Clark David: Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill — First ReadingText is incorporated into the Bound VolumeClark David: Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill — First Reading[Sitting date: 23 July 2015. Volume:707;Page:5316. Text is incorporated into the Bound Volume.]Dr DAVID CLARK (Labour—Dunedin North): It is a delight to follow that member Simon O’Connor who has been praised by the Hon Annette King as a good sound member and in fact as a sound leader of the Health Committee. I think what we have observed there in that speech is that following Annette King is something that many people should do. It is something wise people do everywhere. Actually the member said he followed the Hon Annette King to Gore Hospital not long ago and he might do well to advise the Hon Jonathan Coleman to also follow the Hon Annette King because where the Hon Annette King goes there the health officials follow.I have to say that there have been many stories recently that have been broken in this House about what is going on in the health system. The Minister clearly did not know about the North Shore stuff we heard about in the House today about the staffing shortages there and the crisis and the challenges of meeting the medical need and the real struggle that is going on behind the scenes. He had no idea. The Hon Annette King was informing the public and I can bet you—not you Mr Assistant Speaker—I can bet the people at home bottom dollar that the health officials will be jumping as a result of Annette King’s words today.It was no different when she announced about a week ago the loss of orthopaedic accreditation in Dunedin at the hospital there. And it was not a couple of days either side of that when she announced the loss of accreditation of intensive care training in Auckland. The Hon Annette King is the one who is driving the health portfolio right now. She does not collect the salary; I think she could be a bit disappointed about that. The Hon Jonathan Coleman is still carrying the lunch box around with the silver plate on it and collecting the salary but he is not driving the officials and he is not driving the health portfolio. The visionary here is actually the Hon Annette King and this bill today is somewhat late in coming. The Hon Annette King put a very similar but better one into the ballot 6 months ago. The Hon Annette King is once again well ahead of the Government—Grant Robertson: Visionary.Dr DAVID CLARK: Visionary some would say. In fact along those lines we observe that it was the Hon Annette King who introduced the first nurse practitioner in 2002—2002. In fact beyond that in 2003—and I have a speech here from the Hon Annette King that describes some of the things that nurse practitioners could be doing which we are going to make happen today. This is from a speech in 2003. Twelve years on the Government is catching up. It is no wonder that everybody else in this Parliament thinks it is about time this happened. Twelve years ago the Hon Annette King was saying “Nurses provide consistently high-quality health care to New Zealanders but there is considerable potential for them to contribute even more positively through responsive innovative and collaborative health systems.”Sue Moroney: That’s leadership.Dr DAVID CLARK: That is leadership. She said: “Nurse Practitioners will have an important responsibility in advocating health promotion and disease prevention. Part of their role will be to encourage self-care but they will also have the skills to consider a wide range of health services that may suit individual patients. The vision for the Primary Healthcare Strategy includes developing a high-quality workforce a focus on better health for the whole population and a reduction in health inequalities.”Of course we know that under this Government things have been going in the opposite direction but we do congratulate it on finally 13 years down the track putting through some legislation that will enable these further steps that the visionary Hon Annette King suggested way back—way back—in 2003. It is cost effective as the Hon Annette King noted further on in that speech. It has more of a community focus and the nurse practitioner concept is one that is now proven. It is one that we know brings cost-effective efficient health care to New Zealanders. So this bill is a long time in coming a very long time in coming. It makes a lie of the mantra of the Government that says “faster sooner more convenient” and I noticed that even Simon O’Connor was struggling to remember that mantra in his speech. It did not roll off the tongue and I do not think it would roll off the tongue of many New Zealanders.The Hon Annette King’s bill interestingly if we note does suggest a few extra things that could be achieved and maybe they will be put forward as amendments later in the process. Maybe they will be discussed at the select committee. For example there is the recognising of the role of a nurse practitioner in legislation properly: amending the Adult Adoption Information Act 1985 which would enable a nurse practitioner to provide information on medical grounds; allowing for the provision of genetic counselling; amending the Civil Aviation Act to enable a nurse practitioner to conduct medical examinations; amending the Education Act to enable a nurse practitioner to certify whether a child is well enough to go to school; and so on. It is visionary stuff.A bill was put in the ballot 6 months ago when Annette King’s frustration at the lack of Government progress became clear. She decided: “Well let’s try to do it ourselves.” The Government could have adopted it then in fact and we could have had it in law by now. But this is a Government that has been dragging its heels. It seems a little distracted by other issues and is failing to realise really the urgency of change and the savings that are possible in our health system to deliver better provision of health care for New Zealanders. We can think of examples recently: $140000 TV screens $260000 sun decks New York apartments that cost $11 million hair straighteners and so on. The Government is distracted by these issues rather than focusing on sorting out a health care system that would really benefit all New Zealanders.As the Hon Annette King mentioned in her speech she and I did a tour through many rural hospital areas recently and we heard from the people running those hospitals how useful it would be to have more nurse practitioners and how useful it would be to have that flexibility in the rural health workforce to help deliver the services that are needed. Of course part of that requires this kind of enabling legislation that makes it possible for those jobs to be there and of course for the training of the workforce.We travelled down through Timaru. We visited Timaru Hospital which is considering interestingly amalgamation with Ōāmaru Hospital because of the crisis with funding. Ōāmaru has been threatened with a 5 percent funding cut in its hospital because of the underfunding of health services by this Government—a 5 percent cut after having had its funding frozen previously. We visited Maniototo Hospital where its struggle is to actually deliver services into the future with any kind of certainty in its rural community because the buildings are earthquake prone it has a rating base of 1800 people and a trust runs it because the Government was not keen to provide the health care services there. In Queenstown we heard about the lack of availability of services there for a population of 30000 people that swells to 90000 in the tourist season. At Dunstan Hospital there is another model there and further on in Clutha there is another model there where they are doing more integrated services delivery.In all of those areas we heard how much more benefit we could get out of having this more flexible health workforce that was trained in a contemporary way and overall I guess the feeling is that this Government is dragging its feet. I have to say that the communities we spoke to across the Otago region were very concerned about the cuts in funding in real funding during this Government’s tenure. That has meant that there are service cuts proposed in all of those rural areas. Several of those hospitals have accepted funding cuts next year. They have had their funding frozen previously and they have accepted funding cuts in the coming year.So it is amazing that it has taken so long to get this bill on the Order Paper when the need is so great in the health workforce. We do have Annette King to thank for her leadership in this area and for introducing those nurse practitioners with the master’s qualifications recognised by the Nursing Council to conduct a range of activities that they are entirely able to conduct to create a modern health workforce that is responsive and financially sustainable.I for one look forward to the Hon Annette King not only nominally driving the officials in the health ministry but actually also having that title of Minister of Health. I hope that time will come sooner rather than later. We also heard I have to say in Otago that the halcyon days of health were under the Hon Annette King. Public audiences told us that. They are still looking back to the brief time when Annette King was Minister of Health. They are looking forward to her being health minister again as am I and then we will know that we will not only get this kind of positive progress but get more of it faster sooner and more conveniently for the people of New Zealand.