Coleman JonathanTHIRD READINGS Hon Dr JONATHAN COLEMAN (Minister of Health): I move That the Accident Compensation Amendment Bill (No 2) the Burial and Cremation Amendment Bill the Children Young Persons and Their Families Amendment Bill (No 2) the Holidays Amendment Bill (No 2) the Land Transport Amendment Bill (No 3) the Medicines Amendment Bill the Mental Health (Compulsory Assessment and Treatment) Amendment Bill and the Misuse of Drugs Amendment Bill (No 2) be now read a third time. This legislation will amend eight Acts to remove references to medical practitioner" and replace them with the words "health practitioner". That is going to enable a wider range of suitable health practitioners to undertake certain functions that are currently restricted to only medical practitioners. New Zealand's health workforce is evolving and many health professional groups are now capable of performing the tasks that were previously the sole domain of medical practitioners.The purpose of this legislation is to improve access to services for New Zealanders and this Government wants to ensure that people receive timely care from the most appropriate health practitioner close to home. That is going to be a very necessary approach if we are going to have a sustainable health system that can provide the services that everyone across the country needs in the long term. These eight bills divided from the original bill align very closely to the New Zealand Health Strategy which is all about moving care from secondary care out into the community taking a preventative and early intervention approach and very importantly using all the skills that we have right across the healthcare workforce and deploying them in the most effective manner.I would like to thank members from across the House for the support that they have given to this omnibus legislation in its earlier readings and I would also like to thank the Health Committee and those who took the time to make submissions on the legislation. The legislation has had a long passage to this stage of the Parliamentary process. This has ensured that we now have legislation fit for purpose that will make real changes to how people can access services from health practitioners. We have not only enabled suitably qualified health practitioners to undertake statutory duties but we have also used the opportunity to make statutory terms and descriptions much more consistent right across legislation.I know that a number of members focused on the meaning of amendments for the work of nurses and nurse practitioners in their speeches earlier in the debate. The amendments in this legislation are designed to ensure that all suitably qualified health practitioners are able to undertake certain statutory activities if they have the required training knowledge and skills. In some cases nurse practitioners will be the only suitably qualified group; in other cases nurse practitioners registered nurses or pharmacist prescribers may all be suitably qualified. For other statutory activities a range of health practitioners may be suitably qualified and the most appropriate and available people to undertake the task at hand. The safety of the public remains secure as the regulatory framework governing health practitioners continues to be managed through the Health Practitioners Competence Assurance Act 2003.I will briefly sum up the amendments in each part of the original bill. In Part 1 we were dealing with amendments to the Accident Compensation Act. The legislation amends schedule 1 of that Act so that any health practitioners providing treatment to the claimant are given the opportunity to participate in the preparation and costing of an individual rehabilitation plan for the claimant to the extent that they are willing and able to do so. Examples include physiotherapists or occupational therapists.In Part 2 we had amendments to the Burial and Cremation Act. This legislation amends the term "doctor's certificate" to "certificate of the cause of death". References to "medical practitioner" are amended to allow nurse practitioners to also issue certificates of cause of death and that is quite a major change. Nurse practitioners are qualified in a similar way to medical practitioners to issue these certificates through their training in diagnosis and their position as lead healthcare providers. I can tell you that certifying death is not as simple as it may sound.Part 3 amended the Children Young Persons and Their Families Act 1989. The legislation amends references to "medical practitioner" to enable a social worker to request suitably qualified health practitioners to examine a child. The legislation also replaces references to "psychiatric hospital" with "hospital" to give it the same meaning as in the Mental Health (Compulsory Assessment and Treatment) Act 1992.In Part 4 we had amendments to the Holidays Act 2003. Those amendments mean that proof of injury or sickness under that Act may include a certificate issued by a health practitioner rather than just by a medical practitioner—i.e. a doctor. A suitably qualified practice nurse could provide a certificate of proof of illness or injury that would save a sick person both time and money and at the same time would make the best use of the health practitioner's precious time.In Part 5 we had amendments to the Land Transport Act 1998. The legislation now amends references to "medical practitioner" to allow health practitioners to undertake duties relating to taking blood specimens and assessing the fitness of people to drive. The legislation is also an opportunity to update the terminology so that references to "doctor's surgery" and "surgery" are now replaced with a much more common term: "medical centre". In Part 5A we had amendments to the Medicines Act 1981—specifically an amendment to section 105B(d) of that Act meaning that nurse practitioners will be able to supervise designated prescribers. Nurse practitioners like medical practitioners are authorised prescribers. As new prescriber groups are established under the Medicines Regulations it is important that we have sufficient authorised prescribers to provide the support and mentorship that is going to be needed in order to deliver safe practice.In Part 6 we had amendments to the Mental Health (Compulsory Assessment and Treatment) Act 1992 and these amendments are going to provide the opportunity to insert a new definition of "nurse practitioner" so that that legislation aligns with other legislation. Section 8B is amended to allow a health practitioner who is either a medical practitioner a nurse practitioner or a registered nurse practising in mental health to issue a certificate to accompany an application for assessment. Currently only a doctor can issue such a certificate. Section 9 of that Act is also amended so that an assessment examination may be undertaken by a medical practitioner or a nurse practitioner who is approved by the Director of Mental Health. Currently only medical practitioners can undertake that important and very sensitive assessment so that amendment is a very good example of enabling a suitably qualified person to undertake an assessment examination. Often the nurse practitioners practising in mental health are not only the people who are most available but may also be the people who have the most knowledge of the history in the current situation of the patient before them.In Part 7 we had amendments to the Misuse of Drugs Act 1975 that allow specified nurse practitioners registered nurse - designated prescribers and pharmacist-designated prescribers to prescribe controlled drugs for the treatment of addictions. The parameters for the new groups to prescribe under that Act are the same as those for medical practitioners including the need for health practitioners to be compliant with applicable guidelines issued by the Director-General of Health for the treatment of addictions.The purpose of this omnibus legislation is to reduce legislative barriers so that competent health practitioners can perform a number of statutory functions that were previously limited to doctors only. Changes to the statutory provisions in the legislation will allow competent health practitioners to use their qualifications knowledge and skills to the full scope of their practice and ultimately will help us deliver better health outcomes for a greater number of New Zealanders. This legislation is also going to help us run the health system in a much more efficient manner and improve health practitioner accountability by making practice much more transparent. The Government intends to review unnecessary restrictions for statutory functions for health practitioners in other Acts as they are revised. This is excellent legislation. I thank everyone who has been involved with it and I commend these bills to the House."