. One such check is that the Minister will appoint members of authorities after seeking nominations from professions and the public. This process will also ensure there is an appropriate mix of clinical skills consumer interests and gender and ethnic perspectives on each authority. 
It is particularly curious that the ACT party is concerned about those powers when in 2001 it was introducing legislation to take away some of the clinical decision-making powers of the Medical Council and to give them to the New Zealand Qualifications Authority—a Crown entity appointed by the Minister of Education and again accountable through that Minister to Parliament. 
Notwithstanding the bill’s requirement that the Minister consult those people who are affected by the proposed list there is a tension between the interests of health consumers and those of health practitioners and I note that in the minority reports there is comment that submitters’ concerns have not been addressed. However there is no reference to the fact that submissions from consumer groups supported the quality assurance activity as originally drafted. The committee sought to balance those two perspectives and I compliment it on the recommended changes. The reporting requirement for a quality assurance activity is new but these reports will help to demystify quality assurance and reassure consumers that the protection afforded practitioners is in the public interest. Similarly they will provide the Minister of Health with the assurance that the public interest is being met. 
On the issue of complaints processing the committee recommended changes to clarify the two levels of charge in relation to professional misconduct and I congratulate committee members on the new wording. I support their view that in fact all matters that get to the stage of a disciplinary hearing are likely to be serious and that differentiation between degrees of seriousness is likely to be reflected in the penalty imposed rather than in the charge. The bill will not prevent professional groups from setting codes of ethics as they have traditionally done and they will continue to do so I am sure. But there is a distinction between the setting of such codes and the standards for ethical conduct on which professional conduct committees will need to make judgments under the Act. 
The bill introduces a new mechanism for ensuring that medicines are distributed in a safe environment by requiring operators of pharmacies to be licensed. 
The Health Practitioners Competence Assurance Bill is innovative legislation that provides a framework for the regulation of health practitioners where there is a risk of harm to the public. It has gone through a thorough process of debate and discussion. Now it is time to make it law to ensure that practitioners registered under its provisions are competent to practise. At a recent medical law forum held in Wellington a principal of Chapman Tripp Sheffield Young said the following in a paper presented to the forum: “The key to the success of the HPCA Act will be the implementation of variable scopes of practice and whether the bill has achieved the right balance between risk and intervention so that the health sector and the public support the process.” I commend this bill to the House.