Health (Protection) Amendment Bill — Third ReadingText is incorporated into the Bound VolumeHealth (Protection) Amendment Bill — Third Reading[Sitting date: 09 June 2016. Volume:714;Page:11896. Text is incorporated into the Bound Volume.]Health (Protection) Amendment BillThird ReadingHon Dr JONATHAN COLEMAN (Minister of Health): I move That the Health (Protection) Amendment Bill be now read a third time. I would like to acknowledge the officials and the members of the Health Committee for their work on the bill. There were 71 submissions and the committee heard 22 oral submissions. I know it was a most constructive process. I would like to thank other parties in Parliament for their support of the legislation.This bill amends the Health Act 1956. Back in October 2013 the Government decided to improve the range of measures in the Health Act in two specific areas: measures to protect the public from the risk of sexually transmitted diseases and the spread of some infections and then unrelated but obviously within the same bill in the case of people under the age of 18 measures to protect them from the harms associated with UV tanning. This bill is going to protect people from those preventable harms and it will do so through a range of measures proportional to the risks faced.New Zealand has high rates of sexually transmitted diseases and of course such diseases affect individuals families and communities. There are a variety of potential complications that stay with people for life including chronic pain infertility neonatal morbidity and genital-tract cancer. So these diseases are serious matters indeed. The bill adds new provisions for the surveillance and management of infectious diseases and those measures will improve the availability of information on certain conditions they will provide for more effective management of behaviours that put others at risk of infection and they will strengthen the legislative provisions for contact tracing.The bill establishes a clear legal basis for the principles applying to medical officers of health and the courts in the exercising of their disease-management powers. People exercising these powers will be required to take into account any known special circumstances or vulnerabilities of the individual concerned. These may be due to youth disability incapacity or a range of other circumstances at the discretion of the officer. The bill requires that measures are proportionate to the public health risk that is being managed so that you do not have a situation where a sledgehammer is being used to deal with an acorn. People get to manage or exercise discretion in the range of measures applied.The principles also encourage individuals to take responsibility for their own health and the health of their communities. Currently sexually transmitted infections (STIs) with the exception of AIDS are not notifiable by medical practitioners in New Zealand. The bill makes HIV infection gonorrhoea and syphilis notifiable on a non-identified basis along with AIDS. The notifying of information for STIs needs to be sufficient to enable different kinds of public health interventions while making sure they are complying with privacy safeguards. The bill requires notification of serious STIs while protecting the individual’s identity from being disclosed in the first instance. Reluctance to disclose information or to be diagnosed and treated could arise from fear of consequence as a result. However this information can be vital to help identify others who may be at risk and to prevent further spread of infection and disease. The bill says that information requested and provided under Part 3A will not be used or disclosed for any purpose other than the management of infectious disease.Contact tracing is a very valuable public health tool in preventing and managing infectious disease outbreaks such as gonorrhoea measles and meningococcal disease and it is a very important tool for public health officials. Subpart 5 of the bill extends contact tracing powers to contacts of people suspected of having an infectious disease allowing speedy follow-up and diagnosis and then of course treatment and containment where appropriate.On looking at this bill’s impact on existing venereal disease legislation the committee decided that it should be replaced by this bill. The current definition of venereal disease is not fit for modern conditions. For example it does not include HIV infection AIDS or chlamydia. Other outdated legislation the bill will repeal includes section 79 of the Health Act. This authorises a medical officer of health to detain and isolate people likely to cause the spread of an infectious disease. Part 3A effectively replaces section 79 with graduated powers of increasing robustness when an individual refuses to comply with management aimed at preventing other people from becoming infected.On to Part 2 of the bill which prohibits the commercial provision of artificial ultraviolet-light tanning services to people under the age of 18. A complete ban on the provision of artificial UV tanning services would prevent access to artificial tanning services by adults who are well informed and choose to take on that risk. The Health Committee reported back that it is satisfied the bill will protect the vulnerable under-18 age group while allowing adults to make informed decisions. That is comparable to other legislation such as the sale and supply of alcohol legislation which recognises that 18 is an age at which people are capable of making their own choices.Clauses 8 and 13 of the bill include several new provisions. These provide an infringement process to deal with breaches on the ban of providing artificial UV tanning services to people under the age of 18. This process will deal efficiently with offences and prevent expensive and time-consuming criminal prosecutions. Voluntary standards and guidance on operating sunbeds exist. However surveys have found there is variable compliance with those steps designed to minimise harm despite the considerable effort that has gone in to educating operators and to encourage compliance.I have therefore asked health officials to look into whether licensing of premises and operators and the introduction of mandatory standards is indeed appropriate. Because of the danger that sunbeds potentially pose it is important to have a licensing and training regime that ensures cowboy operators can no longer exist in this particular industry. I have asked officials to provide advice on a range of possible measures including licensing all sunbed premises and operators requiring that operators are trained to ensure the risks of sunbed use are minimised and insisting on clear information being provided to clients before they jump on a sunbed.This bill improves the protections we have for the health of New Zealanders. It is an important part of the legislative framework for managing and reducing health risks and I commend this bill to the House.Hon ANNETTE KING (Deputy Leader—Labour): “Mr Waiter”—I mean Mr Assistant Speaker I rise to speak in support of the Health (Protection) Amendment Bill and—The ASSISTANT SPEAKER (Hon Trevor Mallard): I might call the member soon.Hon ANNETTE KING: “Mrs Waiter”? So this is a red-letter day in terms of health legislation. The Health (Protection) Amendment Bill which the Labour Party supports is one that has been waiting for its day to come—waiting for over 8 years 8 long years—because the Public Health Bill regarding infectious diseases was first introduced by the Hon Pete Hodgson. It was so urgent that we have waited 8 years for it to pass but putting that to one side we are pleased that we have reached the third reading of this bill.This bill does a number of things that are very positive. It improves the range of measures available to protect the public from harms associated with some diseases which include a range of infectious diseases that are notifiable to a medical officer of health. The key thing is that it is done without the identifying information of the patient or the diseased person. It will include HIV infection gonorrhoeal infection acquired immune deficiency syndrome and syphilis. There was a lot of concern from those who work in public health and staff who work in the health agencies that the management of this area over a sustained period was hindered by an Act that was not up to modern standards and up to scratch and in fact that it was long overdue for us to make these amendments.I have to say that the Health Committee worked very hard on this bill as it does on most bills and petitions. It is a very hard-working committee and its members usually find ways to come to agreement on most things. So we did agree on Part 1 of this bill and the three measures that it introduced which are contact tracing the increase in the range of diseases that are notifiable and the option for the management of individuals with significant infectious diseases. But we were not in agreement on Part 2 of this bill although I do believe that members of the Government opposite would have liked to support my Supplementary Order Paper 80 at the Committee stage which would have banned some sunbeds in New Zealand.It would have banned them because of the danger of them. You know I always like to think that we lead Australia in most things. We are very proud as a small nation that we can do things nimbly and that we can do things in a way that a big bureaucratic government process in Australia makes it difficult to do. Australia has banned sunbeds because it has seen the health risks of them and we should have done the same. But unfortunately our Minister of Health decided that he would ban them for those who are 18 and under. This Government is not going to ban them for an age group they consider old enough to make a decision. This is how the Minister has decided we will approach public health issues. So if you want to choose to smoke why are we wasting money on trying to help people to stop? I mean I found the whole argument about saying that the overriding issue and this is what the Ministry of Health said was that it would prevent access to sunbed services by adults who are well informed and who choose to take the risk of UV tanning for cosmetic purposes—well I think this was a very limp-wristed approach.I would expect a former medical doctor to have picked up this issue and led on it in New Zealand and to have said that we are not going to continue to allow people in New Zealand to use commercial sunbeds that lead to melanoma. I do not say that lightly because we do know that the use of sunbeds increases the risk of melanoma by 75 percent as shown in the analysis of over 20 epidemiological studies. They concluded that the risk of melanoma is increased by 75 percent when the use of tanning devices starts before the age of 30—not 18 but the age of 30. Would we not listen to that sort of evidence? Would Professor Gluckman the Chief Science Advisor not be saying to the Minister of Health: “The evidence is overwhelming that if you use this product it increases the risk of getting melanoma by 75 percent.”? It increases the risk of a terrible cancer. And here we are about to spend tens of millions of dollars on a melanoma drug—a drug that is for advanced melanoma when it has reached the point where most people are unlikely to survive—but we are not prepared to take the opportunity to ban commercial sunbeds. We do not need them. You can get enough from the sun—the natural sunlight.What we also know is that those who operate the sunbeds are not always the best of folk when it comes to ensuring that those who use them ought to be using them. We were told at the select committee that the Consumer New Zealand survey found that 40 percent of sunbed operators failed to implement basic safety checks. The public health units carried out a systematic assessment of 97 establishments and found that only 35 percent of operators complied with a joint standard. Half-hearted regulation does not work in this area. Now we are putting in a regime that is a regulatory regime that has to then be checked and followed up and monitored and inspected. The cleanest easiest thing to do in this case would have been to ban them. If people want to use sunbeds in their own home that is their choice but there is no need for us to be providing commercial sunbeds.My worry is particularly for young people under the age of 30 who decide they need to look good and they need to be brown. They spend hours in these sunbed operators so that they feel that they look better while at the same time increasing their risk of melanoma. There is another thing that I found interesting: the Minister of Health has now decided that he is going to do further consultation on the restriction of sunbeds—at the same time as we are passing this legislation. Well we waited 8 years to get to today—we could have waited a few more months for his further consultation on what further restrictions he might like on sunbeds. It just does not add up.I think it must be half-hearted consultation because otherwise a Minister on top of his portfolio would have said: “Hang on. Let’s not pass this bill now. I’m doing further consultation on restrictions and maybe I’d like to include them in this bill or maybe on the advice I receive I would like to ban sunbeds altogether.” Knowing those who are in public health within the Ministry of Health I do not believe that they would support this move. I believe that they would have wanted us to take the public health approach which would remove something that is unnecessary in New Zealand: for people to become more beautiful by having a browner body when we have the sun available. I do not believe they would have supported a move that would see a 75 percent increase in the risk of melanoma for those under the age of 30 who use sunbeds in New Zealand.The Australians were clever enough to see it—and we have the highest rate of melanoma in the world; we are ahead of Australia now—and they have taken a sensible measure. I am very very disappointed in this particular measure and I am sorry that the Government could not see fit to ban sunbeds altogether which my Supplementary Order Paper would have done.We will support the passage of this bill because it does put in place some restrictions for those who are 18 and under but it does not go far enough. I look forward to the day when as Minister of Health I will move legislation that does ban sunbeds so that the cost of paying for very high-cost melanoma drugs when people are at the end of their lives will be unnecessary because we will do what we can to prevent it before people end up with such a nasty cancer.SIMON O’CONNOR (National—Tāmaki): I want to acknowledge the last speaker Annette King. I think it is actually an implicit sign of how good the health system is that she expects to be alive fit and healthy and a Minister in at least 20 years’ time. I think that is fantastic. It is also clearly a night of celebration as has been seen or visualised in the House but I am very pleased that we are now at this third reading of the Health (Protection) Amendment Bill.Can I thank the Minister of Health and his team for bringing the bill to the House. I thank the officials who had quite assiduously helped us through this bill. I am going to touch on the two main themes within it. There is often a lot of talk around the sunbeds but I will spend most of my time talking on the contact tracing side of it. I thank again the officials for their work and understanding. I thank the Health Committee members from all sides. Other members have said it at this stage of the reading and in other stages: it is a very collegial committee. We work very hard together to try to bring I think the best results possible. We do not always see eye to eye and the sunbed provisions in this bill are an example of that but that does not prevent us working ahead.The context of this bill is a reaction if you will to a lack around how we trace infectious diseases in this country. If I go back I am pretty sure I would have mentioned in my first reading many many months ago that the system before the introduction of this bill really just put a moral compunction on a New Zealander to report an infectious disease and it did not really give any powers to medical practitioners to ensure that someone notifies their disease. In other words if someone was found to have something like gonorrhoea for example a doctor could not force them to undertake—well could not force the person to have that effectively registered or noted. And one of the things we have to acknowledge quite importantly is that even though we are individuals we live in a society and when it comes to things like infectious diseases society as a whole—the community—needs to know.So this bill puts in place what we would term “contact tracing” and it basically puts in a series of steps to allow medical professionals to ensure that if someone has an infectious disease it is notified and they are effectively managed contained and assisted as best they can be. So again the moral side is now replaced by a series of steps and structures to make sure not only that that person is well cared for and looked after but also that the community itself is protected.It is bringing together a range of new—sorry the conditions themselves are not new but it is bringing a number of other notifiable diseases into this category; the likes of gonorrhoea syphilis and HIV are three that come to mind. They are words that you will not normally have me speaking about in public but they come under the bill.Another element is actually around tuberculosis or TB which up until the introduction of this bill has been dealt with as a separate piece of legislation. This Health Protection Amendment Bill effectively ends the Tuberculosis Act and brings tuberculosis in as a notifiable disease. Although I think that we are quite well on top of it it is something that we have to look upon quite carefully—particularly for people coming from overseas.Members on the committee in particular will remember that there was a lot of discussion about hepatitis C and in fact quite a good number of submitters came and spoke. Hepatitis C was not put at the top level of a notifiable disease for a variety of reasons but particularly to those submitters some of whom I know are watching I hope and trust they are very pleased with the Government’s announcement of extra funding to Pharmac which is allowing I believe at least two drugs now that directly affect hepatitis C in New Zealand and is in fact moving from a management to a curative model. So I think that that is quite exciting.Within the whole area of contact tracing I think it is really important to stress the importance of privacy. We spent a lot of time as a committee focused on the importance of privacy but we also heard from a number of epidemiologists and those working in public health that there are elements we need to know about—New Zealanders who have infectious diseases—and that includes the NHI or National Health Index number. We have accepted that and the committee amended that into its report and I am pleased to see it remain in the bill.I just want to finish around the whole sunbeds discussion. As chair of the committee I am very comfortable with where we have landed with this legislation. I think it protects the rights and allows New Zealanders who wish to use sunbeds to continue doing so if they are over 18 years of age. We are not here to if you will mollycoddle every person’s decision but I think we have also made a very clear statement in a variety of ways that sunbeds are not healthy at all. I have said many times on the record that the science is very very clear that the use of any sorts of ultraviolet generating machines such as a solaria or sunbed enormously increases the risk of melanoma but I think really importantly it enormously increases the risk of non-melanoma skin cancers which are in fact far more prevalent in this country. So I certainly encourage New Zealanders to enjoy the sun responsibly and not necessarily to use a sunbed but ultimately the choice is theirs as it is the choice of mine to do what I want in life here. So I think we have a good balance and I would like to commend this bill in its third reading to the House.POTO WILLIAMS (Labour—Christchurch East): I rise to take a call on this third reading of the Health (Protection) Amendment Bill. I guess I have the prime spot of the last call on a Thursday afternoon—Grant Robertson: Sought after.POTO WILLIAMS: Yes highly sought after.Even though I had the pleasure of speaking on the first reading of this bill I was not a member of the Health Committee that deliberated on the bill at the select committee stage so I do want to commend the members of the Health Committee and the officials for the passage of the bill and the amendments that were made during the course of that discussion at the select committee.The bill that returns to us really concentrates on two main areas. The first is around infectious diseases and notifiable diseases and of course the second which we have had much discussion on is with regard to sunbeds that are used for cosmetic purposes. One of the elements that I do not think has been discussed fully throughout this first reading that I want to pay particular attention to is that the bill was returned to the House with the inclusion of some key principles as part of Part 3A Subpart 1.I want to discuss some of those key principles. The first one is paramountcy. This principle ensures that the protection of public health is given paramountcy when you are dealing in matters where there are infectious or notifiable diseases at hand. So what that says is that public health interest must be the most important interest when dealing with issues of infectious and notifiable diseases.The second key principle is that of respect where in performing any duties the dignity of the individuals must be protected. Often we are talking about fairly sensitive areas and sensitive discussions and it ensures that when we are having those discussions we treat that person with the utmost dignity. There have been cases where people with certain notifiable diseases particularly if they are sexually transmitted diseases may have been treated with some disrespect.The third principle is that the individual must be given the opportunity to comply voluntarily before any compulsion is placed upon that person. I think it is really important that we give people every opportunity to comply with medical officers when the issue of public health is at risk.Individuals taking responsibility for their own health is principle No. 4 and No. 5 is that consideration is given when an individual has taken the opportunity to do what they can to minimise risk but they may still be at risk of being contagious or at risk to the public but they have done everything they can in order to minimise risk.The next principle is that the individuals be fully informed. The principle of informed consent is one that is well traversed across the health sector and it is important that in this bill it continues to be an important part of the discussion. Next is the principle of proportionality which is with regard to minimising or preventing health risk and also the principle of applying least-restrictive measures which means you ensure that you provide public health and public safety but you do it using the least restrictive measures. So for example you would not go to the extreme of ensuring somebody was quarantined if all they really needed was to ensure that if they were infectious perhaps they wore a mask and gloves.The final principle is that when measures are no longer necessary they are discontinued as soon as possible. That was part of Part 3A—that was Subpart 1. There are another two parts within that piece of legislation: Subpart 2 which looks at the directions given by and to the medical officer and Subpart 3 which was about public health orders.But in my final time I do want to refer back to the issue that has been considered quite a bit in this House in this third reading and that is the matter of sunbeds. The evidence was heard that we should have been looking at banning sunbeds altogether and I concur with my colleague the Hon Annette King. On that note I commend the bill to the House.JACQUI DEAN (National—Waitaki): I am very happy to rise and speak to the Health—The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! I regret interrupting the member but the time has come for me to leave the Chair.Debate interrupted.