Health Practitioners Competence Assurance Bill — In Committee 
Health Practitioners Competence Assurance Bill — In Committee 
[Volume:611;Page:8135] 
Health Practitioners Competence Assurance Bill 
In Committee 
Debate resumed from 26 August. 
Part 4 Complaints and discipline 
Dr PAUL HUTCHISON (NZ National—Port Waikato) 
: 
 This part of the bill focusing on complaints and discipline is very important. After all it has caused national tension over the last 10 to 20 years and a considerable amount of heartache when one goes back to the National Women’s Hospital cervical cancer inquiry the cancer inquiry at Gisborne and of course more recently the Parry inquiry. Coming out of all of those was the Cull report. Certainly one of the great concerns was that even though we had had those tragedies in New Zealand it seemed as though we were unable to learn from the mistakes of history. Helen Cull QC brought together a lot of the great problems that were occurring through a lack of connection between organisations such as the district health boards the various colleges and the Accident Compensation Corporation. Incidents were happening that were severe but no one was aware of the records being collated independently and Helen Cull quite rightly suggested that a one-stop shop should be the approach towards the legislation. Whereas I have criticised a considerable part of this bill and will continue to do so I think that on the whole it has tended to come right in terms of the recommendations of the Cull report. 
There is no doubt however that National’s contribution to getting this part right was in no small way due to the contributions of Dr Lynda Scott and my colleague Judith Collins in the select committee. The processes provided by the bill are a very big jump from the way the old disciplinary and complaints procedures were held when there were huge complaints by patients and various health practitioners that there were long delays. The whole aim of this part is to try to speed up the processes so they are fair efficient and coherent and in many respects this part on the whole has managed to achieve that. There are some worries that some of the smaller organisations will find the compliance costs associated with the requirements considerably difficult but overall because the larger organisations such as the Nurses Organisation the medical practitioners’ organisations and the dental groups have sufficient numbers their organisations are sufficient to be able to cope with the costs implied in the bill. 
When we get to clause 77 “Recommendations and determinations of professional conduct committee” it is important we remember the tribunal’s recommendation that the role of the professional conduct committee should be to ascertain whether there is sufficient evidence to justify the bringing of a charge against a practitioner before the tribunal. Clearly that is a very important issue. 
Hon GEORGINA TE HEUHEU (NZ National) 
: 
 My honourable colleague Dr Hutchison opened the debate on Part 4 “Complaints and discipline” and I am very mindful of the comments he made. Clearly this is a very important part and it behoves this Parliament given the inquiries that sit in the background of this legislation—starting with the Cartwright inquiry then the Gisborne inquiry and the Parry inquiry—to ensure that we get these provisions as good as we can get them. We do not want to see in the future more of the same that we have had in the past. 
I am mindful that my colleague Dr Hutchison is of the view that by and large this part seems to be reasonable but having said that I want to make some comments about two parts of it. The first comment is that the bill establishes a single disciplinary tribunal the Health Practitioners Disciplinary Tribunal to hear complaints against health practitioners that warrant significant disciplinary action. I want to make the point that this tribunal will be made up of ministerial appointees. In other words there is no provision for the profession to elect their own to judge them and I would query that very seriously. I ask the Minister to explain why we have gone almost from one end of the spectrum to the other. I think I am right in saying that previously there was a high degree of professional representation on the tribunal but now there is to be none. We will be subject to the Minister making all the appointments. That in itself I do not think is ever a good thing because there is always the fear of politicisation of the process. 
But it raises the other issue of there being very little degree of self-regulation. The people in the health sector after all are all professionals. A degree of self-regulation in a respectful and supportive environment is surely more likely to ensure competence—which is at the heart of this legislation—than a process that is prescriptive and that has the Minister’s hands on it. So I think that is to be regretted. There comes a time when we have to give due regard to people who are professionals. They owe it to themselves to make sure they do not bring their profession into disrepute and therefore they can be trusted with a degree of confidence to make sure they behave in ways that bring benefit to them. They know very well why they are in those professions. They have the well-being and the safety of human beings in their hands. 
The power of the Minister is the first point I wanted to raise as something I think we ought to be concerned about. The Minister also has the power under clause 83 to dismiss tribunal members at will. There again I think that that places too much power in the hands of one person and for no good reason. Other than that I suppose it is a feature of this Government that it tries to hold power at the centre but that does not always work with professionals. The other point concerns representation for the sector and its members’ own ability to self-regulate to ensure competence. 
JILL PETTIS (Junior Whip—NZ Labour) 
: 
 I move  
That the question be now put 
. 
HEATHER ROY (ACT NZ) 
: 
 As we have just heard Part 4 deals with complaints and discipline. I think it is very important to have some background information and some of the other speakers have touched on this. The complaints process to date has been far from adequate. In fact in some cases it has been quite shocking. Patients who have very valid complaints have waited months and in some cases even years to have their complaints heard and that has been unsatisfactory for everyone. Not only does the person making the complaint have to suffer and wait for long periods of time but also the health professional at the other end of the complaint has a long wait. 
Of course there are always a number of vexatious complaints and these are never easy. People who think they have been wronged are looking for somebody to take the blame. The health practitioner at the other end of it also often has to wait months and sometimes years to have a case heard—even when it is a very simple matter—so that it can be dismissed. 
I think it is fair to say that the Health Committee had a lot of discussion about this part. We received several very good submissions. In particular I would like to refer to the submissions from the Health and Disability Commissioner and from Wendy Brandon of the Law Society and also to the submissions from the professions themselves. I think that at the end of that process this part of the bill was the part that probably the whole committee was reasonably content with. We heard from the previous speaker that the Minister of Health still has great powers but the provisions we now see in this bill are much better than what we have had previously. Complaints will now all go through the Office of the Health and Disability Commissioner and it will be more like a one-stop shop than what we have had previously. 
Doctors are the ones about whom the most complaints are received. The complaints mostly go to the Health and Disability Commissioner but any complaint dating back before 1996 goes to the professional bodies to be referred on to complaints investigation committees. Those committees will now be replaced by professional conduct committees. The select committee had a lot of discussion about the make-up of these committees and came to what I regard as a very satisfactory decision. When a complaint is made against a health professional a majority of that person’s peers will be on the conduct committee. Certainly Wendy Brandon from the Law Society was adamant that that should happen and the professions were adamant that that should happen. Some of the lobby groups were a little disappointed but I think that in the final instance they will be reasonably satisfied with that result once they see how it works. 
There was a lot of discussion about compliance costs particularly for the smaller professions—the people who do not earn a lot. I think those concerns were listened to and addressed well by the officials. I felt they did a particularly good job in that regard and I think the outcome will be very good. The compliance costs have been partly allayed by the fact that the secretariat from each of the professions individually will run the complaints system. It will do the administration for each one and that should see a drop in compliance costs. 
We do have to take complaints and discipline very seriously. The professions do need to be transparent. As we know this bill is about competence despite my concerns that competence was not able to be defined in the bill because everybody felt it was too hard. I think that a level of competence is very important and I think we should have tried harder to define competence but the professions will manage to do it for themselves. I am pleased that professional self-regulation will be there even if it is not the intention of the Government. 
The new one-stop shop will I believe be much better for the complaints system than the one we presently have. The time that people have to wait to have their complaints heard should be significantly less. Despite the fact that the work of the Office of the Health and Disability Commissioner will increase the commissioner seems to think he will be able to cope. I am sure there will be a good outcome for everybody. I think the amount of pressure that somebody is under when a complaints process is in train is often underestimated. The waiting is the hard part. 
Hon ANNETTE KING (Minister of Health) 
: 
 Can I first of all say that I agree with the member who has just spoken in terms of her comments on this part but I say to her that professional self-regulation with responsibility towards the public is the Government’s aim and I think this part certainly encompasses that. 
The point the member made regarding all complaints going to the Office of the Health and Disability Commissioner came out of the Cull inquiry. John Carter would be interested because the inquiry arose out of the Parry case involving Colleen Poutsma and the need to ensure that there was one place where complaints could go. There was something like 14 complaints running against Dr Parry and many of those organisations that had complaints laid before them did not know that other organisations also had complaints. So I think what has been put in place here is very sensible. 
I really wanted only a short call to answer Georgina te Heuheu regarding the appointments to the Health Practitioners Disciplinary Tribunal and to tell her that Part 4 is exactly the same as what is in the Medical Practitioners Act. In other words the members are appointed by the chairperson of the tribunal from a panel maintained by the Minister. When the member was a Minister she was probably one of those who were responsible for this part. None of the tribunal members are elected under the Act and obviously the majority of them are health practitioners. This also applies to the questions asked last night by the member for Whangarei. I want to assure those members that this part is a transfer from the Medical Practitioners Act to the new Health Practitioners Competence Assurance Act. 
BARBARA STEWART (NZ First) 
: 
 I thank the Chair for the opportunity to participate in this part of the debate. I will take only a short call. Part 4 focuses on complaints and discipline and it is a lengthy part. We believe that a complaints and disciplinary procedure is always needed and we support this part. This part is clearly set out. It is very comprehensive and we believe like the previous speaker Heather Roy that it will be very difficult for any disciplinary tribunal to be confused. We believe that professional self-regulation is a key factor in the success of this part particularly if one has the confidence of the public in mind. One of the concerns we did have was the apparent powers of the Minister of Health—any Minister of Health—but that has more than likely been the case in previous situations anyway so it did not really cause us a great deal of concern. There does appear to be though a lot of room for influence by the various Governments of the day but we accept that that is part of the playing field anyway. We definitely support the Health Practitioners Disciplinary Tribunal comprising a majority of health practitioners because they do have the clinical knowledge and expertise to make a judgment on any charges that are brought forward and we think that is absolutely essential. 
JUDITH COLLINS (NZ National—Clevedon) 
: 
 In relation to this particular complaints-processing part of the bill the Health Committee I felt really tried hard to get a good consensus view. I was very impressed by the contributions of all members of the committee in trying to reach a sensible workable solution that would work well not only for the public but also for the health professionals and those accused of misconduct. We had some concerns however and we noted those in the minority report—a quite substantial minority report. 
In particular we were concerned that insufficient weight had been given by the balance of the committee to the submission from Wendy Brandon who was representing the New Zealand Law Society. She was also there in her own right as the former chair of the Medical Practitioners Disciplinary Tribunal. She is a person with 6 years’ experience in this particular area who is known to me as a very sensible level-headed person who is not only a lawyer but used to be a nurse and so brings a new perspective to this area. 
One of the concerns that Mrs Brandon had was that there should be two levels of charges before the disciplinary tribunal. That issue was of concern to us in the National Party and also to ACT—that under this bill the severity of the offence makes no difference to the naming of the charge. In other words a doctor who rapes his patient will be charged under this particular bill—obviously outside the criminal area—with exactly the same charge as someone who makes an error in judgment. The National Party is very concerned because there is a huge difference in reality between levels of misconduct. What we are talking about here is just one size fits all. One of the problems with this bill which we have spoken extensively on in the last 2 days is that it is trying to do too much and to say that everyone is just the same. Well no everyone is not the same. I think the patients of the former Dr Fahey would feel somewhat aggrieved that he could be charged and found guilty of professional misconduct in the same way as a doctor who made an error but certainly was not a serial rapist. So that is one of our concerns with this bill. 
We are of course always concerned about the level of political appointment to bodies such as the tribunal. We were however very pleased that common sense dictated that the tribunal will comprise three professional peers of the person accused and two laypersons one being the chairperson of the tribunal. I think that is a very sensible solution. Some groups of people representing patients or former complainants felt that there should be only one professional peer on the tribunal or none. Some wanted no lawyers involved which I thought was quite interesting from a natural justice point of view. They really showed unfortunately that they are somewhat one-sided and one-eyed occasionally in these matters. It is very very important that any disciplinary process has the support of the professionals it deals with—the health practitioners—because without the support of the professions it will not succeed and that is very very clear. The medical professionals or health practitioners involved in these tribunal hearings must feel they are being dealt with fairly. 
Certainly my own experience through the Law Society working on the complaints committees has been that the professional peers are almost always harder and tougher on the person complained about than the laypeople are. Laypeople tend to have a much kinder and much more understanding view of mistakes and errors. 
Hon JOHN TAMIHERE (Minister of Youth Affairs) 
: 
 I move  
That the question be now put 
. 
A party vote was called for on the question  
That the question be now put. 
Ayes 69 
Labour 52; Green Party 9; United Future 8. 
Noes 46 
New Zealand National 27; New Zealand First 13; ACT New Zealand 6. 
Motion agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to insert new subclause (b)(viiia) in clause 64 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 46 
New Zealand National 27; New Zealand First 13; ACT New Zealand 6. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to insert new subclause (2)(a)(viiia) in clause 95 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 46 
New Zealand National 27; New Zealand First 13; ACT New Zealand 6. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 118 in the name of the Hon Annette King be agreed to. 
A party vote was called for on the question  
That the amendments be agreed to. 
Ayes 82 
Labour 52; New Zealand First 13; Green Party 9; United Future 8. 
Noes 33 
New Zealand National 27; ACT New Zealand 6. 
Amendments agreed to. 
A party vote was called for on the question  
That Part 4 as amended be agreed to. 
Ayes 82 
Labour 52; New Zealand First 13; Green Party 9; United Future 8. 
Noes 33 
New Zealand National 27; ACT New Zealand 6. 
Part 4 as amended agreed to. 
Part 5 Appeals 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 Part 5 deals with appeals to the District Court and the High Court and I think that we will see the concept of scopes of practice really being tested out in courts of law. A person has the right of appeal against a decision made by an authority to decline or suspend that person’s practising certificate or include conditions in that person’s scope or proposed scope of practice. It may be that foreign doctors in this country may appeal and challenge a judgment over scopes of practice and a person’s right to practice within a particular scope. It will come down to the definition of what an individual can do. We heard about Dr Monty Hornbeck. If one were to say that he could practise in a limited scope or try to deny him practice if he appealed that then he could look at grounds for denying him a limited scope or not denying him that scope but allowing a broader scope. This is where we will find that people will test the concepts. It will probably take some years before there is case law that will really define and differentiate where the grounds of that new term lie. 
The terms we heard used about scopes of practice were “leading” “cutting edge” and one that was used under the Resource Management Act: “permissive”.There was a similar sort of permissiveness there about scopes of practice in that we will find how it works when we look at people challenging a decision through the District Court. I bring up the situation in Opotiki at the moment where nurses who are running the local health centre hospital have become quite concerned that they do not have medical cover. That happened on the West Coast as well. Because they had a real lack of locum relief practice nurses were doing first-line call in the weekends. If we are to look at people practising within their scopes of practice—and they can be taken to the disciplinary tribunal if they practise outside their scope—what will happen to the nurses on the West Coast and in Opotiki who feel that basically they are being made to practise outside what would be a safe scope of practice because there are no doctors there? There are 10000 people in Opotiki with no after-hours doctor service. Nurses are on the front line and some of them are expressing concern—just as the nurses down on the West Coast did—that they are being asked to practise outside of what would be their normal scope of practice. They are having to develop diagnostic skills that they feel very concerned about because they do not have the back-up. Nurses on the West Coast pulled out of doing the after-hours roster. They did not feel that they wished to be placed in that sort of position. 
We have heard a lot from the Minister in recent times about the development of nurse practitioners. There is no problem with developing a nurse-practitioner concept so long as they can still practise within the bounds of their training. With scopes of practice we do not want to see our medical and nursing systems being downgraded so that there is a lower level of ability especially in rural areas to develop and provide services. 
Under the bill people who do practise outside their scope are really putting themselves on the line. However People practise outside their scopes every day in this country. It will be interesting to see how that works under the appeal situation. If the system is such that people are pushed to work in that way who will get the blame? It is always the nurse and doctor on the front line who end up before the disciplinary tribunal and who have to take the rap. Eventually they are the ones who will appeal and use Part 5 through the appeals process. 
Hon ANNETTE KING (Minister of Health) 
: 
 I totally agree with the member who has just resumed her seat that no one should practise outside his or her scope of practice. The member said that it happens every day now and she wondered what would happen in the future. Although this part does not deal with scopes of practice it is important that the Medical Council the Nursing Council and the councils that govern most of our health professionals have worked out and have been working out what those scopes of practice are so there can be no confusion as to what a person is being asked to do. No council should allow health practitioners whether they are doctors or nurses to work outside their scope of practice. But how does one know what his or her scope of practice is unless that council has a very clear idea? That was one of the issues that was debated earlier. The Medical Council and the Nursing Council have a very clear idea of what those scopes of practice are. They have worked very hard on scopes of practice. Many of the other professions that come under this bill have also worked hard on those. 
However this part is about appeals and the member raised the issue that courts of law would be used to make decisions. I am sure that the Medical Council told the member that when it met me it said that often it is before the courts right now. The council goes before the court when there is a disagreement by a health practitioner who believes that it has not made the right decision. In fact at this very moment there is an overseas doctor—a surgeon I believe—before the courts. It is common practice. What the courts do—and what the Medical Council believes will continue to happen—is listen to the practice of the Medical Council and what is the practice of the council that is responsible for the registration and competency of its health practitioners. They listen to the Medical Council and that has been the case for many years. Members of the Medical Council told me they have no doubt that that is what will continue in the future. 
JUDITH COLLINS (NZ National—Clevedon) 
: 
 I thank the Minister for taking a call because she is certainly taking the odd call on these issues. I am disappointed that we have not yet heard from the chairperson of the Health Committee Steve Chadwick who I do not think has taken a call on this bill in the entire time that we have been debating it in the last 2 days apart from closure motions. 
Having said that I think it is a good point that we have at least an appeal process as opposed to a review process of the decisions of the tribunal and the authority. An appeal process is one in which it is easier for a person complaining or appealing to actually bring a case. Quite often in these sorts of matters in the past we have had judicial reviews of decisions. They are extremely expensive and it is very very difficult to bring about a change of opinion. I am supportive of an appeal rather than simply a judicial review. I think that is a very good point. 
Having said that I point out that a significant amount of this part of the bill does in contradiction to what the Minister has just said deal with the fact that there will be appeals against findings of scopes of practice. It is all very well for the Minister to say that the courts do try to look at the current procedures of the tribunal that they are looking at in the decisions. However the tribunals we are talking about here are brand-new. This is a brand-new tribunal that we are looking at in terms of its processes in terms of its composition and in terms of the many different health practitioners that it is going to be regulating and looking at. That is one of the issues here. It is going to be quite some time before we get any case law. That will lead to a lot of uncertainty and cost. That is a concern. 
This whole process is going to be by way of appeal far more inclined towards courts and court processes and therefore towards lawyers and legal processes. There has been again a tremendous amount of concern from people like dental therapists as to the amount of costs that might come to bear upon their particular professions. Several smaller professional groups are concerned that although they are very seldom complained about they will end up having to bear the cost of the professions that are the subject of most complaint—in other words the frontline people who are having to make life-and-death decisions. That is a concern and it is a facet of a one-stop shop which this bill is all about. I would have thought that the Minister would listen to the advice of these groups who are people trying to do the right thing and wanting to be properly regulated but who are also very concerned that they are often on relatively low salaries and working in schools and other places where they do not earn huge amounts of money. They are concerned about those particular costs. 
Steve Chadwick 
: The committee listened. 
JUDITH COLLINS 
: It is nice to hear that the chairperson of the Health Committee can actually speak as she is now doing. It would be very very nice if she could take a call and speak to this particular bill. 
Phil Heatley 
: Say something constructive. 
JUDITH COLLINS 
: Something constructive would in fact be very good thank you Mr Heatley. In many ways we are pleased with some of this particular part of the bill but in other ways we are concerned along with our ACT colleague that not enough consideration is given to the practicalities. There is a tremendous amount of consideration given to the theory but as is often the case with the Labour minority Government there is a lot of effort put into the theory and very little effort put into the practicalities. The Government is being driven by particular groups that have its ear more than other groups do. That is a real concern. This part of the bill and the bill itself is going to be a particular bonus to the legal profession. It will be a bonus to the court system. I am concerned that there will not be enough room in the court calendar for it. It will take a long time. 
HEATHER ROY (ACT NZ) 
: 
 I want to address scopes of practice briefly—although that issue is not really part of this part but as the Minister addressed it I think I can probably say a little on it. The National Party member Dr Lynda Scott talked about the nurses in Opotiki in particular but it was indicative of other parts of the country where people are working in crisis situations outside what will become their scopes of practice. 
The Minister says that that is not acceptable but the point remains that those nurses are doing it out of a sense of duty and out of necessity because there is nobody else at the coalface able to deal with the public when they have medical problems. If they are not going to be allowed to do anything at all that will leave areas of the country with no medical staff at all to deal with problems. 
When something goes wrong of course somebody always has to be found to blame and that is where these things may well go to appeal as Dr Scott pointed out. I will not go down that track any longer because I think she has said everything there was to say about the matter. 
Judith Collins 
: It’s worth saying again. 
HEATHER ROY 
: I could say it again but I have other things to address so I will go ahead and do that. My concern with Part 5 is in relation to clause 106 “Court may refer matter back for reconsideration”. We have already heard that when a complaint process is in train it is often a very lengthy matter. [ 
Interruption 
] Perhaps members opposite might like to take a call instead of just shouting across the benches at each other if they have something productive to say. Obviously they do not have; they have quietened down again. 
Pita Paraone 
: It’s those Maori members. 
HEATHER ROY 
: That is right—they are very noisy. My concern about clause 106 “Court may refer matter back for reconsideration” is that it will draw this whole process out and make it very lengthy indeed. The good part about Part 4 as I said before is that hopefully the amount of time that the complaints process takes will go down significantly. In relation to the cases taken to the professional conduct committee after they have been referred on from the Health and Disability Commissioner if somebody is unhappy with the outcome it can then be taken on through the court process. As Judith Collins pointed out lawyers are the ones who will benefit from that as there is often a lot of significant cost involved. The matter can then go the courts and instead of making a determination themselves which in most cases reiterates the findings of the complaints investigation committees which will be replaced with the professional conduct committees clause 106(1) states: “Instead of determining an appeal under this Part the appropriate court may direct the authority or Tribunal whose decision or order is appealed against to reconsider”—so it can then be referred back. 
It may be the start of something just going round and round in circles making the whole process very time consuming and putting a burden on people when we are trying to get rid of that burden. The patient will be left with an unsatisfactory result or the heath practitioner will be. Hopefully vexatious complaints will be out of the system by then. However patients who are really not satisfied with a ruling that has been made are able to draw the process out significantly. 
We know that the professions are hardest on their own. We see it time and time again within the health practitioners tribunal particularly in relation to nurses. Nurses are particularly hard on their own and I have sometimes been staggered at the rulings that have been made. The majority of nurses on the tribunal have made particularly hard decisions against their own profession. Doctors too often do that as do dentists and pharmacists. As they are the professions that have the greatest number of complaints that is where we would expect to see that but that being the case going on through the appeal process then perhaps having the courts refer the matter back to the committees is in some cases asking for a great deal of trouble. 
 The National Party member Judith Collins also mentioned that the practicalities seem to have been overlooked here. A great deal of thought and input is being given to the theory but I wonder just how much input has gone into the practicalities. She is quite right when she says that the tribunals are new. The appeal processes are going to be looking at new and perhaps unresolved problems which are always difficult to anticipate when looking at new legislation. I support my colleagues in the National Party when they talk about whether the practicalities have been looked at. 
Hon GEORGINA TE HEUHEU (NZ National) 
: 
 Part 5 sets up an appeals process and like my colleague Judith Collins I think it is probably appropriate in this context particularly when in a sense we are embarking on quite a new area of policy. We would not want to see the process becoming overused because then that would indicate a failure in the policy. We are dealing with people’s rights to register and practise as health practitioners in a field where everyone is a professional and if for some reason somebody is declined from registering with an authority then it is only proper that we should have an appeals process. 
We have rights of appeal to the District Court in relation to decisions on the directions of any of the authorities that come into play under this new legislation. We also have an appeal process to the High Court against the whole or any part of findings or orders made by the Health Practitioners Disciplinary Tribunal. Under clause 109 there is also provision for an appeal on questions of law. If the appeal is from the District Court then the question of law must be referred to the High Court and if the appeal is from the High Court then it must be referred to the Court of Appeal. The tiered structure of the various courts is there and I hope that the process will not become a field of activism for lawyers because nobody wins other than the lawyers quite a lot of the time—and I am happy to say that even though law is my background. What we want is legislation that is working well to protect the health and safety of the public. If we are to have people constantly appealing or questioning decisions made by an authority or the tribunal then this House will not have reason to be proud of itself when this bill goes through. 
I will pick up the issue of scopes of practice. I was thankful that the Minister stood up at the beginning and gave some reassurance that scopes of practice have been worked out by each of the sectors in this area because under clause 101 there is a provision for appeal where an authority declines to authorise a change to the existing scope of practice of a health practitioner. I have been trying to work out what sort of situation that might apply to; I do not think the Minister covered that in her opening remarks and that causes some worry for me because if scopes of practice were a notion that could be clearly worked out and understood then why would there be a situation in which practitioners would be seeking to change an existing scope of practice? 
Hon Annette King 
: They might be too old to continue in that scope of practice. They might decide they can’t do it any more. 
Hon GEORGINA TE HEUHEU 
: OK. There we go: it is very important that that provision is here. It is to ensure ongoing competence. [ 
Interruption 
] Whatever—whether it is age or anything else. I wonder whether it might have applied to Dr Bottrill. In any event although I am supportive of this part of the bill and of the appeals process I do have a minor worry in that I do not want it to become a plucking-field for the legal profession. It is proper that the appeals process is included in the bill. I support it. 
STEVE CHADWICK (NZ Labour—Rotorua) 
: 
 I move  
That the question be now put 
. 
PITA PARAONE (NZ First) 
: 
 I want to take a short call on this. I am really pleased that two of the Maori members of the Government are here in the Committee though I wonder whether their presence has anything to do with a possible amendment relating to which courts health professionals may take their case. Could it be the Maori Land Court? That seems to be a topic of discussion at the moment. [ 
Interruption 
] Never mind; we will just wait and see. 
First of all my concern with this part is in relation to the likely cost. I think that the processes that are required by both the High Court and the District Court will certainly impose some costs on the health professionals who want to take their case to that level. My major concern is that we have a saying here in our country that we are judged by our peers so I seek some clarification in terms of where the basis for the appeal or the court action is in relation to the vocation of the individual—I want to know whether that is in question. Will those who sit in judgment have the vocational skills to be able to judge? In saying that I am not being critical of our judiciary system; I am talking about a sense of fairness and of being judged by our peers. 
We heard one or two examples about foreign medical practitioners in particular who may not be approved by their peers to practise in this country and who may argue for their right to practise on the basis of their professional competency. Will those who sit in the court have the skill to make that kind of a decision? Will the practitioner go away feeling that he or she has had a fair go at this? Given that that may not happen there is the possibility that the matter may get referred back to the group that gave rise to the original appeal. In my mind that will not only prolong the process but it will add costs. I just wanted to make those two points about being judged by one’s peers and about the costs that will be incurred not only by the appellant himself or herself but by the system in terms of money and the allocation of resources. 
DAVID BENSON-POPE (Senior Whip—NZ Labour) 
: 
 I move  
That the question be now put 
. 
A party vote was called for on the question  
That the question be now put. 
Ayes 69 
Labour 52; Green Party 9; United Future 8. 
Noes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Motion agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 118 in the name of Hon Annette King to clauses 101 and 102 be agreed to. 
A party vote was called for on the question  
That the amendments be agreed to. 
Ayes 69 
Labour 52; Green Party 9; United Future 8. 
Noes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Amendments agreed to. 
A party vote was called for on the question  
That Part 5 as amended be agreed to. 
Ayes 69 
Labour 52; Green Party 9; United Future 8. 
Noes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Part 5 as amended agreed to. 
Clause 6 Structures and administration 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 Part 6 “Structures and administration” really gets to the heart of why National will be voting against this bill. One of the issues of immense concern is the power of the Minister under this legislation. It comes down to a fundamental question about whether professions can self-regulate. We either trust them or we do not. Submission after submission expressed concern about the powers of the Minister to appoint to the authorities and determine any dispute over overlapping scopes of practice. If there were a dispute between nurse-anaesthetists and medical-anaesthetists the Minister would have the final say. There was dispute because people felt there would be a major decrease in professionalism and that the professions would be disenfranchised. The Health Committee received submission after submission on that. 
The New Zealand Medical Association commented on the low morale in the medical profession and amongst primary-care groups today and it felt that this bill would make that so much worse. It said that self-regulation is a cornerstone of safe practice and that each group of health professionals must be able to elect its professional body. They have been doing that for a long time and they wanted that to continue. Members should compare that with what some of the officials were saying which was that they felt that the Minister “must be able to appoint because you’re not going to get the right people otherwise”. I think that gives a very clear indication of a feeling that there is political interference in the process and that is one of the major concerns. 
We heard from the Royal Australasian College of Physicians the Royal New Zealand College of General Practitioners and the Royal Australasian College of Surgeons about ministerial powers and about their concerns of decreased professionalism. They certainly wanted a majority of elected people and they did not want scopes of practice to be decided by the Minister. We debated that at length in the select committee after hearing all the submissions. We debated clause 123 “Disputes about overlapping scopes of practice” and clause 124 “Minister may give directions to resolve dispute”. In the end by majority we came up with a new subclause (2A) which states: “A direction under subsection (2) may without limitation require each authority to co-operate with a panel of experts”—we could not get much further as the Minister will still appoint that panel of experts—“and may also require each authority to be guided by or (as the notice may state) to implement any recommendations of the panel concerning the dispute.” At least we got into the bill a provision whereby there would be a panel of experts that would have some ability to direct the Minister about overlapping scopes of practice. We have not seen before in New Zealand the situation whereby the Minister was able to say that one group may practise one way and another group another way. 
There was an immense concern about the Minister being able to resolve disputes in any way he or she sees fit. Clause 123(3) states: “The Minister may assist the authorities to resolve their disputes in any way the Minister sees fit” and that all he or she has to do is write to the authorities and tell them how to direct their lives. The medical profession is up in arms about that because its members see this as a huge interference by the Minister and the ministerial powers given by that provision really do reduce the professionalism in the system. The clause continues: “including without limitation by advising each authority in writing of 1 or more options for resolving the dispute”. So the Minister has an absolute hands-on approach in determining how different professions will be able to work it out between themselves. That is pretty new to New Zealand and there was real concern that it will reduce professionalism self-regulation and the professions being able to determine amongst themselves how they practise in this country. If we think about how people do practise then we will see there is major overlap in scopes already. 
Hon ANNETTE KING (Minister of Health) 
: 
 When the member began her contribution on Part 6 of the Health Practitioners Competence Assurance Bill she raised the issue of disputes around scopes of practice the powers that the Minister would have how the Minister would be interfering and how that would not be wanted. I want to relay to the Committee that just a few months ago members of the Australian and New Zealand College of Anaesthetists came to me to ask whether I would be able to intervene in a dispute they were having with the Nursing Council over a proposal that nurses would look at a perioperative scope of practice in anaesthetics. They asked if I could help them to overcome that problem and bring them together with the Nursing Council. I told them that they needed to go away and talk to each other. One needs someone to intervene only when one cannot make a decision. 
That is the environment we have now. We have a Nursing Council that is working on a number of issues around scopes of practice. Certainly a perioperative nurse scope of practice is very much on the modern agenda. I have no problems with that so long as it is within the competency of a nurse to be able to do that and that the nurse is trained and has the proper qualifications—the same as a doctor wanting a particular scope of practice. But when it comes to a dispute there has to be a mechanism. I think the lawyers would understand that. If there is a dispute—and they do occur have occurred and are occurring—there needs to be a mechanism to resolve that dispute. One could take them all to court and I am sure Pita Paraone would be worried if everything ended up in court when there was a dispute. 
What has been put in this bill is a provision that as a last resort people can go somewhere for resolution. The Minister has the opportunity to work with a panel of experts who will provide him or her with help. Because of the Acts Ministers of Health work under they receive advice on and are often asked to make decisions on all sorts of things that they have not been involved in in their other lives. What has been put in this part of the legislation is a mechanism that provides that whenever there is a dispute that requires consultation and a process at the end of the day a Minister—whoever that Minister is—will listen to those who have the expertise. Certainly this Minister will. I cannot guarantee that if she were the Minister Dr Scott would do so but certainly I would listen to expertise. 
When we get to the issue of whether there should be elected members then there is a provision in the bill and some future Minister may decide that there will be elections. I have said over and over again: who is this bill for? It is for the safety of the public. When this bill was brought in it had the same number of lay people and professionals. Health professionals are actually in the majority on the bodies and a majority of health professionals makes the decisions. They are doctors or nurses and not just people dragged off the street—the majority are the health professionals themselves. In my view what is needed is a statutory process that is transparent and open which shows who has been appointed and why. 
The member talked about political interference. I have had the experience—and I am sure Georgina te Heuheu has had the experience—of appointing people to those councils. After all only three have elected members—I think the other eight do not—so I am sure that Georgina te Heuheu would have appointed people to the podiatry board the physiotherapy board etc. I guarantee she did not look at the appointments in a political light. The nominations that come in to me are from the organisations and I make the appointments. I do not wonder whether they are members of the Labour electorate committee or have another political connection. 
What have come in to me from those professional bodies have been their professional nominations and I make the appointments in a transparent process. Everybody knows that I have appointed those people because my name is on the document. I believe that gives the public some certainty that this is an open transparent process. At the same time it gives the profession self-regulation. After all the people who are appointed are their own members. 
PHIL HEATLEY (NZ National—Whangarei) 
: 
 What members will gather from that tirade is not only the concern the Minister has in defending this legislation but a recognition from her that one can hide the flaws of poor legislation for only so long before they eventually come to the fore and everyone recognises the legislation for what it is. That is why the Minister acknowledged during the debate on Part 5 that appeals before the District Court and the High Court were more likely to happen under the new legislation than under the current legislation. Members will recall that there are rights of appeal against any decision to decline or register a person as a health practitioner to decline to issue a practising certificate to cancel registration with the authority and on it goes. Scopes of practice were discussed there as well. It is acknowledged that this bill will lead to more appeals in both those courts and that litigation is much more probable. 
So we come to Part 6 which talks about structures and administration. Throughout this legislation we have seen the Minister decide that she will have more fingers in the pie more political appointments and more influence over the process. The importance of clinical safety and the safety of those suffering ill health have been put down the scale of importance. Previously professional groups set their own codes of ethics. That is what happened in the past and that is part of being in a profession. All of those professions we have discussed—pharmacists midwives osteopaths GPs surgeons or whatever—set their own codes of ethics. However this bill proposes that the relevant authorities will now set those codes of ethics. Not only that those sitting on the relevant authorities will be appointed by this Minister and they will set the codes of ethics. I would argue that the Minister should have an arm’s-length relationship with those authorities and that certainly will not happen if she appoints her Labour Party cronies as they retire or get kicked out of their seats in 2005. That is a concern for me. 
I see that clause 110(1) sets up the Dental Council. Clause 110(2) “establishes a body corporate as the authority appointed in respect of the profession of midwifery;” and that authority will be known as the Midwifery Council. We will see an Osteopathic Council set up as well and in respect of the profession of pharmacy we will see an authority known as the Pharmacy Council. All of those will be political appointments by the Minister who may or may not ask those professions for recommendations. She might decide that David Benson-Pope would be best sitting on an authority when they put him out to pasture and that is a concern to me and many New Zealanders. 
It is inappropriate to have this function performed by a statutory body whether or not—I have to add—it is politically appointed. It will be politically appointed but regardless professional groups should set their own codes of ethics. That is what works in other sectors so why does the Minister not accept that it can work in the health sector? These two measures destroy an important check on the power of Government. That is what is happening here—we are destroying a check on this Government. 
Hon RICHARD PREBBLE (Leader—ACT NZ) 
: 
 I had better declare an interest immediately. I am a member of a professional body—not a health body but I am a member of a professional body. [ 
Interruption 
] No no I am a lawyer so I have an interest in looking at professional bodies and how it should be done. I am interested to see that we are setting up a body that Mr Cunliffe is supporting. That member is not a professional but he clearly wants the registration of doctors done by lay people and—worse than that—done by people selected by a Minister of Health who was a dental technician— 
Hon Annette King 
: No. 
Hon RICHARD PREBBLE 
: A dental nurse then who I think has a heavy chip on her shoulder about professional dentists and doctors. 
The Minister said—and I think it is an outrageous public view for the Minister of Health to have—that she believes that there is a tendency for health practitioners to look after their own members and not take the public interest enough into account. She talks as if there were a public interest in having doctors registered who are not properly qualified. I have never met doctors who were not in favour of having the highest quality standards. Whenever I am being treated—or a member of my family or a member of the New Zealand public—I want us treated not by a quack but by someone who is professionally competent. 
Who is most likely to hold professional standards? They are the professionals themselves. The Minister may not know that but the professionals themselves will set high standards and those lay people will try to lower them. Lay people will raise politically correct notions about there not being enough women in this area or not enough ethnic minorities and they will want more women and ethnic minorities registered as health professionals. 
 But it goes further than that. When one reads the clause properly one sees that the Minister— 
Steve Chadwick 
: Have you read the bill? 
Hon RICHARD PREBBLE 
: I have read the bill and I am particularly concerned about clause 116. Subclause (2A) states that before the Minister appoints a member to an authority he or she must publish a notice that: “(i) invites organisations and individuals …” to make nominations. Presumably that could be the chairman of the Labour Party who could make a nomination in respect of who could do registrations. Subclause (4) states that the Minister may “… appoint a person who has not been elected as a member of the authority …” so we could have someone who had not been elected by his or her fellow professionals who had no standing at all but was a good friend of the Prime Minister of Annette King or just a good party supporter. We will now see that sort of politics in registration. 
I say to the Committee that I do not understand why we are putting lay people on those bodies at all. It appears to me to be a matter of political correctness. I would like the Minister to give us examples to support her public statements which I regard as a great insult to the professional bodies of New Zealand and to the doctors and surgeons of this country. I ask the Minister to say where they have been putting their members’ interests ahead of the public interest. She made that statement and she is putting this bill in front of this Parliament. Where is the evidence for it? 
Steve Chadwick 
: And we’re proud of it. 
Hon RICHARD PREBBLE 
: She is proud of the fact that her Government is denigrating doctors and health professionals and that Labour Party lackeys will be put on to those committees which will lower professional standards. That is the comment made by the Government member Steve Chadwick. She wants her name put across so that every doctor in New Zealand knows that it is her view that doctors and surgeons have been putting their own interests ahead of those of the public of New Zealand. That is an insulting statement from a Government that makes political correctness its ideology and is in no way concerned with the real interests of the public. 
I say that the Committee should reject this section and I say to the Minister that it is an insult to every doctor and surgeon in New Zealand. I cannot see how anyone can possibly believe that this bill will result in better health standards in this country. 
Hon ANNETTE KING (Minister of Health) 
: 
 It is with great pleasure that I take a call to answer Richard Prebble’s comments. He told Steve Chadwick that he had read the bill but I direct him to clause 116. We are talking about who makes up these bodies and that clause states that a majority of the members will be health professionals. They are not lay people who are dragged off the streets—old Labour Party hacks—and then put on to some council. The majority are doctors not people working down at the trade union office whom Richard Prebble does not like. The majority of members must be doctors if we are talking about doctors. 
Let me read the provision to the member. Clause 116(2) states: “… (a) a majority of members who are health practitioners; and (b) 2 laypersons if the authority has at any time 8 or fewer members; and (c) 3 laypersons if the authority has at any time 9 or more members.” Mr Prebble said today that he could add up and that only ACT can add up. I say to him that he should have another go at adding up and if he can add those numbers up to be a majority of lay people on those bodies then: “You’re a better man than I am Gunga Din!” One cannot do so. The majority of the members on those bodies are doctors nurses physiotherapists pharmacists dentists etc. 
I suppose Mr Prebble is saying that we have so many doctors who are members of the Labour Party that I will go around shoulder-tapping them and putting them on these boards. If that is true something has changed. That is not the case. In fact the member probably does not know that until 1995 all members of these bodies were appointed under the Medical Practitioners Act of the past. They were not elected and even now a minority is elected. So the majority is appointed. If Mr Prebble would like to look at the membership of those councils he would see that I have not made political appointments to any of them. Members have been appointed from their professions together with a minority of lay people and that will not change. Mr Prebble came into the Chamber wanting to make a song and dance. He did not read that clause of the bill and he got it wrong. 
He then said what an insult it was that I said health professionals were more interested in looking after themselves than their patients. I have said on many occasions before about many organisations including the Medical Association the Dental Association and the Pharmaceutical Society that there is a public perception that health professionals look after their own. I have said I do not actually believe that that is the case but there is a public perception of that. If the member does not want to believe me he may like to speak to some of those organisations. If he rings them up now they will confirm that that is exactly what I have said. I have said there is that public perception and I have to say it comes from cases like that of Dr Fahey from Christchurch. It comes from perceptions about doctors who appear to have got away with things when patients have not been listened to. Perhaps the case of Dr Bottrill is a better example of what has caused that perception as other health professionals who knew about his practice did not do anything about it. There is a perception that the medical profession looks after itself and in this part of the bill we want to have a process that is transparent. We will know whom the Minister has appointed. We will know who the people are. They will be there for us to see with no doubt about it because that gives a transparent process. 
The member may also not know that only 3 of the current 11 boards have a minority of members elected to them. The nurses’ council does not. The council that governs Mr Prebble’s sister does not have elected members. The boards are very happy with the way that the system works because it is open and transparent. People are nominated for appointment and they are appointed. So that member’s speech was about nothing. It showed a whole lot of ignorance about what is in this bill and what already exists. 
SUE KEDGLEY (Green) 
: 
 This is a very critical point I believe. Whether health professionals’ organisations should be entitled to elect some members to their governing bodies is an absolutely critical issue in this bill. The Minister talked about the situation back in 1997 when all the positions were appointments but we are not interested in 1997. We are interested in 2003 in this bill and in trying to improve the situation for the future. 
The fact of the matter is that this bill gives very wide-ranging powers to the Minister of Health over all the health professions covered by it. In particular it gives the Minister of Health the right to appoint personally up to 14 members of every single governing authority established by this legislation. If every single member of every health professionals’ organisation is appointed by the Minister those members are in a sense beholden to the Minister for their reappointment. That simple fact can act as a strong incentive to toe the line and can ultimately undermine the independence of the professions. We have seen that situation with the chief executives of the district health boards. The Minister of Health personally appoints them all they are beholden to the Minister of Health and they are given very clear instructions to toe the line in respect of district health boards. That is one of the reasons that those chief executives are so quiet and that some of them do not even allow members of their boards to speak out publicly. 
So the Greens attach great importance to the provision that the health professions should be able to elect some members to their registration authorities. Indeed allowing the health professions to elect some members to their governing bodies will mean that there is some involvement by those professions so that they have a sense of ownership of their authorities and do not feel that the membership is just all imposed on them. The way that this bill is at the moment means that we are not talking about self-regulation at all; we are really talking about a very very high degree of control by the Government over those professions. 
 I have been involved in a marginal way in some of these appointments and I have seen how very easily such appointments can be really just a matter of dispensing patronage. It is a case of dispensing patronage and also of making the reappointment process dependent on the Minister so that everyone knows that really they cannot rock the boat. We then end up with a whole lot of compliant authorities that basically will all ultimately do the Minister’s bidding. 
That is why the Green Party has an amendment to this clause to make it absolutely clear that upon receipt of a request from an authority to do so the Minister must make regulations enabling and ensuring that at least half the health practitioners appointed to an authority are elected from among the health practitioners registered with that authority. This amendment goes further than Dr Scott’s amendment. I am perfectly happy with Dr Scott’s amendment as far as it goes but it states that only the existing health professions should be able to elect half their members. What about osteopaths? They may want to hold elections. What if at some distant time—say after another 20 years—acupuncturists are finally allowed to have their authority and they want to elect its members? I think that most health professions will end up wanting to elect half the members of their authorities when they realise the degree of patronage and control that is exerted by having the Minister make every single appointment to the governing authority of every health profession in New Zealand. 
So in my view this issue is absolutely critical and I really urge the Government to support democratic elections. What is wrong with a little bit of democracy in the health professions? The Government has introduced a degree of democracy with the district health board elections so why on earth should we not do the same thing here and allow some members of the various health professions’ governing authorities to be elected? According to the way that the bill is worded at present the Minister is not required to allow those professions that wish to hold elections to do so and that is why we have moved an amendment to require that. 
MITA RIRINUI (NZ Labour—Waiariki) 
: 
 I move  
That the question be now put 
. 
PITA PARAONE (NZ First) 
: 
 I want to take a short call with regard to clause 116 and in particular to respond to some of the comments made by Mr Prebble. Supplementary Order Paper 122 in my name suggests that all the tribunal or the group should be health professionals. The Minister used the case of Dr Bottrill where some of his colleagues knew of his shortcomings. I suggest to this Committee that Dr Bottrill’s colleagues were not part of a tribunal process. I suggest again that the people who make up the membership of the tribunal should be health professionals. Of course that is in keeping with my earlier comment about being judged by one’s peers. 
If the Minister is to be part of the appointment process then the professions themselves should be invited to submit the names and although that is stated in the bill I think the professions should have a process of election. In some way I support the Green Party’s suggestion in Supplementary Order Paper 114 in the name of Sue Kedgley. But the point I want to make is that all the tribunal should be health professionals with no exceptions. Although I have some difficulty with the authority that lies with the Minister I believe that whoever is to stand in judgment of their peers should be health professionals from those particular health fields. 
Dr PAUL HUTCHISON (NZ National—Port Waikato) 
: 
 I must admit I was somewhat concerned that the Minister of Health must have a sore tooth tonight because she certainly did carry on a bit when challenged about the membership of the authorities. There are some quite extraordinary ironies about this issue. The Minster has gone to huge trouble in the health and disability legislation to endorse the thought of elected members there—and God help New Zealand in terms of the 21 district health boards that have been personed by Labour Party hacks and various other cronies—and to have an extraordinary mixture of people. But when it comes to professional bodies the Minister says no she will appoint the lot. Undoubtedly that absolutely undermines the independence of the professions. It undermines that whole concept which is hugely important. An amendment that I put forward earlier on was sadly rejected by this Labour Government. 
One of the underpinning purposes of this bill should be that professional responsibility and independence is maintained in order to serve the public best. There are two amendments regarding that. One is in Supplementary Order Paper 103 in the name of my colleague Dr Lynda Scott. It is quite right and appropriate and it states: “Where under any enactment in force prior to the commencement of this Act a health profession has elected members of its governing body that profession may elect 50 percent of the members of the authority or such lesser proportion as the governing body or authority may decide.” I think that is quite appropriate but I must say that for once the Green member Sue Kedgley has come up with quite a sensible suggestion in Supplementary Order Paper 114 in her name. I must admit that my mind boggles at the thought of a whole lot of osteopaths but nevertheless the principle behind her suggestion is absolutely right. 
Not so long ago the Hon Richard Prebble mentioned that this Labour Government has put political correctness in front of everything. When we look at clause 114 we see that no more so than with any other clause. Clause 114 “Functions of authorities” includes the requirement “to set standards of clinical competence cultural competence and ethical conduct”. Well here we are with a bill in which the Minister of Health cannot even define “competence” and she suggests that the area of cultural competence can sit well in it. I can tell members that the other day I bumped into a nurse who was coming home from her cultural class at Auckland Hospital where she works in the intensive care unit. I asked her what her class was about and she said it had spent the last 4 hours talking about the fourth article of the Treaty of Waitangi. Heaven knows where this politically correct Labour Government is going! Undoubtedly that really does take the cake. Quite rightly again my colleague Dr Lynda Scott in an amendment has suggested that paragraph (i) of clause 114 be thrown out. 
I want to very briefly talk about clause 123 “Disputes about overlapping scopes of practice”. That is one of the areas of the bill that has all the professions extremely concerned. I put it on the record that I would like the Minister to take a call and tell the Committee what her plans are for nurse-anaesthetists in New Zealand. The history of this issue is that only 5 to 6 years ago for the sake of maintaining standards general practitioner – anaesthetists who had a diploma in anaesthesia were phased out because we wanted to have increased standards in New Zealand. Here we go! The Minister of Health is suggesting that there be a stream of nurses who can now become independent nurse-anaesthetists. Will the Minister of Health take a call and tell us her intentions? 
Hon JOHN TAMIHERE (Minister of Youth Affairs) 
: 
 I move  
That the question be now put 
. 
Sitting suspended from 6 p.m. to 7.30 p.m. 
JUDITH COLLINS (NZ National—Clevedon) 
: 
 During the debate on this bill we have tried to be constructive in the Opposition and we tried to be very constructive during the select committee process. The Health Committee worked very hard on this bill. We worked very well together across the parties and that was great. However Part 6 is the worst part of the bill and I am appalled that we have it here in the Committee. I will bring up two issues on this particular part tonight. 
The first issue relates to the concept of cultural competence. When I have trotted around the country as I have and have spoken to people in the health profession business I have said to them that this bill has some good bits in it but unfortunately it is like the curate’s egg and has some really rotten bits as well. If and when this bill is passed—and I hope for support tonight for this part not to be passed—it will have the regulators of health professionals concerned not only with the ethical competence and the clinical competence of professionals but also in charge now of their cultural competence. Cultural competence is not defined in this bill because of course it is sort of like the fourth article of the Treaty of Waitangi: it does not exist. We are not even told which particular culture we have to be competent in. That provision is an absolute nonsense and an outrage. 
All of us here tonight in the Chamber have been either the patients of health practitioners and/or health practitioners ourselves. At no stage have any of us gone along to our health professionals and said we wanted to know how culturally competent they are. I would like to hear anybody say that he or she cares how culturally competent the people in the accident and emergency department are when he or she comes in from a road crash. Not one person in this Committee with any brain at all would ever want to ask how culturally competent they are. 
It is absolutely right that any person who goes to a health professional wants to know that that professional knows what he or she is doing and is clinically competent. That is fair enough and it is good that the Minister wants that to be included. Absolutely people want to know that a health professional behaves ethically. They want to know that they will not be told they have to have a bit chopped off that they do not really need to have chopped off just to get income coming in for a professional. They want to know that they will not be sexually molested by a health practitioner—and nor should they be. But for goodness’ sake I ask whether any members of this Parliament have ever asked an orthopaedic surgeon how culturally competent he or she is. If they have I hope they had the result that I suspect that they would have had which was to be told to get out of the surgeon’s office immediately. 
This provision is an absolute outrage. We have a health profession that is under much stress. These people are front-line people and they are struggling to provide the most basic necessities. They have to work in a Third World health system under this Government and here they are being told to be culturally competent. That is absolutely rich. The Government cannot even tell us which particular culture they are supposed to be going for. That is an outrage. 
If we ask who will be in charge of this provision we all learn that under clause 116 it will be the Minister. The Minister has given us all that stuff tonight about how she will appoint doctors to look at doctors but they will be her doctors. They will not be doctors who have the confidence of their professional peers; they will be doctors who have the confidence of the Minister. That does not give a lot of confidence to anyone else and that is one of the problems. The Minister talked to us about how she likes to go and consult with others. I ask the Committee to look at clause 5 where she has chopped that out. 
HEATHER ROY (ACT NZ) 
: 
 I agree with everything that the member over here in the Opposition has just said but I will go back and look some more at clause 116 which deals with the election of people to the authorities. I will do that because when Richard Prebble spoke earlier I think that some members in this Committee did not take him very seriously. I am not looking at anyone in particular but there were some members who did not take him seriously. The points that Richard Prebble made were right on the dot because I showed them to him. 
Doctors dentists and pharmacists currently have elections for their registration bodies and professional bodies. 
Steve Chadwick 
: A good thing too! 
HEATHER ROY 
: It is a good thing. At the Health Committee the majority of people wanted to retain that and clause 116(3) states that regulations made under this Act may provide that one or more of the health practitioners who are to be appointed will be elected. But the Minister’s intention has been made very clear in a newspaper article in the  
New Zealand Herald 
 on 22 July which stated: “Mrs King said yesterday that she did not favour elections for such bodies” and she has told us why that is. 
We in the ACT party say—and I think the National Party and New Zealand First agree with us as well—that that is not right. We believe that the elections are very important for a number of reasons several of which have been outlined earlier in the debate on the bill. We have said that it is very important that the environment needs to be right in order for patient safety to be paramount. However something that we have not mentioned previously is the credibility of the registration bodies among the health professionals—the people whom they govern. For the public to be assured of the competence—that term has not been defined but we will not go there again—of health professionals the health professions must be able to have professional self-regulation. We have heard a lot about that. The other thing is that the professions have to be satisfied that they are working in an environment that is conducive to public safety. 
We heard from many groups at the select committee. In fact an overwhelming number of the submissions were adamant that holding elections was very important and that even in the case of those professions that have chosen for the moment to nominate people to the Minister for appointment to these authorities the ability should remain for them to have elected members should they so choose. The dentists the doctors and the pharmacists certainly want to continue in that vein; they have been very specific about that. 
It was interesting to hear the Minister when she jumped to her feet just before the tea break and talked about the doctors. She specifically mentioned doctors. The doctors are so disillusioned with this bill that they do not want to be part of it any more. When the discussion papers before the bill was drafted came forward and even when the bill was initially put forward they were very keen to be part of it. They thought the bill was a good piece of legislation and that it was certainly heading in the right direction. But as time has elapsed and their concerns have not been listened to they have decided they do not want to be part of it any longer. One of their big concerns is that they can no longer elect their own people to the authorities. 
We elect people to the district health boards. I ask the Minister how we know that we are electing the right people to the district health boards. [ 
Interruption 
] I ask Mrs Pettis who is trying to interject whether that means we will have to abandon those elections as well. If we continue to have elected district health board members it should follow through that the professional authorities if they want to should be able to have elections. But no the Minister said that that is no good. 
In looking further into this part and I refer particularly to clauses 119 to 125 we see that those clauses concern the powers of the Minister. I think the Minister was being a bit modest earlier. She said that there would not be great power there and that even if there was she would not exercise it. However the fact of the matter is that all the professions are extremely worried about ministerial power in this bill not just in this part but right throughout the bill. They are worried that— 
Dr Lynda Scott 
: Scopes of practice! 
HEATHER ROY 
: Yes scopes of practice. They are worried in all areas about the powers of the Minister. The ability is there for an awful lot of political interference. The Minister of Health or future Ministers of Health will be able to make decisions that the Minister cannot currently make. 
GEORGINA BEYER (NZ Labour—Wairarapa) 
: 
 I move  
That the question be now put 
. 
PANSY WONG (NZ National) 
: 
 I agreed with the Hon Richard Prebble who spoke just before dinner. He must have touched a raw nerve with the Minister so I will try to follow through the theme of what he was trying to say. The Minister of Health became very very excited at that point. She stood up and she wants to do so again. We want to encourage the Minister to get to her feet. 
Before dinner the Minister said that making appointments for reasons of political patronage was the furthest thing from her mind. So I thought I would do some research on appointments. We have researched a little into what this Labour Government has achieved. We cannot quite see into the future but I certainly think the past is a good indication of the Labour Government’s performance in this area. The  
Dominion Post 
—Wellington City’s authoritative newspaper—has an article stating that more than 3000 people serve on some 400 quangos funded from the public purse and up to 900 appointments a year are made without public advertisements. What do we have? Let us look at some of those appointments.  
Can members guess the former profession of Chief Human Rights Commissioner Ros Noonan? She was previously a trade union official and she has also recently been appointed by Labour to a new task force. Wow! There is more. Former Labour Cabinet Minister David Caygill who has earned over $100000 from chairing an inquiry into the electricity industry also picks up $50000 a year for chairing the Accident Compensation Corporation. He is considered a front-runner to head the new 7-member Electricity Commission after failing to get the last one off the ground. I see the Minister is getting excited; I am sure she will take a call. A left-leaning former Race Relations Commissioner Gregory Fortuin earns $55000 a year as a New Zealand Post board member.  
Let us look at some more appointments. 
Jill Pettis 
: Relevance. 
PANSY WONG 
: The Minister tried to say Labour would not appoint former party members to positions. How about former Prime Minister David Lange and former Labour MP Jenny Kirk? I am telling members about all the quangos that are staffed by those people—former Labour MPs Jenny Kirk Stan Rodger Jill White Ann Hercus; the list goes on and on. 
Apparently in 2001 Treasury recommended that the process governing political appointments be put into a law in order to give it more force and that appointments be done more openly. Treasury put up that paper to the Government. Can members guess what the response of the Labour Government was? The Labour Government said that it had no plans to adopt Treasury’s recommendation. It would not have a bar of it. 
Now we have this legislation before us which once again gives the Minister plenty of opportunities to reward people and to appoint people who agree with her positions. The Minister is most welcome to stand up and take a call and to try to reassure us as to why the public and the Opposition parties should have confidence the Minister will not exercise her discretion and appoint people whom she favours. 
I do want to pick up another issue that is very dear to my heart. Members who are appointed must be culturally competent. 
John Carter 
: Like my mother. 
PANSY WONG 
: Oh John Carter’s mother. I am sure she is a very cultured woman as far as I know. I wonder how the Minister will satisfy the requirements of a lady of such high standing. But I wonder whether all the different cultures would be included under that term. 
Hon JOHN TAMIHERE (Minister of Youth Affairs) 
: 
 I move  
That the question be now put 
. 
A party vote was called for on the question  
That the question be now put. 
Ayes 60 
Labour 52; United Future 8. 
Noes 56 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7; Green Party 9. 
Motion agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 113 in the name of Sue Kedgley to insert new subclause (5) in clause 110 be agreed to.  
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 22 
New Zealand First 13; Green Party 9. 
Noes 94 
Labour 52; New Zealand National 27; ACT New Zealand 7; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 103 in the name of Dr Lynda Scott to clause 114(i) be agreed to.  
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 56 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7; Green Party 9. 
Noes 60 
Labour 52; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 122 in the name of Pita Paraone to insert new subclause (2) in clause 114 be agreed to.  
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 56 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7; Green Party 9. 
Noes 60 
Labour 52; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 103 in the name of Dr Lynda Scott to clause 116(1) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 56 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7; Green Party 9. 
Noes 60 
Labour 52; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 122 in the name of Pita Paraone to clause 116(2A) be agreed to 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 103 in the name of Dr Lynda Scott to clause 116(2A) and (3) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 56 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7; Green Party 9. 
Noes 60 
Labour 52; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 122 in the name of Pita Paraone to insert new subclauses (2B) (2C) and (2D) in clause 116 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 114 in the name of Sue Kedgley to clause 116(3) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 56 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7; Green Party 9. 
Noes 60 
Labour 52; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 103 in the name of Dr Lynda Scott to omit clauses 123 124 and 125 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 103 in the name of Dr Lynda Scott to insert new paragraph (aa) in clause 134(1) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 56 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7; Green Party 9. 
Noes 60 
Labour 52; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 103 in the name of Dr Lynda Scott to clause 134(1)(f) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 56 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7; Green Party 9. 
Noes 60 
Labour 52; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 103 in the name of Dr Lynda Scott to clause 136(2) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 56 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7; Green Party 9. 
Noes 60 
Labour 52; United Future 8. 
Amendment not agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 118 in the name of Hon Annette King to Part 6 be agreed to. 
A party vote was called for on the question  
That the amendments be agreed to. 
Ayes 69 
Labour 52; Green Party 9; United Future 8. 
Noes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Amendments agreed to. 
A party vote was called for on the question  
That Part 6 as amended be agreed to. 
Ayes 69 
Labour 52; Green Party 9; United Future 8. 
Noes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Part 6 as amended agreed to. 
Part 7 Miscellaneous provisions consequential amendments and repeals and transitional provisions 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 The Health Committee did a lot of work on this part. We tried our very best to improve it because it most certainly needed to be improved. By majority new clause 166A “Review of operation of Act” was added and states: “(1) As soon as practicable after the expiry of the period of 3 years beginning on the commencement of this section the Director-General of Health must—(a) review the operation of this Act since the date of the commencement of this section;”. 
Members who were on the select committee know why the legislation will need to be reviewed. It is an absolute mess. We know there will be problems with it. We know there will be trouble. Everybody on the committee agreed that a review would be needed. It will be a National Government that will have to sort out the mess from this bill because we will be in office when the review is done. The problems around scopes of practice will be the first thing we will have to sort out. Scopes of practice have been defined as “leading edge” “cutting edge” “new” “untried” “untested” and “a new concept”. I believe that every time something like this is done we end up with all sorts of problems. Scopes of practice are not found anywhere else in the world. The only place that tried having scopes of practice was British Columbia and it stopped them. 
Judith Collins 
: Why? 
Dr LYNDA SCOTT 
: They just did not work. British Columbia had so much trouble with them and I think we will in 3 years’ time. We will have to go back to the Medical Practitioners Act because this bill is supposed to be based on it. 
Tonight United Future would not vote to have elected members on authorities. Had they done that my amendments would have won. Dentists pharmacists and doctors would have been very proud of United Future had its members stood up and voted for them. Authorities have elected members now. They have professionalism and they will lose it. That Minister will appoint more “fopms”. Do members know what that stands for? It stands for “friends of the Prime Minister”. There will be more “fopms” on boards and authorities all over New Zealand. [ 
Interruption 
] She thinks that if people get elected they are right. People will not be elected. The Minister will appoint people she can control so that they will not make political noise. There will be a reduction in professionalism. Doctors do not want a bar of that and they will be extremely disappointed in United Future because that party could have voted for our amendment. It could have voted that one amendment through tonight to let doctors dentists and pharmacists have elected members on their boards. But no United Future did not vote for the amendment. 
Sue Kedgley wanted any other group that came under the bill to have elected members as well. The professions want their people elected so that they can have faith in them. But no the Minister will appoint them all. But hey professions will have the right to nominate! Great! We know that this bill changes the quality assurance provisions. They have been changed from the Medical Practitioners Act and there will be concerns amongst the professions. 
Some changes in the select committee were made to the quality assurance provisions because the professions do need to be able to engage in quality assurance activities with some protection They have to know that their meetings will be confidential enough for them to be able to disclose problems. But the provision did not go far enough. I proposed amendments to it so it would go a bit further. People can access the Health and Disability Commissioner the Accident Compensation Corporation and a complaints assessment process in every hospital but if we want quality assurance to work there has to be some protection for practitioners; otherwise they will not freely discuss what goes wrong and that will be another problem. 
Then we come to the powers of the Minister. Under the bill that Minister—or any Minister because this Minister will be the Minister for only a very short time longer—has a huge amount of power to appoint people and to determine the scopes of practice when there is a dispute. The Minister stood up before and said that somebody had to do it. Well let the professions sort things out. They should be doing it. Let them work things out because that is what they have been doing for the last 100 years but now the Minister will have control. 
Hon GEORGINA TE HEUHEU (NZ National) 
: 
 I shall refer briefly to the issue of the review of the operation of the Act. While this legislation has been described as a dog’s breakfast—not by me—if that is the case then it is a very good reason to put in place the opportunity for review. I suggest that there is a more important reason that we must have a review of the operation of the Act. My understanding is that we have tried to encompass all health professionals in one single piece of legislation. There appear to be some new things in the bill but the underlying purpose which is the safety and health of the public demands after seeing how the Act is operating and if we think there is any potential for that purpose to be diminished that that is a good reason for a review of the Act. I think that clause is worthwhile. 
The other area I want to comment on and ask the Minister to enlighten me on is the issue of the period of transition for membership of continuing authorities. Clause 211 sets out the meaning of the period of transition. Presumably then this is the transition—gosh it is John Tamihere in the chair; I hope the Minister is able to answer my question. I turn the Minister’s attention to clause 211 “Meaning of period of transition” and then to clause 214 “Vacancies may be filled by Minister”. What period of transition is envisaged by the Minister? In other words— 
Hon John Tamihere 
: Small. 
Hon GEORGINA TE HEUHEU 
: A small period; that is good. Clause 214 gives the Minister the power to appoint any person to fill any vacancy that occurs during the period of the membership of a continuing authority. Is that transition period small or big? Will the conditions or criteria set out regarding the composition of the board of any authority in clause 116 still apply when and if the Minister has to appoint a person to fill a vacancy that occurs during the transition period and if not why not? I am assuming that it is important because the Minister made a big thing of this that the majority of members on an authority will be health practitioners and that two are lay persons. If a vacancy occurs that was filled by a health professional will the Minister seek to fill that vacancy with another health professional? I guess that if it was a lay person then the replacement would be a lay person. 
My point is that if it is important—and we certainly think it is important that the majority of the membership be health professionals—then I would like some assurance that under clause 214 the Minister will replace a health professional with a health professional. 
 The other thing is whether in making that appointment during the transition period the Minister will then do what she is going to do in relation to permanent memberships on the permanent authorities. Will she or he whoever the Minister might be also then be calling for input for appointment from those groups or persons within the health sector to whom the authority relates? That sounds like a bit of a mouthful but I hope the Minister will be able to give some assurance that like will be replaced with like and that no vacancy will be filled by someone who is not the same status. 
HEATHER ROY (ACT NZ) 
: 
 In speaking to Part 7 I would like to start at newclause 166A. The select committee was very pleased to have this included because it is very important that this legislation is reviewed after 3 years. There have been grave concerns with it as members have heard through the periods of this debate and this review is paramount. The previous speaker referred to the dog’s breakfast and I can tell members where that came from. The Association of Salaried Medical Specialists Ian Powell’s group called this “an ambitious dog’s breakfast”. They did. Ian Powell called it an ambitious dog’s breakfast. He said: “Until now along with the NZMA the ASMS was hopeful that the bill would be sufficiently improved through the select committee process so that it was as good as the MPA which it was intended to replace.” 
All I can say to Ian Powell is that we tried. We did our best. We tried to deal with the scopes of practice despite the fact that they are untried and untested in this country and have failed in British Columbia. But no we are going to have them here because we are cutting edge we are world leaders here! We tried to address the quality assurance activities and had partial success I suppose but certainly they are not what they should be. We tried to deal with the huge ministerial powers with very little success at all. 
Ian Powell went on to state: “While some noticeable and useful improvements have been proposed by the select committee the revised bill remains significantly inferior to the Medical Practitioners Act.” My Supplementary Order Paper has several amendments to this part—to clauses 169 170 175 194 195 and 196—to try to extricate doctors from this bill. They are not the only group. Pita Paraone is going to tell us that the optometrists want to be out as well. 
Steve Chadwick 
: It is too painful. 
HEATHER ROY 
: No it is going to be much more painful for them to stay where they are because the legislation they have at present the Medical Practitioners Act is a far superior and modern piece of legislation that works very well. In the time that it has been in place quality assurance activities have improved significantly but that is not going to happen any longer. The protection will not be there for them when they have their quality assurance. The bill is going to discourage it and that will erode public safety. 
If we flick a little further through Part 7 to Subpart 2 “Transitional provisions” Mrs te Heuheu—I hope I have got the pronunciation right—was talking about those provisions. For some bodies there will be significant changes and I think in particular of the Pharmaceutical Society which is going to go out of existence completely. Pharmacists are actually very sad about that. The Pharmaceutical Society is over 100 years old and has been quite a tradition for pharmacists. I am told that because it is such a huge job it has already started to change the assets and all the bits and pieces that go with the Pharmaceutical Society into the Pharmaceutical Council which will be similar to the other registration bodies. 
It is interesting to see the Minister’s comments to these different groups in particular to doctors and pharmacists. We know already that Mrs King certainly does not favour elections because she does not think doctors are capable of doing the right thing and choosing the right people to represent them. It is interesting to note what she has been saying about pharmacists. Anybody who reads  
Pharmacy Today 
 might have seen a report on its front page a couple of weeks ago in which the Minister states that she does not know how pharmacists can call themselves health professionals when they process photographs and sell gifts. Apparently they are not health professionals any longer. Fancy that! Obviously the Minister’s history is a bit lacking because if she knew anything at all about pharmacists she would know that significant development in processing photographs was made by chemists themselves. That is where it started and that is why every chemist shop in the country sends off films that people take in to have their photographs printed. [ 
Interruption 
] It is part of the bill—it is the role of pharmacists. It is sad to see a Minister of Health who has such contempt for the medical profession for pharmacists and probably for other health professionals as well—except I suspect dental nurses whom she is probably still very fond of. It is a very sad day. 
SUE KEDGLEY (Green) 
: 
 The clause that members have been referring to which calls for a review of the Act in 3 years is arguably one of the most important clauses in the bill. We had to fight very long and hard to get that clause in. When I suggested that we needed to have some parliamentary scrutiny and ability to review the legislation because there were so many new and unresolved issues in it the officials were totally opposed to such an idea. What we see in this bill—and it is a pattern that I have noticed in a number of bills recently—is the Government setting up a broad overarching framework then it leaves all the implementation monitoring etc to regulation and it ensures that there is no parliamentary scrutiny. This bill is one of those where the Government has attempted to have a broad overarching framework with absolutely no ability for parliamentary scrutiny. The vast array of issues such as scopes of practice and so forth are all to be determined by regulation which means without any parliamentary scrutiny. 
We had a major fight with the officials to get the clause inserted requiring that there be a review. The only reason we managed to get it—and I am delighted that I managed to put this provision up and that it gained support—was that we referred to the Radio New Zealand and Television New Zealand bills that are similar but which require parliamentary scrutiny after a number of years. 
Thankfully we at least have this provision. Maybe some officials are hoping that we might quietly forget the clause that it might go away and we might not require the review to take place but I can assure them that some members have already diarised this provision and we will be waiting very eagerly for the review. 
I will be looking very closely at a number of issues for the review. The first issue is the whole question of whether the Minister has allowed elections to be held for those professions that wish to hold elections for their governing authorities. There is a clause which once again we managed to get in that stipulates that the Minister may make regulations to allow elections. The wording is a little bit vague and we did hope to strengthen it here tonight but unfortunately United Future and the Government would not support us. However there is a provision that regulations may be issued and we will be watching the implementation of those regulations extremely closely as I am sure will the professions that are seeking to have elections. Indeed some of them may wish to go to the Regulations Review Committee if they find that the regulations empowering an election are somehow not issued by the Minister. We will be looking at that clause very very closely to make sure that the Minister does issue regulations that will allow those professions that wish it to have elections. 
 Another thing that the Green Party will be looking at very closely is the progress or lack of progress with acupuncturists. I have made the point many times that if this bill were genuinely about public safety and consumer protection then one of the first professions that we would be regulating under it would be acupuncture. Arguably acupuncture can cause grave harm to members of the public if needles are not sterilised or if they are put in the wrong parts of the body. Great harm can occur to members of the public for which reason acupuncturists have been beseeching successive Governments for two decades to bring them under statutory regulation. They have made impassioned and very professional submissions to this bill pointing out all the reasons that they need to be brought under this legislation. Unfortunately their pleas have been ignored by the Government and I cannot figure out why. 
Hon TAITO PHILLIP FIELD (Minister of State) 
: 
 I move  
That the question be now put 
. 
Dr PAUL HUTCHISON (NZ National—Port Waikato) 
: 
 In many respects Part 7 of this bill could be labelled the funereal or wake part of the bill because it deals with miscellaneous provisions consequential amendments and repeals and repeals and transitional provisions. It is a tragedy that the medical professions are not supporting this bill. As Heather Roy pointed out this was described as ambitious legislation from the beginning and there was goodwill at the beginning. There was a tremendous effort to make sure that there was a multiparty buy-in to this bill because it was so important but because of the absolute inability of the Labour Minister of Health to listen to the professions—and this is clearly made out in the submissions—the chief executive officer of the association of full-time medical specialists has unfortunately referred to this bill as a dog’s breakfast. I understand that my colleagues had to fight very hard to have clause 166A “Review of Operation of Act” put in. 
Hon Annette King 
: Did National vote for it? 
Dr PAUL HUTCHISON 
: As I say there are so many things that my colleagues Dr Lynda Scott and Judith Collins have had to work hard to get into this bill because a review of the operation of the Act is very important. It may be that in 3 years’ time or before the Minister will finally come round to realising that professional self-regulation as the basis of health practice in New Zealand is extremely important. Hopefully by then she may have sorted out scopes of practice. I would love her to take a call to tell us what her views are on nurse-anaesthetist practitioners. Unfortunately she was not able to take in the facts when general practitioner – anaesthetists stopped practising several years ago. They had medical degrees and diplomas in anaesthetics and the view was that in order to raise standards for the public of New Zealand they would have to be phased out. I want to know what this Minister of Health’s plans are in terms of the nurse-anaesthetist practitioners. Will she be prepared to come clean? 
My colleague the Hon Georgina te Heuheu spoke about clause 214 “Vacancies may be filled by the Minister” and I ask whether that is an ingenious piece of ministerial mischief. Is that one of those clauses my colleague Dr Lynda Scott was talking about by which the Minister may go berserk on “friends of the Prime Minister”? It says here that vacancies may be filled by the Minister and she has the opportunity there to go quite wild. It will be a great opportunity for the Labour Party hacks and hangers-on. 
Of course once again it is a considerable concern that ministerial powers have become excessive. It is the absolutely Pavlovian-dog reflex of this Labour Government to control and not to have the process that has caused the major medical professions to lose confidence in this Minister of Health. 
I will briefly comment on clause 154 “Application of Trans-Tasman Mutual Recognition Act 1997”. There has been some concern that some Australian registration authorities are not accepting New Zealand practitioners’ registrations and I understand that the bill does address that problem. 
JUDY TURNER (United Future) 
: 
 I will take a very brief call on Part 7. A huge number of provisions are covered in this part and I want to pick up on just one aspect of it. In this part we get a look at the professions that are registered under other Acts and will now be registered under this legislation. We seem to have heard a lot about doctors tonight and I just want to give a bit of feedback from some of the other professions that come under this bill. 
I have an email from the Dental Council of New Zealand which is pleased to support the bill. I also have an email from the Nursing Council welcoming the introduction of the bill. It is really thrilling that the bill will further protect the public by ensuring that practitioners are not only fit to practise but also competent to do so. I have emails from the Occupational Therapy Board the Dieticians Board and the Psychologists Board which also support this bill as it has come out of the Health Committee. The Opticians Board has emailed us to say it is happy with the bill as it has been presented. The Medical Radiation Technologists Board is happy with it as is the Medical Laboratory Technologists Board. The Physiotherapy Board is also happy to offer its support to the bill. So I think we need to keep a little bit of perspective here. 
United Future is pleased about the review clause. We are unclear whether the National Party supported it in the select committee. As this legislation fleshes itself out over the next 3 years any tweaking that may need to happen will become apparent. We feel that some of the provisions in the bill have been worked on to the extent that we now need to put them into operation to see how in consultation with the professions they work out. The review in 3 years will be interesting. I am really thrilled to have had feedback from so many health professionals whose professional futures are encapsulated in this bill and I am thrilled with their support for the bill. 
JUDITH COLLINS (NZ National—Clevedon) 
: 
 That particular contribution from United Future is a bit of a disgrace. I am shocked by that sort of contribution. Is that member going to go out and tell the few people who voted for United Future why its members after marching down the streets of Nelson on the foreshore and seabed issue are voting for cultural competence? How about that? That will be an interesting one for her to come back to us on. 
Let us have a look at clause 154 which deals with trans-Tasman mutual recognition. It states: “Except as otherwise provided in Schedule 4 of the Trans-Tasman Mutual Recognition Act 1997 that Act prevails over this Act.” I have a serious question—as are all my questions of course—for the Minister of Health. How are we ever going to get the Australians to accept this sort of cultural competence nonsense under the Trans-Tasman Mutual Recognition Act? Which will prevail? Will the Australians have to become culturally competent in whatever culture we decide they have to be competent in or will they be let off? 
The reason that is such an important issue is that the Health Committee sat through endless hearings on this bill. One of the submitters we heard from was the midwives union. I like midwives. As a mother I can say that they are generally very nice sensible people. They are really very helpful when one is having a baby and an awful lot more use than most people’s husbands although of course not my own who is a wonderful person. The unionist who said she represented the midwives said she thought this bill was great because of the cultural competence aspect which would stop foreign midwives from coming into New Zealand and practising here without being culturally competent. I piped up and asked which particular foreign midwives she was talking about and that trade unionist who supposedly represented the midwives said—not some sort of strange culture—Australian midwives. I think someone will have to tell her that Australians will probably be able to sneak in too. 
There is a situation whereby some Australian regulatory authorities are putting difficulties in place for some of our New Zealand practitioners. Will they now be saying to our New Zealand practitioners who go there to work because the pay and the opportunities are so much better and because Australia has a good Liberal Government not a Labour one like we have here that they want Kiwis to be culturally competent in Australian culture? That will be fun will it not? That is the sort of nonsense this Government is putting on to us. This Government is giving us the sort of rubbish that is turning us into the laughing stock of the world. Not only does it have nonsense like the flatulence tax which has resulted in our people being laughed at by the Australians but it is giving us this sort of cultural competence nonsense. 
I ask the Minister in relation to clause 154 what will be more applicable. Will it be the cultural competence of the Australians? Will they be considered to comply or will they all have to be indoctrinated like everyone else in this country and to go around being politically correct and utterly hopeless? Is that what they will have to do? Or will we look at these people and ask whether they can do the job whether they are competent professionally and whether they are ethical—in which case boy do we want them because we have a system that is desperately short of qualified health professionals. Under this bill the Government will make it harder for us to get those people. Once we stop the Australians coming in because they cannot be called culturally competent—in whatever culture we are supposed to have—it will be even harder for our health practitioners to go overseas and get training in places like Australia because the Australians will get us back big time and fair enough. 
This part is yet another example that shows that this bill has been correctly described by the Association of Salaried Medical Specialists as nothing more than a dog’s breakfast and it is not a very good dog’s breakfast either. It is a nonsense and it is a disgrace that the United Future party is supporting this rubbish. The one great thing about the Greens is that they mean what they say which makes them better than United Future. 
DAVID BENSON-POPE (Senior Whip—NZ Labour) 
: 
 I move  
That the question be now put 
. 
A party vote was called for on the question  
That the question be now put. 
Ayes 69 
Labour 52; Green Party 9; United Future 8. 
Noes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Motion agreed to. 
JOHN CARTER (Senior Whip—NZ National) 
: 
 I raise a point of order Madam Chairperson. I wanted to raise this point of order after the vote had been taken because I did not in any way want to challenge your right to make the decision that you made. I think it is appropriate for me to point out as a long-standing whip that the debate on that part started at 8 o’clock and went on for just 35 minutes—seven speeches by my count—which quite honestly is not the norm. It is unusual for a part not to have at least a 45-minute debate. I have been noticing that we seem to be going through this legislation at quite a rapid rate. It may well be that the wish is to finish the bill tonight but given that that part particularly was an extensive part as are other parts I do ask you as Chair—or whoever may be presiding—to ensure that there is opportunity for at least a reasonable contribution by members. At least two members who were seeking the call did not get a chance to make a contribution and I do not think it is unreasonable that on any part particularly one of that size we have nine contributions rather than seven. 
DAVID BENSON-POPE (Senior Whip—NZ Labour) 
: 
 Following from the contribution of my respected colleague Mr Carter I point out that the 45 minute tariff is not a reflection of the debate that has happened on these parts. Our records would demonstrate that clause 1 for example was debated for 27 minutes Part 1 for 57 minutes Part 2 for 42 minutes and subsequent parts for 36 minutes 35 minutes 26 minutes somewhat more than an hour for the last part and 29 minutes in this case. I think the Committee is appropriately allocating time as the importance of the provisions warrant and I believe that the tariffs are entirely appropriate. 
The CHAIRPERSON (Ann Hartley) 
: I thank both members for their contributions and remind members that it is the Chair’s call and that I am the sole judge of when a closure will be put. I take note of what both speakers have said. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to clause 155 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to clause 169 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to clause 170(c) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to clause 175 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 111 in the name of Heather Roy to omit clauses 194 195 and 196 be agreed to. 
A party vote was called for on the question  
That the amendments be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendments not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to omit paragraph (b) of the definition of “relevant enactment” in clause 214A(1) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to omit paragraph (b) of the definition of “relevant registration body” in clause 214A(1) to be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 69 
Labour 52; Green Party 9; United Future 8. 
Amendment not agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 118 in the name of the Hon Annette King to Part 7 be agreed to. 
A party vote was called for on the question  
That the amendments be agreed to. 
Ayes 69 
Labour 52; Green Party 9; United Future 8. 
Noes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Amendments agreed to. 
A party vote was called for on the question  
That Part 7 as amended be agreed to 
. 
Ayes 69 
Labour 52; Green Party 9; United Future 8. 
Noes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Part 7 as amended agreed to. 
Part 8 Amendments to the Health and Disability Commissioner Act 1994 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 Part 8 makes amendments to the Health and Disability Commissioner Act 1994. That Act was brought in by the National Government and has been an extremely successful Act of Parliament. The Health and Disability Commissioner has been extremely effective and I congratulate him on the leadership he has given. 
Major changes were made to this part during the select committee process and because we managed to deliver the one-stop shop that Helen Cull QC talked about we will support this part as it really will continue to improve things. Helen Cull QC produced a report in response to the Parry inquiry. It decided that there was no concerted approach to complaints mechanisms with up to 14 agencies separately investigating the same adverse medical event. Can members imagine what it is like to be a doctor or patient in the front line? It is absolutely mind-boggling. People have no idea about the time it will take the complications it will cause and the difficulty for patients and their families. They have said that unless one is very articulate and competent one does not manage to find one’s way through the system. So the report recommended a one-stop shop. Under this bill pre and post-1994 complaints will go to the Health and Disability Commissioner. Not many complaints are pre-1994 but there are still some. 
A lot of the complaints heard in the Parry inquiry were about how patients were treated by what were called complaints assessment committees which were set up pre-1996. We also heard from a Mr Wilson who talked about how the Accident Compensation Corporation had found medical error but the complaints assessment committee had thrown out the case. It was extremely confusing for people when one organisation or agency found significant error and then the disciplinary tribunal found no error. That sort of confusion in people’s minds has been very difficult. 
But if all complaints are to go through to the Health and Disability Commissioner then obviously that agency will need more resourcing. In secret we heard evidence about what it was like for a person to have somebody become fixated on him or her and make malicious complaint after malicious complaint. Every complaint that had gone through the process was shown to have no grounds but every single one had to be investigated. The Health and Disability Commissioner needs to have the ability to deal with malicious complaints. The commissioner also needs time lines to speed up the process. Time and time again we heard how long it takes to get through that process how long it takes for a complaint to be heard and for there to be a resolution. That is something we have hoped to improve. 
I have an amendment to Part 8 which I hope members will consider. The amendment takes out the Human Rights Review Tribunal. If the director of proceedings determines that there is no case to go forward then there should not be the double jeopardy of someone being able to go to the Human Rights Review Tribunal. I have an amendment to remove that clause which I hope will be supported tonight. 
 With the quality assurance programmes I talked about before and the complaints assessment procedures that have improved markedly at our hospitals around the country one hopes that a majority of complaints can now be sorted out at the coalface and these days I think that often happens. When people make a complaint they want firstly acknowledgement of what they have suffered and secondly they want to make sure that it does not happen to anybody else. That can often be sorted out at the coalface of our hospitals if complaints are taken seriously if the families and persons concerned are worked through the issues and if people simply say “sorry” when there are mistakes and problems and then move on to ensure that systems change. 
Dr PAUL HUTCHISON (NZ National—Port Waikato) 
: 
 I am grateful for the opportunity to speak on this most important Part 8. Like my colleague Dr Lynda Scott I would like to congratulate the commissioner on the very strong and excellent submission he made to the Health Committee. I believe it was very much that shaping and influence that led National to support this part of the bill. 
It is also really important to go through just a bit of the history that led up to the Cull report because it is a sad indictment on the New Zealand health scene over the last 20 years. It was not just the Cartwright inquiry report in respect of National Women’s Hospital; history then repeated itself with the sad saga at Gisborne and once again and more recently we had the Parry incident up in Northland. Helen Cull QC collated the various concerns into a report that had a huge impact and it really shaped the basis of this Part 8. 
Helen Cull concluded that the current complaints system was inadequate. Its principal problem was that there was no concerted approach to complaint mechanisms with up to 14 agencies separately investigating the same adverse medical event. It is absolutely incredible that the New Zealand health system had got itself into such an unfortunate situation. There was the Accident Compensation Corporation on the one hand the district health boards on the other and the various medical bodies were not talking to each other and not collating the same statistics. Certainly when the Health Committee went through the Parry report a year or so ago it was quite evident that that was a major problem so it is extremely good to see the Cull report being embodied in legislation over these next few weeks. 
The report recommended three immediate solutions. The first is a requirement that various agencies be required to report practitioners whose practices are below acceptable standards to the Health and Disability Commissioner and to professional bodies. Undoubtedly that was long overdue and appropriate. 
The next solution is mandatory reporting by professional peers if there is reason to believe that a colleague is practising below an acceptable standard. With a true Pavlovian dog reflex the Minister of Health immediately said: “Let’s dob in a doctor!”. That was the cry of the Minister of Health. That was what she wanted to do immediately. Fortunately common sense has prevailed because she finally recognised—with a lot of aid—that no workplace would work constructively if that sort of atmosphere were to prevail. 
The third solution is to give professional authorities the power to suspend practitioners temporarily if they pose a risk to public safety or to impose conditions on their practices prior to the laying of charges before a disciplinary tribunal. 
I have just been looking through the submissions of the various major bodies including the New Zealand nurses’ organisation and it is interesting that all of them support the changes that have been made. But Dr Lynda Scott’s point that clause 231 should be changed has also been unanimously supported by both the New Zealand Medical Association—the association of fulltime specialist practitioners—and the Medical Council of New Zealand as well as the nurses’ organisation. They have all pointed out that clause 231 needs changing and I hope the Minister will take note of it. 
HEATHER ROY (ACT NZ) 
: 
 I would like to lend the support of ACT New Zealand to Dr Lynda Scott’s amendment to this bill. There is the fear that this bill will add multiple jeopardy and I believe that is a very realistic fear. The legislation may well open the door to wider involvement of the Human Rights Review Tribunal in medical affairs. Successful complainants to the Health and Disability Commissioner will be able to bring proceedings before the Human Rights Review Tribunal where the commissioner does not refer the case to the Director of Proceedings. 
At present it is possible to do this only if the director declines or fails to take proceedings and that right remains. Some quite prominent lawyers have warned that some lawyers are likely however to test the limits of the Human Rights Review Tribunal—as is often the case when these bodies alter—and there may be an initial flurry of cases to test the potential of this jurisdiction. In fact many people are predicting that that is exactly what will happen. David Collins QC identified this as a potentially fruitful area of growth which could provide meaningful compensation to those whose rights had been breached. The Human Rights Review Tribunal could also award damages of up to $20000 which is quite a lot of money. 
Pre-tribunal hearing settlements have been made for compensatory damages for a range of cases. One such case was a baby born at Hutt Hospital who suffered severe brain damage. That can occur as many people and health professionals in the Chamber will know for a range of reasons. This baby later died at home and in 2001 the tribunal awarded $20000 for compensatory damages and this decision was upheld in the High Court. So that is just a glimpse of what we might be letting ourselves in for if this clause is not removed from the bill. 
The New Zealand Medical Association has also been quite vocal in that respect. The association said it believes that this complicates the process and adds a new unnecessary avenue for complainants to exercise their rights. Complainants who appeal directly to the Human Rights Review Tribunal are likely to benefit from at least some successful damages awards and their appeals may lead to simple apologies being ascribed a monetary value which was not previously the case and certainly is not something we want to encourage in this country. 
The New Zealand Medical Association has had discussions with the Ministry of Health about that matter and the association has asked for this provision to be removed. Certainly ACT supports the association in that and we support Dr Lynda Scott’s amendment to this bill in that regard. 
In speaking more generally about part 8 I think that there are many clauses in this part that we are very pleased with as some previous speakers have said. At the Health Committee we had long discussions about this part as we had with all other parts. The new provisions for the complaints process certainly as I have spoken of before are something that I think everybody on the committee felt was a step in the right direction. Having a one-stop shop where all complaints go directly to the Health and Disability Commissioner to be vetted and then either dismissed because they are not appropriate or are vexatious or referred on to the new procedures committees certainly is a step in the right direction we believe. It should see complaints processed in a much shorter time which is an advantage for everybody—including for the complainant who will have his or her complaint thrown out because it is not appropriate or dealt with in a speedy manner. 
 Also for the health practitioner of course it is very taxing and very stressful to have a complaint laid against one particularly if that complaint is not warranted. There are doctors whom I know reasonably well who have had complaints laid against them and years later they still have not been processed or dealt with. It is very difficult for the health practitioners to continue practising to a good standard when that is the case. They worry a lot about the proceedings that are before them but no time frame is given. So time frames were mentioned and it is important that cases are met with expediency. 
STEVE CHADWICK (NZ Labour—Rotorua) 
: 
 I move  
That the question be now put 
. 
JUDITH COLLINS (NZ National—Clevedon) 
: 
 It is always nice and such a rare occurrence to be able to support something from this Government and in particular this Minister. But I have to say that it is only because of the sterling work of the Opposition members of the Health Committee. I include in that the Green member. We worked together very very fully to get some sense into the legislation. We found a part that we can actually feel quite happy about but with an amendment. I would like to support my colleague Dr Lynda Scott. In her Supplementary Order Paper she is asking that clause 231 be deleted. Again I am following on from my colleague in the ACT party Heather Roy who yet again has made another sensible and considered contribution to this debate. 
We must not have a double jeopardy situation in these complaints. As a lawyer I have acted for medical practitioners who have found themselves on the wrong end of complaints. I have also acted for people who had complaints against medical practitioners or health practitioners as they are now called under this bill. It is for those medical or health practitioners the most worrying thing. They are people who do not stand around saying: “Oh well I’ve got a complaint today; so what who cares!”. They do not take that sort of “Black Adder” approach. What they do do is worry. They worry and they worry and they worry. We are talking about people who are under the most immense stress in their day-to-day lives and who are in many ways never off call. They are always no matter where they are—in a plane for example—health professionals and they are going to be called on if something goes wrong. 
I note my colleague Dr Lynda Scott saying that yes she knows because she has been there and still is. I must say that we all often consult Dr Lynda Scott and Dr Paul Hutchison on all sorts of little issues but fortunately not Dr Hutchison in his previous occupation for some time! Doctors nurses health professionals—I want to call them health professionals; I do not like this “health practitioners” nonsense. These people are professionals and for goodness’ sake why can they not be called that? Maybe we should move an amendment quickly to get that changed. It is absolutely appalling that those professional people who dedicate their lives to providing service for others are being told that they are no longer professionals. That is a shame. What we have to do is get rid of this double jeopardy; the situation where if people cannot get them one way they will get them another. 
We have a tremendous amount of faith in the Health and Disability Commissioner Mr Ron Paterson. We know he is someone who has the support of this House in this area. I think I can speak for all the parties here—and we are all nodding—that we have a lot of faith in his ability and in the ability of his team. We do not need somebody second-guessing him in this. We do not need to put the people through this again if he has dismissed a complaint. Why should they have to go back again? Why have another go? In this particular clause anything that slows down the process of complaint is a bad thing. In fact complaints just like justice must be speedy enough. In other words it has to be able to be dealt with within someone’s lifetime. It certainly has to be dealt with within a period of time so that people can then get on with their lives. It should not be something that drags on for 6 years. It should not be something whereby a health professional—I will use that term again: a health professional—is being bullied and pursued by somebody who decides that he or she has a problem with that particular health professional. 
Certainly at the select committee we heard time and time again of people in the health professions who were in fact the subject of constant complaint by the same person. 
Hon RICK BARKER (Minister for Courts) 
: 
 I move  
That the question be now put 
. 
Hon GEORGINA TE HEUHEU (NZ National) 
: 
 I appreciate the opportunity to take a call on Part 8 because this is such an important part of the legislation. Previous speakers have referred to the Cull report the work of Helen Cull which has informed these amendments. I congratulate Helen Cull QC on the work she did in this area. It took a lot of courage commitment and perseverance because what we are dealing with here are professionals and of course no professional group of people likes to get found out in any way. That is the fact of the matter. It is important that we can address what was clearly an inadequate process that had such tragic results but more than that led to even further tragedy for the women involved and for the families because there was no provision for an adequate process. It is important that we have had good information and that we were able to address the issue in a comprehensive way and with some confidence. 
We will never forget so hopefully we will never again see that situation. It is amazing to me that we had a situation where there was nothing that gave any health professional any responsibility to report on colleagues who were practising below acceptable standards. There was no power to suspend prior to charges being laid so one wonders about the agony some of the women were going through. 
This issue of no mandatory reporting is an indictment on our health system. It is an appalling situation and as I said earlier it resulted in utter tragedy for a number of families in this country. Helen Cull’s report recommended three immediate solutions. I have already touched on one which is the mandatory reporting by professional peers if there is reason to believe that the peer was practising below an acceptable standard. The other two recommended solutions are a requirement that various agencies be required to report practitioners whose practice is below acceptable standards to the Health and Disability Commissioner and that a professional authority have the power to suspend practitioners temporarily or to impose conditions on their practice prior to the laying of charges before a disciplinary tribunal. 
 It is proper that we make a serious contribution to this part of the legislation. These are serious matters when the sector has failed the public of New Zealand and this Parliament has too. That these things could happen indicates a massive failure of public policy. It is something that none of us in this Parliament can be proud of and we should all be pleased that we are in a position to correct and address the situation in a comprehensive way. This is a time when a person is probably proud to be a member of Parliament and able to think that we are doing something worthwhile. I know we all think that we always do that but there are times when we do something that is of far more importance than other things and this is one of them. 
It absolutely underpins the purpose of this bill which is the protection of the health and safety of New Zealanders. It is a tribute to the women who persevered and who were not put off under the most awful circumstances in bringing their complaints forward and progressing them under what I would imagine would have been severe hardship and also a tribute to Helen Cull because it takes a professional of significant competence and integrity to be able to find his or her way through circumstances such as these and come up with this sort of report. 
MARTIN GALLAGHER (NZ Labour—Hamilton West) 
: 
 I move  
That the question be now put 
. 
A party vote was called for on the question  
That the question be now put. 
Ayes 68 
Labour 52; Green Party 8; United Future 8. 
Noes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Motion agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to the definition of “authority” in clause 220(4) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to the definition of “health practitioner” in clause 220(4) be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to new section 42(2) in clause 225 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to new section 42(3) in clause 225 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendment set out on Supplementary Order Paper 103 in the name of Dr Lynda Scott to clause 231 be agreed to. 
A party vote was called for on the question  
That the amendment be agreed to. 
Ayes 47 
New Zealand National 27; New Zealand First 13; ACT New Zealand 7. 
Noes 68 
Labour 52; Green Party 8; United Future 8. 
Amendment not agreed to. 
The question was put that the amendments set out on Supplementary Order Paper 118 in the name of the Hon Annette King to Part 8 be agreed to. 
Amendments agreed to and Part 8 as amended agreed to. 
Part 9 Amendments to Medicines Act 1981 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 Part 9 is about pharmacies the restrictions on ownership and the provisions under which they operate. Pharmacies in this country are reeling at the moment. Why? Because of stat dispensing. As a geriatrician I was very well aware that it was a sensible move to go to monthly dispensing. I used to go into people’s houses to assess elderly people and I used to take shopping bag after shopping bag of medication out of their houses. Not only was a lot of money being wasted but the medication made people sick. People used to share the pills around. If one pill was good they would have six of them. People got very muddled about what they were taking. 
That led to something called closed control where medication was put into little pop-out packs. Pharmac these days changes the medication that people get—the colour the shape. It is the same generic drug but the appearance changes a lot and that really confuses older people. So rather than their trying to figure out every day what to do with all the different medication under what is called closed control it now is put into a pack showing the day and the time to take it. 
Pharmacists have paid for that. They have basically subsidised it out of the money they have been getting. They have done it for all the rest homes and all the elderly people who are a bit confused about their medication but they have never really been paid for it. They have just done it. Now because stat dispensing has gone—we are going to 3-monthly dispensing—pharmacists will lose 30 percent of their revenue. Because of that loss they will not be able to take on interns. There are a whole lot of pharmacy interns who cannot get positions. 
We will see pharmacy closures in rural areas. I went to Clevedon the other day with my associate health spokesperson Judith Collins. A pharmacist there said there is no doubt about this; she has worked out the impact of stat dispensing on her pharmacy and it is going to close. She works next to a doctor’s practice and that closure will mean that people in Clevedon in rural outlying areas of Auckland will not be able to get access to medication. Nor will the people of Wakefield; Wakefield near Nelson is another place that is affected. The pharmacists there have said they will be closing the pharmacy. So pharmacists are reeling under what has happened to them due to Pharmac and the Minister of Health making these changes. 
This bill talks about partial deregulation which means that 51 percent of a pharmacy business needs to be owned by a pharmacist and that a pharmacist can own up to five pharmacies. This is the situation currently in Australia. It is quite a move from the situation here at the moment where pharmacists can have only one pharmacy. We are really concerned about protecting access in rural areas and improving that access but the Minister’s clause 254—and we will be supporting Heather Roy’s amendment—states that she can determine by Order in Council that a pharmacy can be owned by any particular community organisation or person if she believes that health services or access to those services in that location will be improved. This is all about the Minister wanting primary health organisations to be able to own pharmacies. She wants to nationalise primary health-care in this country. She has already done it with the doctors. She has forced them to join primary health organisations because they get no access to new funding if they do not join. Now she wants primary health organisations to be able to own pharmacies as well. 
The Minister has made disparaging comments about pharmacists being in retail as well. Well it is the retail part of their businesses that cross-subsidises some of the other activities that pharmacists do. But now they are going to have to tell the district health boards that they cannot do those things any more for free and that the boards will have to pay them. If the boards want closed control if they want pharmacists to dispense medication they are going to have to pay them to do that. I was in Kaikoura the other day and the pharmacist there took me through some of the accounts. He showed me that to provide certain things like methadone costs him more; it costs him an awful lot. So I am afraid that the district health boards will actually have to pay pharmacists for what they do. 
JUDITH COLLINS (NZ National—Clevedon) 
: 
 This part of the bill as my colleague Dr Lynda Scott has stated is primarily about pharmacists and pharmacies. Perhaps the most important provision in this part is one that might surprise people. It is the insertion into the principal Act of new section 55G in clause 252. What does this section provide? It provides an exemption for mortgagees in possession. Do members know what that means? It means that all the regulations and the rules about who can operate pharmacies who can own pharmacies and who can be in charge of pharmacies are relieved for a period of 3 months when there is a mortgagee in possession which means that the pharmacist has gone broke. That is exactly what is happening right now in this country to pharmacists. 
Dr Lynda Scott came to my electorate of Clevedon the wonderful electorate of Clevedon and came with me to see the Clevedon pharmacist. We then trotted across to the Manurewa electorate the electorate of the Hon George Hawkins. We did the job of George Hawkins. We went to see one of the pharmacists there who was just getting over a ram raid through her shop window. She had been burgled. Her shop window in the electorate of the Minister of Police had been ram-raided by people wanting drugs and they got them. So that is what we have got; we have got a section in this bill that is devoted to what to do when the pharmacists go broke because they surely will. 
Under the stat dispensing rules that this Government has put in place pharmacists are in fact going broke. They are worried people. Pharmacists are not simply sellers of medicines. It is a sad point but it is true that this Minister of Health has no respect for pharmacists. I do not know what she thinks pharmacists are learning in their 5 years of full-time training. I think she thinks they are learning just to type a few labels and stick some pills in bottles. But that is not true. The pharmacists whom we are talking about are highly trained health professionals and they deserve to be treated as such. To have this Minister of Health denigrate them and say that because they have sold a camera they are not health professionals shows the absolute limit of her capability as Minister of Health—and that is not very much. 
That is what we are dealing with here; we are dealing with a profession that is under siege. Not only is it under siege from the stat dispensing rules but also it is under siege from the fact that our qualified pharmacists who are very well-qualified are able to do much much better if they go overseas. One particular pharmacist told me that he is dispensing 300 times a day. This is a pharmacist who as he said would normally now want to be retiring or working part-time but he has to stay working because people have been going to him for years and they trust him and they trust his advice. They know that he does more than just type a few labels and stick them on bottles. They know they can trust him. 
This pharmacist cannot get locums. He cannot get graduates coming out of pharmacy school to work for him because instead of earning just $65000 a year which is the average I am told that well-qualified pharmacy graduates can expect to earn in this country they can earn A$90000—in other words some real money. They can earn $90000 a year in Australia just like that. These health professionals do not want to stay here under this sort of Government. They do not want to stay here talking about stat dispensing and nonsense like that. 
These people have shown me what is happening. I go around my electorate and I see what they are doing just as I go around the Hon George Hawkins’ electorate and find out what he is doing which is not much. They have shown me the boxes and boxes of drugs that elderly people routinely have. I think now of my dear departed mother and the huge boxes of drugs that she used to take. It was very very confusing even for a woman as intelligent and vibrant as her. She used sometimes to get a bit confused and would have to make a little list of what she had taken and when. That is quite normal. A lot of older people particularly if they have had strokes—a lot of elderly people have a series of strokes—find that their memory becomes a little less reliable. 
These pharmacists are such professionals. They put the drugs in little bubble packets put dates on them and go to a tremendous amount of effort. And what does this Minister do? She lets Pharmac rob the pharmacists. She lets Pharmac get away with it. She lets Pharmac actually say to the pharmacists: “We don’t care if you have extra work; we’re not going to pay you.” 
HEATHER ROY (ACT NZ) 
: 
 I rise to speak to Part 9 “Amendments to Medicines Act 1981”. I would like to address my Supplementary Order Paper 98 which seeks to make an addition to clause 254. Basically as Lynda Scott mentioned previously it seeks to prevent the Government—district health boards and primary health organisations—from coming in and taking over pharmacies throughout the country and turning pharmacists into State employees. 
This Supplementary Order Paper is indicative of a growing problem within the health sector. It is the Government’s intention to nationalise or socialise the health sector and we are seeing it with the primary health organisations. They are umbrella organisations that are being set up around the country. General practitioners are certainly being encouraged to join them and the incentive is there to do so because if they do not then they miss out on cheaper health-care for their patients. The intention is for health care eventually to take this form everywhere in the country and for general practitioners no longer to own their practices. The Minister of Health has made no secret of the fact that she wants pharmacies to be part of public health organisations. She has made very encouraging noises and wants pharmacists to participate. As yet very few have. I think only a handful of pharmacists have gone in with primary health organisations but the Minister has certainly made her intention well known. 
It is a shame that the Minister does in fact have such contempt for the health professions. As I mentioned previously the Minister’s comments on the front page of  
Pharmacy Today 
 a few weeks back were very revealing. She said that pharmacists are not real health professionals because they have diversified; that they sell gifts sell cameras and develop photographs and that means they are not committed to providing health services for the community. Anybody who has had any dealings with pharmacies or regularly attends pharmacies of course would not agree with that at all. My Supplementary Order Paper is to prevent the Government from coming in and taking over pharmacies and in fact turning pharmacists into State employees. 
The pharmacists have been under siege of late and have been subject to concerted attacks on several fronts. It is no wonder that we see a shortage of pharmacists in this country. Like other health professionals they are heading overseas to greener pastures where working conditions are better where ownership is better and where they can certainly earn a lot more money. In this country we are seeing the socialisation of health services. Certainly one is encouraged to be part of a group rather than to own one’s own business. Small business is the backbone of this country and should be encouraged. Owner-operators particularly have provided a great deal to the economy of this country and my fear is that the pharmacists will join those groups that are being really discriminated against because of increasing compliance costs more and more difficulties in owning one’s own business red tape and all those things that make it very difficult to make one’s own living. My Supplementary Order Paper seeks to address that. 
SUE KEDGLEY (Green) 
: 
 I too would like to speak particularly in relation to pharmacies. The Green Party was extremely pleased that we managed at an earlier period in time to stop provisions that were originally in this bill that would have completely deregulated pharmacies. But it does seem to me that what we may be seeing—and we can start to see this pattern emerging and this bill is part of that pattern—is the Government trying to deregulate or get rid of pharmacists in a more indirect and covert way. 
This bill has some quite good regulations on the ownership of pharmacies. They all look well and good until one notices that one of those little provisions allows the Minister of Health to recommend by the making of an Order in Council—a secret provision that we continually see slipping into legislation now—the exemption of any pharmacy from all the regulations contained in this bill. We did manage to get some amendments to this provision during the Health Committee hearing and I am pleased about that. Before the Minister makes her secret Order in Council she has to be convinced that health services will be improved that the change is necessary to meet the needs of the community in that particular location and so on and so forth. So we did give some parameters to this sweeping exemption by Order in Council. 
But nevertheless we do have concerns that there may be a hidden agenda at work here. It is a great mystery to me why this Government seems to have a hidden agenda to undermine the pharmacy sector in New Zealand. I cannot understand it. I have tried to work out what is really going on here. It may just be that the Minister has had a fight with the pharmacy sector and as a result has decided that it needs to be got rid of or undermined. I am not sure. 
Anyway what is worrying me as Lynda Scott pointed out previously is that stat dispensing has wiped out 30 percent of the revenue of pharmacies. Can members imagine wiping out 30 percent of the revenue of MPs taking off 30 percent of our income or wiping out 30 percent of doctors’ incomes or the incomes of anyone else? There would be an uproar. But no we just quietly wiped out 30 percent of the revenue of pharmacies. So inevitably there will be a demise of rural and community-owned pharmacies in particular. It might take a year or two but very soon we will see them starting to go into receivership as Judith Collins has said and close down in various parts of New Zealand. 
What will we do then? Well under the provision in this bill we will start replacing the small owner-operator pharmacies in New Zealand which have been in existence for decades and decades. One would have thought the Government would support small owner-operator businesses but instead it will shut them down and will replace them with primary health organisations. Clearly that is the underlying agenda here. 
One of my concerns about that is the potential conflict of interest. On the one hand a primary health organisation doctor will be prescribing medicines and on the other hand a primary health organisation pharmacist will be dispensing those medicines. There has always been a very clear distinction between the writing of pharmaceutical scripts the prescribing of medicines and the dispensing of medicines for the very good reason that there are huge potential conflicts of interest because a good way of making money would be to prescribe a great many medicines which are subsidised and then dispense them. But there are other conflict of interest issues as well. I do have concerns. 
RODNEY HIDE (ACT NZ) 
: 
 Let us talk about consumers for a change rather than suppliers. We want to make it cheaper for New Zealanders to get prescribed medicines and to enable them to buy over-the-counter medicines like cough mixtures and flu tablets more cheaply. We can all agree that that is a good goal but Part 9 still provides a privileged position for pharmacists with regard to pharmacy ownership. Despite 15 years of attempts to deregulate and open up the ownership of pharmacies the monopoly provisions continue. I still cannot believe that we in this country deliver that privilege to 931 pharmacists rather than concentrate on supplying the best service to customers particularly to those people who want low-priced drugs—children and the elderly who are the ones most in need of them. 
No other professional body in New Zealand has that kind of protection. Any one of us can own a doctors’ surgery or a drug warehouse but only a pharmacist can own a pharmacy. That is wrong because it creates an artificial monopoly that jacks up prices and lowers the level of service. I ask the Government to support my amendment that deregulates the ownership of pharmacies in New Zealand because that will provide a better service and lower-cost drugs. 
I tell Government members that I am not a lone voice in saying that. The Consumers Institute hardly a bastion of right-ACT thinking says that the current privileged and protected status of chemists shops prevents consumers from benefiting from lower prices and extended operating hours. Government agencies ranging from the Ministry of Health to Treasury the police and Te Puni Kokiri all say we should get rid of the pharmacists’ monopoly and that is what my amendment does. It removes the ownership provisions and it ends the privileged status of chemists. 
Of course dispensing and selling medicines requires high professional standards and those will be retained. A licensed pharmacist will always be required to operate a pharmacy. No matter who owns the pharmacy a licensed pharmacist will always be there. My amendment contains a number of consequential amendments that are required once the ownership restrictions found in new sections 55A to 55G inserted by clause 252 of the bill are removed. But those are technical details. I hope the Committee sees that this amendment of the bill is comprehensive. 
It is time that we stood up for the consumers in all of this. My amendment will answer the health Minister’s own concerns. The Minister of Health was quoted last month in the  
New Zealand Doctor  
as follows: “If pharmacists just sold things related to health care it wouldn’t be so offensive but they run Lotto outlets they sell cameras gifts and you name it. They’ve turned themselves into retailers of anything they like but they’re opposed to other retailers having a pharmacy outlet in their organisation.” I agree with the Minister. On top of that I say that a pharmacy located within a supermarket will deliver cheaper medicines to lower-income New Zealanders at a venue where and at times when they can access them. 
I have another quote from the Minister of Health again from the same publication: “Everyone knows it is a nonsense. As long as you’ve got a pharmacist dispensing that’s what’s important not who owns the building.” I find myself at times agreeing with Annette King and I agree with her on this matter. Let us end this ridiculous anomaly. I urge Government members to vote— 
Hon Annette King 
: What about those ones? 
RODNEY HIDE 
: The National Party is all right. I urge the Labour Party to vote for working people for our elderly and for our young people so that they can access low-priced drugs in extended hours. Let this Parliament stop protecting 931 privileged suppliers who have a monopoly. We have done so everywhere else. I say to the Minister that we even did that for the dental nurses. 
Hon Annette King 
: They were never regulated; it was the dentists. 
RODNEY HIDE 
: The dentists; I am sorry. We did it for the dentists and the consumer benefited from that. We have done it elsewhere in the economy. Let us in this Committee fix this monopoly tonight. I ask members to please vote for my amendment. 
STEVE CHADWICK (NZ Labour—Rotorua) 
: 
 I move  
That the question be now put 
. 
Dr PAUL HUTCHISON (NZ National—Port Waikato) 
: 
 Thank you Mr Chairman for the opportunity to speak on this part of the bill. I must say— 
Hon Dr Michael Cullen 
: The late night port. 
Dr PAUL HUTCHISON 
: The late night port? What an odd remark but it has come from the left and that is totally appropriate. We have just heard Dr Rodney Hide talking about—I am sorry Rodney Hide; we will not confer an honorary doctorate on him. 
Hon Dr Michael Cullen 
: No it was Dr Jekyll and Mr Hyde. 
Dr PAUL HUTCHISON 
: Maybe that is more appropriate. We have heard Mr Hide talk about consumers and that is absolutely right because when it comes to pharmaceuticals we want to make sure there is safe dispensing. The whole point of this bill is to protect the public. That is absolutely vital and it depends very much on the professionalism of pharmacists. This bill has been all about quality assurance continuous quality improvement and peer review. All those things will hopefully ensure that there is safe dispensing and that the consumer will be protected. 
There has been great concern amongst pharmacies throughout the country over the last few months particularly out in small towns and hamlets like Port Waikato. That pressure has undoubtedly been influenced enormously by the dispensing change that the Minister has ushered in. I realise that the Minister will once again get that toothache—that Pavlovian response—and say it was not him but Pharmac. But undoubtedly the change has put huge pressure on pharmacies throughout the country and particularly as I say in the country areas. Pharmacists have frequently come to me and expressed their concern about the fact that the smaller pharmacies in particular may go out of business. They have been concerned about their trainees and about the flight of young pharmacists to Australia. There is no doubt that it has had an incredible effect on them. 
One aspect of this issue has been the gradual and stealthy nationalisation of the health system under Labour. For example there has been the establishment of the 21 district health boards and the extraordinarily inequitable primary health organisations. I think it is absolutely appropriate that Heather Roy has brought in Supplementary Order Paper 98 to ensure that the primary health organisations are not able to buy out pharmacies throughout the country. That is absolutely right and proper because the basis on which the primary health organisations are structured is totally inequitable. That is yet another reflection of this Labour Government’s stealthy nationalisation of the health services in New Zealand. Today the Press Club was addressed in Wellington by an English psychiatrist who said how bad the situation was in Great Britain yet that is the very model that Dr Cullen and Annette King are trying to emulate in New Zealand. The health system is becoming worse and worse in the UK and it will become worse here for New Zealand consumers because of what those Ministers are trying to do. However I think that Heather Roy’s amendment is absolutely right and proper. 
 There is another characteristic that I think is worth mentioning in this debate and that is the fact that Pharmac does dominate the situation in New Zealand. If we are to consider making major changes at some stage we will probably have to think about removing the commercial protection of Pharmac. If we are to think about getting free-trade agreements in the long term that is one of the things that we will have to think about. There is no doubt that the market in New Zealand is hugely distorted and that is one of the effects of the dominance of Pharmac. 
Hon ANNETTE KING (Minister of Health) 
: 
 I have been waiting for Part 9 of this bill for a long long time. I will begin by thanking Rodney Hide for his honesty and for having the courage to put forward an amendment that he believes in and which his party stands for. He was prepared to stand up in this Committee and support that amendment. 
I say to Mr Hide that the comments he quoted from me were absolutely correct. I firmly believe them. I would have very much liked to deregulate pharmacy ownership. I tried very hard to deregulate pharmacy ownership before the last election. I went along to the Pharmacy Guild’s conference before the election and said that I was very keen to deregulate pharmacies. I did not think that one needed to own a pharmacy in order to be a good pharmacist; I thought that one needed to be competent with the skills to be a pharmacist. I said that I would like to deregulate pharmacies and I was followed by one Bill English. When Bill English spoke at the Pharmacy Guild’s conference he said National did not support deregulation. He said that there was a safety issue in doing that and that National opposed deregulation. 
One could have knocked me down with a feather because I happen to have 1998 Cabinet papers in my possession and who signed those papers? A former Minister of Health named Bill English. What did those Cabinet papers state? They stated that pharmacies should be deregulated. Those papers were also signed by Mr Luxton who was an honest member of Parliament. He said pharmacies should be deregulated. Those members said that there were no safety issues in doing that and that we ought to deregulate pharmacies. What happened then? We got a little close to the 1999 election so they then put in a deferral proposal to Cabinet and that was in place until National lost the election. Now before the next election National is opposed to deregulation. 
 The story has not stopped—this is very funny—because Rodney Hide has put forward an amendment. Mr Hide who is an honourable man has told me that the National Party will support his amendment. National was in favour of deregulation—flip. Then it was opposed to it—flop—and what has happened? Now it is in favour of it again. There is another flip. National is the flip-flop finger-in-the-air which-way-is-the-wind-blowing party. What a lot of cant we have heard from that party. If any New Zealander wanted to know about a party that could not stand on its principles that person should look at the National Party. Now National is in favour of deregulation again and Mr Hide has said that National Party members will vote for his amendment. How could one trust them on absolutely anything? One could not. At least ACT through Mr Hide has had the courage of its convictions. 
No members of the National Party had the courage to even speak to the amendment. They want to vote for it but we should not ask them to speak to it because they just want to pretend that they are in favour of it to some of their constituents. But when those members are talking to their pharmacists they are real lions. They say that they have real courage and that they stand up for pharmacists. When they are talking to their business people they say that they stand up for them. One would not know where they are. 
I say to Mr Hide that I am sorry I cannot vote for his amendment and neither can our party because when we introduced this bill we gave a commitment to pharmacists that we would support 51/49 percent control. 
Progress reported.