Scott Lynda: Health Practitioners Competence Assurance Bill Health and Disability Commissioner Amendment Bill Medicines Amendment Bill — Third Readings 
Scott Lynda: Health Practitioners Competence Assurance Bill Health and Disability Commissioner Amendment Bill Medicines Amendment Bill — Third Readings 
[Volume:611;Page:8621] 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 The Health Practitioners Competence Assurance Bill was 272 pages but has now been split into three bills. It was comprehensive legislation that failed abysmally to measure up to the standard that it should have reached. The bill originally sought to have 11 Acts of Parliament included under one Act to ensure the competence of health practitioners throughout New Zealand to be able to practise safely to protect the public and to assure quality assurance in the ongoing education and credentialing of people involved in health practitioner competence. The bill did not achieve that. In the Health Committee we worked very hard to try to make improvements to it. 
But it should not have been a political bill. It should have been the sort of bill that everybody round the select committee table could agree on and work on but that did not happen. One has to ask why. One has to sheet it back to the Minister of Health. The Minister of Health had not asked the ministry the hard questions in the development of the bill. She should have sent the bill back to the select committee. She should have sent it back for the ministry to go back to those people who were so concerned about the bill until she got it right until the ministry got it right and until people were happy with it. 
Some of the people included under the bill—physiotherapists occupational therapists and dental technicians—have Acts of Parliament that are very old dating from 1947 and 1956. They were very pleased to get new legislation. But the doctors the medical practitioners in this country absolutely opposed the bill. They work under an Act that was brought in by the National Government—the 1995 Medical Practitioners Act. The bill was supposed to be modelled on that Act of Parliament. Initially the doctors said that was fine because they are very happy with the 1995 Act. They think it has solved about 30 years of problems. They were happy for the bill to go ahead based on that. But that was not what happened. What happened was some very new things were introduced. 
One of those things was scopes of practice. They were not defined on paper. There were no academic pieces of work that people could subject to peer review to decide what exactly scopes of practice meant and how they would affect health practitioners in this country. There was no intellectual rigour applied to this concept. It is not practised anywhere in the world. The only place in America that thought it might go down this line has not implemented it because it has been too difficult. Scopes of practice have been described as cutting edge and as enabling legislation. The last time we heard that was on the Resource Management Act and members know what a mess that turned out to be. People do not know exactly whether scopes will be broad or narrow or how they will be interpreted. Only through case law when people turn up before the Medical Practitioners Disciplinary Tribunal and other disciplinary tribunals will we actually get some strong concepts about what scopes of practice are. 
That is one of the major concerns that medical practitioners have. They want out of this legislation. Heather Roy and I worked to try to get medical practitioners out of the Health Practitioners Competence Assurance Bill but we failed because United Future would not support us. Otherwise we could possibly have moved ahead. 
The other concerns in this legislation are the powers of the Minister and there not being elected representatives on registering bodies. That is of major concern to bodies like that of the doctors who previously have been able to elect representatives. It is about professional competence and professions actually feeling they have some control of their profession; they are very unhappy that that is occurring under this legislation. 
One part of the original legislation will now become a separate Act when it is passed—that is the Health and Disability Commissioner Amendment Bill one of the three bills that this major piece of legislation has now become. We agreed with that. That was a good part of this legislation. We worked hard on it in the select committee to make changes. We agreed with this part because it is based on the Cull report and develops a one-stop shop gets rid of the complaints assessment committees and ensures that all complaints about health professionals go to the Health and Disability Commissioner’s office. That is a very good advancement. We know from the Parry inquiry that it was the complaints assessment committee and the process of getting through it that caused most of the problems. I will never forget Colleen Poutsma’s husband saying: “If you are not very determined and very articulate you cannot get through this process.” That was not good enough and we do have to help people through the process. We welcome this change and we are pleased to see it. 
The other changes that have occurred are now in the Medicines Amendment Bill. At the moment the pharmacists are absolutely reeling because stat dispensing has come in and Pharmac has gone back to 3-monthly dispensing. This has seen a 30 percent reduction in the income of pharmacists. We are seeing rural pharmacy closures already. We are seeing interns having to do a fifth year to get placement to be fully registered. Half of them cannot get places now because the pharmacists cannot afford to have them. We see rest homes that had their medicines dispensed in blister packs now facing the costs of paying for stat dispensing—a significant increase when rest homes and continuing care units have had no increase in funding from this Government and have had massive increases in costs. In this situation pharmacists will be partly deregulated. They can own up to five pharmacies and up to a 51 percent shareholding. The Minister has an exemption clause that allows her to allow other ownership if it will improve health services within an area. 
Another area that the doctors were particularly concerned about was quality assurance. Over the last 8 years probably since the Medical Practitioners Act came in quality assurance has improved markedly in hospitals around the country. Complaints procedures and doctors nurses and other health professionals getting together to engage in quality assurance activities have seen a marked improvement from the 1980s when I first began practising as a doctor. Thirteen percent of people who are admitted to hospital suffer iatrogenic harm which means harm that comes from the treatment they receive—either from medicines from getting a hospital-acquired infection or from the treatment they have somehow harming them. It is absolutely essential that when one has a near-miss or something goes wrong or some unexpected event occurs in a practice the practitioner can actually sit down with people and look in a protected way at what went wrong so that he or she can improve those services so that he or she can say: “This was the problem. Let’s do something about it. Let’s make it better. Let’s improve the systems.” 
If quality assurance is not protected—and we did make some changes in the select committee but many feel we did not go far enough to protect quality assurance activities—then people will not voluntarily offer up information about what has happened or what has gone wrong. One case at Waitemata hospital—the Lachlan Jones and Malcolm Beggs case—was used as the reason that we now have to open up quality assurance. There are lots of different avenues for people to take a complaint—through the hospital complaints system and through the Health and Disability Commissioner’s complaints system. If a practitioner on the front line cannot look at his or her practice and do case reviews then that will be very significant. I do not wish to see a reduction in quality assurance activities. 
National has not supported this legislation not because the concepts were not right and not because we do not want all health practitioners in this country to practise safely but because the legislation was not consulted on properly and because there are things in this legislation that the practitioners especially the doctors are very unhappy with and they should know because they are practising on the front line.