Paraone Pita: Health Practitioners Competence Assurance Bill — Second Reading 
Paraone Pita: Health Practitioners Competence Assurance Bill — Second Reading 
[Volume:610;Page:7541] 
PITA PARAONE (NZ First) 
: 
 I welcome the opportunity to speak to this bill. I should mention that New Zealand First will not be supporting it as has already been indicated in the minority report shared with other parties from this side of the Chamber. That said I want to say at the outset that the intent of the bill is laudable. I have no argument with the concept of this proposed legislation—ambitious as it might seem. Unfortunately what is now being presented to this House is a far cry from what was originally introduced. The protection of health consumers is of paramount importance and the regulation of health practitioners is a vital and necessary component of that protection. However there are aspects of this bill that are quite disturbing and after hearing submissions from interested parties I am not alone in having serious misgivings about features of this bill. 
Let me start by looking at the word “competence”. How is that defined and how will it be assessed? The rationale for its non-inclusion is that standards change and vary between professions. But could not consideration have been given to a standard level clause? The definition in clause 5 of the bill describes the required standard of competence as being “the standard of competence reasonably to be expected of a health practitioner practising within that health practitioner’s scope of practice.” Nowhere in that definition is reference made to patients. Surely patient outcome should be mentioned somewhere in that definition if not as the central component. 
As for the term “health practitioner” who qualifies as a health practitioner and who does not? What are the implications for groups such as ambulance drivers who apply medical procedures but are not deemed to be health practitioners or audiometrists who might be put out of work if the provision of hearing services is limited only to audiologists? What of the health practitioners who fail to register because the compliance costs are too high? Will this bill create an underground health system comprised of unregistered practitioners providing lower-cost health care to patients who cannot afford the registered practitioner? The concept of scopes of practice is confusing untested and a potential area of conflict amongst professionals. The Minister of Health is given too much power over health professionals in this bill which could be used to exert undue influence over a profession. These are some of the issues that need to be addressed before I would consider lending my support to this bill. 
I have already mentioned compliance costs and I would like to look at that issue more closely because I think it will be a major issue for some health practitioners. Take for example a self-employed podiatrist working in a suburban clinic treating the feet of mostly elderly patients some of whom can barely afford the consultation fees. This person is making a living now but by the time all the overheads are taken care of there is not a lot of excess cash left. As well as registration costs this legislation could see that person having to spend thousands of dollars on equipment and that might be just enough to tip the balance between that person having a viable business and tossing it in or working underground because it is just too hard to make a go of it. Surely that is not the intent of this bill. Let us take a reality check—health professionals are not all wealthy doctors on high salaries. There are thousands of self-employed practitioners out there who are battling along trying hard to keep their heads above water. Let us not forget about them. 
The concept of scopes of practice is one that is likely to cause confusion and conflict. As I mentioned earlier this model is ill-defined and ill-tested. It is considered by many to be a failure in the only other area that has implemented it—the Canadian province of British Columbia. As yet it is unclear how disputes between professions with overlapping scopes of practice will be resolved. An example of that conflict is the alarm being expressed by doctors trained in the administration of anaesthetics at the suggestion that registered nurses be allowed to prescribe and administer anaesthetic drugs. That proposal is consistent with other policies such as the introduction of independent midwifery and changes to the Medicines Act allowing health-care practitioners other than doctors to prescribe medicines. Those changes save money but at what cost to the well-being of patients? 
Without wishing to belittle the training and professionalism of those in the nursing profession I wonder why anaesthetists undergo a minimum of 13 years of extensive training first in medicine and then in specialised training only to be told that a nurse with considerably less training will be able to undertake their duties. A lot of them are wondering too. I bet a lot of patients will be wondering why on earth we will be controlling their anaesthesia at a time when they are actively suspended between life and death. If decisions such as these are left to the Minister how can we be sure that intense lobbying and pressure by interest groups will not influence the outcome? To leave everything in the final analysis to the Minister is anathema to democratic processes and smacks of Big Brother. It also leaves the Minister open to charges of manipulation and corruption. 
Another concern I have with how scopes of practice will actually work in practice is that the concept seems to be trying to achieve two separate things. One is registration or standard-setting and the other is credentialing or certification of individuals within standards. I feel that this issue has not been thought through properly especially as they are entirely separate facets of the Medical Practitioners Act with registration happening under the auspices of regulations set out in that Act and credentialing happening individually in the work domain. 
 I think we need to be careful here that two separate matters are not being merged into one because of confusion and of lack of consultation as to how things operate in the real world. I feel that the medical profession already gets pretty bad press for its handling of adverse events and complaints against it. People have become quite cynical over time when they see doctors policing themselves with only the most glaring cases of incompetence being prosecuted. Even then the practitioners seem to get off very lightly compared with the victims some of whom die due to wrong diagnosis and treatment or in some cases wilful mistreatment. 
This bill does nothing to inspire confidence that complaints will be dealt with in a fair and transparent way or that the interests of patients will be given centre stage. The focus of this bill is not on the consumer but rather on the provider. The power to investigate complaints and control the process will be given to the tribunal. From the outset this adversarial approach does not engender faith in the system. On the contrary it sets up an environment of hostility and weariness between health professionals and consumers undermining the trust that is so essential in such a relationship. Correct me if I am wrong but this bill seems to limit the avenues available to consumers who wish to lay a complaint and it seems to be most concerned with protecting the practitioners from the possibility of any fallout from complaints from consumers. 
What has set this bill apart from other legislation that this Government has been responsible for introducing? There is no mention of the Treaty of Waitangi and its principles. I wonder why. Are health practitioners exempt from applying the principles of the treaty that the Government has required other sectors of our community to adhere to or is the bill’s intent to leave that responsibility to particular professional groups? 
I feel that we should not be too hasty in repealing the Medical Practitioners Act for the simple reason that if something is not broken why fix it? The robustness of the Act is evidenced by the fact that this bill is modelled on it. Given that the scope of this bill is much wider than that of the Medical Practitioners Act and that many submitters are predicting problems ahead why not keep both? At least they should be kept until the legislation is reviewed after 3 or so years. 
Doctors I have corresponded with have expressed concern at the lack of consultation on aspects of this bill most notably the concept of scopes of practice which comes to us courtesy of the policy unit of the ministry rather than from professionals actually working as health practitioners. Doctors have distinct responsibilities and accountabilities the substance of which they fear will get submerged in this bill. I have already noted that patient outcomes should be included in the assessment of competence. It is easy for legislation such as this to get bogged down in bureaucratic legalese and for us to lose sight of its reason for existence which in this case is the protection of patients and customers of health practitioners and health-care providers.