Craig LizDr LIZ CRAIG (Labour): Thank you Madam Deputy Speaker. Well it's a pleasure to talk on this bill which has been a really interesting one for a first-time MP because it's the first bill that the Health Committee has actually taken right through the submission stage. It's been also really interesting because both sides within the Health Committee completely agree on what we want it to achieve. What we want to achieve is all newborn babies enrolled with a general practice by six weeks of age and also we want to make it as smooth as possible. As you can see by the debate though where we diverged is at what we needed to do to do that because we believe that a lot of the stuff that this bill proposes is actually already happening.But first let's talk about why we need to enrol babies early. I think the most important thing is getting those first vaccinations in on time particularly in the case of pertussis or whooping cough. When I used to work on the children's wards we'd often see little babies coming in with pertussis. The problem you've got is in the community: a lot of people's vaccinations sort of wear off and so we don't have a herd immunity and these little babies can get really really sick and they end up in hospital requiring oxygen and they can stay there for weeks at a time. So getting those vaccinations in early is really important.But the other thing that we want to make sure is that it's as easy for parents as possible because the problems you've got those first six weeks even for experienced parents are particularly challenging. The issue is even for people that have had several kids getting over a long difficult birth can take quite a while establishing that breastfeeding getting up in the middle of the night those nightly two-hourly three-hourly feeds and also if you've got other kids—trying to juggle all of that.I think the other thing is if it's your first time there are a whole lot of those questions—how do I stop my baby crying; is all that vomiting too much or is that just like normal—and I think when you're juggling with all of that in those first six weeks the last thing you want to do is go through a whole lot of complex paperwork. I think the second thing you're actually wanting to worry about is—DEPUTY SPEAKER: Stop bringing me in.Dr LIZ CRAIG: —OK if indeed—sorry. What parents are worrying about is if indeed that vomiting is actually too much then who do you go and talk to about it and you need a primary care practitioner or a GP identified so you can go along. So we agreed on what we wanted to achieve but where we diverged is what we want to do about that situation. What we think is that a lot of this is actually happening already because what the bill is proposing actually duplicates a lot of the processes that already happen when a baby is born and they start to do a pre-enrolment with a GP. So it was interesting listening to some of the submissions.Thinking through the two submissions I took most credence from were from the practitioner groups that actually have the most to do with newborn enrolment and they were the College of Midwives—because they're there day in day out looking after those mums—and the Royal New Zealand College of General Practitioners. What I want to do is just read you some of the quotes from their submissions.So what the college of GPs said is the College is of the view that the Bill is not necessary. … The Bill is not accompanied by any financial support or incentives." Further "there [are] no enforcement mechanisms [or] sanctions which raise questions about its value. It appears the Bill is primarily a guide rather than a compulsory measure. Guidance on timeliness of newborn enrolment already exists."Similarly the College of Midwives—because these are the ones that are looking after those mums before baby is born and once baby is born—"the College does is not fully understand what this proposed bill is intending to introduce that is different [from] what already occurs. It appears that the proposed bill is not based on a clear understanding of current processes and structures that are already in place."So if new legislation isn't necessary then what should we be doing? I think the problem is that much of what the bill proposes actually is already happening. In 2012 they introduced a pre-enrolment system and what that meant is that all newborn babies needed to have their information including their parents' preferred GP entered into the National Immunisation Register (NIR). Then what the NIR does is it automatically pings that GP's practice and says "Would you accept this baby?" Then GPs are encouraged to get back within two weeks and accept the baby into their practice or if they don't then they decline. Before the system was set up less than half of newborn babies were enrolled with a GP by three months of age but once the system was in place—by 2017 the latest data we've got—75 percent of newborns are now enrolled with a GP by three months of age. So we've seen huge improvements over that time just with putting these processes in place. But there are reasons why we are getting some delays and that's probably why not all babies are enrolled by six weeks. Some of them are because the GPs are just a little bit slow in getting back and accepting their patients but in other cases the GP doesn't actually know the mother and so they may not wish to take on the patient. We've also got a lot of practices where you've got a lot of heavy workload and if the practice is full then the patients get declined.The College of Midwives in their submission also talked about the fact that you've got a lot of families that are moving around a lot and so it becomes a bit of an issue to get them enrolled with one GP. Also they were saying that there was a subgroup of families who actually don't want to engage with health services and that is their choice. So the problem we've got is that adding a whole layer of legislation on top of this is not likely to fix it because some of the problems are stemming from the fact that we've got a shortage of some GPs in some areas and that's what's underpinning the decline rate. In other cases the question is: can we ethically introduce legislation that forces parents to enrol their babies? We on this side of the House don't think that we want to be doing that. So what do we actually want to do? Well our preferred option is for the Ministry of Health to work with district health boards (DHBs) primary health organisations (PHOs) and general practices to continue to improve that timeliness of enrolment. We've done that before with things like immunisation rates where we have concerted efforts and we're looking at streamlining our processes. At the Health Committee the ministry had told us that they were already working with PHOs and asking them to get GPs to improve the timeliness of their responses back about whether they can accept a patient. I've also said that they want to work—and are working—with DHBs and PHOs so that if the patient gets declined there are processes in place so that they can find another alternative doctor.What we think though is that in addition just to those measures we do need to do some other stuff. So there are three other things that we're recommending that the ministry does. The first of them is introducing some performance measures by the DHBs' annual plans. What we're suggesting is that 55 percent of newborns be enrolled with a GP by six weeks and 85 percent by three months. Having worked for many years in the area of monitoring it's really interesting to watch how if things get included in annual plans and they're actively monitored by the ministry DHBs do pay attention. This is what happened with the immunisation targets and the immunisation rates. They start to pay attention and say "Well how do we work with those practices to improve their performance?" So immunisation saw steady increases and that's what I think can happen here.The other thing we want to look at is the ministry working with DHBs to negotiate clauses in the PHO service agreement that relate to timely newborn enrolment. Finally what we're recommending is the ministry implement a whole monitoring and reporting system based on that national enrolment service and makes sure that DHBs can access that so we've got up-to-date information on what the proportion of enrolments are across the regions. We think that as I've said experience with immunisation suggests that we can do this. We just need to work together further.So just quickly summing up we think—and we agree across the House—that we need to get babies enrolled with a general practice in those first six weeks of life and that that process needs to be as simple as possible for parents. But we on this side of the House don't think that putting in place legislation that duplicates what's already happening but creates no new policy levers is the way to go. We think that we need to continue with the Ministry of Health working with PHOs DHBs and GPs to improve timely newborn enrolment. So unfortunately we can't recommend this bill to the House. Thank you."