Scott Lynda: Health Practitioners Competence Assurance Bill — Second Reading 
Scott Lynda: Health Practitioners Competence Assurance Bill — Second Reading 
[Volume:610;Page:7539] 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
I am not surprised that the Hon Ruth Dyson gave the lead speech in this debate on this bill because the Minister of Health does not want to be anywhere near it. It is my understanding that an assurance was given - certainly to the Association of Salaried Medical Specialists - that this bill would not be in the House this week. The reason that assurance was given and the reason that the National Party will not be supporting this bill is that there are major problems with it. This bill which has 272 pages tries to be all things to all people and does not achieve any of them. There are major concerns about this bill. This bill should not have been a political bill. It should not have had the New Zealand National Party the ACT party and the New Zealand First Party voting against it. This bill should have been about producing a standard for public safety in terms of our health professionals that all parties in this House agreed to. But that was not achieved and I will outline some of the reasons why it was not achieved and why the National Party will be voting against this bill. 
Its aims are not ones that are not worthy. It aims to ensure that all health practitioners be they nurses doctors dentists occupational therapists physiotherapists or the others who make up the 11 groups included are competent to practise and keep up to date through their practising life and that there are appropriate disciplinary and investigative procedures in place when things go wrong. Those are worthy ideals. But this bill which was supposed to be based on the Medical Practitioners Act 1995 is a far cry from that Act. The Medical Practitioners Act was very successful legislation which made a huge difference to how medicine was practised in this country. It solved some of the problems of the previous 30 years. 
When the Hon Ruth Dyson talked about Nick Smith’s petition which was about a dermatologist who practised in Marlborough and Nelson she mixed up concerns about how the profession decides on competence with concerns about this bill and scopes of practice. After the Medical Practitioners Act the New Zealand Medical Council was able to register people like Dr Hornbeck and was able to override some of the decisions of the colleges but that had not been happening. The pressure that was put on by Nick Smith’s petition and the ACT member’s bill brought that to light and from that time the Medical Council did override some of the decisions and we did look at having more effective registration of some of our foreign doctors. So that is not a sound argument for the scopes of practice concept that is put up in this bill. It is a very new and untested concept. 
The bill repeals 11 Acts of Parliament and covers 55000 professional people. National members will not be supporting it because the Government has bitten off more than it can chew and has failed to give proper rigorous analysis to the new concepts it is proposing as it combines 12 professional groups. Those groups are chiropractors dentists dentitions medical auxiliaries doctors nurses occupational therapists physiotherapists opticians ophthalmologists pharmacists and psychologists. They all come under this one piece of weighty legislation. Those groups have different levels of Acts of Parliament governing them at the moment. Some are as outdated as 1948. 
Some among that group like doctors have modern comprehensive legislation that they want to keep. Doctors in New Zealand want out of this bill. They do not want to be included under this bill. They want to stay under the Medical Practitioners Act because they have huge concerns about how this bill will operate. They are under modern legislation that is working well and they do not want to come under this legislation. That bill which was introduced by National in 1995 was well consulted on. There was not disagreement about that bill as there has been about this bill. It was well-thought-out legislation that solved 30 years of problems for doctors and for their patients. It improved patient safety in New Zealand which is not to say that everything was perfect but all in all that legislation did improve the situation markedly. There was appropriate registration of doctors and ongoing credentialing of them through their working lives via continuing medical education; and quality assurance programmes developed and flourished in all our hospitals and health services. 
Those quality assurance activities focused on systems failure. Thirteen percent of people admitted to hospital suffer iatrogenic harm. “Iatrogenic” means harm caused by the nature of a patient’s treatment—that is the pills a patient takes the treatment a patient receives and the fact that the patient might have been exposed to hospital infection. Good quality-assurance ensures that mistakes near misses and systems failures are discovered and corrected and that one has the ability to learn from mistakes. The Medical Practitioners Act also saw complaints against doctors treated in a very different way. After 1995 the Health and Disability Commissioner investigated all breaches of the code of rights and all complaints. 
I am pleased to see a one-stop shop developed in this bill; that is one of the things I have supported. There are problems with long delays in the processing of complaints and we will support the amendment that provides that health practitioners have only 3 weeks in which to respond to the Health and Disability Commissioner. But all in all district health boards doctors and most members of the public now have more confidence in the medical profession and their hospitals due to the Medical Practitioners Act. 
Enter this bill which bears little resemblance to that Act. The problems are scopes of practice the power of the Minister increased cost ministerial appointments to registering bodies quality assurance changes lack of timeliness of complaint resolution and cultural competence. What has the Government got right? There are some things that it has improved. I do think that some of the changes to the quality assurance processes will be an improvement. Also some of the practitioner groups are under very old legislation and this bill will be an improvement for them. If the Ministry of Health had consulted more widely—and by “consult” I mean actually listening and changing things that the groups found unacceptable; not just giving those groups a lecture on what was going to happen—we would have a better bill before us. 
Scopes of practice are a problem. Where is the intellectual and academic work on that concept? Nowhere. The concept has never been used in New Zealand or anywhere else. The New Zealand Medical Association made an Official Information Act request for the Ministry of Health to supply it with its papers on scopes of practice. What was the result of that? Nothing because no work in a paper form had been completed. It seems that two of the policy sector groups had had a conversation about scopes of practice. Well that is not good enough for New Zealand. We really do not have a clear understanding of what scopes of practice will mean. Two people in the ministry thought it up. We have already had Annette King endorsing nurse anaesthetists in two speeches. The Minister will have the right to decide on the scopes of practice for these professional groups. One cannot consult on a concept that is not defined until it appears in a bill. As no one is too sure how those scopes will operate there is widespread concern especially from the 10000 doctors and 50000 nurses. Will the scopes be wide? Why are they not using educational achievement and attainment? What is going to happen when there are disputes? Then there are the problems with ministerial powers. There are many other problems with this bill which I outlined before and I do not have time to go into all of them. They need to be sorted but not just in the Committee stage; they should have been sorted earlier. The National Party will not support this bill.