11. Question No. 11—ACCJAN LOGIE (Green) to the Minister for ACCQuestion No. 11—ACC11. JAN LOGIE (Green) to the Minister for ACC: Fakafetai lasi and xiexie Mr Speaker. Is she confident the changes to ACC announced today will create comprehensive cover for all injuries resulting from childbirth?Hon Dr AYESHA VERRALL (Associate Minister of Health) on behalf of the Minister for ACC: As I said in my response to the earlier question 85 percent of women in New Zealand experience a birth injury and 5 percent of these are severe and require ongoing care. Under current legislation most of these injuries are not covered by ACC despite sharing similar features to other physical injuries covered as accidents. That's not fair and it is why I have worked with ACC and medical experts on a list of birth injuries that will ensure up to 18000 more women are covered each year. The list is intended to include all acute injuries to a birthing parent that results from the birth process.Jan Logie: Is she concerned that a definitive list of birth injuries may result in situations where some birth injuries are covered but others are not for arbitrary reasons?Hon Dr AYESHA VERRALL: Indeed which is why the types of injuries that were covered were carefully considered and advice was sought including from experts in obstetrics and gynaecology on the types of injuries that can occur in the birth process. We agree that this is an important area: the matter of who is covered and not covered. As new legislation will be required to bring in these changes there will be an opportunity to scrutinise this at the select committee.Jan Logie: Why has she chosen to include uterine prolapse on the list of birth injuries that will now get ACC cover—which we're grateful for—but not bladder prolapse for example?Hon Dr AYESHA VERRALL: My understanding of the rationale for uterine prolapse is that uterine prolapse is not an injury it is the result of other injuries that are included on the list and that is why coverage could be received for uterine prolapse. If the member wants further advice on the matter of bladder prolapse she may need to put that question in writing.Jan Logie: So can the Minister confirm that she is open to expanding the list or adopting a broader definition or non-exhaustive list if further birth injuries are identified through the select committee process?Hon Dr AYESHA VERRALL: We have gone through a thorough process with experts in the area to make this list and we expect that it will hold up to scrutiny through the select committee process.Jan Logie: Will she ensure that the changes apply retrospectively so that a new parent who gave birth say two months ago who may still be suffering from birth injuries will also be eligible for cover and rehabilitation?Hon Dr AYESHA VERRALL: As the member will know from her time in Government the legislation guidelines are clear that the starting point for all legislation is that it should have prospective not retrospective effect. Retrospective changes to ACC would make it extremely difficult to predict the volume of claims that would be made to ACC and balance the interest of ACC levy payers. There are exceptions to this rule but Cabinet's test for retrospective cover includes things like addressing a previous legal error or addressing a matter that is essential for public safety. While there have been some retrospective changes to ACC to correct errors new categories of cover have not been created retrospectively and doing so would create a dangerous precedent.Jan Logie: Is the Minister comfortable with continuing to deny ACC cover to babies injured during birth when adults and children experiencing disability because of accident are covered?Hon Dr AYESHA VERRALL: The changes announced today are about fairness and improving equity and health outcomes for women. Extending cover to injuries suffered by babies during childbirth would mark a significant change to the nature of the cover under the scheme. It would also have an impact on the long-term sustainability of the scheme. Officials have estimated the cost of covering children injured during childbirth to be at least $375 million to $525 million per year. This number is only based on the number of babies who have severe brain injury at birth due to hypoxic ischemic encephalopathy which is just one type of injury suffered during childbirth.Jan Logie: How will this approach that only intends to cover some physical injury excluding injuries to pēpē and broader mental health meet the needs of Māori whānau for holistic support?Hon Dr AYESHA VERRALL: The mental health issues caused by an injury that is covered by the scheme would be subject to cover so that is addressed through the changes that we propose. I think in terms of the wider issues around the mental health of whānau around the time during and after childbirth we as a Government know that that is an important area of work and my colleague the Associate Minister of Health has added two items of work to the maternity action plan updated and released today. That includes one particular area of mental trauma after the loss of a child. That will be worked on first by research with those whānau and secondly by the development of a bereavement pathway. Secondly we are doing much wider work in the area of stocktaking maternal mental health services to guide further strengthening of those services.