Scott Lynda: Health Practitioners Competence Assurance Bill — In Committee 
Scott Lynda: Health Practitioners Competence Assurance Bill — In Committee 
[Volume:611;Page:8145] 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 Part 6 “Structures and administration” really gets to the heart of why National will be voting against this bill. One of the issues of immense concern is the power of the Minister under this legislation. It comes down to a fundamental question about whether professions can self-regulate. We either trust them or we do not. Submission after submission expressed concern about the powers of the Minister to appoint to the authorities and determine any dispute over overlapping scopes of practice. If there were a dispute between nurse-anaesthetists and medical-anaesthetists the Minister would have the final say. There was dispute because people felt there would be a major decrease in professionalism and that the professions would be disenfranchised. The Health Committee received submission after submission on that. 
The New Zealand Medical Association commented on the low morale in the medical profession and amongst primary-care groups today and it felt that this bill would make that so much worse. It said that self-regulation is a cornerstone of safe practice and that each group of health professionals must be able to elect its professional body. They have been doing that for a long time and they wanted that to continue. Members should compare that with what some of the officials were saying which was that they felt that the Minister “must be able to appoint because you’re not going to get the right people otherwise”. I think that gives a very clear indication of a feeling that there is political interference in the process and that is one of the major concerns. 
We heard from the Royal Australasian College of Physicians the Royal New Zealand College of General Practitioners and the Royal Australasian College of Surgeons about ministerial powers and about their concerns of decreased professionalism. They certainly wanted a majority of elected people and they did not want scopes of practice to be decided by the Minister. We debated that at length in the select committee after hearing all the submissions. We debated clause 123 “Disputes about overlapping scopes of practice” and clause 124 “Minister may give directions to resolve dispute”. In the end by majority we came up with a new subclause (2A) which states: “A direction under subsection (2) may without limitation require each authority to co-operate with a panel of experts”—we could not get much further as the Minister will still appoint that panel of experts—“and may also require each authority to be guided by or (as the notice may state) to implement any recommendations of the panel concerning the dispute.” At least we got into the bill a provision whereby there would be a panel of experts that would have some ability to direct the Minister about overlapping scopes of practice. We have not seen before in New Zealand the situation whereby the Minister was able to say that one group may practise one way and another group another way. 
There was an immense concern about the Minister being able to resolve disputes in any way he or she sees fit. Clause 123(3) states: “The Minister may assist the authorities to resolve their disputes in any way the Minister sees fit” and that all he or she has to do is write to the authorities and tell them how to direct their lives. The medical profession is up in arms about that because its members see this as a huge interference by the Minister and the ministerial powers given by that provision really do reduce the professionalism in the system. The clause continues: “including without limitation by advising each authority in writing of 1 or more options for resolving the dispute”. So the Minister has an absolute hands-on approach in determining how different professions will be able to work it out between themselves. That is pretty new to New Zealand and there was real concern that it will reduce professionalism self-regulation and the professions being able to determine amongst themselves how they practise in this country. If we think about how people do practise then we will see there is major overlap in scopes already.