Reti Shane: Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill — First ReadingText is incorporated into the Bound VolumeReti Shane: Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill — First Reading[Sitting date: 18 August 2015. Volume:707;Page:5924. Text is incorporated into the Bound Volume.]Dr SHANE RETI (National—Whangarei): It is a pleasure to stand and speak positively and affirm this bill the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. Fundamentally and substantively this bill is administrative renaming the term “medical practitioner” as “health practitioner” thereby increasing the scope and the number of people who can be engaged. The purpose of this will be to increase efficiencies in the health system and it will do so in several ways.First of all health practitioners will be able to deliver better end-to-end service without having to do segments of care then have a medical practitioner intervene and they then complete their care onwards. So end-to-end care is better preserved.It also prevents skill dilution. When you have highly skilled practitioners who have to undertake sometimes labour-intensive repetitive work you get what is called skill dilution. They lose their career path and they lose interest. They move out of what they are doing. So a bill like this also prevents skill dilution.Most important what it also does is that it allows more clinical people to do more things. I think this is useful in resource-depleted areas particularly. One of the things that this bill will do is amend the Accident Compensation Act 2001. This allows a health practitioner leading the case to be involved in individual rehabilitative plans. Many times that practitioner may actually be a physiotherapist a podiatrist or maybe even a chiropodist. The health practitioner is also able to prescribe various aids and appliances. So the theme here is that the health practitioner with the most knowledge is able to contribute and I think that is the way that it should be.The Burial and Cremation Act 1964 is also amended. Particularly it allows nurse practitioners to complete certificates of causes of death. This is a very important function. The certificate of cause of death is very important for epidemiological studies. It gives us some sense of trends of death and trends of disease over time. It is actually also very important for closure for patients. I have often found that when they have got their certificate of death in their hand they can look at it and in amongst their grief that episode of sadness reaches some level of closure. New section 46B in clause 9 addresses this and talks about how a medical practitioner or a nurse practitioner can complete a death certificate.If I could just go over some of those clauses—first of all it applies to a person who dies of an illness so if you succumb due to an accident you go to a coroner’s inquiry. It also says that the death has to be a natural consequence of illness and the section also says that a health practitioner has to reasonably consult with any other health practitioners who have been involved in the last illness.There are some safety clauses in this section as well. A health practitioner or a nurse who attended the person may refuse to give a certificate of death if a previous practitioner cannot say: “Yes I think this was due to illness.” Another safety clause is that a medical practitioner or nurse practitioner must not give a certificate of cause of death unless they have taken into account previous medical records and the circumstances of the death and of course they have examined the person’s body. The final safety clause in this section is that the certificate of cause of death must not be given if a death must be reported to the New Zealand Police or to a coroner. So I think there are a number of safety clauses there.When you do a certificate of death it is actually quite a time-consuming event. You need to coordinate with the funeral director to be at the funeral parlour. So you coordinate schedules you go in and the very first thing you need to do is to certify that the person is dead of course. There are a number of ways clinically to do that. What you then do is you complete some documentation that asks whether this person had a notifiable disease or any sort of disease that the funeral home might need to know about or that the public needs to know about. You are then asked whether they had a pacemaker because if they are going to be cremated you cannot do that because pacemakers explode under cremation. Then you actually do the certificate of cause of death. In my experience this takes probably 30 to 35 minutes and sometimes three-quarters of an hour and to have this done by an appropriately qualified person I think is a really good thing.New section 46B also specifically talks about nurse practitioners and our colleagues across the House have talked about them today. These are indeed highly trained professionals many of whom actually have prescribing rights as well. In fact just on Friday I tried to persuade the Tāmariki Ora nurse in Nelson to become a prescribing nurse practitioner with Te Piki Oranga the service she was with and we have tried to enlist nurse practitioners up into some of our resource-depleted areas in Northland. Nurse practitioners really do have a high scope of practice. They are registered with the Nursing Council in a registered scope of practice they have had a minimum of 4 years of experience in specific areas of practice they have actually completed a clinical Master’s and they have passed an assessment panel as well. When I looked at the Nursing Council website a few days ago there were actually 116 nurse practitioners.We have just talked about the Burial and Cremation Act and it strikes me that there are three registered nurse practitioners who might especially benefit from that Act. These are nurse practitioners with scopes of practice—there are only three of them—in palliative care. The three of them come from Auckland Canterbury and Southland. Auckland and Canterbury may well be well served by medical practitioners in other services who can complete certificates of cause of death but I am pretty sure that Southland would be very pleased to have a nurse practitioner who can complete some of this documentation.This bill also amends the Children Young Persons and Their Families Act 1989. Health practitioners are able to prescribe and undertake medical examinations. The duties of care are also amended so that health practitioners are aligned with medical practitioners.I am always sort of interested in what health policy we enable and how many people it might actually touch—is it a few or is it many—and I think it is actually the amendments to the Holidays Act 2003 where this legislation may actually touch the most New Zealanders. When we look at the efficiencies that this bill creates—let us take your standard practice and how we actually complete a sick note. The patient comes in you then consult with them and what most of us would generally do is then show the patient through to another room and the nurse completes the sick note. They then will be required to come back to you for you to sign it and then it is complete. Well that could be 45 to 50 minutes for a patient—that is a lot of time. What could happen here now with the work flow is that they could be seen and diagnosed by a nurse practitioner or an appropriate health practitioner. The sickness certificate could be done and that could all be completed in 15 minutes. This is particularly so if the nurse has high skills in some of the more frequent things that we see sickness notes for like a urinary tract infection for example. This can often be point-of-source tested in the surgery. The patient does not need to see the doctor but can see an appropriately—