Clark David: Substance Addiction (Compulsory Assessment and Treatment) Bill — First ReadingText is incorporated into the Bound VolumeClark David: Substance Addiction (Compulsory Assessment and Treatment) Bill — First Reading[Sitting date: 15 March 2016. Volume:712;Page:9702. Text is incorporated into the Bound Volume.]Dr DAVID CLARK (Labour—Dunedin North): I rise to announce the Labour Party’s support for this bill at least through to the select committee. It is very nice to be able to support a Government bill in the health area. We are painfully aware of the effects of the $1.7 billion in cuts to the health sector by this Government. I guess perhaps we should note that this bill comes from the Hon Peter Dunne who is a member of a minor party in the Government rather than the major party which seems to be increasingly out of touch with ordinary New Zealand and the aspirations of ordinary New Zealand which include being able to go to the doctor and being able to have affordable and accessible quality medical care and that goes for the vulnerable of course as well as everyone else. So Labour will support this first reading to update the Alcoholism and Drug Addiction Act 1966. It is 50 years—Hon Peter Dunne: It’s to replace it not update it.Dr DAVID CLARK: Replace it—my apologies. The Minister is correct. It is to replace it. The Act is 50 years old. It is time for it to be replaced. It is not in line with modern clinical practice and delivery. So it is good to see the recommendations of the Law Commission being picked up and finally being put into legislation.Under the current 50-year-old legislation two medical certificates are required to make an application to the court for compulsory treatment and neither has to come from a specialist drug or alcohol practitioner. Therefore we on this side of the House support the idea that it will be a requirement that compulsory treatment can start only via an approved list of specialists when the criteria for compulsory treatment are met. It seems a sensible step.There are of course risks that go with the change and we must safeguard the rights of patients undergoing compulsory treatment. There is a risk that these new measures will be taken up in greater number because it is seen to be more relevant or shorter term or for whatever reason—these are the debates as the Minister points out that we will have in the select committee—and there is a risk that in that process with more people going through the system the safeguards will not be observed in the way that they might be. But I think these are risks worth taking because it is time to update this legislation and there is no doubt about that. But we just must find the balance so that patients have the same rights as those held under existing mental health legislation.Having a shorter time period—8 weeks with the option of extension with the goal of moving an individual into voluntary treatment—seems a far more progressive approach to treating severe substance abuse where patients are unable to make a treatment decision. It is a transition and ultimately we want the patient in so far as they are able to take responsibility as a part of their own care and rehabilitation back to the state they would like to be in. The statutory period for treatment under the current legislation is 2 years which far exceeds the time frame needed for treatment in many cases.The regulatory impact statement indicates a best guess of 200 orders per year being the result of this legislation as opposed to the 70 orders that are currently the case. On this side of the House we want to raise questions about whether that will be adequately funded. The regulatory impact statement makes the claim that there will be net economic benefits and there is a study quoted an American study that says—and this is from the regulatory impact statement provided by the Government—that “It is estimated that for every dollar spent on addiction treatment programmes there is a $4 to $7 reduction in the cost associated with drug-related crimes. With some non-residential programmes total savings can exceed costs by a ratio of 12:1.” We must take that of course with a grain of salt. It is coming from the USA and it is not looking at the New Zealand context. The results may vary as the saying goes. But there is a clear indication that there is likely to be a net benefit from looking after those with addictions and looking after the mental health issues that go with them. That of course is something that I suspect will be accepted around this House.The question comes as to how it will be funded. It is a net benefit to the economy but that does not mean that it does not come with an accompanying cost in the health system. We are told in the papers produced by the Government that there has been $775000 given to the health sector for implementing similar legislation annually and that that should cover the cost of this increase. I guess the jury is out on that and we will invite submissions to the select committee about whether that will realistically cover the costs in the sector which is already stretched—hugely stretched.Members of this House will have people coming to see them in their electorate offices to describe some of the unfortunate consequences of having a stretched health system in the area of mental health and addictions. I am sure all members of this House have had people come to speak with them about those issues many of which end in very tragic circumstances. It is incumbent I believe upon this House to ensure that these kinds of changes are properly resourced so that the intent of looking after the vulnerable is realised rather than platitudes merely being mouthed in this House.We have got plenty of evidence that the health system is squeezed. There are 20 district health boards that have sent 160000 people to their GP without specialist appointments since 2010. There is a constant flow of information about the implications of having an underfunded health sector and with that figure of $1.7 billion in underfunding it is little wonder that those areas where people are more vulnerable are the ones that tend to get squeezed first. The Labour Party has discovered through Official Information Act inquiries that this financial year a further $163 million worth of cuts are being enforced across 17 district health boards and of course that all flows through. That number dwarfs the $775000 that is claimed to fund this particular activity as is listed in the regulatory impact statement.So we have got a health sector that is being squeezed by this Government and that is having negative consequences for the public of New Zealand who are recognising that they cannot access the health care that they would expect to in a prosperous nation. We have seen things like the drug Keytruda erupting into public debate and I think that that is a symbol of a wider concern that New Zealand cannot afford medications that are funded in the UK in Australia and elsewhere because it seems the current Government does not place the same priority on health care that a Labour Government would.We on this side of the House in the Labour Party believe that the public health system must ensure essential health-care services are provided free for all New Zealanders and we believe that that health system is currently under threat. The health system is no longer able to provide Kiwis with high-quality safe patient care where and when it is needed in every case and that is a sad situation to be in. So I come back to the point that the promises in this legislation will need appropriate resourcing in order to be realised.There are other points in the regulatory impact statement that warrant highlighting in the first reading of this bill. There is very little international evidence on the effectiveness of civil compulsory substance addiction treatment in achieving good long-term outcomes for individuals. One might hope that shortening the period of compulsory treatment might go some way towards addressing that and if a modern progressive approach is used—where the buy-in of the patient comes earlier in the piece—perhaps new evidence will emerge that that is a more successful approach. But we must acknowledge that the evidence around compulsory substance addiction treatment is thin and that is acknowledged indeed by the Government in its regulatory impact statement.We must also recognise that there is little data in New Zealand on the number of people in New Zealand who have a severe substance addiction and who may meet the proposed threshold for compulsory treatment so we just do not know how many people this will apply to. The estimate of 200 that the Government has brought to the table is a guess—it really is a guess—and the estimate of funding that will be supporting it is based upon the funding that it believes will be necessary to support a guess. The number of people who qualify for this or who may fall under the legislation may be a far greater number particularly in this day and age when we are observing growing inequalities in society which have been very clearly linked through the literature to an increase in mental health concerns within a society.So we have got a case where we have a New Zealand that is not as it should be where we have financial pressures growing on far too many and where the 1 percent are charging ahead under a Government that looks out for their interests—a Government that is increasingly out of touch with the lot of ordinary New Zealanders—and therefore we have a growing number of people presenting with mental health issues. You just need to go and speak with the police. A significant proportion of the police’s work these days is concerned with mental health cases. That happens increasingly in a society where there is that gap between the very very wealthy—the ultra-wealthy—and the rest of the country and where that gap between the richest and the poorest grows ever more.So let us bear that in mind when we look at the estimates of the cost and the support that has been given to the district health boards to implement this legislation. That is where our concern will lie with this legislation—that the resources simply are not there. District health boards are being asked to make over $163 million in cuts across 17 district health boards this financial year alone. In that circumstance it is very hard to imagine just how they will afford to put this kind of legislation in place effectively in the spirit in which it is intended.More than half of the district health boards in the country are running deficits at present. Indications from Treasury are that cost pressures demographic changes and an ageing population will require even more significant changes to the health system over the coming years. This Government does not seem to have a plan for our health system. This is one piece of legislation though that we can support because it modernises something and is in line with the recommendations of the Law Commission which seem very very sensible.