Health (Protection) Amendment Bill — Second ReadingText is incorporated into the Bound VolumeHealth (Protection) Amendment Bill — Second Reading[Sitting date: 27 May 2015. Volume:705;Page:4073. Text is incorporated into the Bound Volume.]Health (Protection) Amendment BillSecond ReadingHon Dr JONATHAN COLEMAN (Minister of Health): I move That the Health (Protection) Amendment Bill be now read a second time. I would like to thank the Health Committee for its work on this bill. The committee received 71 submissions and heard 22 oral submissions.Of course good health is hugely important to New Zealanders. I think when you look at it it would be the No. 1 priority for people across the nation. That is why I am very pleased that this bill supports the Government’s unwavering commitment to good public health as reflected in the recent Budget whereby health received over $400 million of new funding. Of course there were a number of excellent new initiatives there that are supporting working families in New Zealand in terms of their health. But it was a health Budget for all New Zealanders.Anyway this particular bill will amend the Health Act 1956. Back in October 2013 the Government decided to improve the range of measures in the Health Act in two specific areas: measures to protect the public from the risk of the spread of some infectious diseases and in the case of people under 18 years of age measures to protect them from the harm associated with artificial UV tanning. The bill will protect people from these preventable harms and it will do so through measures that are proportionate to the risks that are faced.Unfortunately New Zealand has very high levels of sexually transmitted diseases. This impacts heavily on individuals families relationships and communities. Sexually transmitted infections have a variety of complications including chronic pain infertility neonatal morbidity and genital-tract cancer. The bill adds new provisions for the surveillance and management of infectious diseases. These measures will improve the availability of information on certain conditions provide for more effective management of behaviours that put others at risk of infection and strengthen legislative provisions for contact tracing. The bill strengthens the principles applying to medical officers of health and the courts in exercising disease management powers. People exercising powers will be required to take into account any known special circumstances or vulnerabilities of the individual. These might be due to youth disability incapacity or other circumstances.The bill also requires that measures are proportionate to the public health risk that they pose. The principles also encourage individuals to take responsibility for their own health. Currently sexually transmitted infectious diseases with the exception of AIDS are not notifiable by medical practitioners and laboratories in New Zealand. The bill makes HIV gonorrhoea and syphilis notifiable on a non-identified basis along with AIDS. The notifying information needs to be sufficient to enable different kinds of public health interventions while complying with privacy safeguards. Submitters said that clause 5 and clause 6 went too far in restricting effective monitoring of serious sexually transmitted infections in favour of privacy. This is because the list of identifying information that should not be disclosed with disease notifications included sex date of birth and National Health Index number. The reported-back bill requires notification of these matters while protecting the individual’s identity from being disclosed in the first instance.Submitters were also concerned about potentially coercive actions by officers such as contacting a young person’s employer or school and asking for details about friends and associates. Reluctance to disclose information or to be diagnosed or treated could arise from fear of the consequences as a result. However that information may be absolutely vital in identifying those who may be at risk and to prevent the further spread of disease. The bill says that information requested and provided under new Part 3A will not be used or disclosed for any purpose other than the management of infectious diseases. Contact tracing is a valuable public health tool in preventing and managing infectious disease outbreaks particularly diseases with a rapid onset such as meningococcal disease and gonorrhoea. New Subpart 5 extends contact tracing powers to contacts of people suspected of having an infectious disease and that is an important change. That will allow for speedy follow-up diagnosis treatment and containment.It is important that contact tracers are trained and are suitably qualified health or community work practitioners and the bill has been changed to require that. It clarifies the interface between appointed formal contact tracers and informal contact tracers. The latter might be general practitioners sexual health clinic staff or organisations like the New Zealand AIDS Foundation. The bill will not regulate their largely voluntary contact tracing practices unless they are nominees of district health board employees or a medical officer of health.The committee was clear that existing venereal disease legislation is badly in need of an update. The current definition of “venereal disease” is not fit for modern conditions. For example it does not include HIV AIDS or chlamydia. Other outdated provisions the bill will repeal include section 79 of the Health Act. That authorises a medical officer of health to detain and isolate people likely to cause the spread of infectious disease. New Part 3A effectively replaces section 79 with graduated powers of increasing robustness when an individual is not complying with management aimed at preventing the spread of further infection.Part 2 of the bill prohibits the commercial provision of artificial ultraviolet light or UV tanning services for people under the age of 18. The Health Committee reported back that it is satisfied that the bill will protect the vulnerable under-18 age group while allowing adults to make informed decisions. That is comparable to other legislation such as legislation on the sale and use of alcohol which recognises that 18 is an age where people are capable of making their own choices.Clause 8 and clause 13 include several new provisions. These provide an infringement process to deal with breaches of the ban on providing artificial UV tanning services to people under the age of 18. This process would deal efficiently with offences and prevent expensive and time-consuming criminal prosecutions. Voluntary standards and guidelines on the operation of UV tanning beds already exist. However surveys have found consistently that there is variable compliance with those voluntary steps designed to minimise harm despite considerable effort to educate operators and to encourage compliance. I have therefore asked health officials to look into whether the licensing of premises and operators and the introduction of mandatory standards are appropriate.This bill is going to improve the protections we have for the health of New Zealanders. It is an important part of our legislative framework for managing and reducing health risks. I commend this bill to the House.Hon ANNETTE KING (Deputy Leader—Labour): Labour supports this bill the Health (Protection) Amendment Bill. We support this bill. The amendments come from the Public Health Bill which was introduced by me quite a number of years ago. When the Minister of Health said that he had an unwavering commitment to good health well I can say that 7 or 8 years ago so did we. Unfortunately we have had to wait some time for this to become a big enough priority for the Government to bring into this House. I am very pleased we are now on the second reading because there has been concern that the current legislation does not fully support public health practices. That has been articulated by those who work in public health and those who have worked in public health agencies over a very sustained period of time. We realise these concerns. In fact there are many more amendments that do need to be made that are in the Public Health Bill which still sits on the Order Paper and perhaps the Government may like to lift a few more things out of that bill and proceed with them.This bill does give effect to the Government’s decision in October 2013 to improve the range of measures available to protect the public from the harm associated with infectious diseases and with artificial UV tanning. I think the Minister probably pretty clearly set out the aim of the bill and just briefly it is to increase the range of infectious diseases that are notifiable to the medical officer of health without identifying the information of the patient or the diseased person. As the Minister said this includes HIV gonorrhoea and syphilis. It also improves the management of persons with infectious diseases by providing new management options including directions issued by the medical officer of health court orders urgent health risk orders and interventions. It strengthens legislative provisions for contact tracing of people who may have an infectious disease and this bill introduces a ban on the provision of commercial artificial UV tanning services to people under 18 years of age.I just do want to correct the Minister—maybe he had not been informed—it was not a unanimous decision of the Health Committee that we would only ban commercial UV tanning services for people under 18. In fact there is a minority report provided from Labour the Greens and New Zealand First and I will get to that in a moment. I do want to say however that I am really pleased at the way the Health Committee is working under the chairmanship of Mr Simon O’Connor. I thought that we had a very good chair in Dr Paul Hutchison and we worked very well together. I have to say that Mr O’Connor is shaping up to be a very good and open chair.The work that was done on this bill I think is commendable because when you look at the number of amendments that have been made they were made—with the exception of UV tanning services—through listening to the submissions that came from the public. Also I think a very good contribution was made by Kevin Hague who because of his background and the work that he had done in many different spheres but particularly working for the AIDS Foundation was very helpful in helping us make some of these amendments.I do not want to go through all the amendments we made. Anyone reading the bill would see that the select committee improved the bill by the amendments we made. But I do want to look at the amendment relating to privacy and identifications of persons. We have recommended that the changes here will ensure that the information collected by the new Part 3A “Management of infectious diseases” is to be used or disclosedonly under the provision of the Health Act. This is to encourage individuals to provide private information without fear of inappropriate disclosure. I think it is really important that the fear that something about a person could somehow be made public is recognised. I think that we have amended that so we make that a lot stronger. Also with regard to identifying information it does allow the sex date of birth and the National Health Index number of a person with a notifiable disease to be disclosed. That will assist medical officers of health with disease surveillance.The only other point I want to mention is in the whole area of appeals. I want to pay credit to Kevin Hague for raising this issue and getting an amendment up which would never have happened in the way it did if we had the previous Minister of Health Tony Ryall. Although Dr Coleman is not here to hear this little bit of praise I may give him—and this will be a very rare occasion—Dr Coleman was sent the suggested amendment that was made within the committee as we were deliberating. It was an amendment made by Kevin Hague that enabled a person to be able to make an appeal to the High Court about a District Court’s decision on an order part of an order a variation of an order or an extension of an order. It gave a proper appeal process which was not in the original bill. When we came to an agreement on it it was sent to the Minister of Health and the Minister of Health responded within a very short time and accepted the amendment. I say sincerely that I do not believe that we would have got the same response having been through a number of bills under the previous Minister.However I do want to express my real disappointment—and I actually even think that most members on the committee share this disappointment—that we could not get the Government to agree to ban commercial UV tanning services in New Zealand. You see we are a Health Committee and we do like to base our decisions on good evidence. That is what we must do. We must look at the evidence and we must then say: “What is the best we can do for the public health of New Zealand?”. The Minister said: “These changes we’re making are proportionate to risk.” Well that does not apply I have to say to the banning of UV tanning services which applies only to those under 18.I would like to say why. The World Health Organization classified sunbeds as a carcinogenic in 2009. It estimates that sunbed use before the age of 35—not 18 but before the age of 35—increases the risk of melanoma by 75 percent. Can I repeat that: sunbed use before the age of 35 increases the risk of melanoma by 75 percent. Skin cancer is one of the most common forms of cancer affecting New Zealanders. Each year over 2000 new melanoma cases are identified and on average 325 New Zealanders die from melanoma every year.Sunbed operators at the Health Committee—and we hadonly one submission I think that we heard; only one came along to support it—claimed that artificial UV tanning beds are an important source of vitamin D. Well the Ministry of Health the National Institute of Water and Atmospheric Research the World Health Organization senior dermatologists and the Commerce Commission argued that short-wave UVB rays which are rays that reach the outer layer of your skin from commercial use pose a cancer risk that far outweighs any minor vitamin D benefits. The overwhelming majority of submitters were opposed to the commercial use of these sunbed services.In fact Australia which does not often beat us in terms of public health in many health measures has banned them. It can see that they are of no benefit. We are now going to rely on some sort of code. Unfortunately there was very recently on 8 May an undercover surveillance of tanning salons undertaken by Consumer New Zealand and it uncovered that more than 40 percent of the 60 sunbed operators it visited failed to implement safety checks such as checking the customer’s age asking them to sign a consent form and providing information on the dangers of UV exposure. One operator allowed a 14-year-old to use a sunbed.We do not believe this bill has gone far enough. This was the opportunity for us to ban the commercial use. We cannot stop what people do in their own homes; that is up to them. But there is absolutely no benefit from the commercial use of sunbeds. There is high risk presented to New Zealanders. I just feel that many members on the committee felt the same way as we did but were unable to do anything about it. So although we support the bill we want to strongly stress that during the Committee stage we will be introducing a Supplementary Order Paper to ban the commercial use of sunbeds.SIMON O’CONNOR (National—Tāmaki): I am very pleased to take a call on this Health (Protection) Amendment Bill which is on its second reading here. Can I thank the Hon Annette King for her generous words. I think such generosity is probably costing me thousands of votes in my electorate at the moment—people who are going: “Oh what’s he doing?”. But actually in all seriousness I do want to acknowledge all the members of the Health Committee and in particular Annette King Kevin Hague from the Green Party and Barbara Stewart from the New Zealand First Party for the cooperative nature in which the committee is working—Louisa Wall as well as a Labour member and then my fellow National Party members Jacqui Dean Barbara Kuriger Scott Simpson and Dr Shane Reti. It is a fine committee and I think it is one that is working together because we understand that there is always politics in all things but health is one of those matters where we try to work together.I think we have heard in the speeches tonight two so far that by and large there is a lot of agreement but also—and it hints at the political nature or the difference of views—that you do not agree on everything. I am very pleased to see that members of the House from all the parties are supporting this as I understand it. This bill is in two parts. The substance of the bill is around contact tracing and the second part of the bill not as substantial but of course as important is around sunbeds.As the Minister pointed out we had 71 submissions. I thought that was actually a really good number in light of the nature of this bill. In fact I thought there was a very high quality of submitters who came before us. I cannot remember the exact breakdown of how many came to talk to us around the contact tracing side of things versus the UV tanning but I am sure other members will echo—well I hope they will—that it was the quality of the submissions and the quality of the oral presentations. These were people who are experts in their field. That is not to take away from the individuals who might come and choose to share their experiences. But I thought there were very high-level submissions to us. Twenty-two people were heard. It kept the committee busy but I can say for myself and I am sure for the others that actually it was incredibly fascinating as we would talk through the different issues.The first part of this Health (Protection) Amendment Bill is around contact tracing. For those in the House and particularly for those at home this is about how we work out whom a person with an infectious disease has been in contact with. The intention of this bill is to enable health authorities to better manage infectious disease outbreaks or to limit them when they arise. So we are talking infections and I hope my father listening at home is not going to blush. We are talking about things like syphilis gonorrhoea tuberculosis HIV and the like—so some serious diseases that are out there in the community or potentially so. With those I note that tuberculosis is currently under another Act. One of the elements of this bill is to actually take it from being a distinct Act of Parliament the Tuberculosis Act and integrate it into this Health (Protection) Amendment Bill.These are serious infectious diseases and when they arise we as a society need to move swiftly and promptly to limit their effect. One only needs to think of the measles outbreak. That is not—I had better be clear—one of the infectious diseases noted at the highest end of this bill. There are good reasons for that but I think of the outbreak—I think it was in Christchurch—and just how swiftly these diseases can spread and therefore consequently the State the health authorities if you will need to move swiftly to manage them.So we have introduced these extra diseases to be traced. A big part of that is: who are the people whom those with an infection have been in contact with? Up to now the provisions have not been sufficient enough or proportionate enough. To put it really simply if someone chose not to actually enable contact tracing to help with certain diseases it would not happen. So we are strengthening the ability of health agents to encourage and then enforce the information required so that we can make those contacts and better understand the spread of disease. One of the debates of course is around privacy and that was discussed at length. There was some concern from some submitters particularly around the use of the National Health Index number—that it could lead to the identification of particular people and consequently discourage them from coming forward.We heard from a good number of submitters who work within the epidemiological field who said that the need for this data is absolutely paramount. Having data such as the sex date of birth and the National Health Index number are very very important. One thing the committee did in a few of the changes it looked to bring about was to list principles which we are hoping will be clear not only to the public but to the courts if they need to get involved. The first principle above all others is that the intention of this bill is to protect public health not just the person with the infectious disease but all of us. That is the paramount principle.But we as a committee thought it was also really important to stress that the respect and dignity of the individual must always be noted and upheld and thirdly—although not in a priority order in this case—that a proportionate response is followed. So depending on the nature of the infection their proximity to people for example the length of the infection and so forth—what is the proportionate response? Because as indicated implicitly by Annette King in her speech there is the ability to bring about court orders to force an individual to release the information required. Again we would want that to be a proportionate response depending on the infection.I want to briefly touch on the question of acute hepatitis C. This was something that members on the committee will know about. We spent an enormous amount of time considering whether acute hepatitis C should actually be brought into the same level as gonorrhoea syphilis HIV and the like. We took a lot of advice and decided it did not require at this stage to be at that top level but I think it is really important for the House to understand and those submitters that it does remain on the schedule. It is still part of the Act. One has to think of this as a graduated bill a graduated response. Although it is not at the top level it is in there. It is a formidable disease and fortunately one that does not occur as frequently as some others but when it does it needs a lot of treatment. I am very pleased to see actually that there are a number of very good pharmacological options available now for people there.Briefly I want to acknowledge as the Hon Annette King did Kevin Hague’s contribution around appeals. It is really important and certainly for me that you always have consistency in legislation. The ability of a person to be able to reach through the respective courts to have their appeal heard around these matters is consistent so reaching the High Court makes a lot of sense. I think it is important though that the orders remain in place. The committee did debate this a bit that if someone is going to start going through the legal appeal process it is not going to stop the ability of the health organisations to engage. When it comes to infectious diseases we need to move promptly.I want to turn to the sunbeds the UV tanning beds. The science is very clear on this. It is unambiguous and I am more than happy to stand on the Government side and say this with the legislation as it is with a graduated response to UV tanning beds. This bill seeks to say that under-18s should not use them and that there should be regulation for those who do. Auckland Council amongst others has actually quite a good system in place already and it was really good that it came in and talked us through how it regulates sunbeds in Auckland. I think it is a model to follow. I want to be clear that it is not the model; there are a few we can look at. But we are looking at a regulatory approach. It is sort of that graduated approach or one step at a time.Again the science is very clear. As many members know I worked at Southern Cross before coming into Parliament so although I am not a doctor I involve myself with a lot of things medical and particularly in the dermatological and plastics field. Look there is no doubt about the issue of skin cancers in this country and the place that sunbeds can play in that. I think I heard from one of the experts one of the doctors I used to contract with that something like 7 minutes a day of sunlight is all that we need so where is the need for sunbeds in that case?I think we have come to a proportional response in this regard. We understand the science; we understand the information put to us by a number of medical experts in the likes of the Cancer Society. On this side of the House I think we are saying that we understand that and we understand the excessive risk for those under 18 but at this point we feel that an outright ban is probably not the best way forward. We will introduce a graduated approach to that. We will see that regulations are put in place.As any responsible group would do—in this case the Government the ministry or the Minister—we will continue to engage with the information. So I think we have landed in a good place and if I might say as I conclude I think it was good to put a bit of light on to this bill.LOUISA WALL (Labour—Manurewa): Kia ora. Lau Afioga le Fofoga Fetalai. Kia ora. I am a proud member of the Health Committee and I want to echo my colleague Annette King’s kōrero earlier about how this committee is working. It is a very productive committee. I think that a lot of the discussions that we have are incredibly important because we are talking about a health system that we want to help design and to ensure meets the health needs of all New Zealanders. Essentially the Health (Protection) Amendment Bill covers two areas. I am going to touch a lot on one of those areas but briefly the first area is about protecting the public from the risk of the spread of some infectious diseases. I think that what we did in the committee was have quite an interesting discussion about what some of those diseases should be. Obviously the bill wanted to introduce tuberculosis to the schedule but there was much debate about whether or not hepatitis C should be added. Obviously because of that we had discussions about other diseases that we think should be monitored because the spread is actually causing an adverse effect particularly in some communities. The second area that the bill covered was really about protection from the harm associated with artificial UV tanning.I am going to spend the majority of my contribution talking about the ban on solaria or UV tanning machines because I think the evidence was actually incredibly compelling that 18 is in fact not the right age to have set if we were going to protect the largest number of New Zealanders. I want to agree with my colleague Annette King when she said that the World Health Organization is categoric in terms of UV tanning machines causing cancer. From the evidence that the World Health Organization has gathered in fact 35 years should be the age that we ban the use of UV sunbeds if we were going to set an age. That is part of the discussion that I think is still ongoing. Essentially we have set it at 18 years because once you are over 18 you are an adult and the State ceases to care about you. This is even though we have got overwhelming evidence that the use of these devices is harmful to you and in spite of 2000 more New Zealanders getting diagnosed with melanoma every year and over 326 of us dying because we get melanoma. So in spite of all the evidence we set the age at 18 because up to the age of 18 you are a child and as the State we will protect you. But if you are over the age of 18 you are on your own and you make your own decisions. So if you are not as informed or if you practise UV sunbed use because you think it makes you look attractive and you want to be browner or whatever it might be we say that that is your choice.What we in the Opposition say is that it actually should not be your choice because at the end of the day there are alternatives. If you want to get brown you can spray stuff on you these days right? So if you are doing it for cosmetic reasons there are actually alternatives that are not going to kill you. What we said was that actually given that there is an existing by-law—Auckland Council has one that already bans under-18-year-olds from using UV tanning machines—the effectiveness of this piece of legislation is essentially going to benefit only 25 percent of the sunbeds that are out there. Auckland Council made that decision and the other interesting submission from my perspective was from Palmerston North City Council. It made a decision as a council. It made a decision because it had some evidence from a dermatologist a woman called Louise Reiche—I hope I am pronouncing her name correctly—that in the MidCentral District Health Board region the rate of melanoma is 51.55 per 100000 people. The national average is 39.12.So as a council it got actively involved in this piece of legislation because it was relevant to the council and also there was a case of a young 16-year-old Jessie Anitoni who got cancer. There was a lot of publicity I guess in that community about the effects of UV tanning machines so it was very clear that it wanted central government to ban them. Rather than having every local council in the country going through a process of banning these machines it wanted us to take responsibility as central government and enact a piece of legislation that was going to benefit the community—the public good. This is because when you look at who actually benefits from using UV sunbeds there are some cohorts of New Zealanders who do such as those who suffer from seasonal depression and are actually prescribed to go and have some UV sunbed treatments and also people with psoriasis. So actually there is a medical rationale for using UV sunbeds that we agree with. In fact it would have been exempted in terms of a ban because it was to be used in a medical procedure. Those beds are actually in hospitals and they are available to people who need them.So I think that the decision that the committee made to set the age at 18 is really not in the interests of New Zealanders. It is not in the interests of the 326 people who die from melanoma every year and the over 2000 New Zealanders who get diagnosed with melanoma every year. If we had been brave—and I do not even think that we would have been brave. In fact Australia and Brazil have already banned UV sunbeds because they realise that it is bad for the community and for the citizens of their countries. Are their rates higher than ours? Actually they are not. We have higher rates than Australia. We have higher rates than Brazil. So this really was I think one of the critical decisions that the committee made—the decision not to ban them—because we think that that would have somehow sent the message that we were being nanny State we were telling people how to live their lives and we were not allowing them to be adults and make decisions for themselves. Well actually no. Our responsibility as legislators is to protect the people of New Zealand and when we have evidence which is overwhelming that says that the effects of UV sunbed usage is so detrimental and that there is nothing to be gained from it then I think it is incumbent on us to act. I have not given up hope. I want to acknowledge that my colleague Annette King has got an amendment that wants a progressive system over a period of time that will mean that in 5 years there will be no more UV sunbeds. So we are not going to take them away immediately but we want to phase them out progressively and let those people find the spray-cans if they are doing it because they want to look lovely. They can go to the chemist and buy those and look all brown and people will think that they have been in the sun. They do not need to sit under those sunbeds and actually harm themselves.The only other thing I wanted to cover was that I was really interested in the discussion about what is ionising and what is non-ionising. What I want to highlight in my take-away from the ionising/non-ionising debate is that I understand that non-ionising is actually low frequency—it is not as intense. But what I also got from the discussion we had with the experts was that it is about the compound effect. It is about the compound effect so how much is too much? If you go and have these sunbeds once a week once a fortnight once a month—actually what is the frequency when the compound use of these things actually has the same effect as ionising radiation? That was not clear. I am clear about what is ionising and non-ionising because associated with UV radiation are cell phone towers Wi-Fi power lines and all those things. They are in our environment. I understand that. We live with those. But what we did not get to do was to consider that if this is non-ionising with a compound effect then actually maybe we should limit the frequency. So are we going to say: “OK you are over 18. You can make up your own mind but actually you can use these things only once a fortnight. If you use them more than that the compound effect is like using ionised radiation.”? So that is my contribution to this debate. I look forward to an ongoing discussion because I am hopeful that the Government is going to support Annette King’s amendment. Nā reira tēnā koutou katoa. Talofa lava.SCOTT SIMPSON (National—Coromandel): It is a pleasure to stand and take a call on the second reading of the Health (Protection) Amendment Bill. Just following from the last speaker Louisa Wall I think that for many on the Health Committee the biggest education was actually not about the terms ionising and non-ionising; it was actually to separate them from iodising. At one stage we had someone who was convinced that the word was “iodised” as in salt and of course it is a completely different thing.I would like to join with other speakers tonight in congratulating the work of the total committee actually. When we see a select committee working at its collegial best to ensure good outcomes for legislation I think that that is when we see Parliament working at its best. I am delighted to report to the House that under the chairmanship of my colleague Simon O’Connor the committee is functioning very well very collegially and we are getting good results. I think members will have seen something of the tone of the committee reflected in the speeches that we have heard tonight and I am sure that will continue to be the case as this debate continues.Notwithstanding the minority report of the Labour Party New Zealand First and the Green Party I am very pleased to learn that I think all those parties are going to support the progress of this bill through the House. The point of difference between Government members and Opposition members around the committee stems as Louisa Wall has said from the extension or the potential extension of the commercial UV tanning clinics and as the committee chair Simon O’Connor made clear during his contribution—and the Minister—that is at this stage a step too far. I am personally quite relaxed about that at this stage but I would like to reserve my personal view on how that might unfold over the years to come. I think that in many of these matters relating to health science and education we find that it is a learning process. Technology and information change and we find ourselves in a position to be flexible and nimble of foot in terms of the legislative response.This bill seeks to amend the Health Act of 1956 and the fact that we are amending that Act gives some context to the change that has occurred in both medical science and in human knowledge over the period of time since the principal Act was passed by this House. So it is very appropriate given the changes in both medicine and also in society that we update legislation to accommodate changed circumstances.Back in 1956 I doubt that there could have conceivably been a situation like one that may exist today where people for reasons that were probably almost criminally motivated would use the fact that they had some kind of communicable disease some kind of infectious disease to actually wreak harm upon other human beings. I think that would be something that the legislators back in 1956 would have found difficult to comprehend.Regrettably we have had cases in our recent history where for instance—and this is very rare I know but it is important that as a legislature we accommodate the rare situations—people infected with AIDS or HIV have gone about actually infecting others in a way that is as I say criminally negligent and culpable if not anything to do with medical responsibility.So we need to update our legislation to ensure that as a society we have an opportunity to protect the greater good of the wider community from what are essentially rogue individuals. This amendment bill essentially does that. It creates a progressive stage of restrictions management if you like—controls might be another word we might like to use—in terms of managing people who have a defined range of infectious diseases. Some of those diseases are quite damaging and they are highly infectious and I think we have an obligation an absolute obligation as legislators to put the protection of the wider community first.There are times when we have to think about the potential impact on the rights of individuals versus the rights of the greater wider community. This bill I think seeks to achieve that through a number of means. One of the I guess constitutional issues that those who are interested in matters relating to civil rights and personal human rights might have been concerned about—and it was raised in the select committee—was the question of how far these additional management provisions would go in terms of inhibiting the rights of individuals who may be infected with a particular disease.So the framework that the committee and this legislation seek to adopt uses a principle of risk management and proportionality based on the risk associated with the individual versus the risk to the wider community. I think the bill places as few restrictions as are possible while at the same time maintaining that greater good concept and principle that is important to protecting the wider public health objectives of the original statute and of course this amending piece of legislation.The measures provide actually better tools for public health staff to deal with people who for one reason or another do not voluntarily seek treatment or do not voluntarily modify their behaviour once they have been diagnosed with a communicable and notifiable disease. So that behaviour I think is one that we need to be able to balance carefully against the individual’s rights.So where consent is not given—and I stress that this is a very small minority of potential cases—the current legislation simply does not allow for an appropriate response. For instance the current legislation does not allow for the detention of an infected person. The provisions in the bill cover the rights duties offences and penalties and a range of restrictive powers and procedures for directions and court orders and it also creates a regime for urgent orders for people whose consistent and persistent behaviour may place others at risk. I think that is an appropriate moderate response given the state of society and science today.Powers at the lesser end of that regime—for example the power to give directions—are able to be exercised by a medical officer of health and I think that again provides an appropriate response to the lesser communicable and infectious diseases. Directions are the community-level measures and they may include for instance directing people to seek testing or treatment or counselling or they may involve the direction of people not to attend public places for a specified period of time. There would be some who would argue that the restriction on the movement of an individual may be a step too far. I am not one of those people. I think that this is a balance that is about right. If people choose not to take their responsibilities to their wider community seriously then I think we as a society have an obligation to enforce those responsibilities for them.The lack of such intermediate powers has been identified as a weakness in the 1956 legislation so this amending bill we are considering here tonight provides a more restrictive power—for example detention in some cases. But that can be exercised only following a public health order made by a District Court. The select committee considered appeals and the process all around that sort of thing and I think we have landed in a pretty good spot.I have addressed most of my comments this evening in the second reading to matters relating to civil rights and the ability of the State and us as a legislature to enforce powers on individuals in cases when that is required and I think balanced and necessary. This is I think a very good piece of legislation. It updates some now quite old legislation that was well intentioned in 1956 but that is in serious need of an update. This bill does that and I thoroughly commend it to the House. Once again I thank the select committee for the collegial and congenial way it has conducted its affairs. Thank you.KEVIN HAGUE (Green): Talofa lava Mr Assistant Speaker. I want to begin by thanking members of the select committee. As others have said the Health Committee works in a very collaborative way and I appreciate that from members from all sides. I also want to pay tribute to the officials who worked with us. This is a fiendishly complex piece of legislation and the officials did a great job of staying on top of that work. Thank you to the submitters also who are no doubt watching this debate tonight. Some great submissions were heard by the committee. And thanks in tonight’s debate to Annette King and Simon O’Connor for noting my particular contribution to the debate in the select committee and to Jonathan Coleman in fact for agreeing to the changes that I recommended.As others have noted this bill has two parts and both of those parts go to the limitation of individual liberty. Part 1 limits individual liberty for the sake of the public good and therefore seeks to strike the balance on that issue. Part 2 deals with another situation the restraint of individual liberty which is where the State intervenes to curtail the liberty of an individual to take action that would cause harm to themselves. These are two of the kinds of situations that this House grapples with from time to time.Picking up on one of Scott Simpson’s comments in the most recent contribution Part 1 as he said seeks to amend the Health Act of 1956. I am reminded that a couple of years ago in this House we passed the marriage equality Act which was overhauling a piece of legislation from 1955. That legislation had fossilised in law some attitudes and mores from our society at that time. I have worked with Nikki Kaye in fact to draft a bill to completely overhaul adoption law because the Adoption Act 1955 fossilises some mores and attitudes about children that pertained to that time but are no longer relevant in ours. In 1956 the Health Act was written to deal with some particular issues—chiefly tuberculosis in fact—and it applied attitudes towards the restraint of liberty that prevailed at that time but no longer seem as relevant.Perhaps unusually in this House I have had some experience of applying the 1956 Health Act. I used to be the executive director of the New Zealand AIDS Foundation. I dealt with a situation—in fact a couple of situations—in a New Zealand city of a person who had HIV and who had persisted despite all efforts to change his behaviour in having unsafe sex with multiple sexual partners and I was faced with the dilemma of what on earth I should do about it. Doing nothing would mean that a number of people would be needlessly exposed to the risk of HIV infection—something I certainly did not want on my conscience—so I looked to the law. What did the law allow me to do? What did the Privacy Act permit me to do? What did the Health Act permit me to do? I was astonished that essentially the only path that the Health Act made available was for me to notify the medical officer of health who then would seek a court order to detain this man indefinitely. That was the only option that the law provided.So I am relieved that I have played an active part in some of the work that went into drafting the Public Health Bill which sits at No. 30 on the Order Paper—it would be great to move that forward some time—specifically to actually provide medical officers of health with a wider suite of tools and with the option of action that is proportionate to the risks that they are trying to mitigate. I am very pleased to see these measures progress through the House.I did have some concerns—which I expressed in the first reading debate and members of the select committee will know that I raised them repeatedly during our hearings—about whether or not the existence in the bill of the provision that would enable medical officers of health to obtain identifying information about those who had for example tested positive for HIV would constitute a disincentive for people to test. Body Positive shared that concern. We heard the Human Rights Commission also expressing some concern about that point and about whether the contact tracing provisions would also provide a disincentive for people to test.At the AIDS Foundation we provided our own testing services. Why did we do that? We did that because we knew that many of those who were at risk feared going to established health services for testing because even though those services were offered anonymously they did not trust those services to keep their information anonymous. They feared discrimination. So I am still troubled by that risk—whether the benefit of better epidemiological data outweighs the risk that some people will no longer present for testing—but I am reassured by the evidence of the New Zealand AIDS Foundation and other epidemiologists that my fears are groundless on that point.I want to just briefly note my approval that we are adding chlamydia to the list of conditions for which the powers and provisions of this bill can be used by medical officers of health because this is our No. 1 sexually transmitted infection. It is the No. 1 infection which we need to be taking action on. So I am very pleased to see that development.I come to Part 2 which is the part of the bill concerned with sunbeds. As the minority view in the select committee report says like my Labour colleagues—and I am sure that Barbara Stewart will mention this in her contribution still to come—I am disappointed that the Government did not move on this. We have heard for example the evidence of what Australia is doing. We have heard the evidence repeatedly from the cancer organisations and the health experts. In fact I think that almost all of the evidence that the select committee heard on Part 2 said: “This does not go far enough.” There is no benefit to having these sunbeds except in the rare cases that Louisa Wall has mentioned. They should be banned all together. There is no safe level of exposure.I think it was Scott Simpson actually at one point in the select committee—perhaps after we had just heard the excellent submission from Consumer New Zealand—who said that there are still people associated with the sunbed industry who maintain that there is no link between their industry and cancer. The very next submission we heard was the one submission—the one submission—that we heard from someone who said that we ought not totally ban these sunbeds. This was someone from the industry who actually presented us with a couple of reports that she had printed off the internet that in fact claimed that there was no link between sunbeds and cancer.What that goes to is exactly what Consumer New Zealand had told us which is that the industry simply cannot be trusted to act in a responsible way. It has had a voluntary code for a long period of time and as Annette King has outlined tonight the industry has repeatedly and in a prolonged way completely failed to comply with its own voluntary code. In that time many many New Zealanders have been exposed to unnecessary cancer risk. These sunbeds should be banned altogether and I encourage the House to have the courage to do so.BARBARA STEWART (NZ First): I am very pleased to take a call on behalf of New Zealand First. New Zealand First will definitely be supporting the Health (Protection) Amendment Bill.It is a brilliant committee the Health Committee. Basically we work to improve the health of all New Zealanders and we all work very constructively towards that end which is a really good aim for a committee. I must say a thankyou to the officials who were very patient and to all of the many submitters who came along to talk to us.This bill is more and more important—particularly the contact-tracing part—given the number of people who are now coming into New Zealand with multidrug-resistant TB. This type of TB cannot be cured it can only be managed so contact tracing of these people is really really important. We know that there are many of them in the hospitals but we also know that there are many walking around our streets our cities and we need to ensure that we have notification of them before they contaminate others with the disease.We are satisfied with the confidentiality changes made to this bill—thanks to Kevin Hague from the Green Party—regarding the private information of patients. The information of New Zealanders is not going to be freely available beyond the necessities of actually managing an infectious disease so that is an important change that we made as a Health Committee to the bill.I was delighted to hear what Dr Coleman said about the inclusion of chlamydia and other STDs in the list of notifiable diseases. Submitters were absolutely positive that this was something that had to occur. We need to ensure that there is some education around this mandatory notification especially for younger people because the last thing we want is for them to go untreated because they are frightened of some sort of mandatory notification and not getting themselves checked. So confidentiality is important and we will be very interested to see how this works out.We in New Zealand First were hoping to see sunbeds banned. We had heard about it on a previous select committee trip over to Australia and we do not believe that this bill actually goes far enough: to ban commercial sunbeds outright. Many of the submitters—most of the submitters except one—actually wanted these tanning beds banned. I would say that damage that is caused to skin by using a sunbed does not just stop when you turn 18. I know that many years ago I decided that I would like a tan so after trying many of the products to paint one on and getting the racing stripes—not an even sort of look—I decided that I would go to one of these sunbed clinics. I was accepted fair skin and all and I have never had such a bad burn; it took weeks and weeks for it to go away and I did not have any tan whatsoever. As my brother said to me I got the vegetable tan: red as a beetroot and peeling like an onion—and it lasted for months. So I am one of those people who when I heard the submitters come along and talk about the evidence of skin cancer before 35 and the increased risk of melanoma now know that I have to take some action and perhaps look at what I may have done to myself. We know that 2000 cases of skin cancer are identified each year and I am just hoping that I will not be one of those cases in years to come.The Ministry of Health recommended banning these sunbeds for commercial use and we know that Australia has banned these beds as has Brazil. The irony of it is that our sun over here is just as harsh and we should be following their lead. We know that Australia has a higher level of skin cancer than we do but we have a higher death rate from skin cancer than Australia does. We were quite concerned too when Consumer New Zealand came along and after doing a check on many of the sunbed operators found that the regulations were being regularly flouted: 17 out of 20 operators allowed type-1 skin mystery shoppers to have a session—I think I must have had a type 1 skin. Therefore I think that more needs to be done to ensure compliance with these rules—perhaps some consent form perhaps ensuring that people are advised of the dangers—and of course there is the age but I would have been past that age.One of the things that really concerns me is that there is no monitoring on the strength of the light and the intensity of the light that the beds are actually emitting. Knowing that we are now importing second-hand sunbeds from Australia—and many people have them privately in their homes—really makes one wonder what can be done to ensure that the cases of skin cancer that may occur at some later stage are monitored as much as they possibly can be. So there are quite a few issues there.I know that we will be speaking on the sunbeds at some later stage but I would like to say that this is a good bill. The Health Act 1956 needed updating. Since 1956 a lot has changed and we in New Zealand First believe that preventive measures are far better than trying to fix things up once they have actually gone wrong. We need a fence at the top of the cliff rather than the ambulance at the bottom. So we in New Zealand First will be supporting this bill as it is working towards protecting the health of all New Zealanders and for us that is a priority. Thank you.JACQUI DEAN (National—Waitaki): I enjoyed Barbara Stewart’s contribution to this debate along with other members of the Health Committee. The Health (Protection) Amendment Bill has been through a good process in the select committee and the House and I along with others acknowledge the good work that the committee has done. I felt for the member Barbara Stewart when she described her experience on a sunbed receiving what I suspect was quite a bad burn in the process—and have we not all done that? I too have done that and I recall getting bad burns on a number of occasions. But that was simply being out in the sun as a child on the shores of Lake Taupō back in the day when as children we would be out in the sand digging catching tadpoles swimming and doing all of the things that kids do.I vividly rememberbeing badly sunburnt. I come from a medical family—mum was a nurse and dad was a doctor. The point I am trying to make here is that the perils of sunbeds are known and are not contested except by the one proponent of sunbeds who came to the committee. Just as you can receive a bad burn from a sunbed so you can from the sunshine. I guess that these days parents and schools—thank goodness—take a lot of care of kids so we do not get to see that degree of burning. I highlight the issue just to say that we need to be very careful that we do not overly prescribe nanny State provisions as somebody today said. Maybe I agree with the position that you cannot protect New Zealanders from every little bit of harm. I acknowledge that tanning beds are dangerous. So is alcohol but we are not banning that are we? It is that same principle of banning versus regulating.Hon David Parker: How about water?JACQUI DEAN: Good point—a very good point. Do not make me lose my track. That is very unfair. The point I was trying to make was that—Hon Ruth Dyson: It’s still a very good story.JACQUI DEAN: Yes drinking Ruth. Yes it is all about the drinking is it not? The point I was trying to make is that the position we came to in the committee was to restrict the use of tanning beds to those people aged 18 years and older.I was walking along Lambton Quay the other day with this in mind. I happened to go past a sandwich board that was extolling the virtues of tanning. As we had just had that conversation in the select committee I picked up a brochure took it back to my office and had a look at it. I think what needs to happen in the tanning industry with solaria and sunbeds in the face of the scientific evidence is for some responsibility to be taken and for some acknowledgment to be given that there are dangers associated with sunbeds. In some people’s eyes there are benefits. That is fine. I acknowledge that there are benefits in some people’s eyes but there certainly are dangers. I also just want to make that first point again. The dangers of burning are not just with sunbeds; it can happen any day of the week outside in the sunshine.The member is also right in saying that there was one submitter who had quite a different view on the scientific evidence and that was interesting. I thought it was a brave attempt by that submitter to fight her corner. It was a female submitter. I do not recall her name. Why not fight her corner in the select committee? The fact is that she was an importer of sunbeds and from memory had franchises for sunbeds. Why not fight her corner? I know that I have got it all round the wrong way because the provisions relating to sunbeds—Part 2 clause 13 of the bill—include the new provisions that provide for infringement processes to deal with people who do not comply with the new regulations around sunbeds.I also thought about the contribution made by a Labour member who said that there are some health benefitswith solaria in a very narrow range and that they relate to depressive illnesses relating to winter and also to psoriasis. I do know a couple of people who suffer from psoriasis and I do know that occasionally they will take a course of sunbed sessions because that provides them with relief. The member Louisa Wall said that yes there are sunbeds available at hospitals. You can go to the hospital—you can if you can find a car-park—make an appointment go in and have treatment. Or you can go to the solarium during your lunchtime and get your treatment there. So I do not think that with sunbeds we should necessarily throw the baby out with the bathwater. There are some beneficial aspects to sunbeds. I will leave that to one side but that was the major cause of disagreement within the committee over this otherwise accepted bill.Kevin Hague mentioned in his speech tonight—and he gave some very thoughtful contributions on this in the select committee—the issue of the need for contact tracing whilst at the same time protecting the privacy of some vulnerable populations. This was a point that was also considered very closely by the committee. On the one hand there is the need to stop the spread of some pretty infectious diseases such as gonorrhoea and hepatitis in some populations. STDs are not great diseases to have and they can hang around for many years and can cause all sorts of problems later in life—all sorts of health issues. They are not diseases to be taken lightly. But as Kevin Hague pointed out to the committee—and this was also backed up by submissions—the provisions around contact tracing need to be very carefully applied so that the rights of individuals are not necessarily impinged and so that the rules around contact tracing and the provision of information are commensurate with the potential risk that is posed by the disease.In this bill contact tracing is designed not to be a mallet but rather to be a process that has gradual interventions. The first stage of that is to attempt to gain voluntary consent from somebody who has presented at a hospital or a GP’s surgery and is found to have what is now going to be a notifiable disease. If that consent is not gained voluntarily then the bill introduces a duty on a person who may have an infectious disease or who might have been exposed to an infectious disease to provide the prescribed contact information. That contact information could well be clearly people whom they have had contact with—names addresses; that sort of thing—obviously so that the medical officers can trace those people and can confine the outbreak or potential outbreak.The practice of seeking voluntary consent for contact tracing will be the preferred method and the first option for managing the risk of infection. The provisions in the bill increase the range of infectious diseases that are notifiable thereby improving the surveillance of infectious diseases that are of concern including their long-term impact on health. The more quality information that is held about these things the more likely it is that any potential outbreak or spread of an infectious disease or STD can be contained. There are measures being introduced in the bill to protect the identity of individuals and to allay concerns that people might not seek treatment if they believe that their identity will be made public. The issue that Kevin Hague brought very clearly to the committee is that we do not want populations of people hiding away for fear of being publicly exposed as having a certain notifiable disease or STD.The approach taken in the bill and I congratulate the Minister on this approach is to use the principles of risk management and proportionality. Rather than as I said using a mallet to strike a walnut the principles of risk management and proportionality are brought into play in this bill. This is a good bill which is being well supported around the House. We do have a point of difference of course around tanning services—of course we do—but otherwise I am pleased to see that the bill is enjoying good support and good debate. I commend it to the House.Mr DEPUTY SPEAKER: I call Jan Logie—a 5-minute call.JAN LOGIE (Green): Fa‘afetai lava. I rise to take a call on this the second reading of the Health (Protection) Amendment Bill. It will be a relatively short call I think. Much of the content of the bill has been well covered in the House this evening. The Greens are supporting this bill and also supporting the Labour Supplementary Order Paper to extend the ban on tanning beds.This bill does take us forward on both provisions. The bill kind of breaks down into two halves—one is in relation to contact tracing for infectious diseases. There has been an extension and an inclusion of new diseases in that list—which is a good thing—including chlamydia which as my colleague Kevin Hague pointed is the most prevalent sexually transmitted infection in this country. So it is very good to have it on that list.This legislation was first written in 1956 so it is well overdue to be updated. My colleague Kevin Hague in his speech at this stage told the story of his experience with the AIDS Foundation—which was quite informative for the House—when he was in the situation where somebody he knew was I think HIV positive and perhaps not engaging in safe sex. He was concerned about interventions and contact tracing. The only possibility at that stage according to the legislation was to inform the medical officer of health who would then go to a court and that person would be detained. So it was a very very blunt instrument and not one that balanced people’s rights versus the outcome in terms of protection. So it is very good that this bill is now introducing stages and that first stage which has already been stated would be the preferred option of seeking voluntary consent from people for contact tracing. Then on a failure of that there is to be a duty for that person who may have been exposed to a disease or who may have the disease to provide the contact information for the tracing to be able to happen. So that is all very good.I would just like to note from that the discussion I have been hearing in the House this evening from members who sat on the Health Committee that it sounds as if it was a very constructive process. It was an interrogation of what this legislation would mean in practice and in the balancing of it on that basis and that is a fantastic thing to happen. That is what we would really love to see happening more often in this House and through the parliamentary process.It does seem that the second part of the bill—which in relation to sunbeds—reached an ideological divide or a brick wall. It seems that the Opposition side of the House was primarily weighing on the side of the need to ban the sunbeds because of the extreme harm that is caused. The fact is that New Zealand has such high levels of melanoma—2000 new cases are identified every year and over 300 people die of melanoma in this country every year—and the information is that in terms of sunbed exposure for those under 35 there is I think a 73 percent increase in the risk of getting melanoma from using a sunbed. That makes sunbeds to my mind—not having been through this process—a dangerous item.It is disappointing to see that this legislation is banning it only for those under 18 particularly in light of there having been supposedly voluntary regulations or a code of conduct for the use of sunbeds in place already that have not been abided by. Consumer New Zealand has been doing surveys and has found that these companies are not abiding by it. So how would we expect them to abide by this limit of 18 years? We know that some pubs do not do it. Are we expecting these people who are already breaching their own voluntary rules to be consistent just because we pass the law?I met with Business New Zealand people the other day to talk about another matter and they said to me: “Jan you know actually if it comes to what we think is a nanny State you pass the law and we’re going to ignore it.” I did not realise business was quite so anarchic but apparently that is how some businesses think. When there is such a problem with melanoma I think actually we just need to ban sunbeds for safety purposes. Thank you.MEKA WHAITIRI (Labour—Ikaroa-Rāwhiti): Talofa Mr Deputy Speaker. Talofa e ngā mema o te Whāre nei. It gives me pleasure to take a short call on the Health (Protection) Amendment Bill. Listening to all the contributions tonight can I also acknowledge obviously the collegial way in which the Health Committee worked.In listening attentively to the contributions made tonight I do want to raise a couple of facts in relation to them that have come to my attention. Every year 325 New Zealanders die from melanoma. Sunbed use increases the risk of melanoma by 75 percent. A Consumer New Zealand survey found that 40 percent of sunbed operators failed to implement basic safety checks. I understand that the majority of submitters at the select committee believed that banning sunbeds would result in a decline in skin cancers.If I can take us back Labour supports this bill. It is great to see that the Government is finally acting on the work started by our colleague the Hon Annette King. The amendments in this bill are from the Public Health Bill introduced by Annette King some 7 years ago which was in regard to infectious diseases. That bill stemmed from the concern that the current legislation does not fully support public health practice as being articulated by staff in health agencies over a sustained period of time.The bill gives effect to the Government’s decision in October 2013 to improve the range of measures available to protect the public from the harm associated with some infectious diseases and with artificial UV tanning. The aim of the bill is to increase the range of infectious diseases that are notifiable to medical officers of health without identifying the information of patients or diseased persons. This will include HIV infection gonorrhoea infection acquired immune deficiency syndrome—AIDS—and syphilis. It also aims to improve and manage persons with infectious diseases by providing new management options including directions issued by a medical officer of health court orders urgent health risk orders and interventions. It also aims to strengthen legislative provisions for the contact tracing of people who may have an infectious disease or who may have been exposed to one. It also aims to introduce a ban on the provision of commercial artificial UV tanning services to people under 18 years old.Tonight we have heard that the tension in the select committee particularly with the Opposition members has been around the full banning of commercial UV operations—i.e. tanning beds. Of course Labour will be introducing an amendment for the House’s consideration when we come to the Committee of the whole House which is around why we propose an outright ban.In terms of the select committee like previous speakers I too want to acknowledge the way in which those members have operated and come to the House. I understand that 71 submissions were received and 22 submissions were heard before the select committee. I was not a member on that committee but I do acknowledge the way in which people have conducted themselves.I understand too that scientific data was presented to the committee. That scientific data indicated coming back to the contentious issues of banning sunbeds that sunbeds emit a higher concentration of UV radiation than the sun. Personally I cannot say that I have experienced sunbeds. There are probably very few in my family whom I can actually tap on—Kris Faafoi: Not me.MEKA WHAITIRI: Not you either Mr Kris Faafoi. But there is a serious nature around the impacts of UV sunbeds and so all jests aside it is important that we do acknowledge those who lose their lives. A previous speaker Jacqui Dean mentioned something that I do have to differ with her on in terms of her statement about taking a mallet to a walnut. I would hate to be the one who is sitting in front of the families of the 325 people who do lose their lives every year through these sunbeds.I look forward to the bill coming back to the House and to its being debated in the Committee stage. Labour therefore supports it and we look forward to the support of the Committee in terms of our amendments. Thank you very much.BARBARA KURIGER (National—Taranaki - King Country): It is a pleasure to be here tonight taking a call on the Health (Protection) Amendment Bill. It is particularly pleasing because this is the first bill that I have actually followed from the beginning as a new member of Parliament and I am following its way through the process. So it is always going to be particularly relevant to me.It is clear that some parts of the legislation from over 50 years ago need updating in order to improve it for modern times. If I think back to 50 years ago a lot of infectious diseases and things were actually quite isolated within communities because people actually did not travel as far as we do now. So when you think about the progress in travel and the way people shift around communities in the last 50 years the risk has become much much greater than it ever was in the past. It is also the science that we have developed over time and the thought development and also the tracking systems that we have. When everything was manual 50 years ago there was not the ability to do some of the things that we do now.The Health (Protection) Amendment Bill aims to amend and update the Health Act 1956. It also seeks to update the legislation around sunbeds. If I think back I cannot remember any of our parents brothers sisters or people back many many years ago actually having a fetish for sunbeds. I think people are now starting to learn the lessons of those sunbeds and we are starting to become aware of the harm that they are capable of causing.Good health is of crucial importance to New Zealanders young and old. This National Government has an unwavering focus over the past 7 years in respect of maintaining and improving our public health services. New Zealanders are receiving better and more convenient health care and it remains one of the Government’s priorities.During this bill’s time in select committee we heard over 70 submissions that came in. I was really really impressed to see the diligence that people applied when they were presenting their submissions. The other thing that I was really impressed with over the course of sitting and listening to those submissions was the way that different groups in the community that are working together to strive to make things better in the health sector were actually coming together and working on joint submissions to make their cases stronger. I was very very impressed with that. They did bring a lot of concerns to us. I would also like to commend the officials who were in the room because as you can imagine tracking a whole range of infectious diseases and contact tracing is actually quite a large thing to do. So we were always able to test and measure back with those officials for things saying: “Is this possible? Can we do it? The things that these people are asking for—is it possible to do that with your system?”. The reassurance that they gave us that it was possible certainly helped us to make our decisions.The provisions in this bill are multiple and they primarily allow for the tracing of people who have infectious diseases and the introduction of a ban on the provision of commercial UV tanning services to those individuals under 18. I have to say that this is the area where I feel that those people need to be protected more than in other areas. People who are under 18 have not actually had the opportunity to read as widely as older people and they are still very much minors. They are not old enough to vote and they need to be protected in that sense of the word.But I also want to make a comment. We heard before about how we have pubs letting in people who are 18 and people will not respect the law. Well to be honest pubs will only do that until somebody actually catches up with them and until somebody actually realises that they are selling alcohol to a minor. I believe that the regulations around this are going to ensure that these places are tested measured and audited in order to make sure that they are not breaching the legislation. I also think it is really important that they do have respect for the legislation whatever the age of people they are dealing with because we know so much more now about the dangers of how sunbeds are used. I think it is really important that the usage of them is much more under control because unfortunately this is an industry where it has largely been ignored. The more you ignore the regulations the more you open people up to health risks and the more you find that they are susceptible to getting melanomas from sunbeds.I too have to say that I am impressed with the overall cross-party support that was shown in the Health Committee. It is certainly rewarding to New Zealanders when we are able to work together to achieve great results. The Health Committee is definitely a pleasurable place to go and I give credit to all the members of the team. I have to say that it is also reflective of our chair Simon O’Connor who does a great job in chairing the committee. Since the first Act in 1956 as I have said before the knowledge and scientific development have put forward strong evidence in a lot of these areas. It was great to see that evidence coming in and having people talking to us.I am very pleased with the outcomes that we are putting forward this evening in the House. On balance I know we have heard a bit about whether we should widen the scope of sunbeds but I think the evidence of health harm gives sufficient justification for intervention particularly around those people who are under 18. Other than that the measures in this legislation largely provide for better tools for public health. We have a better opportunity for staff to deal with infectious diseases especially when people do not offer to seek voluntary treatment. So if somebody is not actually coming in and presenting with a disease and not obviously offering voluntarily to behave in a best-practice way around this then this legislation gives the officials a chance to do something about it. It places a duty on the medical practitioner who is in charge to provide information to officials who are in charge as to whether there are measures needed to prevent the further spread of disease. I think this is such an important thing and the cooperation between the health officials and the public means a safer environment for all New Zealanders.I want to say that we did have quite a bit of discussion and we did have some people coming in to the select committee who were rather concerned about privacy issues around that. But the bill has provisions in it that make sure that everybody’s privacy is absolutely protected. However there is always a balance and there is always a judgment and I think we are reaching that right judgment where there is a balance between the person’s own privacy issues and protecting the public as a whole. And so you do not get to the point where actually you are keeping someone’s privacy so quiet that the rest of the public are exposed to a huge risk.It is a pleasure to be here tonight supporting this second reading of the bill to improve the tracing of people and to increase the range of infectious diseases that are notifiable. I think it also provides a series of incremental options for the management of individuals with significant diseases whose behaviours do put others at risk of contracting a disease. There are a number of changes that will streamline legislation such as the inclusion of tuberculosis as a notifiable disease under the Act and the consequent repeal of the Tuberculosis Act 1948—that is an Act that goes back quite a way in time. It is my pleasure tonight to commend this second reading of the bill to the House. Thank you.IAIN LEES-GALLOWAY (Labour—Palmerston North): I must say it is a pleasure to hear that the Health Committee is still operating with a constructive and mostly bipartisan approach. As someone who was a member of the committee for 6 years I must say that I miss that committee. I understand that under the chairmanship of Simon O’Connor it is doing well.Sarah Dowie: I’m hurt. You’re on TPR—I’m hurt.IAIN LEES-GALLOWAY: Well Sarah Dowie we have got an interesting select committee tomorrow so we will cross that bridge when we get to it—more interesting for you guys than it is for us I must say. But it is good to hear that there is a convivial mood at the select committee and it was good to hear that we can have a bipartisan approach to some of these health issues and how constructive it can be. I am pleased that the member who was speaking previously Barbara Kuriger was enthusiastic about the bipartisan approach—a new member who delivered a very good 10-minute speech; well done.This bill does a number of important things—a number of important things that I think as some of my colleagues have pointed out could have been introduced quite a long time ago if the legislation that included these aspects and others had been supported by the National Party back when the Labour Government introduced them. So we could have been 7 years ahead of where we are right now if we had had that same bipartisan and constructive approach back when National was in Opposition. It is a shame that we did not have that same bipartisan and constructive approach.This bill does a number of things that I know the National Party has had some issue with in the past. It increases the range of infectious diseases that are notifiable; it improves the management of individuals with infectious diseases whose behaviour puts other people at risk of contracting a disease by providing new management options including directions issued by the medical officer of health court orders and urgent health-risk orders and interventions; and it strengthens the legislative provisions for contact tracing of people who may have an infectious disease or may be exposed to one. All of those measures require a degree of I suppose a person having to divulge information about themselves. It may be uncomfortable for people to divulge some of that information but it is really important for public health for our community and for our collective health that those individuals are expected and are now required under this legislation to offer up that information.The New Zealand National Party has not always been a big fan of this approach. I go back to the minority view expressed in the report back on the Public Health Bill which was the Labour bill that was introduced by Annette King that contained many of these provisions as well as others. Under a paragraph entitled “Forced disclosure of health information” National had this to say: “The bill in requiring disclosure of health information creates a provision for non-Government health care providers to mandatorily supply information to the Ministry of Health beyond what if any is already voluntarily provided. This has potential to create significant costs for these non-Government providers (such as private hospitals general practices and Māori health providers) and funders (such as health insurers) without reimbursement. For example the cost to private hospitals of employing specialist coding staff to supply surgical data by purchase unit or diagnostic related group to the ministry will not be insignificant. The ministry advisers even acknowledged that it may take considerable time for providers to collate requested information. Providers and funders could be required to provide confidential financial and business information in the name of ‘advancing health knowledge health education or health research’.”It goes on. It goes on to talk about National’s concerns about people having to divulge information and health providers having to provide such information the costs that would be related to that and the impact on people’s individual freedom to maintain that information. That was one of the somewhat spurious reasons on which National based its opposition. This is not new. We have seen the National Party do this a number of times where it sees a political opportunity to make political attacks and to undermine a Government whether or not that actually is in the interest of advancing the well-being or the health of New Zealanders.The fact that 7 years on we are hearing from members about the wonderful bipartisan approach that has occurred at the select committee and the fact that these are all important measures to improve the public health I think absolutely reveals the appalling political games that the National Party played with health when it was in Opposition. It is just true. Some newer members are looking over at me shaking their heads a little bit. Well this might be a history lesson for them. They might not have been aware of this but actually time and time again in the 6½ years that I have been in Parliament we have actually debated and passed nearly unanimously in most cases legislation that the National Party in Opposition vehemently and loudly opposed because there was some group out there that it was trying to appeal to or even if there was not a group out there that it was trying to appeal to but it just saw an opportunity to undermine the Labour Government. That was all it was about.Brett Hudson: The unions elected your leader and you talk about people being beholden to groups. What a joke!IAIN LEES-GALLOWAY: Well there you go. That is the level of debate. That is what Brett Hudson thinks is an important contribution to make to a debate about public health. He is wrong of course. He obviously actually has not understood how the Labour Party works but what we are talking about here Brett Hudson is advancing the public health and well-being of New Zealanders and the fact that the National Party plays politics—the fact that the National Party plays politics around these things. It is great and it is fantastic that we are doing this and that the select committee in its bipartisan and constructive approach has actually come back expecting that even more information will be devolved including sex date of birth National Health Index number—all things that are going to be useful in terms of bringing under control notifiable infectious diseases and advancing the public health and well-being of New Zealand. I just come back to the fact that we could have done this 7 years ago—we could have done this 7 years ago. But what does the National Party do with all this stuff? It always plays politics.I had a look because I am not on the select committee any more at the departmental reports and I found that there were two departmental reports—one on infectious diseases and one on the issue around sunbeds—both of which were nearly 100 pages long. There were numerous submissions and there was obviously a lot of evidence to go through. It would appear that for the most part the select committee in its bipartisan and constructive approach has taken an evidence-based approach to these issues including the issues around the link between sunbeds and melanoma. I noticed one of the reports that the select committee received noted that there was a strikingly high rate of university students who use suntan beds. Those would be university students I assume who are over 18 and who are possibly in their early 20s who are using these beds. It is concerning that these young people are perhaps using these beds in an unregulated environment not being fully aware of what the long-term impacts might be of using those beds.It is good to see that Parliament is working together to do things that are constructive that take a long-term view of health and that are about maintaining health and well-being to try to prevent disease further down the track particularly around melanoma. It is good to see that for the most part the Government seems to have followed the evidence. There are some small differences of opinion between this side and the other side of the House about how far it went in following the evidence but for the most part this side of the House is very pleased to see the continuing passage of this legislation. We are just so disappointed that it has taken 7 long years for National to finally see sense.Dr SHANE RETI (National—Whangarei): It is my privilege to speak to the Health (Protection) Amendment Bill tonight. Just in brief reply to the previous member Iain Lees-Galloway I would indicate that we are certainly interested in learning from the past but we are more interested in working in the present and that is certainly where I would like to be tonight. I would also like to acknowledge my colleagues on the Health Committee for the due diligence they have done in progressing this bill and the guidance of the chair Simon O’Connor.There are two themes to this bill as has been commented on. There is the infectious disease theme and the UVB tanning theme. I will talk to each of them.I will talk first of all to the infectious disease theme and there are several parts that this bill actually talks to. First of all it talks about modernisation improving contact tracing and improving management options. As has been commented on the previous Act is an old Act from 1956 and it is modernised in this new amendment. If we look at some of the areas that are modernised we had Toi te Ora suggest to us amending “premises” to include “vehicles” so the definition of “premises” now reads “… any commercial premises private premises vehicle ship or aircraft”. That makes sense. An “educational institution” was also clarified as “… any place where people gather for the purpose of education or training;” and “an individual who has an infectious disease” now includes “… an individual who is infected or colonised by or is a carrier of an organism capable of causing the disease even if the individual does not exhibit any of the symptoms of the disease.” We have modernised the Act with this bill.The second part of the bill that I will talk to is around some of the new diseases that have become notifiable. In fact they are not new diseases but they are now notifiable. Very important diseases—HIV gonorrhoea syphilis—are now added to the schedule along with hepatitis A hepatitis B hepatitis not otherwise specified leprosy rabies and malaria. So these are really important diseases that we have now put on the correct schedule. This bill also attends to contact tracing. I was a sexually transmitted disease officer in Northland for many years and contact tracing was very very important to us. It is nice to see these regulations tighten up and give us new and better tools for what we are doing.What we have done with contact tracing is significantly strengthened with graduated measures a sliding scale and a range of techniques we can bring to the task ranging from voluntary to non-voluntary contact tracing and also including self-managed contact tracing. Significant powers have been given to the medical officers of health for example. To safeguard those potentially intrusive activities that they have the bill enunciates a number of principles that describe the balance between voluntariness self-management and public risk. These principles include “Respect for individuals” “Voluntary compliance” “Individual to be informed” the “Principle of proportionality” “Least restrictive alternative” “Measures to apply no longer than necessary” and that the “paramount consideration … is the protection of public health”. I think these are some of the safeguards to the new powers we have given under the bill.We have also looked in the amendments to section 74 at notification of some of the infectious diseases. This was the point that Kevin Hague made which I think is absolutely correct. There was a lot of discussion around provision of identifying information with the notification information. I would add here that the New Zealand AIDS Foundation when it presented to the select committee was very comfortable with the range of information we were looking to collect. That aside we felt that we should peel it back and that we did not need all of it. So where the initial list was name date of birth sex address place of work and National Health Index (NHI) number we have peeled that back to sex date of birth and NHI number. Again the New Zealand AIDS Foundation and other stakeholders were very very comfortable that that was appropriate information to be collected—particularly NHI numbers which can be symmetrically identified to a person. The foundation felt that considering the NHI is stored appropriately and meets a lot of privacy constraints it was comfortable with that.Behaviour that is risky to public health is also covered under this bill. As I have mentioned medical officers of health are given increased powers of compulsion. There are other safeguard measures. One of them is in regard to the Director-General of Health. In many places in the bill it is stated: “If the Director-General so requires the medical officer of health must send him or her a copy of all or any of the directions given … under this section” which is another really good safeguard. There is another part to that: “If the disease that the individual is believed to have is not a notifiable infectious disease every direction given to the individual must have the prior approval of the Director-General.” Again that is another good safeguard.I would like to talk briefly about chlamydia. I think this is a really important thing that the Health Committee has had added to this bill. Chlamydia was commented on as the most obvious sexually transmitted infection that was not on the infectious diseases schedule and not on the notifiable diseases schedule. A 2014 report by the Institute of Environmental Science and Research looking at 2013 data showed that across all the district health boards there was an incidence rate of 633 cases of chlamydia per 100000 people. That was less than what it had been in the previous year so it was improving but it was still twice that of Australia and in absolute numbers it was 25000 positive tests. This committee raised the attention of officials to chlamydia and placed it on the schedule. We have placed it on the infectious diseases schedule and its type is non-notifiable—that is in the Health Act schedule 1 Part 2 as amended by clause 10.This is a big step. If we look across the bill and ask what parts of the bill will touch the largest number of people and impact on the largest number of people I think this clause is an unexpected benefit that we will look back on and say: “Ha! We really did something good there. We really had an impact on vulnerable communities with that clause. I mean we didn’t know at the time whether we were quite going to do that.” So chlamydia now joins other infectious diseases that are non-notifiable in schedule 1 Part 2 which includes standard influenza scabies and impetigo contagiosa which is school sores. They may seem trivial but let us remember some of these can be really quite significant. School sores can certainly destroy your kidney through a bizarre autoimmune process. So again I just want to commend the committee and officials for taking into account and including chlamydia in that schedule.I would like to now turn to the second theme which is around artificial UV tanning services. As the member Jacqui Dean commented it is actually quite common in hospitals to find UV services. Particularly in the dermatology department you will find UVB which is used quite frequently and UVA. UVA particularly is used in “PUVA”—psolaren plus UVA. Again she mentioned psoriasis and 10 to 20 percent of New Zealanders have psoriasis. Probably those in this room tonight who have dry skin on their elbows and knees will think it is just dry skin but no it is not; it is psoriasis. Of those who have the unfortunate affliction of dandruff 20 percent will actually have psoriasis as well. So it is quite common. Therapeutically we would use—Kris Faafoi: Give me a script for that.Dr SHANE RETI: I could. Actually you do need a prescription for light therapy. It just shows how controlled it needs to be.Anyway Part 5 of this bill talks to UV tanning services and fundamentally restricts them to being used by those over 18. The question first would be: well why restrict it at all? There is very clear evidence of the nexus or the relationship between ultraviolet radiation and skin cancer. We generally break skin cancer into two types: melanomatous and non-melanomatous. The melanomas are the brown moles that change in size shape and colour and certainly that can be very terminal. There is in fact a very high frequency in young people. It is one of the most common causes of cancer in young people. The non-melanomatous are the scaly lesions on the back of your hands—the basal cell carcinomas squamous cell carcinomas and solar keratosis moles—Simon O’Connor: The full squamous cell.Dr SHANE RETI: The full squamous cell as you say. There is very clear evidence from the people who presented to us of the relationship between UVB and melanomatous and non-melanomatous skin cancer. It is unequivocal; there is no question on that.Where there was some debate was around age. We looked at age and said look it needs to be consistent with other legislation. It needs to be consistent with where we think the age of autonomous consent and autonomous understanding sits and consistent with other legislation such as tobacco and alcohol legislation. If we are going to set an age as was correctly mentioned by someone we need to consider how we are going to monitor that. How are we going to check that the sunbed industry is indeed treating only people over the age of 18? What is required there and what you will see in Part 5 is quite a detailed infringement platform or infringement programme if you like. We wanted to be firm but we wanted to also be fair in what we were doing so there are escalating infringements to try to avoid the unnecessary criminal prosecution pathway which can be long and expensive. Having said that the officials made it very clear that if there were repeated and deliberate infringements they would head to criminal prosecution.It has also been commented and I think it is interesting that our prime intervention here is on age. We could look at what the Auckland Council has done. It has actually regulated the industry under by-law. I think there are some interesting things coming out of that as well. There are actually other parts of the legislation that can be brought to bear in this arena—there is legislation around electrical safety and various other things—but I think reassuringly at the end of the day what we have said in the new Part 5 is that we will review it in 3 years’ time. So let us learn the lessons from what Auckland Council has done as a by-law. Let us see how this goes.I think this is an excellent piece of legislation and I think it will give us much better tools to do a better job. I commend it to the House. Thank you.Bill read a second time.