Roy Heather: Health Practitioners Competence Assurance Bill Health and Disability Commissioner Amendment Bill Medicines Amendment Bill — Third Readings 
Roy Heather: Health Practitioners Competence Assurance Bill Health and Disability Commissioner Amendment Bill Medicines Amendment Bill — Third Readings 
[Volume:611;Page:8626] 
HEATHER ROY (ACT NZ) 
: 
 I rise to speak to the third reading of what was the Health Practitioners Competence Assurance Bill. That bill has now been divided into three bills: the remaining Health Practitioners Competence Assurance Bill the Health and Disability Commissioner Amendment Bill and the Medicines Amendment Bill. Like my colleague in New Zealand First ACT New Zealand will be supporting the Health and Disability Commissioner Amendment Bill but will oppose the other two bills. Our concerns certainly have not changed as the legislation has progressed from the bill that was initially brought to the House to the three bills that it now is. 
I have to say that this is a very sad day for New Zealand. It is a very sad day for health professionals whom the Government insists on calling “health practitioners” because in fact they are very professional and I think they deserve to be called “health professionals”. It is a very sad day for the health professionals of this country for several reasons. The first is that the Government has not listened to them. Many of the groups that came to the Health Committee—and we had slightly more than 250 submissions I think—had very similar concerns about scopes of practice quality assurance provisions the great amount of ministerial control that this legislation will allow and about elected members of authorities. The Government was unwilling to listen to those concerns and make the significant changes that would have made it much more palatable for medical professionals in particular—but some others too—to accept the provisions within this legislation. 
When the Ministry of Health issued its discussion paper in 2000 the Health Practitioners Competence Assurance Bill was welcomed because the underlying principle behind the bill—of using the most modern health occupational legislation the Medical Practitioners Act as the basis of developing new umbrella legislation—was a very good idea and most of the professional groups agreed with that. However as time progressed things changed significantly and the Health Practitioners Competence Assurance Bill that was finally presented to the House at the Committee stage was so far removed from the Medical Practitioners Act that in parts it was barely recognisable. 
It is a sad day also because medical practitioners are very unhappy with this legislation—so much so that they asked to be removed from it. They have made their concerns very well known and I put forward a Supplementary Order Paper to have them removed from it. The National Party and New Zealand First both supported my Supplementary Order Paper because they could see the damage that will be caused as a result of medical practitioners having to abandon modern up-to-date and very well-working legislation and change to the Health Practitioners Competence Assurance Bill. It really is a retrograde step both for themselves in their practices and most important for patients when it comes to safety concerns. 
It is also a very sad day for the Pharmaceutical Society. The Pharmaceutical Society is an organisation that has existed for over 100 years. It has built up a great number of assets and operated very professionally over those 100 years and there has been a great deal of emotional attachment to the society as time has evolved. Certainly pharmacists are very sad to see that go. As time has gone on and it has become apparent that they will have to disband their society they have been making provision for that. But there will certainly be a great deal of sadness because of the emotional attachment they have felt to it and that is not necessarily a bad thing when we are talking about medicine and the care of patients. 
The legislation has been described by Ian Powell of the Association of Salaried Medical Specialists as an ambitious dog’s breakfast and I think that sums it up quite well. It is certainly ambitious legislation. It will see the repeal of 11 Acts relating to different professions so that there will be one huge omnibus piece of legislation. It is hugely thick and hard to lift and it will not cover everybody’s concerns as huge umbrella pieces of legislation seldom can. Some groups were very pleased to see the introduction of the Health Practitioners Competence Assurance Bill. Physiotherapists and occupational therapists for example have been working under 1949 legislation. Practice has certainly moved on in that time. The legislation relating to dietitians has been in existence since 1950. For those professional groups it is time to move on and have up-to-date legislation. Although the Health Practitioners Competence Assurance Bill is not perfect it will serve them better than the legislation they have at the moment. I myself feel that they would have been better to hold out for amendments to their own Acts but it is a move forward for them. 
One of my great concerns which I mentioned several times during the other reading debates and the Committee stage was the lack of a definition of “competence” in the legislation. Here we have legislation that is all about competence and patient safety yet competence cannot be defined. We were told at the select committee that it was too hard to define. If something is too hard to define how can it be in the title of the bill? How can it be a yardstick by which people must be judged? I say that it is near on impossible and for that reason I feel very sad that we are progressing with something that does not even have a definition. 
The concerns I mentioned that most of the professional bodies had were very similar. Firstly I want to talk about scopes of practice. Scopes of practice remain unresolved in the minds of the professional bodies. In particular there is concern about the intention of broad scopes of practice and there was much discussion about that. The professions were told that scopes would be broad but in practice they have been watered down by other wording that in effect implies narrow or personal scopes of practice. For some professions that will not be too much of a problem. Occupational therapists have already worked out their scopes of practice. In fact they have decided to have just one scope of practice so for them things will not change. For groups like medical practitioners who have lots of vocational branches that they work through by educational means the scopes of practice will be extremely difficult to determine and they will be extremely difficult to bring into practice. 
Another area of difficulty with scopes of practice is when there are overlapping scopes and several professions might perhaps perform one function. I think in particular of acupuncture. There are acupuncturists who want to be part of the Health Practitioners Competence Assurance Bill. I am told that there are physiotherapists in outpatient clinics for whom 70 percent of the time acupuncture is involved in the practice. Also many general practitioners these days perform acupuncture. So scopes of practice will be a nightmare to determine for areas such as those. 
I move on to quality assurance activities. In particular we are concerned about protected activities. The medical profession in particular and also increasingly other professions have operated very good quality assurance activities which have enabled the groups to learn from the mistakes that have been made. They have been able to do so in a protected environment and they are very worried now that this will not happen. If they cannot be offered protection those very valuable discussions will not continue because people will be fearful of the result of those discussions. That affects not only the professions themselves but also in a very large way—and I do not think that the Government has looked at this properly—patients whose safety will be compromised. The ministerial control in this legislation is very great and many of the professions are quite rightly worried about that. I will not go deeply into the issue because we discussed it at length during the Committee stage. However it is a justifiable worry for the professions. 
Elected members of authorities are also going. The Minister has made it very clear that she is not in favour of those even though the provision is in the legislation that they could possibly exist. She has said on several occasions that she in not in favour of them so the doctors the pharmacists and the dentists who elect members for their bodies at the moment will no longer have the ability to do that. This sad day I think needs to be noted. Today we need to say goodbye to professional self-regulation. What other professions do not have professional self-regulation? There are many. [ 
Interruption 
] Mr Cunliffe may well clap but he should wait until he next goes to see his doctor. The fact that professional self-regulation is going is a very sad thing. Elected members of authorities are going and that too is a retrograde step. It is the professions themselves that know which of their members are best to govern them. It is not as though they have a majority holding on each of these things; it is just that these people are there to represent them. Today we are also saying goodbye to some of the improvements that came in under the Medical Practitioners Act—most particularly the improvements relating to patient safety.