Craig LizDr LIZ CRAIG (Labour): Thanks Madam Assistant Speaker. It's an absolute privilege to speak in some detail on this bill which amends the Health Practitioners Competence Assurance Act 2003. This is actually an Act that I've practised under for the majority of my career.As we know the Act as it stands aims to protect the health and safety of members of the public by ensuring health practitioners are competent and fit to practise in their professions. What I want to talk about tonight briefly is just to go over why we need the Act in the first place and then secondly a bit more about what this bill actually adds.So why did we need the original Act? I want to think about three scenarios. I think the first one is John. So John's recently moved to New Zealand. What he wants to do is he wants to earn a bit of money doing cut-price vasectomies. So it's the Act that empowers responsible authorities here the Medical Council of New Zealand to decide what qualifications John needs before he can set up as a registered medical practitioner.The other thing though is it's also the Medical Council of New Zealand who'll determine the scope of his practice because unfortunately if John happens to be a psychiatrist who's qualified in the United States even if he gets registered here in New Zealand it doesn't actually mean that he can start performing surgical procedures out in our community.Another scenario that's governed by the Act: Susan qualified as a GP in 1980 and she's been working as a sole practice practitioner and a rural GP all by herself for a number of years now so she's way way too busy to be reading any medical journals and she hasn't been able to go to any conferences. So what's happening with Susan is she's starting to lose touch with all those developments in terms of diagnosis and best treatment and her patients really risk not getting access to the best of care. So again it's the Act that empowers the Medical Council to make sure that Susan does some professional development and also if they've got concerns they can require her to complete some competence or recertification programme. So it gives them the teeth to be able to do that.The third scenario is Bob. Bob has been having a bit of trouble at home and as a result he's coming to work and he's smelling of alcohol. On one occasion recently they had to cancel his list because the operating theatre staff decided that he was not sober enough to actually practise. So it's the Act that empowers the Medical Council to start taking complaints and receiving them from either concerned members of the public or other colleagues and then to refer them to professional conduct committees so they can have a proper look at it and then if they think it's warranted they can pass that on to the Health Practitioners Disciplinary Tribunal. So what this Act does is it makes sure that medical practitioners are competent to practise in our country and the public is assured that the relevant authorities have got oversight into all of those areas.But then what does this bill do? What we want to start with is a bit of history. The Act was passed in Parliament in 2003 and it really came into full effect in 2004 and it now covers 23 health professionals. It includes medical practitioners—so doctors overseen by the Medical Council—but also the nursing and midwifery councils dental council pharmacy council—a whole raft of practitioners. Section 171 of the original Act required that the director-general carried out a review of the Act in 2008 so that's 10 years ago—just noting—and since then there've been two reviews. The first was completed in 2009 and that just looked at whether the Act was operating as intended. The second one completed in 2012 was more policy focused and it was really trying to work out whether the Act was still doing what it was meant to be doing given the changes in the health system. That reported back in 2012 and both of those reviews recommended a number of improvements. What they were saying was the Act was functioning as intended but they said there were areas that we needed to make a number of legislative changes on. So that was six long years ago and finally we've got around to it as a result of an incoming coalition Government.So there were four main areas where they recommended that changes were made and the first one was making sure that responsible agencies could actually demonstrate that they were doing what they were meant to be doing. The second one was making sure that they were transparent in their processes so that those who referred concerns in and those people employing people that were being reviewed actually knew what was happening. The third one was looking at how we do interdisciplinary collaboration because a lot of balls were getting dropped from passing from team to team so looking at how we actually do seamless communication so things don't get missed. The fourth one was looking at better workforce information and I just want to go to each of those in a little bit more detail.So the first one was looking at whether responsible authorities were actually doing what they were meant to be doing. What this Act introduces is five-yearly performance reviews for responsible authorities. These reviews will be conducted by independent reviewers but they'll be assessed against independent criteria that are determined by the Ministry of Health under consultation with the authorities. The whole aim there is to make those reports publicly available on the authorities' websites so that people can be assured that they're doing as intended.The other one is greater information about disciplinary decisions because sometimes it was a bit opaque about something getting referred to one of these authorities and then not quite knowing what happened to the complaint. It seems quite obvious but what this bill requires is that responsible authorities have to release information about their decisions back to the person that notified the concern in the first place and also in terms of their employer as well because that's quite pertinent information if you are employing somebody whose performance is under review.The other issue is about publication of names of those undergoing disciplinary proceedings. You've got health practitioners who may have failed to meet standards and the question is: are those names able to be released to the public and in what way? I think even though medicine now is very very much evidence-based as a practitioner it's still very much an art as well as a science. Basically mistakes do get made and I guess what we're looking at here are not those one-off mistakes but those systematic mistakes that are going to make practitioners a risk to their patients. So it's always the balance between the public's right to know and public interest and the practitioner's rights for privacy and natural justice. What the bill requires is that the responsible authorities develop policies about how they're going to notify whether they're going to name the health practitioners and the reasons for those decisions and put those up on their websites.Inter-professional communication's been touched on by a number of people and this is an area where often it's not individual practitioners that are making individual mistakes but it's where bits get missed in between handing over from one team to another—blood tests don't get followed up information's not passed on about someone being at risk. So this is where the bill provides greater recognition for teamwork and inter-professional communication.The fourth one is workforce data and making sure that we've got the right data so we can have the right staff with the right skills in the right places at the right times. This is entirely feasible. Every year that I've had to renew my annual practising certificate I've had to do a workforce survey and all the stuff you put on your annual practising certificate renewal about your occupation and who you're working for—that gets supplemented with how many hours you've worked and also what your intentions are for the next year of practice. So that information's really valuable but it's not being collected consistently across all professions so this bill gives the responsible authorities a legal mandate to collect that data and then to pass it on to the Ministry of Health to use for workforce planning. What will always be the assurance though for the privacy perspective—it's always going to be presented as aggregates or anonymised data.There's a range of other changes that the bill proposes. Some of them are just straight clarification about the responsible authorities' ability to receive complaints from members of the public. Some changes are about reducing administrative burden on reporting requirements for quality assurance procedures. Some changes allow amalgamation of responsible authorities when it's useful and some look at making sure that it's very clear that the administrative costs of the Health Practitioners Disciplinary Tribunal are met by the responsible authorities.So this is a really great bill and it makes sure that those responsible for keeping our practitioners competent and practising to the top of their scope are also themselves under scrutiny. Therefore I commend this bill to the House. Thank you.Bill read a first time. Bill referred to the Health Committee.