Health Practitioners Competence Assurance Bill — In Committee 
Health Practitioners Competence Assurance Bill — In Committee 
[Volume:611;Page:8219] 
Health Practitioners Competence Assurance Bill 
In Committee 
Debate resumed from 27 August. 
Part 9 Amendments to Medicines Act 1981 ( 
continued 
)  
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 I understand that Part 9 if the amendments are passed will become a separate bill. The Health Practitioners Competence Assurance Bill is going to be split into three bills. Part 9 deals with pharmacies and the way in which they will be owned and operated. 
When I was last speaking on this matter I said I had been in Cleveland with my good friend Judith Collins. I do not think this Government really understands the pressure that pharmacies and pharmacists are under at the moment. We went to two pharmacies one of which had just been ram-raided. The pharmacist was shocked. Even though she had put up all the security screens she then had to pay $45000 I think to put up those big metal posts to stop the shop from being ram-raided again. 
Parts of this bill talk about pharmacists and pharmacies having to be secure. Believe me they know the risks and costs of that! We understand the important role that pharmacists play in health care in New Zealand. As a geriatrician I was very aware that medications in the elderly are a big problem and often cause iatrogenic disease. People often get sick because of the pills they take. I was spending a lot of time taking people off those medications. Pharmacists do a fantastic job in this regard. They spend a lot of time looking at the medications that people take—looking at the interactions they could cause. Indeed every day of the week pharmacists pick up prescribing errors—all the time. They pick up interactions that may occur. 
Those sorts of things that pharmacists do often are not quantified or paid for. They spend their time learning about drugs and how they work in the body—especially in aged care and with young children. In those groups the medications can make someone very sick indeed. So pharmacists do a great job in that respect. They are among the most consulted health professionals. People often will go and have a talk to their pharmacist to find out what the pharmacist thinks a problem may be—whether the person needs to go to the doctor. In that regard we respect the work that pharmacists do and how competent they are to do that. 
In the past we have had the situation where a pharmacist could own only one pharmacy and certainly that rule has caused problems. It has caused problems in rural areas where maybe only part of a practice was really viable especially in smaller rural areas. So it has been increasingly difficult with decreasing populations for those pharmacies to remain viable. On this issue of pharmacists being able to own only one pharmacy there has been a great deal of debate about freeing up the system. The debate has gone on all around the world about allowing pharmacists to own more than one pharmacy and whether pharmacists need to own them at all. Those debates have occurred and I have looked at all the different areas of the world—for example in Europe and Britain where they have deregulated but they do have regulations as well that look at local needs. They look at access they look at improving quality health-care to improve it for the patients who need to use pharmaceutical services and to see a pharmacist. 
That has to be the bottom line really. It has to be about improving the ability of individuals to get access to medications in a way that improves their health care. That is what we do have to look for. We appreciate that medicines are not ordinary commercial items because medicines have that ability to make people very unwell. There are safety issues around the prescribing and dispensing of medications. The number of people who end up in hospital every day of the week because their drugs have made them sick is pretty extreme. It is always a matter of getting the balance right. We need to know that that risk is monitored and that that is very clear in any changes that one makes. 
A big problem at the moment of course involves the manufacture of methamphetamine and P. People manufacturing that have got it from pseudo-ephedrine which is a very common substance in cold remedies. 
JUDY TURNER (United Future) 
: 
 United Future has given serious consideration to the many opinions offered on the issue of deregulation of pharmacies and our decision is that at this time we will support the intent of the legislation in this regard. Pharmacists have to contend with a range of interventions that involve their profit margins—namely Pharmac price-setting co-payments district health board contracts and in recent times a return to stat dispensing fees. All these interventions serve to cramp the competitive opportunities for pharmacists. United Future feels that the partial deregulation set out in the Health Practitioners Competence Assurance Bill is sufficient at this time. 
I take the opportunity to endorse the comments of others who have spoken with high regard of the pharmacy services that are provided by our pharmacy professionals here in New Zealand. We must never lose sight of the fact that that profession is an essential primary health service and at a time when New Zealanders are facing shortages of staff in certain areas of the health profession it is important that we look after the interests of pharmacists so that we do not start to face a crisis in that area as well. United Future will be supporting the bill as is and we have serious concerns about what the huge step of full deregulation would mean to the industry at this time with the many issues that it is facing at present. 
STEVE CHADWICK (NZ Labour—Rotorua) 
: 
 I move  
That the question be now put 
. 
RODNEY HIDE (ACT NZ) 
: 
 Let me first thank the Minister of Health for standing up and taking the brave and courageous stand as a Minister of Health of being on the side of the sick the elderly and our young people over the issue of access to drugs in New Zealand—drugs that make people well—and the price of the drugs that make people well. We face a big decision on this bill concerning my Supplementary Order Paper. Are we on the side of a legislated monopoly or are we on the side of enterprise and freedom? No one is suggesting that one should not have to be a pharmacist to dispense pharmaceuticals but we are asking ourselves whether we should legislate a monopoly on the ownership of chemist shops. The United Future party and the Government are saying that what we have now is nuts. It is nuts because now in order to dispense drugs in New Zealand one has to own the chemist shop. How stupid is that? One can be a dentist without owning the dental facility. One can be a doctor without owning the surgery. Why limit the ownership of chemist shops to pharmacists? Why limit the use of capital? 
Judy Turner 
: You don’t have to own a pharmacy to work in one. 
RODNEY HIDE 
: Judy Turner the great hope of the United Future party says that one does not have to own a pharmacy in order to work in one. That is true. But one has to be a pharmacist in order to own one right now and that is what is wrong. Judy Turner shakes her head and agrees. With this bill the Government and the United Future party have made it a bit easier and said that one has to own 51 percent only. Where is the logic in that? Why not 49 percent? Why not 47 percent? Why not 62 percent or better yet why not do as the Minister of Health agrees should be done along with the Consumers Institute of New Zealand Te Puni Kokiri the police and every advocate group of consumers that looks at those issues? Why not come down on the side of the sick the young and the elderly and say “None.”? [ 
Interruption 
] It is all right for David Benson-Pope to criticise the Minister of Health but he can take a call and make his own speech. 
We should do the brave and the right thing. We should join with the National Party vote for the amendments on my Supplementary Order Paper and have a Labour Party caucus stand beside its Minister of Health. We should send a message to the chemist shop owners that we respect their work and their professionalism and that as a Parliament we are not prepared to legislate privilege a monopoly or an advantage of a supplier over the customer—because that is what we are doing with this bill. How pathetic is it that a Parliament of 120 MPs should be cowed by 931 chemist shop owners all scared that someone else might buy into the business employ them and offer a better service. 
Sue Kedgley 
: Why would it be better? 
RODNEY HIDE 
: We should let the customer choose. What is wrong with customers wanting to go and get their prescriptions from a pharmacist at the supermarket? We notice that chemist shops are quite happy to compete with supermarkets for a whole lot of other goods. It will be interesting that the Greens the United Future party and—it looks like—the Labour Party will be sinking the Minister of Health. Members of those parties will be standing up in the Chamber and saying that they favour a commercial monopoly over the sick the elderly the young people and the working families who are the ones who are paying the bills. Let me have someone stand up in the Chamber and say that a legislated monopoly gives cheaper prices and better service. When has that ever happened in the world? 
Steve Chadwick 
: What about professionalism? 
RODNEY HIDE 
: Yes what about professionalism? What about a bit of competition and choice? 
DAVID BENSON-POPE (Senior Whip—NZ Labour) 
: 
 I move  
That the question be now put 
. 
PITA PARAONE (NZ First) 
: 
 I want to take a call on Part 9 of the Health Practitioners Competence Assurance Bill partly because I have put forward a Supplementary Order Paper that I want to take the opportunity to speak to but also in relation to the Supplementary Order Paper submitted by Mr Hide. I signal that New Zealand First will not be supporting it. We believe that any suggestion of deregulation at this time is not at the right time. That is number one. 
Number two is that the bill is subject to review in 3 years’ time. We should look at it then. If the truth be known some members on this side of the Chamber support the Supplementary Order Paper without really wanting to do so—because of previous circumstances they are obliged to do so. I reiterate that New Zealand First will not be supporting the ACT member’s Supplementary Order Paper. 
I want to talk to my amendments to clause 240 on my Supplementary Order Paper. I want to add to the definition of “authorised prescriber”. My Supplementary Order Paper amends the definition by including a little bit more detail as to what the term “authorised prescriber” should mean or should include. It should include “authorised ophthalmic prescriber” and again I am referring to the optometrists—following the approaches that members of their association made to me I was convinced that I should support their call for that. 
In addition I propose another amendment to clause 240(3) after the words “medical practitioner” to include the word “optometrist” with the definition meaning that it is a health practitioner who is or is deemed to be registered as an optometrist with the Optometrists and Dispensing Opticians Board continued by this legislation. 
Similarly that definition should be included within the meanings of “medicine” “new medicine” “prescription medicine” “restricted medicine” and “prescription optical appliances”. Again that is in keeping with the approaches made to me by the members of the Optometrists Association. I would like to see a new clause 243A included referring to the sale of prescription optical appliances by retail. I seek support for that Supplementary Order Paper. 
SUE KEDGLEY (Green) 
: 
 I would just like to say that I am very pleased to see the Minister for Small Business here while we discuss the issue of pharmacy. Perhaps it would be a very good thing for the Minister to examine the 900 small pharmacy businesses in New Zealand. Maybe he could even consider doing a regulatory impact analysis of those businesses because he would find that under this Government not only have their co-payments been reduced but 30 percent of their income has been yanked out as a result of stat dispensing. At the same time we have imposed increasing regulatory and compliance costs on pharmacies in New Zealand. I appeal to the Minister for Small Business who is sitting in this House to look at this particular area. There are all these wonderful moves towards reducing the compliance costs of small business in New Zealand and the Minister has been doing some great work in that area but I think this is one area he has overlooked. 
Turning to this bill I would like to speak very briefly to Mr Hide’s impassioned speech in favour of his particular amendment. The first thing I would like to say to Mr Hide is that there is absolutely nothing whatsoever to stop supermarket operators having pharmacies in their supermarkets right now—nothing but greed. The only reason they are not doing it is that they want to be able to take all the profits for themselves. 
Secondly I would like to point out that we are not talking about sweeties confectionery or cakes but about medicines and pharmaceuticals. As Dr Lynda Scott has intimated the fourth major cause of disease is adverse interactions with pharmaceuticals. We are talking about potent and toxic substances and we cannot just compare them with confectionery and cakes. There needs to be a strong regulatory mechanism and trained pharmacists are needed to make sure that there are not adverse interactions between medicines that have been prescribed. Just as Dr Scott has I have had letters from pharmacists pointing out that by checking the prescriptions doctors send in they have avoided major problems. Doctors for instance will dispense 11.9 milligrams of something when it should be 1.19 milligrams and so forth so pharmacists have a very important role in checking the scripts that doctors write. They have a very important role in the whole ethics of a pharmacy and in making sure that medicines are not dispensed in a way that could be abused particularly where those medicines could be the basis for drugs like methamphetamines. Pharmacists who own and operate their own pharmacies have a very strong ethical commitment. 
The member keeps talking about a monopoly in this area. If this role were handed over to supermarkets it would be to a monopoly of two New Zealand supermarket chains both owned by global multinationals. So instead of going into our community any profits would be sent offshore. We would be giving up 900-odd small businesses in New Zealand to a couple of global multinational corporations. I cannot see how that would advantage New Zealand—quite to the contrary. I think that small pharmacists have done a magnificent job in New Zealand particularly the community-owned small pharmacists. They function to a great extent almost as social workers in their communities and we should be supporting them not undermining them. 
The question was put that the amendment set out on Supplementary Order Paper 115 in the name of Pita Paraone to insert a definition of “authorised ophthalmic prescriber” in clause 240(1) be agreed to. 
A party vote was called for on the question T 
hat the amendment be agreed to. 
Ayes 13 
New Zealand First 13. 
Noes 97 
Labour 52; New Zealand National 23; ACT New Zealand 6; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 111 in the name of Heather Roy to omit the words “medical practitioner” and the definition of “medical practitioner” from clause 240(3) be agreed to. 
A party vote was called for on the question  
That the amendments be agreed to. 
Ayes 42 
New Zealand National 23; New Zealand First 13; ACT New Zealand 6. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendments not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 115 in the name of Pita Paraone to insert a definition of “optometrist” in clause 240(3) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 13 
New Zealand First 13. 
Noes 97 
Labour 52; New Zealand National 23; ACT New Zealand 6; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to amend the definition of “registered health professional” in clause 240(3) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 43 
New Zealand National 23; New Zealand First 13; ACT New Zealand 7. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 115 in the name of Pita Paraone to insert new clause 240A be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 13 
New Zealand First 13. 
Noes 98 
Labour 52; New Zealand National 23; ACT New Zealand 7; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 115 in the name of Pita Paraone to insert new clause 243A be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 13 
New Zealand First 13. 
Noes 98 
Labour 52; New Zealand National 23; ACT New Zealand 7; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 248 be agreed to: 
to insert the following new subclause: 
(3)Section 50 of the principal Act is amended by inserting after subsection (5) the following subsections: 
(6)For the purposes of  
subsection (4) 
 in the case of an application for a licence to operate a pharmacy  
individual 
 includes the following persons: 
(a)an administrator of the estate of a deceased individual: 
(b)an assignee within the meaning of the Insolvency Act 1967 carrying on a pharmacy in his or her capacity as assignee of the estate of an individual: 
(c)a liquidator carrying on a pharmacy under the authority of section 260 and the Sixth Schedule of the Companies Act 1993: 
(d)a receiver or manager of the property of a company carrying on subject to the Receiverships Act 1993 a pharmacy comprised in that property. 
(7) 
Subsection (6) 
 does not entitle any person to carry on business in a pharmacy after– 
(a)the expiry of 1 year after the date of the death of the deceased individual or the date on which the individual was adjudicated bankrupt or the date of the first appointment of a liquidator receiver or manager in respect of a company that has carried on a pharmacy; or 
(b)subject to any conditions that the licensing authority imposes the expiry of any extended period or periods permitted by the licensing authority.  
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 249 be agreed to: 
to omit subclause (1). 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 249 be agreed to: 
to insert the following new subclause: 
(2A)Section 51(1) of the principal Act is amended by inserting after subsection 6(f) the following subsection: 
(g)That in the case of an application for a licence to operate a pharmacy the applicant is a person who is able to satisfy the condition set out in  
section 55A 
. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 249 be agreed to: 
to insert the following new subclause: 
(3A)Section 51(6) of the principal Act is repealed and replaced with the following: 
(6)If in any case the licensing authority has reasonable grounds to believe the holder of a licence has failed or is failing to comply with any conditions attaching to the licence the authority may suspend the licence for a reasonable period to enable the authority to consider the case. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 249 be agreed to: 
to omit subclause (4) and substitute the following new subclause: 
(4)Section 51 of the principal Act is amended by inserting after subsection (6) the following subsections: 
(6A)If after giving the holder of a licence whose licence is suspended under  
subsection (6) 
 a reasonable opportunity to be heard and after considering any evidence addressed or submissions made by the holder of the licence: 
(a)the licensing authority is satisfied that the holder has failed or is failing to comply with any conditions attaching to the licence the authority may- 
(i)cancel the licence; or 
(ii)reinstate the licence; or 
(iii) reinstate the licence subject to conditions: 
(b)the licensing authority is not satisfied that the holder has failed or is failing to comply with any conditions attaching to the licence the authority may- 
(i)reinstate the licence; or 
(ii)reinstate the licence subject toconditions. 
(6B)If the licensing authority is satisfied that the holder of a licence to operate a pharmacy has failed to comply with any conditions attaching to the licence the authority may instead of or as well as exercising the powers conferred by  
subsection (6A(a)) 
- 
(a)impose on the holder of the licence a penalty not exceeding $40000; 
(b)forbid the licence holder or any person with an interest in pharmacy from holding any interest in or operating a pharmacy for a period not exceeding 5 years specified by the authority. 
(6C)A penalty imposed under  
subsection (6B) 
 may be recovered in a court of competent jurisdiction as a debt due to the licensing authority. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 249 be agreed to: 
to omit subclause (5). 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 251 be agreed to: 
to omit this clause and substitute the following clause: 
251 Duration of Licence 
(1)Section 53 of the principal Act is amended by repealing subsection (1) and substituting the following subsection: 
(1)Subject to  
subsections (2) and (3) 
 every licence unless sooner cancelled under  
section 83 
 of this Act continues in force for a period of 1 year and then expires. 
(2)Section 53 of the principal Act is amended by inserting after subsection (3) the following subsection: 
(4)Subject to  
section 50(7) 
 in the case of a licence to operate a pharmacy granted to an applicant who is an individual the named  
licensee  
shall be deemed to include any of those persons mentioned in  
section 50(6) 
. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 252 be agreed to: 
to omit this clause and substitute the following clause: 
252New section 55A inserted 
The Principal Act is amended by inserting after section 55 the following section: 
55A 
Mandatory condition of licence to operate pharmacy 
It is a condition of every licence to operate a pharmacy that the holder of the licence must not request or require any pharmacist who is employed or engaged in duties at a pharmacy to act in a way that is inconsistent with the applicable professional or ethical standards of pharmacy practice. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to clause 253A be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 43 
New Zealand National 23; New Zealand First 13; ACT New Zealand 7. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to clause 253B be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 43 
New Zealand National 23; New Zealand First 13; ACT New Zealand 7. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 98 in the name of Heather Roy to new section 105C(2) in clause 254 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 43 
New Zealand National 23; New Zealand First 13; ACT New Zealand 7. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 254 be agreed to: 
to omit this clause. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the following amendment in the name of Rodney Hide to clause 255 be agreed to: 
to omit the words “section 55C” in new subsection 114A(1)(b) and new subsection 114A(2) and substitute the words “section 55A”. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 30 
New Zealand National 23; ACT New Zealand 7. 
Noes 81 
Labour 52; New Zealand First 13; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 125 in the name of the Hon Annette King to Part 9 be agreed to. 
A party vote was called for on the question  
That the amendments be agreed to. 
Ayes 68 
Labour 52; Green Party 8; United Future 8. 
Noes 43 
New Zealand National 23; New Zealand First 13; ACT New Zealand 7. 
Amendments agreed to. 
A party vote was called for on the question  
That Part 9 as amended be agreed to. 
Ayes 68 
Labour 52; Green Party 8; United Future 8. 
Noes 43 
New Zealand National 23; New Zealand First 13; ACT New Zealand 7. 
Part 9 as amended agreed to. 
Schedules 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 Schedule 1 is about the provisions applying to the Health Practitioners Disciplinary Tribunal. As we know this bill was supposed to be based on the Medical Practitioners Act but the medical practitioners do not want a bar of this bill any more. They want out of it completely because they do not like what has happened to it. They do not think it will be anything like as good as the 1995 Medical Practitioners Act which was of course brought in under a National Government a very good Government that brought in the Health and Disability Commissioner Act and the Medical Practitioners Act and solved the problems of 30 years which had been happening in relation to dealing with complaints quality assurance and credentialing in our hospitals. 
We have heard a bit of concern about this bill with its provisions applying to the Heath Practitioners Disciplinary Tribunal from the groups included. I am talking about the physiotherapists and the occupational therapists. They were really concerned about the cost. I bet members do not know how much it costs to run the disciplinary tribunal per day. It costs $20000 to $25000 per day. That is a lot of money. [ 
Interruption 
] That is what they told us. So they were really concerned as were the 12 groups that will come under this bill that they would face the major costs involved in running a Health Practitioners Disciplinary Tribunal. They were saying they did not want to come under one tribunal. They actually wanted to have their own smaller tribunals that could reduce the costs for them. 
The decision was that there would be only one tribunal but some changes were made to the schedule to allow for a reduction in costs so that the occupational therapists and physiotherapists would not face the huge costs that occur like the costs that doctors are faced with when appearing before the disciplinary tribunal. It is a very big event not just for the doctors but also for patients and their families to go through the process that gets them to the Medical Practitioners Disciplinary Tribunal. It takes some years to work through the gathering of evidence and the investigation. This schedule deals with the powers to summon witnesses the powers to investigate witnesses’ allowances privileges and immunities and contempt; all the things that are the legal status of a disciplinary tribunal. 
We were concerned that there is now only one level of charge. The National Party does not believe that that is the way it should be. We do not think that there should be only one charge. That means that somebody who may be found guilty today of professional misconduct which is a much lower charge than disgraceful conduct will be all lumped together under one charge now. That will put extra stress upon the medical profession and the other health practitioners who come under the disciplinary tribunal. It is far better to have two or three levels of charges so people know the degree of severity though we do have the profession being able to look at cases of fraud or sexual abuse—that sort of thing—under a separate category. 
The chair of the tribunal is appointed for 3 years and can serve no more than 9 years. I think Wendy Brandon did an extremely good job when she was chair of the tribunal. It was her view that we should have more than one charge but that was not listened to. Changes were made to the fees that will be available. The chair and deputy chair are paid a fee at a rate fixed by majority of the chairpersons of all authorities under this bill. That was something we added. What was struck out was looking at fixed remuneration. We do not want the costs for the other professions that now come under this Act to be too high. Witnesses do get paid allowances and we did make changes to legal and medical assessors. The words “the tribunal may from time to time appoint a legal assessor” was struck out. What we put in place was that “the tribunal may from time to time appoint a technical adviser.” 
Dr PAUL HUTCHISON (NZ National—Port Waikato) 
: 
 These schedules represent the unpleasant ending of a bill which the chief executive officer of the Association of Salaried Medical Specialists described as a dog’s breakfast. These schedules indeed are a veritable dog’s breakfast and how unpalatable! Here we have this whole bill—a monolith of 270 pages including 90 pages of schedules just to sort out the huge complexity within which this Labour Government insists on entangling the health services of New Zealand. 
In looking at schedule 1 “Provisions applying to Health Practitioners Disciplinary Tribunal” once again one has that awful déjà vu of the Minister of Health who insists rather than having the professionals elect their own members she wants to appoint them. 
We go on to schedule 4 and I just happen to see some of the Acts that are being amended including the Human Tissue Act. In that Act the definition of the term “medical practitioner” is being repealed. The bill goes on and talks once again about this question of competency. Yet here we have a bill where the Minister of Health has failed to define competency which is what this bill is all about. Despite this monolith of 270 pages the Minister of Health once again has failed to define one of the most elementary features of it. 
 What a huge pity it is that the medical profession lost confidence in the Minister of Health Annette King! What a pity that she could not even define competence let alone carry the medical profession of New Zealand with her in terms of what should have been a very important bill that was based on the Medical Practitioners Act! That is a good piece of legislation that was brought in by the last National Government yet what a tragedy it is that the Minister of Health lost confidence in those who have to take the ultimate responsibility for the highly complex cases that do come into the health arena in New Zealand. 
I go on to discuss the Trans-Tasman Mutual Recognition Act. I was interested to see once again stated in the Government’s commentary to the bill that: “The objective of the Trans-Tasman Mutual Recognition Act is to reduce regulatory barriers to the movement of goods and persons in registered occupations. ... The Act does not currently apply to medical practitioners. The Act takes precedence over this bill as stated in clause 154. This means that health practitioners (except doctors) who are registered in Australia must be granted registration in New Zealand when they come to work here if they have complied with competency requirements including cultural safety.” 
Once again that phrase “cultural safety” brings up a déjà vu nightmare in my mind when I think of that poor nurse I met the other day struggling home from Auckland Hospital where she had undergone her cultural safety day. 
 She bemoaned to me that she had spent several hours being talked to about the mythical fourth article of the Treaty of Waitangi. Here we are the Minister of Health of New Zealand wanting to impose on the poor old Aussies the New Zealand standards of cultural competence; competence that she cannot even define let alone this concept of cultural safety which seems in her mind to be focused on the fourth article of the Treaty of Waitangi. 
We must finish at schedule 5 bemoaning once again what a shame it is that this bill has not received multiparty agreement due to the failings of the Minister of Health. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to omit the item relating to the Medical Council of New Zealand from schedule 2 be agreed to. 
Amendment not agreed to. 
The CHAIRPERSON (Ann Hartley) 
: The remaining amendments to schedules set out on Supplementary Order Paper 111 are out of order in that they are inconsistent with previous decisions of the Committee. 
The question was put that the amendment set out on Supplementary Order Paper 115 in the name of Pita Paraone to insert new regulation 41A in the Medicines Regulations 1984 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to 
Ayes 13 
New Zealand First 13. 
Noes 98 
Labour 52; New Zealand National 23; ACT New Zealand 7; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 102 in the name of the Hon Annette King be agreed to. 
Amendments agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 118 in the name of the Hon Annette King to the schedules be agreed to. 
Amendments agreed to. 
A party vote was called for on the question  
That the schedules as amended be agreed to. 
Ayes 68 
Labour 52; Green Party 8; United Future 8. 
Noes 43 
New Zealand National 23; New Zealand First 13; ACT New Zealand 7. 
Schedules as amended agreed to. 
Hon PAUL SWAIN (Minister of Transport) 
: 
 I move  
That the Committee divide the bill into the Health Practitioners Competence Assurance Bill the Health and Disability Commissioner Amendment Bill and the Medicines Amendment Bill pursuant to Supplementary Order Paper 105 
. 
A party vote was called for on the question  
That the motion be agreed to. 
Ayes 68 
Labour 52; Green Party 8; United Future 8. 
Noes 43 
New Zealand National 23; New Zealand First 13; ACT New Zealand 7. 
Motion agreed to. 
Bill reported with amendment.