King Annette: Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill — First ReadingText is incorporated into the Bound VolumeKing Annette: Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill — First Reading[Sitting date: 23 July 2015. Volume:707;Page:5312. Text is incorporated into the Bound Volume.]Hon ANNETTE KING (Deputy Leader—Labour): I rise to support on behalf of the Labour Opposition the Health Practitioners (Replacement of Statutory References to Medical Practitioners Bill. I am pleased it is going to the Health Committee. Where else would it go? It is a committee that is made up of some very good members and it is very well chaired by Simon O’Connor. So we look forward to having more work at that committee; we are underworked at this stage. What this bill does as you have heard from the Minister is it amends a number of Acts to increase the range of health professionals who are able to function in certain roles that are currently carried out by medical practitioners.I want to begin by saying that I really welcome this change. It has been very very long in the making. The first nurse practitioner was introduced into New Zealand in 2002 13 years ago. The reason I know that is that I was the Minister of Health who brought in the first nurse practitioner. And what is a nurse practitioner the listening public might ask? A nurse practitioner is a registered nurse practising at an advanced level in a specific role who has a Master’s-level education and is recognised by the Nursing Council of New Zealand. We have literally thousands of nurses now with Master’s-level qualifications and above.Back in 2002 it was very much part of what we as a Labour Government wanted to do. I would just like to recall something that I said at that time. I said that nurses provide consistently high-quality health care to New Zealanders but there is considerable potential for them to contribute even more positively through responsive innovative and collaborative health services. I said that nurse practitioners will have an important responsibility in advocating health promotion and disease prevention and part of their role will be to encourage self care. But they also have the skills to consider a wide range of health services that may suit individual patients. I then went on to talk about the Primary Health Care Strategy because diversifying our health workforce—a high-quality workforce—with a focus on better health for the whole population and reducing health inequalities was the very very basis of the Primary Health Care Strategy. Fundamental to that was ensuring that people got the right services in the right place from the right practitioner.So we have had for many years the ability for nurses to be able to carry out a much more broadened role. On 12 September 2005 I actually announced the first prescribing rights for nurse practitioners. That was 10 years ago and the Cabinet of the day under the Helen Clark Government approved new regulations to allow nurse practitioners the ability to prescribe a range of prescription medicines and controlled substances. It took 6 years of work to get to that position and it allowed something like a hundred nurse practitioners to start prescribing.Since then there has been one big long wait for anything else to happen. And so I note that in the Cabinet paper on this bill I received from the Minister some time ago it was back in October 2011 that Cabinet did approve a number of changes to widen the range of health professionals who could undertake the functions that are currently carried out by medical practitioners. We are 5 years on and this has not been concluded. The work has taken this long by this Government. So important was it to have an extension of the role of health professionals that it has had to wait 5 years to be introduced today.You see the rhetoric on health is all very well from the Government but the follow-up and the follow-through just do not match.The role of different health practitioners could enhance our ability to provide health services particularly in rural and provincial New Zealand. Last week my colleague David Clark and I visited all the small rural hospitals in Otago and in part of the Southland area. We went to Timaru to Ōāmaru to Maniototo to Queenstown to Clyde and to Clutha.We spoke to those people who work there on the ground and heard at first hand what they said.One of the things that they need—desperately need—is a workforce suitable to provide the health services that they need. They mentioned the need to have nurse practitioners able to carry out a wider range of services. It is often hard to staff those areas with GPs with doctors. It is very hard at times to get the right staff in the right place but a nurse practitioner with broadened skills with the ability to prescribe and to carry out a range of functions would enhance their ability to provide those health services.One of the things the Minister said in his speech about this bill—he said that the Government wants services closer to home. Well that is the very fundamental principle of the Primary Health Care Strategy. It is the fundamental principle of a good primary health service. Services closer to home—there would not be a member in this House who would not want their family to have services that could be provided as close to home as possible. And we could provide so much more in those communities with the right health workforce and a real commitment to closer-to-home services.So what happened when we went to Queenstown? We got the example of how services closer to home by the right health professional are not happening. They have just seen three out-patient clinics in their town—a town of 30000 that rises to 90000 in the season—losing out-patient services. And that is the kind of message we got where we went. The services are not provided closer to home often because of the lack of a health workforce often because of the lack of commitment and often because the rhetoric does not match the action. So I am delighted that now there is going to be a greater range of health professionals able to provide health services and able to prescribe. I have to say again that it has taken far too long. We should not have waited this long if we really cared about providing those services to our communities.I then looked at the regulatory impact statement that was provided for this bill. I note that it was done by the Ministry of Health and one of the things that it did say in it was there was going to be no cost—there was going to be no cost to this. Well I have to tell you perhaps there is no additional cost to business in theory but if we are really going to expand the role of nurse practitioners and other health professionals there is a cost because they cost more. You cannot pay a nurse practitioner who has a masterate in higher qualifications extra training and the ability to prescribe the same as you would pay a practice nurse. Unfortunately the money that goes with a nurse practitioner has not flowed through to district health boards and there are too few nurse practitioners in New Zealand right now. So there is a cost and will that cost be picked up and provided for by the Government in its health budget or will it be told to take it out of the budget it has already got? If that is the case regardless of this extension to the role of nurse practitioners and other health professionals there will be little that happens unless the money follows to pay for them.One other thing that is in the regulatory impact statement is around the consultation. It said that overall the sector was in favour of the amendments that the Minister of Health is making in this bill. It said it would improve efficiency reduce some of the workload burden on doctors and enable professionals to use their skills more. The submitters came from the Nurses Organisation. They were very supportive of the change and they have been supportive since 2002—very patient and have waited a long time.But unfortunately there were groups that opposed it. And unfortunately I say again the groups that opposed it were medical practitioners. We have these old demarcations that still exist. If we are to have a fully operating primary health team it is not a matter of who has got what; it is how you can give the best service to the patients that you are attending to. That means using all the skills—the pharmacist skills the nursing skills the nurse practitioner skills and the skills that exist in the community—to provide an excellent service to patients as close to home as possible. So I still think we have got some battles to go through in terms of that old demarcation. We do support this bill. I see it is supposed to be passed by December. In the Health Committee I can assure you that the Labour Opposition will be ensuring it is passed by December.