Dyson RuthHon RUTH DYSON (Labour—Port Hills): I am delighted to speak in support of the second reading of the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. It does not win any awards for the snappiest name but the name certainly describes the contents of the bill. I remember when the bill was introduced the Minister said Its time has come." and the Hon Annette King quite rightly said: "Actually its time was years ago." This is so overdue as the member Scott Simpson who has just resumed his seat has bravely pointed out to his—it is probably not a career-enhancing move you made there but it was an honest opinion expressed: that this is well overdue. We are supporting it because it certainly means now that a lot of the legislation that needs to change to recognise the increased qualifications the competency and the ability of other practitioners to perform tasks will keep up with the reality. So much of our legislation is outdated and I know that other members who have spoken have referenced the fact that this is an omnibus bill simply because it alters so many other pieces of legislation and updates them. Not only is that a good thing—to recognise the valuable contribution that many members of our health system currently make but they cannot do some things that they are competent and trained to do—but also it recognises the very real cost pressures that we have in our health system and the workforce issues that we face as well. We know that the Government has underfunded our health system in the last 8 years by about $1.7 billion. That is a huge amount of money that the Government has not put into the health system which it should have put in to keep up with the demographic pressures and the population pressures. We have got an ageing population we have got huge cost pressures we have got workforce issues and instead of recognising that as a package of concerns that is reducing the ability of New Zealanders to get the healthcare that they need—that is the outcome of that—the Government has been short-funding it and tinkering with a lot of other measures that were necessary. But with this legislation it is actually doing the right thing. We have got about 50000 nurses in New Zealand registered with the Nursing Council of New Zealand. We have got a looming GP retirement about—well not quite half but nearly 45 percent of current GPs have said that they intend to retire over the next decade. We cannot magically whip up a huge number more GPs to replace those ones who are retiring—that is not possible. A lot of GPs are leaving New Zealand because the health system is so restrictive. They are finding it more satisfying to go overseas. I know a lot of general practitioners decide not to remain operating in New Zealand because of the costs that the current National Government has imposed particularly on small businesses. It just layers more and more and more regulation and requirement and from a National-led Government it is quite a surprise to many of those GPs—in fact quite a shock. Hon Simon Bridges: I know—that's what we expect from you.The ASSISTANT SPEAKER (Hon Trevor Mallard): Order!Hon RUTH DYSON: But that is what is driving them to change their voting pattern as well actually. Thank you Mr Bridges for your acknowledgment that this is exactly what you are hearing in your electorate as well. I am glad that you have confirmed that. With that short-funding of the health system and the number of GPs who have said that they are going to retire—that is a huge stress on our workforce. Something has to give and that is the big piece of the puzzle that National is just refusing to acknowledge. There has been a lot of ridicule poured on backbench National Party members recently about the substance of their members' bills. I want to just say that this Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill was actually the subject of a member's bill that I drew up some time ago. It was never drawn. I have replaced it because I have changed portfolios and I always have member's bills that are relevant to my portfolios. But I became very familiar with some of the stupidity of our existing legislation and how important it was to recognise that you do not actually need a doctor to sign a death certificate. You do not need a doctor to sign a medical certificate for Child Youth and Family. There is a whole range of things that other people in the health system can do but the legislation restricted them from doing it. So this is moving the legislation in keeping with the changes that have been driven not only in terms of competency but also in terms of qualification. It was I think maybe 2002—it was some time ago—that nurse practitioners were introduced as a new profession. That is a higher level of qualification for nursing than we had ever had before and now we have thousands of nurse practitioners who are able to do within their competency a great deal of things that previously only doctors could do. I remember when midwives were certified to be able to deliver babies. Previously it had to be signed off by a doctor—a ridiculous situation and as Kevin Hague pointed out it was often just the form-filling that the doctor did whereas the actual work had been done by a nurse. But somebody had to sign it off according to the law and of course who got the money for it? The person who signed off the form which is pretty outrageous. So this bill is making the health system more fit for purpose. It will give it greater sustainability because of the need to have more people practising where they currently are not but also given the fact that so many of our doctors are retiring. It does need the Government to come to the party in the end and start funding our whole system in a way that recognises the health inflation costs the demographic changes and the population growth. There is $1.7 billion of underfunding in our current health system. That is not a way that our health system can thrive and grow. No wonder we have so many people who are not able to get their specialist assessments when they need them. I have seen it in the media myself as well as having constituents come to my office—people who are in a lot of pain who need surgery and who are not able to get a referral from their GP and then get in to see a specialist and get that surgery. I saw a case recently in the press where a woman had mortgaged her house in order to get a shoulder operation because she could not get that operation in the public system. In New Zealand in 2016 those sorts of occurrences are just a disgrace. So I would be very happy if we could have not just a debate on this improvement—and improvement it is—but also a proper debate on how we can ensure that the health system in New Zealand is funded and supported to deliver the level of healthcare that New Zealanders need. I do not think that is asking for too much. We have had it in the past and it is really only through the miserly behaviour of Bill English—shocking because he was a former Minister of Health himself actually—that we have seen not enough money going into the coffers. In the end a system will work despite what Governments do because of the nature of the people. We are so lucky in New Zealand to have right throughout our health system amazingly dedicated passionate people. They will keep our health system going but there is only so much they can do without the support from central government that they are clearly not getting at the moment. They cannot work so many hours that they are exhausted. I saw a survey recently where GPs were saying that they often worked longer hours than they should and something like 10 percent of the GPs who were surveyed said that they had performed actions with their patients that could have done harm and they had performed them in error because they were so tired. That is a terrible situation for patients who go to their doctor relying on them to be on top of their job but the doctors have been working such long hours and have been under such a lot of stress because of the regulatory environment developed for small businesses by the National Government that they actually make errors. That is something that should be unacceptable in New Zealand. Having said all that I think that this is a very good bill. I am pleased that it is making progress at long last through the health system. I look forward to the final stages of it soon."