Webb Duncan; Sepuloni CarmelJAN LOGIE (Green): Thank you Mr Chair. I thank the Minister for that and we heard those arguments around clarity within the committee but we were also a people who were familiar with that argument and I include Dr Simon Connell and Dawn Duncan amongst others who heard that argument and said that actually they didn't think that that would necessarily provide more clarity and part of what we heard about was the diagnostic list. Then we still had DHBs and different hospitals used different medical language so there's actually potential for confusion and barriers over those diagnostic tools and it would have been entirely possible to come up with a kind of equivalent that could have been co-designed with community and put in place at an operational level and could have addressed those issues while providing the general provision in law without the requirement. And I commend the Minister for the three-year review and the work we all did in the select committee to get to this point of having expanded it. We tested really hard about what might be missing but also with the knowledge that there hasn't been much research in this whole area. Medical science is an evolving thing but the evolution is not going to finish in three years right? And do we really want to be requiring legislative change at every single point when medical knowledge improves or clarifies injury? I would say no.I did just want to speak and give voice to the point made a bit more by submitters around this being a problematic construct particularly for Māori. The point too is partly the individualism partly the requirement for the specific diagnoses and the privileging of the medical system in that process of getting support and treatment which is—and we were told by the advisers to the committee that actually there is no need for a Te Tiriti clause in this and that it will be fine; it will just be done operationally. But the view from Māori submitters on the bill was that actually this is an inherently problematic approach. We are saying—and I'll quote from one of the submissions—The fact that the bill focuses only on the birthing woman not more widely and holistically on whānau or any injury or trauma potentially caused to them does not acknowledge a Māori world view or provide for the collective responsibility that we share with hapū and iwi noting the colonialism and institutionalisation of birth has systematically fragmented Māori women's spiritual spatial and corporeal experiences of birth and have led to poor birth outcomes for women and babies coupled with generations of women and whānau who have been denied access to whānau support mātauranga Māori rongoā tikanga pertaining to maternity and to lands and waters being used for healing." This I know has come up at the Mana Wāhine hearings and yet here we are in legislation while those hearings are going on locking in a confirmation of that model that we know is causing harm. I hope that this will be mitigated and I'd love to hear from the Minister any commitment to mitigating it in prevention work and what ACC may pick up around the prevention of birth injuries to help mitigate this but acknowledging that it will just be a mitigation. There were submissions noting that they saw this as really—I guess that probably speaks to that point.Dr DUNCAN WEBB (Chief Whip—Labour): I move That the question be now put.JAN LOGIE (Green): Thank you Mr Chair. As signposted by Michael Woodhouse earlier I would love to take the opportunity to speak to the amendment around the extension around mental injury. I do want to start because I'm sure the Minister will do it anyway but I'll just take the moment to say that in the bill while it's not clear for people and initially it was unclear to me in terms of the extent of cover for mental injury that is included in this—actually whenever there is a physical injury on this list and there is a mental injury then there will be cover for mental injury as through treatment injuries. That's really I think important for people to understand and know because we want them to be able to access that support.The point I would like to speak to today though is actually where there aren't injuries on that list and yet there is a mental injury. I acknowledge that this is not a point where we're going to get agreement with the Government because the Government's position is maintaining the existing boundaries around mental injury that exist within the ACC scheme which is there needs to be a physical injury—it's either I think section 21 in terms of sensitive claims or it's a workplace-related injury. The Greens have a fundamental view that those boundaries are deeply problematic and are not working for our communities. We know in terms of perinatal mental health in this country we have a real problem. Suicide is the leading cause of maternal death in this country. Fifty percent of women who suffer with anxiety or depression in pregnancy will develop perinatal depression. Twelve percent of pregnant women have severe anxiety or depression. And they're separate issues; that is the broader context. But what we heard through the submission process was of people who had deeply traumatic births where there was not a physical injury. And one example was where somebody spoke of their friend's experience saying some difficult births can leave women labouring for days. This puts their nervous systems into high states of arousal for long periods. The post-traumatic stress disorder which can result can be very debilitating. One friend was exhausted from days of painful labour and then had to endure invasive medical interventions. These did not go well and led to her watching her blood shoot across the room at the same time as fearing for her life and the life of her baby. This led to many years of terrifying nightmares. That was a situation without an injury on this list. I do not get the logic of how that is different from an injury on this list and it was not considered a treatment injury. We also have heard the stories of women particularly in rural communities where there may not be a birthing centre. I've heard this particularly from Queenstown but I'm sure there are other areas as well where they need to be airlifted out under urgency and if they have a partner they're often in a car driving maybe with another child not knowing if they're going to live or die. And there's no physical injury on this list at the end of that but that is an entire family traumatised and I don't think the average person in the street understands why we wouldn't get them the same support as we would get somebody if they'd also had a perinatal tear. I just don't think it's your average person's logic to make that distinction and I don't think it understands birth in its wholeness and I don't think it does credit to the sense and the importance of whānau and particularly when in that situation and in others the midwife might get cover. It doesn't make sense to me Minister and I understand existing boundaries but sometimes it's time to just blow them up and do what makes sense and is the best thing for our communities.Hon CARMEL SEPULONI (Minister for ACC): I do note the points the member has raised; I won't be supporting the Supplementary Order Paper. I do believe though that there is a broader piece of work that needs to be undertaken with regards to accident compensation cover for mental injury. That needs to be done in a comprehensive way rather than a bitsy way that might concentrate on one particular mental injury as opposed to not concentrating on something else. I have said to ACC that I want that work to begin next year but this is not the place to fix everything. This particular bill is to cover the physical injuries that come about from giving birth and as the member has pointed out where there is a mental injury that ensues because of the physical injury then that will also be covered. The more comprehensive broader issues that the member is talking about can't all be covered in this one piece of legislation but I do agree there needs to be that work done on mental injury. And as I have indicated publicly that will start next year."