Hague KevinKEVIN HAGUE (Green): It is a pleasure to rise to speak in this debate. It was such a long time ago that the Health Committee heard submissions on this bill that I had to refresh my mind on its content and on the submissions we received.The way I like to begin second reading speeches is to thank the officials who assisted the select committee and thank the submitters on the bill. The submitters on this particular bill made a very positive contribution indeed. They mainly came from the professional groups that will be affected by the bill and most of the submissions were of quite a technical nature. I think it is fair to say that as reported back from the select committee most of the professional groups that did submit on the bill will be pleased to see the changes being made. Perhaps the medical groups will be somewhat less pleased as in general they prefer to see no change but I am sure that in time they will come to understand that these changes have been positive for their practice as well.The health budget is inevitably constrained. No matter how much of the tax take gets put into the health budget there will always be extra needs that could have been met had there only been some more resourcing so there is a deep imperative on the Government and on this House to ensure that the resources that we have available to the health sector are used as efficiently as they can be. This bill relates specifically to the resource that is the health professionals but the same principle applies to the physical resources. Are we using operating theatres as efficiently as we could be? The answer is no in fact—we could do better in that. Are we using the dollars as efficiently as we could be? We actually do not know because the only part of the system that we actually do cost-benefit analysis on is the pharmaceutical side. If we had an extra dollar to put into health we do not actually know whether it would be better to put that into pharmaceuticals or into other interventions. So in those areas we could do a lot better at improving the efficiency of our resource use in health.But this bill in relation to health professionals certainly does result in better utilisation of the health professionals whom we have available. The legislation before us and the professional rules that apply to health professionals place limits on the scope of practice of health professions—and that is appropriately so—but those restrictions should be only those that are reasonably justifiable on clinical grounds. They should not go further than that because if they go further than that—as the existing law does—what it means is that we will have health professionals whose time and skill we are using inefficiently. That means we will not be getting as much health gain from the skill of those health professionals as we could and should do.We select committee members have had a robust series of discussions with submitters and amongst ourselves to test the changes that were proposed in the bill as introduced. We have made a number of changes that on balance we believe make the bill a better bill. Inevitably there are judgment calls to be made and I believe that the select committee has made those calls in the right place.I want to conclude by referring to my own experience as chief executive of the West Coast District Health Board because I believe it illustrates the pressing need for this reform. I note that nursing organisations for example have been clamouring for urgent reform of precisely these rules in legislation because we have nurses in particular unable to practise to the full extent of their skill and knowledge because of arbitrary and inappropriate rules in our legislation. So I am sure they will welcome this bill being taken to the next step.In an area like the West Coast—pretty much as Barbara Kuriger has spoken about in relation to Taranaki and King Country—many many people receive their primary healthcare from nurses and those rural nurse specialists do an absolutely fantastic job. I well remember one of my visits to a rural nursing clinic to follow up on what actually happens on the day that the doctor comes to visit—because the nursing service is supported by a general practitioner who visits. Actually that general practitioner's time is principally spent signing forms to essentially certify as correct the practice that the nurses had already put into place. So all of the expertise and skill in providing healthcare for patients had been delivered by nurses and the doctor who presumably and certainly does have expertise and skill in areas that the nurse does not have was unable to apply that expertise and skill because all of the doctor's time had to be spent in needless form-filling required by our current law.Actually moving beyond that arbitrary and inappropriate restriction on nursing practice will ensure that the nurse is able to provide a full service to the extent of the nurse's capability but also that we get to use the doctor's time more appropriately—a better health gain all around which surely ought to be the driving principle behind all of our work in relation to health. I commend the bill to the House.