Health (Protection) Amendment Bill — In CommitteeText is incorporated into the Bound VolumeHealth (Protection) Amendment Bill — In Committee[Sitting date: 11 May 2016. Volume:713;Page:11030. Text is incorporated into the Bound Volume.]Health (Protection) Amendment BillIn CommitteePart 1 Infectious diseasesHon ANNETTE KING (Deputy Leader—Labour): This bill has two main parts to it. The first part deals with infectious diseases. The second part deals with sunbeds. Obviously one part of it is more important for the Labour Party than the other in terms of the debate. I want to say to the Minister in the chair that Labour will vote for the bill but we do have Supplementary Order Paper 80 which I have had tabled for quite some time and I would hope that perhaps the Minister may have taken time to read it.This bill has been a long time in gestation. In fact some of the original parts of this bill started when I was Minister of Health 11 long years ago although you would think when you listen to the current Minister of Health that it was just the other day because obviously I am responsible for everything that has ever gone wrong in health. But I have to say that when I was Minister of Health some of the work that is in this bill came out of the rewrite of the Public Health Act. So we have had a long wait to get this bill to the stage it is now. It was first introduced into this Parliament on 31 July 2014 we reported it back from the Health Committee on 1 May 2015 and we had the second reading of the bill on 27 May 2015. So it has been almost a whole year since the second reading before we have got to where we can actually start to debate what it is all about.The first part of this bill will increase the range of infectious diseases that are notifiable to the medical officer of health without identifying information of the patient or diseased person. It will include HIV infection gonorrhoea infection acquired immunodeficiency syndrome and syphilis. It is a long overdue and very welcome update of a bill. We had a large number of submissions on the bill—very very good submissions in my view—and we had them from the most pre-eminent organisations in New Zealand whether they were district health boards or whether they were sexual health organisations medical associations and so on. People took to this bill with seriousness in terms of how we could improve it.I would like at this point just to pay tribute to Kevin Hague who I know would have liked to be in this debate. Kevin Hague because of his experience as a former director of the AIDS Foundation was very valuable in the debate and discussion at the select committee when we looked at Part 1 of this bill. He was able to look at the practical implications as it would deal with patients who would be affected by it.One of the changes that he recommended in this part of the bill—and one that I also want to give credit to the current Minister of Health for—was to put forward an appeal mechanism that allowed an appeal to the High Court after a decision by the District Court. The bill did not have that in it. The committee discussed it and we decided that it was a good suggestion to have this additional appeal ability and it was taken from the committee by the health officials—taken straight to the Minister of Health—and within a very short time there was agreement from the Minister of Health to include that change to Part 1 of the bill. I have to say that I do not believe that would have happened under the previous Minister of Health Tony Ryall. We probably would have waited a long time and he would have said no. But this Minister perhaps because of his understanding also as a medical doctor could see that this was a very good change indeed.We did make quite a number of amendments to Part 1 of the bill and the amendments are on the Minister’s Supplementary Order Paper 127. We have agreed to all of those amendments. There is no dispute from the Labour Opposition on this part of the bill. We believe that we have brought it back to this House in good form. I will not go through all the parts of it as I do not think that is necessary. I will save a lot of my discussion for Part 2 of this bill.The question was put that the amendments set out on Supplementary Order Paper 127 in the name of the Hon Dr Jonathan Coleman to Part 1 be agreed to.Amendments agreed to.Part 1 as amended agreed to.Part 2 Artificial UV tanning servicesThe CHAIRPERSON (Hon Trevor Mallard): The Hon Annette King again.Hon ANNETTE KING (Deputy Leader—Labour): Yes Mr Chairman. This is the part of the bill where I do not agree with the Minister of Health’s decision. In fact we have a minority report from Labour New Zealand First and the Greens in relation to this part of the bill. In Part 2 of the bill as it was introduced the Minister wished to ban sunbeds for young people under 18 years of age. We had many submissions on this part of the bill and practically every one of them thought that we could do much better. They thought we could do much better because of the very strong evidence that sunbeds are very bad for the health of New Zealanders. In fact we believe—well we do not believe; we were told—that sunbeds increase the risk of people getting melanoma by 75 percent. They increase the risk of getting melanoma by 75 percent so you have to ask yourself why we would continue to allow the commercial use of sunbeds in New Zealand. Do we not in a public health approach try to minimise the risk to New Zealanders? Is that not the very approach we have taken with tobacco and with requiring people to wear helmets when they are on their bikes? Think of the range of measures that we have put in place to protect the health of New Zealanders.What we did at the Health Committee was to put in a minority view that said we believed that sunbeds should be banned in New Zealand except for medical purposes. That is what my Supplementary Order Paper 80 which has been available for quite some time now—in fact since 20 May last year—does. What it does is to ban the use of commercial sunbeds except for medical purposes. The reason we did that was that it was based on the evidence that was provided to the select committee. I can see no good use in having sunbeds for commercial purposes for New Zealand at all. In fact I brought down one of the submissions that I think was important because of the submitter’s dealings with patients and that is the submission from the New Zealand Medical Association. It said: “the NZMA is supportive of a complete ban on the use of commercial UV tanning services for cosmetic purposes and we ask that the Committee gives this recommendation serious consideration during its deliberations.” Well in fact the committee members did give it serious consideration and three parties said: “We want to ban them.” Unfortunately that was not the view of the Government members or the Minister.I have to say I have great respect for our Ministry of Health officials—they do a great job—but their regulatory impact statement is a great disappointment to me. When you read their regulatory impact statement you would have to think that it is more important to the Ministry of Health to ensure people’s rights to a tanning machine than to ensure the health of New Zealanders because it sets out its objectives against which the policy options could be assessed.This is what the Ministry of Health says its objectives are. It developed these objectives against which policy options could be assessed and they included first preventing and reducing the risk of public harm from commercial sunbeds. Tick—you could not disagree. Next is that any new controls or interventions for this purpose need to be “risk- and evidence-based”—risk- and evidence-based—and “good international practice;”. Risk- and evidence-based was a reason provided to the select committee as to why these are not good for the health of New Zealanders. Of course as we know the World Health Organization itself has made its own comments on this. It believes sunbeds are carcinogenic. The third objective is that it be “appropriate to protect health and safety while still enabling the use of medical UV devices for the treatment of certain skin conditions …” Tick—agree. Then the next one states that options should not impose “unnecessary or unjustified compliance costs”—well if they are banned I doubt whether there is a hell of a lot of cost or a need to have inspections or to have codes of conduct. They are just banned.The last objective—and this is the one that I really found offensive—says to not “unnecessarily restrict access to services desired by well-informed adults unless there is good reason.” Why do we have legislation regulation and taxation on tobacco because surely these are well-informed adults? Surely they want to keep smoking? That is their choice if you were to read this—why restrict access? You see it does not add up.I am going to say this—and people might disagree—I do not believe that this is what the Ministry of Health thinks. I also know officials in the Ministry of Health. They are good public health people. I do not believe this is what they wanted. This is what is provided but it is certainly not good public health practice. It is certainly not what a forward-looking Government would put in place.It is interesting that in Australia a country that I do not believe usually outstrips us when it comes to health policy—in fact it is a slow follower of New Zealand in the main—they have banned the commercial use of sunbeds. The ban took effect from 1 January this year. One of the things that we were told at the select committee was that used sunbeds from Australia were heading to New Zealand so that we can give melanoma to our people because they do not want it over there.It is also an irony to me that the Government has announced $39 million of new expenditure for Pharmac much of which the Minister said is going towards a new melanoma drug called Opdivo when at the same time it is not prepared to ban sunbeds which as I said to you increase the risk of getting melanoma by 75 percent. It does not add up. Why have we not got the courage of our convictions to say we will ban them? My Supplementary Order Paper allows 3 years to phase them out. It gives the commercial operators the opportunity to change what they are doing. It is not unreasonable but it is a good public health measure.I feel strongly about this and so do so many people who have contacted us particularly those who work in public health including doctors nurses and specialists. It is a mystery to me as to why we have not gone the whole hog. Instead what we are doing is that we are banning it for those under 18 years of age. Melanoma does not just stop for those under the age of 18 years. Unfortunately melanoma is actually a problem for young people—yes—but those who are older than 18 also get melanoma.I am very sorry that we have not been able to achieve an ultimate outcome in this bill. We certainly did an excellent job in Part 1. This is a disappointment—from Part 2. I do not care whether there are those who say a Supplementary Order Paper such as mine is the nanny State. I am over this nanny State stuff. I am over putting that up as an argument when we should be protecting the public health of New Zealanders rather than allowing the continuation of a practice that when used leads to 75 percent of New Zealanders being likely to get melanoma.We will vote for this bill. Now I see the Minister of Health arriving in the chair. He probably missed the slight praise I gave him a wee while ago so I am happy to repeat it. He did act quickly on Part 1 when we made an amendment to it. But he has not been moved to change the position on sunbeds—to ban them. I urge the Minster to rethink it so that it is not his legacy that he finishes as the Minister of Health—RIA BOND (NZ First): I am pleased tonight to rise on behalf of New Zealand First and take a call in the Committee stage of the Health (Protection) Amendment Bill. In this call I specifically want to address in Part 2 clause 13 which inserts New Part 5 in the Act. I will say that this bill does not nearly go far enough towards fighting skin cancers and melanoma here in New Zealand. There have been a lot of calls taken in this House on the first and second readings that outlined good solid reasons why this Government should ban sunbed use outright here in New Zealand. Our minority report as mentioned by the Hon Annette King showed strong dissatisfaction that we did not go far enough to ban sunbeds here in New Zealand.Under the orders of Minister Coleman the Ministry of Health sought public views on artificial tanning safety measures with its consultation document entitled Reducing Harm from Commercial Sunbeds: Consultation document. I found that rather interesting that document which called for public submissions. I could not quite determine whether or not the commercial element was really given the same amount of consultation to submit from those people’s business perspective on the issues that they could see in the regulation of sunbeds or regulation becoming stronger in ruling the sunbed industry. So tonight throughout this call in the Committee I am leaning heavily on my experience as a business operator in the hair and beauty industry where the very equipment that we are addressing in Part 2 is actually what I used in my business.In my business we sold suntanning concession tickets to people but we had the good practice of ensuring that every client who came through the door who wanted to have a suntanning experience actually met my requirements. They had to have the correct skin tones and they were scored through a consultation process. And I can tell you that at times it was a really unpleasant situation and one that not only I but my staff were put through from mothers—mothers who wanted their 12-year-olds their 14-year-olds and their 16-year-olds to get browner. I used to sit there and think: “This is crazy.” As a parent I would never allow my child under the age of 18 to be on a suntanning bed. So New Zealand First completely supports the call to ban any users under the age of 18from suntanning services.It is quite prevalent too in what we have seen since 2009 when the World Health Organization released its finding that sunbeds were in fact carcinogenic. I can say it caused a pulse a shudder throughout the New Zealand suntanning industry. All of a sudden I saw in my industry disclaimers being written up from salon owners and tanning bed owners to ensure that none of the blame came back on them should those tanners who were not correctly assessed develop skin cancers or melanoma in the future. I found it rather disheartening for that to be a big part of the industry. I could understand on one hand why operators quickly scrambled to try to protect themselves—that was because of the level of investment in the suntanning beds. Some salons invested only about $10000 in second-hand beds that were here in New Zealand; other salons throughout New Zealand made a big investment of from $80000 to $140000.So what that did for the industry—and I am sure that the Government advisers themselves know this—was it forced a quick concession of sales that were deemed and called 1-month unlimited suntanning sessions. These were available for a cheaper price than under any other fixed sessions and started mostly—depending on what area you lived in in the country—for $30. So you could suntan any time any day—whether you wanted to go once or twice—for that whole month with unlimited sessions. And certainly you may be surprised to know that mostly men took up that opportunity—men did. That is reflected in the fact that men have been known to have a 40 percent increase in skin cancers and melanoma especially on their backs because often they do not check their backs. It is really good now that the industry is actually telling their clients that their wives must check their backs for any dark spots. We are trying to encourage men to not only get other health checks but ensure that they also get their backs checked.I want to add that women in New Zealand have a high incidence of skin cancer melanoma on their legs and that is because predominantly we know that we tend to like the sun and we sit outside and we sunbathe quite a bit. So this particular part in this bill really interests me because it was—[Bell rung] Mr Chair?The CHAIRPERSON (Hon Trevor Mallard): Ria Bond.RIA BOND: Because it was—The CHAIRPERSON (Hon Trevor Mallard): You do not need to put your hand up.RIA BOND: Oh sorry. Ha ha! I have just got good manners Mr Chair.So that is why it was essential for me to come down to the Chamber tonight and talk about this particular part of the bill. From my 26 years in the industry I have to say that I stopped selling sunbed services in my business because I for one could not actually sit there with the thought that someone may in the future develop skin cancers and melanoma from a service that I offered to members of my community. I am quite proud of the fact that I recognised that that was not a good long-term thought to have.I also want to say that to be brown is sold to the industry as being sexy. We get reps who come into our salons and they contravene what the Cancer Society tells us—they do. The reps tell us that the Cancer Society will always oppose what the solarium society says which is that it is actually safer to suntan inside on a solarium bed because it has a controlled release of UV. They say that that is safer than suntanning outside. That is how they get their beds inside those industries inside those tanning clinics and inside those salons—and they make it easy for you to pay it off—and that is a concern because now many years later I know that that is not true. I started to investigate the true facts myself which led me to believe that I should not sell those services in my salon.I do want to say also that the whole sexy factor of being darker tanner—we see that in our reality shows on TV now and in the show Geordie Shore where even now they actually get to promote their own tanning products and that is affecting our young ones. It is also affecting women and men because they want to look better and I guess to have a little bit of brown or nice brown—it does sell sexy and that is the wrong message to send. It is the wrong message for our consumers and it is the wrong message for our community.I also want to say that the Dermatological Society states that it is really disappointed that the Health Committee decided not to ban sunbeds outright in New Zealand. I have to say as a former user that I certainly support that as well.I want to address the second reason why I had to come down to this Chamber today. I want to address the fact that this bill in no way whatsoever covers UV nail technicians or the nail industry—that is what has made me come down to this Chamber. We put our hands inside UV lamps when we get our nails done inside nail salons and we are exposed to UV. I am quite concerned about that—so concerned that I am hoping that the Hon Annette King would support me to make small amendments to her Supplementary Order Paper 80 which is a great Supplementary Order Paper by the way as it futureproofs up our UV exposure in this country.My amendments that I seek to table tonight to amend Supplementary Order Paper 80 in the name of the Hon Annette King are to clause 13 in new Part 5 to replace new sections 113 and 114. Under new section 113 “Interpretation” I would like to add in the simple words “UV nail lamps” after the word “sunbeds” and before the word “sunlamps” and to add the words “UV nail” after the word “tanning” and before the word “services”. In proposed section 114 I would like to add the words “UV nail” after the word “tanning” and before “services”. Under subsection (1) I would like to add “artificial nail services using UV”. In subsection (2) I would like to add the words “or UV artificial nail services”. My explanatory note for that is simply that throughout this bill the nail industry has completely been forgotten about but consumers are still exposed to UV lamps on our hands and feet and that is just as important as on our bodies.I would like to commend the Hon Annette King for her Supplementary Order Paper. It in no way at all should be considered nanny State; it should be considered responsibility. It should be considered responsible to minimise the harm that UV exposure is causing here in New Zealand. We want to decrease the incidence of skin cancers that we have and also melanoma. So I would like to get support from the Labour Party the Green Party members across the Committee and the Minister to support my amendment of the Supplementary Order Paper of Annette King.I want to add to that that when I started as an apprentice I actually performed nail services in my salon and—The CHAIRPERSON (Hon Trevor Mallard): Dr the—no. The Hon Dr Jonathan Coleman.Hon Dr JONATHAN COLEMAN (Minister of Health): No I am not Lockwood. I was just very impressed by the outbreak of bipartisanship that we have had across the House two nights in a row. So I would thank Mrs King for her comments and of course the Committee came to a unanimous conclusion on the first part of the bill but now we are discussing the second part. I would thank also Ms Bond for those interesting cultural insights into the world of Geordie Shore. She made some good points actually about UV tanning and exposure to the hands. That is something that was not actually considered but it is a good point indeed.The wider point here is that we are talking about whether or not we should have banned sunbeds for people over the age of 18. People were unanimous on the Health Committee about the need to remove that exposure for children under the age of 18 but then you get to the issue of people aged 18 and over and this is where the philosophical differences really do come in. Mrs King was very adamant and she has expressed it here with Supplementary Order Paper 80 that the sunbeds should be banned.Well there is no doubt that melanoma is a problem in New Zealand and sunbed exposure is a risk factor for that—there is no question about that—but there are all sorts of things that people choose to expose themselves to on a daily basis that are a risk for all sorts of cancer. There is eating fat—that is a risk for all sorts of nasty cancers—there is drinking alcohol and there is actually exposing yourself voluntarily to sunlight. So if we are saying that we want to remove all risk there would be a lot of things that the Labour Party would be wanting to ban including I should think letting you go to the beach in summer. Obviously that is completely impractical but you have got to get the sense of proportion—Clare Curran: Silly man.Hon Dr JONATHAN COLEMAN: —around the problem here. Do you know how many of these sunbeds there are in New Zealand? OK so Ms Curran is calling me a silly man. Can Ms Curran tell me how many sunbeds there are in South Dunedin? No. The village idiot of South Dunedin—she can interject but she cannot make a constructive contribution. Well I can tell her that—Hon Annette King: Hey we were being nice to each other.Hon Dr JONATHAN COLEMAN: Sorry we are being nice.The CHAIRPERSON (Hon Trevor Mallard): The member—Hon Dr JONATHAN COLEMAN: OK I withdraw and apologise in advance. I am not wanting to break my flow so sorry Ms Curran. But what I would say is: do you know how many there are—[Interruption] Look listen up. Listen up Labour people you will learn something. There are 260 sunbeds in New Zealand and dropping. Fewer and fewer people are going to these things. We have taken this considered approach and you look at the by-law brought in in Auckland where a year ago it implemented this by-law requiring quite strict registration requirements for sunbeds. Sunbeds have dropped by 20 percent over that time. So I think we already have in place a sinking lid on sunbeds because the regulations that will follow on from this bill are going to make it really pretty tough if you want to continue to operate a sunbed. You are going to have to have your operators registered. You are going to have to have the sunbeds themselves registered. You are going to have to take notes in the manner that someone practising some branch of medicine would have to. You are going to have to have patient-care notes. You are going to actually have to screen out high-risk—Hon Annette King: Bureaucracy.Hon Dr JONATHAN COLEMAN: There will be a lot of bureaucracy—that is the point Mrs King. So I do not think that you will find too many people who are going to want to continue to operate sunbeds. They are going to have to screen out high-risk skin types. So people like me—I will not have any chance of going to Paul Goldsmith’s sunbed-tanning clinic you know because I am one of these Anglo-Celtic types. They will say: “No. There is no way we are going to let you under a sunbed.” There is going to be a lot of compliance burden on those who continue to want to offer this service but it being a democracy there will still be the option for those who do want to provide this service to actually do that.What you will also find I think is that with all this form-filling all the hassle that the clients are going to have to go through and the way these things are going out of fashion I reckon in a few years’ time there will not be very many people going along to a sunbed. There will be fewer and fewer.Hon Annette King: Give a lead Jonathan. Give a lead.Hon Dr JONATHAN COLEMAN: Mrs King is just itching to ban this but I want to hear the list of other things she wants to ban. We are not a party that bans things.Hon Ruth Dyson: Listening to you—I want to ban listening to this speech of his.Hon Dr JONATHAN COLEMAN: Mrs Dyson—she wants to ban listening to me. In fact she does not even have to be here. She has the choice to leave now of her own accord but no she chooses to stay because actually she knows there is a real point here.So Part 2—look it has been a good debate on the bill overall. I would like to thank the officials for their excellent regulatory impact statement. They did a great job on that. I think Mrs King has been way too tough on them. They understand the perspective of the Government. I think this is the exact right move. I think you will see very many fewer of these beds in the next few years and this is the right approach.LOUISA WALL (Labour—Manurewa): Thank you Mr Chair for giving me the call—for allowing me to speak. I was a member of the Health Committee through the majority of the deliberations in terms of the Health (Protection) Amendment Bill and I just want to reiterate what my colleague Annette King said about Part 1 of the bill. I thought it was incredibly collegial. I think we worked through quite diligently and actually you would have seen that there was only one speaker on our side because it was such a succinct debate—there was nothing really for us to add.But Part 2 of this piece of legislation has been completely different and that really was because we tried to implement some evidence-based action for a piece of health policy. That evidence was provided by many submitters who came to the select committee including the Cancer Society many specialists and cancer survivors. There were people who had detrimental effects not only from using sunbeds or tanning machines or solaria—whatever you want to call them—themselves but also because they worked in industries that as Ria Bond has articulated provided those services. But then some members of the industry saw how destructive this piece of equipment was.I really wanted to give some numbers to this whole debate because in New Zealand we have over 2324 diagnoses of melanoma every year and we actually have 354 deaths. That is the context of my colleague Annette King’s Supplementary Order Paper 180 and the rationale from our side to actually ban these devices. It is also congruent with Australian statistics. Australia has over 2000 deaths per annum and 80 percent of its annual cancer diagnoses are skin cancers. So Australia was very much led by the evidence—it was led by these sorts of statistics—so it was incumbent on the Government and the states of Australia to ban sunbeds and they actually did so to protect the health and well-being of their citizens.It actually costs us over $25 million per annum to treat people with cancers which is a lot of money and I would have thought that rather than treat people every year who get diagnosed with melanoma we would want to stop people getting melanoma in the first place. So if sunbeds are proven—which they have been through numerous studies. There are the World Health Organisation and American studies Brazilian studies studies from France and the EU and the reason I bring up all these countries is that they are having discussions themselves about banning sunbeds. Based on evidence—based on medical evidence—we have already seen sunbeds banned in Brazil but France EU countries and the United States are going to ban them as well.I was just googling before about the cost of premature deaths. Can you put a value on—what did they call it here? I actually did find a table. It is the value of a statistical life. So these are people who die prematurely and if we have these 354 deaths every year from melanoma does that equate to something? For New Zealand the value on a statistical life is $3.35 million so for us at that death rate that is a $1.17 billion cost to the country from having people who get melanoma and then die from it.Hon Ruth Dyson: And it could be prevented.LOUISA WALL: And it could be prevented. That is why this is an incredibly frustrating Committee stage debate to have because I think the proposition in Annette King’s Supplementary Order Paper enables the industry and gives it a bit of time to decommission its sunbed machines and it will recoup any losses. In Australia it was interesting. It actually compensated the operators $1000 a sunbed.SIMON O’CONNOR (National—Tāmaki): I did not actually think I was going to be efficacious in taking the call at this point but look I want to acknowledge what other speakers have been saying around this issue in Part 2. I would dispute one part. I am not sure whether it has been frustrating—that is just my opinion—but I think it has actually been quite informative. I am not supportive of the amendments to Part 2 to ban sunbeds and I would like to elucidate that a little.This Part 2 actually does two things—well it is all about sunbeds. Importantly just quickly to highlight for the Committee it is also introducing infringement notices. This is a small but significant change that the Health Committee recommended. The initial draft of the bill had what were effectively criminal provisions—that you could be fined—and I think it is important to raise here in the Committee of the whole House that the select committee thought it was important to have an infringement notice approach as well partly for the reason of proportionality. You do not want to always just go straight to a criminal prosecution. It is not always appropriate and it can sometimes be too heavy-handed. I think that proportionality is what also reflects certainly in my decision not wanting to ban sunbeds and that is because there is actually a very small number of sunbeds or solaria in New Zealand—around 200 or so and declining.It was intimated by the Minister of Health that it is also a philosophical approach and that it is one around actually allowing people to make choices—sometimes those we would think unwise but they are their choices nonetheless. Look the science on this is incredibly clear OK? Sunbeds are bad for your health. The increased chance of skin cancers including melanoma—there is no doubt that the use of solaria will cause greater harm. I think it is really important too when we are talking about solaria and skin cancers to know that melanoma is just one form of skin cancer—there are many many types. Just the simple use of a sunbed and what it might do—there are squamous cell carcinomas and basal cell carcinomas and solar keratosis as well. So there are a whole lot of negative effects.I want to be very very clear—and I have been I think—in the constructive discussions that the select committee has had and in this debate. There is no doubt about what the science says. However in this case does it mean that it absolutely has to be banned? No I do not think so because of the analogy of something like smoking. The science in my opinion is pretty clear too around smoking and although some of us might like to see that banned as well we do not think from this side of the House that that is the appropriate response either. You know human beings make choices. We have heard from other speakers as well that eating certain types of fats has an effect. There is the use of alcohol. I know there is debate at times around the smoking of or the use of marijuana. There is no doubt scientifically that that is a harmful substance but there is not necessarily the universal call in the House for that to be banned too. So it is just trying to take a consistent approach.I really appreciate the work that the member the Hon Annette King has put into her Supplementary Order Paper 80. I actually think that this is a really good and constructive one; it is just that I cannot completely agree with it. In principle I understand where it is coming from but philosophically again I do not think it requires this House to ban sunbeds. I think it is actually a prudent approach and as we have done within Part 2 and within the provisions we have said that for under 18-year-olds it should be banned. The evidence is again abundantly clear that it is a much much higher risk to someone under 18 years of age so I think that is an appropriate step.I think too when we heard from Ria Bond—and she was drawing on her own experience in a salon; she shared some of that—you got an indication of how people can make their rational choices either to be requesting the service or as she explained in her own case to be choosing at many stages to allow that to happen but eventually saying no. I was quite interested by her amendments to the Supplementary Order Paper around nails. Personally I would need to go away and understand that a little bit more—it was something that never came up in the select committee. I am no doctor; I am no scientist. It would be interesting to know whether the difference of I think keratin in your nails versus the skin—whether that makes any difference. Again it is a pity it did not come up but I think it is worthwhile. I think the other element—POTO WILLIAMS (Labour—Christchurch East): I want to just bring also some other aspects into the discussion particularly around the use of UV tanning services for treatment in hospitals. This bill sets about giving permission to provide artificial tanning services for people over the age of 18 and there is an exception to that age requirement if the person is receiving treatment at a hospital.I have a family member who is receiving just such a treatment for a particular skin condition and the reason I want to talk about this is that it is a carefully closely managed treatment. The UV treatment is delivered in very very short bursts it is managed by well-trained clinicians and it occurs in a hospital setting where blood tests are taken the condition of the skin is monitored very closely and medication is also applied. There is very very close regard given to the health of the person as they are undertaking this UV treatment. This is UV treatment that is very similar—but given in very light doses very small doses—to the type of thing that you would get sitting in a sunbed for 10 minutes.With the types of times that I am talking about when you are actually using this as a therapy we are talking about seconds. We are talking about tens of seconds perhaps 30 seconds; we are not talking about minutes. Only when your skin has been conditioned over several weeks and you have been closely monitored by these very well-trained clinicians—your blood tests are taken and you are very closely monitored—is it possible to actually have the treatment go to anywhere like a minute and a half. This is a clinical treatment versus what is going to be available to the general public over the age of 18 in a suntanning clinic using a sunbed for several minutes at a time.So there is an obvious risk that is identified by clinicians in the use of UV as a treatment for skin conditions and that has not necessarily translated in this bill to be determined as a risk for people over the age of 18 who are taking this risk with their health. It does concern me that we are not considering actually outright banning the use of sunbeds.It is interesting that we make reference to the work that is happening in Australia because in Australia they take much higher regard to the risk of melanoma through exposure to the sun and through sunbeds. In fact as an interesting point I had always thought that in Australia they had higher rates of melanoma but for certain melanomas we beat the world. I was really surprised to hear that. The Australians not only have taken the view that sunbeds themselves are dangerous but have also taken the added step of if you are a worker who works all day in the sun you are required by your employer to wear personal protective equipment which means long sleeves long trousers and a hat and to actually apply sunscreen. Their measures to protect people from the damage that the sun can effect far outstrip anything we do in this country and yet we lead the world in rates of certain melanomas.So this legislation could have gone so much further. In fact you could say we are actually quite negligent.RINO TIRIKATENE (Labour—Te Tai Tonga): I am pleased to take a call on Part 2 of this bill. I do want to speak in support of the Hon Annette King’s Supplementary Order Paper 80 and I am very disappointed that the Minister of Health will not be supporting her Supplementary Order Paper because this was an opportunity for us as a Parliament to draw an end to the use of suntanning beds. We could have gone far and we could have done things for the public good for public health but sadly it seems that we are not going to be heading that way.I would like to go into the provisions of Part 2 and in particular clause 13 which inserts new section 114 “Ban on providing artificial UV tanning services to persons under 18 years” as part of new Part 5. In particular subsection (2) says: “The owner or operator must not provide artificial UV tanning services to a person under the age of 18 years.” That is the age limit that has been applied but I am really surprised that when we look further to subsection (5) there is provided within the legislation a defence—a defence to a sunbed operator administering or providing services to an under-18-year-old.I would have thought that if we are going to make it an offence under this part of the legislation let us make it a strict liability offence. Let us not provide a defence because we are actually letting that operator off the hook. We are letting them off the hook because there is a statutory defence. They do have a defence for putting an under-18-year-old on a sunbed but I believe that this needs to be much more strict. Even though the defendant has to prove that defence it still should not apply because the harm that we are hoping to prevent through this legislation—well the sunbed operators can get away with it. They can get away with it effectively so we should make it a strict liability offence. There should be no defence. If an under-18-year-old is put on sunbed then is an offence—that is an offence—committed by whoever is there providing those services. So I think that is a shortcoming.There is even the idea of infringement notices if we carry on through the new Part 5. To me infringement notices seem like a slap on the back of the hand with a wet bus ticket. That is what they are. If we look at who actually issues these infringement notices well it could be an environmental health officer. Do we really expect local authority officers to be going around and issuing these infringement notices—actually making the relevant inquiries necessary to be sure they are able to issue these infringement notices?The whole suite of provisions around these so-called proportional measures is just an outright nonsense. It really is. Really what it is doing is providing people in the suntan industry with a lifeline. There is no real strict punishment. It is allowing them to carry on and effectively do what they do. As I mentioned it even allows them to continue to provide their services to under-18-year-olds and effectively to be without fault. I think we need to send a much stronger message—we have the opportunity to do that with Mrs King’s Supplementary Order Paper—because those measures are not effective.Hon ANNETTE KING (Deputy Leader—Labour): I will take just a brief call because I think Ria Bond deserves a response to her amendments to my Supplementary Order Paper 80. I have spoken to Ria Bond to say that I think she has made a very good suggestion. In fact Simon O’Connor said that he thought she had as well but that it was not possible to support it and this is the reason. With a change like that if the Government did vote for it—which obviously it probably will not—we would not have given the public an opportunity to make a submission on it. It would not have gone through a process; it would have been totally out of the blue. There would have been no opportunity for the public to make a submission and what we want to do is to ensure that they do have the opportunity to make a submission on something that changes a whole industry. I did suggest to Ria Bond that maybe it is something that New Zealand First might like to submit as a member’s bill at some stage. So I thank her for her thoughtfulness and also for her ability to put forward a very practical approach to this whole bill from her experience as a businesswoman in this area.There are just a couple of other things. I was a little disappointed in the Minister of Health’s response I have to say in that he believes the way that we will get rid of sunbeds is by having a lot of bureaucracy and that in the end everybody will get sick of the bureaucracy and they will finally pull out. I would have thought that the Minister could man up—you know he once told me that I should man up—and take the final step which is to ban these sunbeds. As much as I respect the chairman of our Health Committee I do not accept his argument that allowing it to continue is a philosophical issue. It is a health issue—it is a health issue—which we were trying to address here tonight.So those are the few comments I wanted to make. It does not look hopeful that my Supplementary Order Paper is going to pass but at least we can go out—New Zealand First the Greens and Labour—hold our heads up high and say that we did our best to try to prevent the unnecessary deaths of young New Zealanders in particular who are attracted to sunbeds because as Ria Bond said they want to look beautiful because they are brown. So we have done our best. We have put our best foot forward. If it does not succeed then it certainly does rest on the Government’s shoulders.LOUISA WALL (Labour—Manurewa): Just to finish my contribution I want to say that this bill is called the Health (Protection) Amendment Bill and that word “protection” is really interesting. When you look at the definition if you google it online it says “the act of protecting or the state of being protected”. So in Part 2 we are saying that only people under the age of 18 deserve to be protected by the State. If you are over 18 then you get no protection. You are on your own it is up to you and you make a choice and I just find that not to be a philosophical debate. It is actually one that is based not on evidence and not on what makes sense but obviously on a philosophical perspective that those members on the other side of the Chamber just cannot see past. They cannot see past that philosophy and cannot be guided by clinicians and other people who are incredibly passionate about this particular issue.I have had a quick look just for people’s interest and in Australia the campaign to ban sunbeds actually started in 2007. It was started by a young woman called Clare Oliver who was diagnosed with melanoma. She died at the age of 26. She had melanoma for 4 years so essentially during the last 4 years of her life she campaigned to ban sunbeds. It was picked up by agencies—the Cancer Society and the Peter MacCallum Cancer Centre. A really interesting fact is that the Federal Government health Minister at the time was Tony Abbott. His contribution at the time was that we needed to regulate and there are no finer regulations across Australia. Actually Western Australia was the last state to ban sunbeds. That came into effect on 1 January 2016.We can make law when we have leaders who are passionate about issues. It seems to me that we have no leadership on this issue on the other side of the House. We have people who have had melanoma who through the Cancer Society have advocated—in fact the Palmerston North City Council changed its law because one of its young women constituents got cancer. People who have power get moved by real stories real lives; it just seems that here in New Zealand this Government is not moved. It is not moved by the—and I will repeat it—354 New Zealanders who have died from melanoma each year. It is not moved by the over 2300 New Zealanders who are diagnosed with melanoma each year. It just makes no sense to me and I think makes no sense to us on this side of the House that the Government would not act to ban sunbeds. Kia ora.The question was put that the following amendments in the name of Ria Bond to the proposed amendments set out on Supplementary Order Paper 80 in the name of the Hon Annette King to Part 2 be agreed to:to insert in new Part 5 new section 113 “UV nail lamps” after “sunbeds”; andin new section 114:insert “UV nails” after the word “tanning” and before the word “services” in the heading;insert in subsection (1) “or artificial nail services using UV” after “tanning services”; andinsert in subsection (2) “or artificial UV nail services” after “tanning services”.A party vote was called for on the question That the amendmentsto the amendments be agreed to.Ayes 12New Zealand First 12.Noes 109New Zealand National 59; New Zealand Labour 32; Green Party 14; Māori Party 2; ACT New Zealand 1; United Future 1.Amendments not agreed to.The question was put that the amendments set out on Supplementary Order Paper 80 in the name of the Hon Annette King to Part 2 be agreed to.A party vote was called for on the question That the amendments be agreed to.Ayes 58New Zealand Labour 32; Green Party 14; New Zealand First 12.Noes 63New Zealand National 59; Māori Party 2; ACT New Zealand 1; United Future 1.Amendments not agreed to.Part 2 agreed to.Clauses 1 to 3The CHAIRPERSON (Hon Trevor Mallard): Annette King’s proposed amendment to clause 2 is now ruled out because of the loss of her Supplementary Order Paper.Clause 1 agreed to.Clause 2 agreed to.Clause 3 agreed to.Progress to be reported presently.JAMI-LEE ROSS (Junior Whip—National): I move That the Committee report progress.The CHAIRPERSON (Hon Trevor Mallard): Leave is sought for that purpose. Is there any objection? I will report progress.House resumed.The Chairperson reported the Health (Protection) Amendment Bill with amendment and no progress on the Coroners Amendment Bill.Report adopted.