King AnnetteHon ANNETTE KING (Deputy Leader—Labour): Labour supports this bill. It is a very simple bill a bill that went through the Health Committee relatively easily with collaborative work across all parties represented within the select committee. But I do want to make a few comments about it.The first one is that this is a bill that has taken far too long to get on the legislative agenda because straight after the election of 2014 Treasury and the Ministry of Health advised the new Minister Dr Coleman to push ahead with this long-awaited bill to remove the barriers to health workforce flexibility. In fact it was one of the 12 recommendations made by Treasury to the Minister and Treasury said that they needed to identify and remove unnecessary barriers to workforce flexibility by progressing the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill"—the very bill we are debating tonight. This is back in August 2014. Treasury noted that the bill had been under development for several years and there was frustration at the lack of progress particularly amongst the nursing profession. In fact its publication the Nursing Review first reported in April 2008 on the work of an expert advisory group reviewing the health law to remove such barriers so that there could be more innovative practice. So updating this legislation became a priority for those in the profession but unfortunately it went on the go-slow here in the Parliament. We now have over 50000 nurses in New Zealand registered with the Nursing Council and we know that there is a looming GP issue in New Zealand with around 44 percent of GPs saying they intend to leave the profession over the next 10 years. So we really do need to be developing a very flexible health workforce—those with the skills to be able to undertake work—and allowing them to become more active with their experience. This is what this bill does. We do also know that we have got over 3000 young doctors revealing the extent of their workload—that some of them are reporting 16-hour shifts for 12 days in a row. We have reports of young doctors falling asleep while driving home and over a thousand admitting they had made a mistake affecting patients because they were tired. So the need for us to pass this bill to allow those who have undertaken the training to be able to use it in a much more comprehensive way is urgent. The first nurse practitioner—these are nurses who have a very high level of additional training—graduated in 2001 and since then we have got many many more who have graduated and have been waiting to use their experience. Tonight I would like to just acknowledge one particular person who has been pushing for this for many years and that is Judy Kilpatrick who was the chair of the Nursing Council right through the development of nurse practitioners and getting the first nurse practitioner recognised. My complaint I have to say—if it is a complaint—is the slowness at putting this bill in place knowing the pressures we have on our health workforce knowing the need to undertake more innovative practice. We needed to have passed this bill to allow our health workforce to be able to use their skills as I said. What the Minister went through in some detail is exactly what this bill will do and it is about removing the references to medical practitioners in legislation and allowing other suitably qualified health professionals like nurses to perform appropriate tasks which will allow that flexibility in the workforce as I said. There are some good examples of things that they could do when this bill is passed: participating in claimants' individual rehabilitation plans issuing certificates of proof of illness or injury for sick leave arranging medical examinations of children or young people and taking blood specimens from road users are just some of the things that they would be able to do when this bill is passed. This bill is an omnibus bill. It amends seven statutes to increase the range of functions that can be performed by health practitioners under those statutes by changing certain references from "medical practitioner" to "health practitioner". That will enable us to see far more innovative practice. I do look forward to the opportunity when we get to the Committee stage to ask the Minister of Health questions about others who could be added to "health practitioner" should they be registered under the Health Practitioners Competence Assurance (HPCA) Act. The first that come to mind are paramedics. Because paramedics are not registered under the Health Practitioners Competence Assurance Act they are therefore not recognised in terms of the bodies that are covered in this bill. The paramedics have been waiting to have registration under the Act for years going right back to about 2008. We have paramedics who undertake very very skilled procedures on the side of the road—highly skilled people. In fact some of the procedures they are able to undertake are more skilled than those of a GP but they are not registered under the Act. One of the things that I would like to see is paramedics become registered so they too can be included as health practitioners because I can see the role of paramedics being very important in a flexible innovative workforce—providing services not just at the side of the road but in fact in people's homes and other settings. They I think are a group who desperately need to be included as health practitioners and recognised as health practitioners. I also wonder—and I could not see it but we will hopefully find out with the new Social Security Act rewrite that is taking place now—whether the Social Security Act will be included in this bill. I have gone through it and I cannot see the inclusion. I see Child Youth and Family but I do not see a rewrite of the Social Security Act where nurse practitioners under that Act will be undertaking particular procedures. So that is another question that I would like to ask of the Minister. We do support this bill. We are sorry that it has taken so long—sorry for those who have been waiting for its passage. I sometimes wonder why bills in this House that seem so trivial to many people in the public come before those that could make such a difference in the lives of people and in the operation of our health services and that get pushed to the back of the queue. This is one of those bills. Go right back to 2008 and we are 8 years on from that first report that came back then from the expert advisory committee to 2016 when we are now at the second reading of a bill that has taken so long in gestation to get to this stage. I think we need to look more carefully at some of the bills that we have and the priority that is put on them when we are deciding what should be debated and passed in this House. This might seem a minor thing to those who do not understand the health sector but it is a major thing if we are going to have innovative flexible creative provision of health services and this bill will help do that it is said by those who understand from nurses to those other health professionals. As the Minister said there were a few in the medical profession who raised concerns but I do not think they need to be concerned and neither did the Health Committee. We believe there is enough protection in this bill and within the HPCA Act around competency and around qualification to ensure the safety of the public. So we do support this bill and we welcome its hasty speed through this House."