Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill

I present to the House a legislative statement on the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill.

ASSISTANT SPEAKER (Ian McKelvie): That legislative statement is published under the authority of the House and can be found on the Parliament website.

Hon CARMEL SEPULONI: I move, That the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill be now read a second time.

At the moment, many women who are injured during birth cannot access the treatment and financial support they need through ACC. This reflects a broader issue with the ACC legislation. We know that women make fewer claims than men, have fewer injuries covered than men, and each woman’s claim costs ACC a third less than a man’s in entitlements. Officials initially thought this bill would support 18,000 women per year by extending ACC cover to a list of maternal birth injuries that was based on injuries recorded when New Zealanders are discharged from hospital. Using its own estimates about how often the injuries on the list occur and how many parents will make claims, ACC now expects to support 28,000 women per year to access the support they need; 10,000 more than initially estimated.

This bill addresses a historical inequity in the ACC legislation. But it also represents the Government’s first step towards addressing the gender and other inequities in New Zealanders’ access to, and the support they receive from, ACC. I want to first acknowledge the Education and Workforce Committee, which has reported back on the bill. The bill is a first of its kind and represents real progress towards our 2020 election manifesto commitment to return ACC to its original purpose of assisting all New Zealanders who have had an injury. I thank the committee for its diligent consideration of such an important piece of work.

I also want to acknowledge everyone who has submitted on the bill during its select committee stage. I understand the committee considered submissions from many individuals, including those who bravely shared their experience of birth injuries and notable medical organisations. Their input has proven to be invaluable in this process.

A large number of submitters were concerned that the bill does not cover all maternal birth injuries. I want to reassure these submitters that the bill is intended to cover all maternal birth injuries that can be caused by childbirth. This is why I am very pleased with the two changes the Education and Workforce Committee has made to the bill. One of these is to add a number of additional birth injuries to the bill for cover. I welcome this change. I knew when I introduced the bill that the list would need to be carefully scrutinised to make sure that it is comprehensive. That is why I encouraged New Zealanders to make submissions on the bill and asked my officials to continue to work closely with the experts throughout this process. I am confident that the committee’s change ensures that the bill provides comprehensive cover for birth injuries.

The other change the committee made is to include a review clause for the list of birth injuries to futureproof the bill. I wholeheartedly endorse this change, which will keep the list up to date with developments in medical science. The select committee process also thoroughly explored an alternative approach to covering these injuries, putting a general definition of “maternal birth injury” into the bill, instead of listing all covered injuries. This would risk cover being applied inconsistently. Because of different medical professionals’ interpretation of the general definition, some parents could receive support for an injury but others with the same injury may not. That’s the opposite of what we want to achieve. The committee’s rigorous process has given me confidence that the list approach taken in the bill will remove uncertainty and limit the number of women who have to fight for the support they need through the courts. Most importantly, it will support them in accessing treatment to aid their recovery as quickly as possible in what will already be a time of great change in their lives.

This extension of cover to an estimated 28,000 birthing parents will improve the support available to those who suffer childbirth injuries, and, in particular, provide them with more timely access to surgeries and to pelvic physiotherapy. In addition, if a birthing parent suffers a mental injury caused by a birth injury or any other physical injury that is the result of an injury on the list, they can also be covered by ACC. I want everyone to know that the way that the accident compensation scheme is set up already allows for those consequential injuries to be covered, and they do not need to be listed to be included.

I want to thank my colleagues from across the House for their unanimous support for extending ACC cover to maternal birth injuries. This shows just how clear it is to all of us that this is a change that is not only necessary but long overdue. I also want to acknowledge the Green Party’s differing views in the select committee’s report. I understand that these concerns have been fully explored during the committee’s thorough process, and I look forward to discussing them at the committee of the whole House stage of the bill.

As I have said before, this bill also addresses some of the changes made in 2010 which disadvantaged tens of thousands of New Zealand workers. In particular, the bill provides more clarity on what is involved for gradual process injury claims at work and more equitable cover for claimants.

Aotearoa New Zealand looks very different from what it did 50 years ago, and our workforce looks very different too. The old legislation reflects the inherent gender disparities in the accident compensation scheme that are the result of its focus on physical injuries, which are more common amongst men in male-dominated types of work. This bill is our commitment to begin addressing the gender disparities in ACC and to reverse some of the 2010 changes so that we can provide better access to ACC and ensure it delivers better outcomes for all New Zealanders. I’m excited to see the real-life impact of this work and I look forward to the future where families will have the care and support needed from the start of their journey into parenthood, and workers will be better supported by ACC. Thank you, Mr Speaker. I commend this bill to the House.

The question is that the motion be agreed to.

In the first reading debate on this bill, my colleague and friend Louise Upston encouraged people with traumatic and negative experiences of their births to come forward and submit, and we certainly had a large number. The Education and Workforce Committee had a large number of women who did just that, and we heard submissions from over 790 people and 46 oral submissions. Some of them were harrowing, as mums described occasionally lifelong sequela from traumatic birthing experiences, and, if anything, that brought home to the committee and to officials the need for this, I think. So I want to thank them. It brought a human story and face to the improvements that we’re making to the ACC legislation.

I want to also put on record my thanks to officials, who were put through the mill quite a bit, I think, in terms of the questions that we asked—some were very technical—but I also want to acknowledge a parliamentary colleague: Sarah Pallett. It was very helpful to have a registered midwife on the committee. I have huge regard for our midwifery community. I have a sister who is a midwife of many years, and I’m very proud to say that I have a daughter now who is a registered midwife at Middlemore Hospital, and they have to deal with these things on a day-to-day basis.

So the bill is better for this process, as the Minister for ACC has acknowledged, and I want to thank all the people who helped us along that journey. It was a tough one, and we start with the premise that 85 percent of birthing mums are going to have a form of trauma that’s likely now to be covered by this.

I mention that in the context of—and anticipating the contribution by our Green colleague Jan Logie on—the Green Party view of the report. The Green Party aren’t happy with the way in which we have got here, with a specified list of birthing injuries, and we looked at this very closely. I think we’ve actually struck the right list as a start point, and Sarah Pallett was very helpful in that regard, I must say. But I do acknowledge the reasons why Jan Logie and the Green Party have concerns about this, and I have no doubt that there will be a close watch on whether or not trauma that’s experienced by mums in the labour and birth process—if it doesn’t end up being covered by ACC, I think we’ll all want to know why, and there is a review built into the bill now as part of the select committee’s recommendations. We’ve had reviews in the past that have been sort of lip-service clauses going into a bill, but I think this is a really, really important one, and the ACC officials actually gave us a commitment that they would be looking at that very closely all the way through in any event.

So there are six extra injuries that the committee is recommending be added to the bill. There were a couple of other things, I think, that we looked at, and there were many submissions calling for this. One was mental injury, and this has been a challenge for successive Governments—the degree to which mental injury should be covered. We’ve settled on a place that is mental injury as a consequence of physical injury, and, of course, post-natal depression and other psychological stress that may not be related to a birthing injury is not going to be covered. I can understand why.

My concern more broadly about mental injury is that—despite the backslapping that the Labour Government gives itself—our mental health services, despite the extra funding, is not in better shape. My worry is that like with many other conditions, as was my experience as an employee at ACC and as Minister of ACC, ACC becomes the default provider because the pathway to care is perceived to be shorter and better, and I worry that if we do broaden out the range of the definitions of injuries and mental injuries, that would be the case. I think that’s also the case with the other birth sequela that Jan Logie will talk about.

One area that I think we really do need to keep an eye on is injuries to the babies themselves. I remain uncomfortable at the possibility—and the difficulty, actually—in understanding whether a baby born with a severe, often neurological injury or condition is actually as a consequence of the birthing injury, and the arbitrary distinction between when does a person get cover and when does a person exist. I think that when you’re in labour, you’ve got a human being that’s about to come out and can be injured in the process. I think we need to look very closely at that, and I understand ACC’s reticence around that. Some are covered, but those are lifelong conditions that can be extremely expensive, and I’m not sure that we’ve actually captured all the injuries to babies that we could or should.

The Minister mentioned equity, and she did so also in her first reading speech. I accept the point she’s making, and this will close the gap between men and women in an equity sense. But, as she said in her first reading speech, there was billion-dollar difference, I think, in the costs of ACC claims—men more than women. I urge caution with that as a metric, because if there is an inequity, the goal is not to increase the costs to women. It’s to reduce the costs incurred by men who get injured—young men, particularly—who are much greater risk-takers and who have a propensity to slide their motorbikes in the gravel or to wrap their cars around lamp posts or break their legs on the rugby field or have trees fall on them in the forest. But, actually, the equity is not to increase the number of injury claims by women; it’s to reduce the claims by men—Jan Logie is not so sure. But there’s no doubt that men are less risk-averse, actually, and the injury prevention efforts by ACC are actually targeted at reducing those costs for our male rangatahi.

Indeed, injury prevention needs to be a part of birthing injury prevention, as well. As I say, I think we have a tremendously competent health professional group in charge of maternity care, but there’s no doubt that mistakes are made and they lead to injuries, and now that there is cover here, I think ACC can and should pay closer attention to professional standards, competencies, and clinical best practice to make sure that we can reduce the number and impact of birthing injuries on women in New Zealand. So it’s not just reducing injuries for men that we need to do.

I want to just touch, in the end, on the other minor changes that the Minister describes as the reversing of the terrible changes that the previous National Government made in 2010. Firstly, let’s have a bit of a context here. In the four years up until that change, the unfunded liability on Labour’s watch went from $4 billion to $13 billion, and the cost of ACC claims went up by 57 percent, or five or six times the rate of inflation. That’s because Labour have a track record of softening and expanding the scheme and of taking their eyes off the rehabilitation ball, and they haven’t actually reversed that many of the changes that we made in 2010 in any event.

Even with the hearing loss changes, prior to 2010, there was no threshold for entitlements to hearing aids. We put in a 6 percent hearing loss because that’s what Australian jurisdictions did and it’s what the United Kingdom did, and it actually recognised that between zero and 6 percent, there was little case to be had, according to the science, for a hearing aid to be provided. That was still the advice that officials gave us at 6 percent.

So there’s a bit of virtue signalling going on here. I think there were two reversals—if you’d even call this a reversal—but that’s a minor irritant in a bill that is going to improve services for birthing mums. I look forward to having a more detailed conversation in the committee of the whole House about it, but, in the meantime, we’re very happy to support it at second reading.

Thank you, Madam Speaker, and a pleasure to take a call in this second reading. With the ACC legislation being introduced 50 years ago, it is very clear that the existing legislation was due for an overhaul, and that is what this bill is actually doing. We have heard mention of issues of gender balance, fairness, and equity in the ACC scheme. That brings me to the story that we heard during our submission process of a couple, where one of them slipped in the pub and had an injury that was similar to the one that his wife sustained during childbirth, except one of them was covered—the one from the man—and the one from the woman wasn’t covered. So it’s obvious that birth injuries, as they’re currently not covered in the legislation, were a very important place to start the work.

It is really important to put up front that this bill is intended, as the Minister said previously as well, to cover all maternal birth injuries that can be caused by childbirth. I want to thank the Minister, the Hon Carmel Sepuloni, for bringing this bill to the House. We are really grateful for that. It is a first of its kind, and, once this bill is passed, 28,000 women will benefit from this improved legislation. That is 10,000 more than initially expected. I want to also thank the officials and advisers for their work on this, and my colleagues from the Education and Workforce Committee for working so collaboratively on this bill. I join the previous speaker, the Hon Michael Woodhouse, in also commending a special mention of our wonderful colleague Sarah Pallett. She subbed in to our committee on many meetings and took the opportunity to share her extensive knowledge and expertise on this particular issue, and the bill is better for it. Thirdly, but not lastly, I would like to thank every submitter on this bill; they bravely shared their personal stories, and their contributions were extremely valuable in informing our consideration. The feedback actually resulted in amendments being made with regard to the injuries covered.

Now, the previous two speakers, the Hon Carmel Sepuloni and the Hon Michael Woodhouse, already mentioned the review clause, so I won’t go further into that. But I want to talk a little bit more about an addition that our select committee made in the process, which is that we also opened a briefing into the accident compensation scheme cover for maternal birth injuries. What we put in our select committee report is that we hope to see this briefing reinstated in the 54th Parliament by the Education and Workforce Committee. It means that, in addition to the review clause, this briefing will then give an opportunity to review how the bill is working in practice. If it turns out that there are obvious injuries missing, then, through the briefing, injuries could be added to the schedule rather than awaiting the three-year review period.

Our committee heard very many notable institutions and organisations—I won’t mention them all, but it was from drawing on their mahi and all of the personal stories from the submitters that the committee recommended a number of additional birth injuries for inclusion in this bill. That is exactly what this process was supposed to do, and because of that process, we are here at second reading, discussing a more comprehensive and better bill. I commend it to the House. Thank you, Madam Speaker.

Thank you, Madam Speaker. I rise in support of the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill. While the bill does cover those other matters, as our spokesperson for women I’d like to concentrate my contribution this evening especially on birth injuries.

As spokesperson for women, I’m really pleased to see these changes come about that will allow maternal birth injuries to be covered, and I spoke in the first reading about the fact that I’d actually started drafting a member’s bill very close to these lines but the Minister beat me to it, and congratulations to the Minister and to the Education and Workforce Committee for beating this thing into shape and coming out with an even better bill than was first presented to this House. I’m also very pleased to see that it does, actually, as the Minister acknowledged, balance the scales a little in favour of women, given that this is a system where men are predominantly the award-recipients of claims and payments. So it is very nice to see something tipping in favour of the women of New Zealand.

But we do have a little bit of discomfort around the lack of robust costing, and I think that, while the regulatory impact statement has done a rudimentary estimate of about $25 million annually, we on this side of the House don’t view that as robust, and we don’t think that we have had enough of a provision or, indeed, an insight into an estimation of how many additional claims may be made through the ACC system once this piece of legislation does pass into law and is in place, and therefore we don’t have a full understanding as to what that is going to cost the Crown or the taxpayer. We do know, though, that there are about 18,000 women a year who do suffer quite severe, quite traumatic injuries. About 85 percent of women who give birth in New Zealand each year do need medical attention, and, as we all know, in this day and age, medical services don’t come quick and they don’t come cheap.

The amendment bill proposes that ACC extend cover to include seven injuries as accidents, and they include the perineal tearing, obstetric haematoma of the pelvis, and ruptured uterus and uterine prolapse. Some of these injuries are particularly painful and they take an exceptionally long time to recover from, and they do have long-term effects on the lives of new mums who suffer them. We do know, and I did refer to this in my first speech to the House on this subject, that perineal tears particularly are not uncommon in childbirth, but the most severe are known as third- and fourth-degree tears, and that was what I did personally appeal for in the first reading in the House, because they do involve some really debilitating injuries. So I’m very pleased to see this kind of injury being included in that schedule, because they do often require surgery and general anaesthetic and ongoing physiotherapy.

There is also the fact that ongoing medical issues, as many people in the public do know, are profound and they are exhausting and they are time-consuming and already, in a period of time that can be life changing for women, this is the last thing they need to contend with as well. So, while we would agree—and I understand the select committee did hear a lot of submissions around the fact—that mental health injury needs to be covered as well, that will not extend to the likes of postnatal depression, but it is pleasing to see that the select committee took the view that mental health distress related to maternal birth injury would also be covered.

I think the bill is making an excellent step towards advancing the rights and protections of women in New Zealand, and particularly mums. We do think that it is a much-needed change for what has been a painful and unfair consequence of a legislative change that was made just a couple of years ago. We do not think, as I have referred to, that the Government has fully justified the costs, but I am happy to commend this bill to the House.

Thank you, Madam Speaker. It’s an honour to take a call on the second reading of this bill. It was one of the highlights of my parliamentary career so far to sit on the Education and Workforce Committee to consider this bill. We heard so many submissions, and it wasn’t easy. Some of the submissions that we heard were very difficult to hear. Some of them were absolutely heartbreaking. We had 800 submissions in total, and I want to take this opportunity to thank the submitters who came to our select committee and bravely shared their very difficult stories of some very, very difficult injuries that they suffered at a very difficult time in their life.

I also want to acknowledge the Minister. This is a very important bill that came about because there was an issue that was raised about the equity of the ACC scheme and the fact that these particular types of injuries weren’t covered. She saw this issue and she addressed it very quickly, and I want to commend her for that. I also want to commend my colleagues from across the House on the Education and Workforce Committee. We did work very collaboratively together. There may be some areas of disagreement, but, in general, I think that we all agreed that this was a step in the right direction.

Many people who submitted to this bill wanted it to go further, and so the three things I would just mention are that the Minister has clearly said—and I state this for the record as well—that the intention is for this bill to cover all birth injuries. It also covers mental health associated with birth injuries and it is a first step in this regard. So I think these are really important steps to consider and issues to mention when considering this bill. Also we have the review in three years, and the additional briefing that the committee has looked into.

So we did take this really seriously. We did scrutinise this list, as the Minister requested of us. We heard from obstetricians, we heard from nurses, we heard from physios, but, most importantly, we heard from the women who were affected by birth injuries. We made improvements and, as a result of that, 28,000 more New Zealand women will receive the help they need after suffering a serious injury. So I commend this bill to the House.

Thank you, Madam Speaker. In contrast to an earlier bill, it’s a real pleasure to rise and speak in support of the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill. I will get to some of the points of, kind of, difference that the Greens had around this bill, but this is a day to celebrate. It is a really important step for families in our country to have the injuries that thousands of birthing parents have been carrying in silence, often in shame, without treatment or support for years. I also, like everybody else who’s spoken tonight, really just want to acknowledge the submitters first. Also when the Greens did a call out earlier, we got 900 stories from birthing parents around their experiences of birth that we passed on to the Minister, and I just want to thank all of them and just say how humbling it was, I think, for everybody on the committee to be able to hear and read their stories.

And before getting into the substance of the bill, I also just want to acknowledge just a sense of being really disturbed by the failure of our health system. Getting ACC now to respond to these injuries is one thing and is a really, really important step, but the fact so many of these injuries were not even ever picked up or responded to by health practitioners and the degree of silence that’s existed in our society—and I note too for myself, as, you know, like a feminist who’s been active on a range of issues, this is not an issue that I have previously picked up before. That shocks me now that I’ve heard all of these stories, because this is something we should have done something about a long time ago. So I really want to acknowledge everybody who shared their story, and the Minister for bringing this piece of legislation, and then the committee, and to acknowledge the chair, and Sarah Pallett, our resident midwife, for the journey and the process, and also having a previous Minister for ACC from the National Party. It was like a very intense experience, I think, for the poor officials, so I’ll also acknowledge them.

There were changes made, and I acknowledge, in terms of the Minister’s articulated intent, that this bill will cover—and I’m going to clarify this a little bit from what has been said—all physical injuries and consequential mental injuries to birthing parents. There is a difference from covering all birth injuries to doing that, and this is a good first step towards covering all birthing injuries. We are pleased to see a significant number of injuries that have been added to the list to ensure people get the support that they need, which is ultimately what this is about.

We heard so many stories about people, you know, like living with injuries where they weren’t able to pick up their babies, they weren’t able to play with their babies, and they weren’t able to do housework. Sexual relationships: they weren’t able to enjoy sex anymore, so then relationships broke down as a result of it. Like, then you think about the profound impact of that. Here you are, this most joyous experience that you’ve, hopefully, been looking forward to for most of your life, and then it turns into that, and you’re trying to connect to your baby and know how important that attachment is for the entire life of your baby; too much—too much, without support, without intervention and support. So this is what this is about addressing.

For the Greens, we didn’t want this defined list of birth injuries because it is a unique approach in the Act to have a defined list. Nowhere else does that exist within the ACC legislation. For us, we don’t think the best way to address embedded sexism in a system is to create something unique, special, just for those birthing parents and women. That seems like that might actually have potential to embed a degree of discrimination into the system. We could’ve lived with it, even a bit more than what we’re living with now, if there’d been, kind of, a catch-all, which is similar to some of the other workplace gradual process injuries, where there’s a provision that enables things not on the list to be covered. But the officials’ advice was that they thought that would catch too many things, and that makes me sad. I don’t think we should be fighting to defend the existing boundaries within ACC, when we know those boundaries right now are deeply problematic and causing lots of harm. So that was why we were looking for a general cover.

I heard the Minister say that the rationale for not going for general cover was because it might lead to different outcomes. We also heard that between different areas, different language is used to describe injuries, so we may well end up with that difference in cover anyway, even with that specified list. There’s a real potential it’ll create more bureaucracy and potential for disentitlement as practitioners use that different language to refer to different injuries. It’s also, for us, a really fundamental point of the separation of the physical from the mental from the whānau actually negates a Te Ao Māori worldview. So we’re embedding a Pākehā world view on to a system that is supposed to be providing support for all people in this country. We think we could’ve done a bit better than that, and a generalised approach that included whānau would’ve been a way to do that.

Also, just the potential for it to exacerbate existing problems with the approach to treatment injuries by focusing narrowly on cause rather than focusing on the impact of an injury or a person experiencing it was a concern for us. The point about requiring a physical injury before mental injury gets covered, I do just want to point to how problematic that occurs to me to be, particularly for birthing parents in rural areas. I’ve heard a significant number of stories of people whose births do not go to plan. They may be haemorrhaging, and they have to be airlifted. In this, I’ve heard several cases from Queenstown area—and I know this will be similar in other areas of the country—have to be airlifted out to another city. Sometimes they have to divert their partners in a car racing to one town to meet them. Then they’re diverted to somewhere else, and their life is at stake. There is no physical injury at the end of that that is on that list. But boy, will there be a mental trauma that is a result of the physical process. So I was not convinced that we should not have had a clause to ensure that there was cover for those women.

I also just want to speak to the point around—and I was really encouraged to hear the Hon Michael Woodhouse talk about the openness around needing to consider injuries to babies in the future. Also, we heard from people who’d fought through the courts to get cover, and that it had been a full-time job to get treatment injury cover for their child, and recognising that’s an inequity. Very, very few people are in a place to be able to fight the system through the courts to be able to get that cover. We know people are not getting it. All the way through the hearings, we were hearing things that sounded like treatment injuries to most of us around that table that were not being covered as treatment injuries. So for the Greens, actually ensuring cover for all birth injuries to pēpē would be the best way to avoid that problem and to ensure that they get the support that they need. Cost for us is not an argument. It is a massive difference—and I’m not going to buy into the sexism that we’d heard previously about men’s behaviour and women’s behaviour. But just to say this is a really important day for whānau in this country, and the Greens are happy to support.

Thank you, Madam Speaker. I stand on behalf of the ACT Party to support this bill, the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill. The first thing I would really like to do is to thank the submitters. We had over 800 submitters, and many of these were women that had traumatic experiences while giving birth. And the stories that we heard from there are just horrific because of the amount of treatment that they were unable to access. Also, listening to women that had given birth overseas with one child and then came back to New Zealand and had their second child, and just the total way they were treated and how these injuries had occurred. Also, the other sad reality, we heard from these women that have had a child and they are now not even considering having second or third children because of the traumatic birthing injuries that have occurred.

Next, I would actually really like to thank the ACC officials for listening to all these submitters; actually looking at the list and hearing what these ladies had to say, due to their births being traumatic experiences; and adding many injuries to this list. However, again, as the Green Party said, there’s always going to be a line—what is actually an injury, and then what is actually part of. And it gets very, very difficult because there was also the consideration of that grey area between medical and ACC. However, we are very glad to know that the ACC will be holding a three-year review instead of a five, which they gave us the options. However, again, as we mentioned at the Education Workforce Committee, which we worked really well with, we insisted that we will have a briefing paper put forward to the next Parliament to suggest that they have a review every year. As we all know, we also can miss things, and we want to make sure that we don’t miss these horrific injuries that can occur to these women.

Now, what we also believe, from the original, is around 85 percent of women in New Zealand may experience this. You know, this a huge number, and it’s quite sad to think how many women are currently carrying birthing injuries which will not be covered because they were not going to go back. So it would be very nice to see if there is some way within the ACC bill that some of these women may be able to prove injury that they may want to look at—how to get some treatment. We do want women to be able to have more children, and if they’re carrying an injury now, what is the likelihood that they’re going to do it again?

So I would really like to see that. Yes, I know that we haven’t fully costed this, because, I think, the biggest thing of all was we actually do not know how many women will be claiming. I know that they estimated, back at the beginning, it was around 17,000 to 18,000 would benefit from this bill. But I am guessing it’s going to be a lot larger than that, since we have increased the number of injuries to that list. And also, it is good to see that the mental health side of a traumatic birth will be looked at as well, because there’s also some very interesting stories that women have told us with that.

But the other thing is that everybody is also talking so much about the greatness of the maternity birth injuries, but there are also matters in this bill. Again, lowering the threshold from 6 percent to 5 percent for hearing loss. But there’s also one bit in five of the other clauses that are here that still concerns me: raising the board from eight to nine, saying that they need broader representation.

Again, I look back. Last year, we had three appointments put on to this board. So I’m pretty certain we should have had good representatives back then when they were appointing these three new appointees. And also within this bill, there are seven other little technical things that help, also, around assisted dying for children that parents do assisted dying for. So this is great. We’re moving it into our modern world, which is forever evolving. And we’ve got to make sure that we are covering people and making sure that they have the access to good care.

The biggest thing of all is that I still think there’s much more that we have to look at, at ACC. It’s a 50-year-old Act—it’s 50 years old. Things change so rapidly in this modern world: technology and treatments within the hospitals. We may have to start looking at how we reform ACC and how we can move it into the times. There are things that we could be probably doing a lot better than what is being done now to help people with their injuries, be it a maternal injury or a work injury or a sporting injury. We need to keep looking and moving forward instead of necessarily looking at something that is 50 years old, which is ever so slightly younger than me. And I’m pretty certain that for kids that are born today, there’ll be totally different new things. So, hopefully, we can look at this bill and improve it even more for the better. Or we just start writing something new that fits our modern times so that everyone is looked after.

Now, also in the bill, with the other five policy changes, there’s a clarification in clause 8 around section 30, clarifying the test of work-related gradual process, diseases, or infections covered and restoring the more climate-friendly test that applied before 2010. Of course, this was around the changes that the National Party did. However, we also heard from the firemen’s association around cancers. I know that the ACC say that, yes, it would be picked up, but there are still so many different questions around that, around the firemen, especially also volunteers that sometimes don’t receive the same coverage. So there’s something there that we still need to improve on and have a look at, because we need the firemen and women that look after us, and especially the volunteers within New Zealand, because there’s a lot of small rural communities and we have to make sure that we’re looking after them or anyone—first responders—that may attend to something that could end up causing them problems down the track.

I would like to commend this bill to the House. And, once again, I would like to thank all the women and also all the experts that submitted on this bill. I commend this bill to the House.

Thank you, Madam Speaker. I’m delighted to be able to take a call on the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill. This is a bill that will improve lives. I want to acknowledge the submitters, who—we’ve heard quite a few speeches now on, obviously, the trauma that many submitters have faced and how harrowing that was at the Education and Workforce Committee. So well done to everyone across the House on the select committee. It seems like it was a very engaged select committee and also had the benefit of Sarah Pallett and her expertise as a midwife. So well done to all involved, and, of course, the officials, who, obviously, responded to that work.

I want to focus on the maternal birth injury part of this bill, rather than the other matters. I just want to take a moment to go back to the principal Act, in section 3 of that, where the purpose is “to enhance the public good … by providing for a fair and sustainable scheme for managing personal injury”. How that Act operates is that, at section 20, this relates to who is covered by the compensation scheme, it applies to (2)(a) “personal injury caused by an accident”. That word “accident” is a key definition, and that comes in at section 25. Now, what this bill does is it adds a new subclause to that section 25, new subclause (1)(f), and so that inserts “an application of a force or resistance internal to the human body at any time from the onset of labour to the completion of delivery that results in an injury described in Schedule 3A to a person who gives birth.” So that’s what this bill does.

And then we have this new Schedule 3A of the Act, and that schedule lists what a maternal birth injury is. We’ve heard from some other speakers a bit about what’s in that list, and also that the select committee revised the detail of what was on that list, and it sounds like a very fine process. In addition, I want to note that at new section 25A there’ll be a review of these provisions within three years.

And so, really, I’m very proud to be part of this Labour Party and just supporting the Government that’s providing for women, who have previously missed out on the benefits of our very important and world-renowned ACC scheme. I really want to thank Minister Carmel Sepuloni for bringing it to us, and I commend this bill to the House.

Thank you, Madam Speaker. I’m also delighted, like the previous speaker, Rachel Brooking, to stand and speak in support of the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill. The bill, of course, in legislation, allows certain maternal birth injuries received during childbirth to be covered by ACC, and the schedule sets out that list of injuries. At select committee, by dint of careful consideration of the submissions and a great deal of discussion and good technical advice, it was further defined and other specific injuries were added to the schedule, and I think we did good work in achieving that at the select committee.

Look, it was a very collaborative process, I would have to say, and a very enjoyable process to be working in the select committee on this bill. Like all the others, I would like to acknowledge the submitters that put their very personal and often very emotional stories to us. When you think that this bill isn’t retrospective, none of those particular women, mothers, giving their stories were doing this for the benefit of themselves but rather for the benefit of other women who were going to go after them. So I really want to acknowledge them and their bravery in speaking out about some of the very most vulnerable and harrowing periods of their time.

The chair, Marja Lubeck, gave a submission that obviously hit home to her, and I want to share one of the ones that was really a penny-dropping moment for me.

Hon Member: Penny dropping! We got you there.

PENNY SIMMONDS: Thank you, good. Everyone is awake! So in the midst of hearing a number of these very harrowing stories, you get very immersed in it, but one young woman told us of the situation where her partner went to rugby practice, and, at rugby practice, he pulled his hamstring. He then went to the doctor or went to his physio, was able to straight away go through to physio through ACC, yet this poor woman, as a mother who had suffered significant pelvic floor injuries, wasn’t covered, had been trying to get cover to be able to go to physio, couldn’t afford to pay to go to physio, and it was obviously impacting on her quality of life, her ability to care for her children, and was likely going to have ongoing impacts for her. All of a sudden, the nonsensicalness of this situation was very, very clear: that you could pull your hamstring in rugby and straight away be covered for physio through ACC, but go through a traumatic birth experience, get a significant injury, and not be able to get cover. Immediately it was obvious that changes needed to occur. I think that speaks to some of the equity issues that the Minister commented on earlier.

I would like to acknowledge my colleagues on the select committee. I felt we worked well together to get the very best out of this bill but also to make provision for being able to review it and see if further changes needed to occur. I also, like the chair, want to acknowledge the officials who supported our select committee, the clerks, and the report writers. I think we may well have scarred our very young male report-writer for life in some of our technical discussions about birth injuries.

Look, there were nearly 800 submitters, and they were across a wide range of people—health professionals, mothers, and a wide range of people. Of those, we heard 46 orally. I do want to very briefly acknowledge those who submitted on behalf of the hearing impaired. We heard some very good technical advice and some very real-life stories from those people with a hearing impairment as well, so I don’t want them to get lost in our euphoria of the maternal birth injuries being accepted. But I think we’ve gone through a very good process with this bill, and I commend the bill to the House. Thank you.

Kia ora, Madam Chair. He was an undiagnosed giant—5.14 kg. The words are “massive shoulder dystocia”. The result was I was on crutches for eight weeks. I had, at that stage, a very active 2½-year-old and a very sleepless newborn. It was pretty horrific. And there was no ACC cover. I remember asking my midwife, “Do you think there might be ACC?” “No, dear.” We underestimate how extraordinary ACC is and how much it protects us. I am so deeply grateful to the select committee and to my colleague Sarah Pallett for the work that has been done. But to Minister Sepuloni for picking this up and protecting 27,000 more New Zealand mums a year, thank you. I commend this bill to the House.

Thank you, Madam Speaker. I rise with enormous pride this evening to speak on the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill, and wanted to add my gratitude to the Education and Workforce Committee who very kindly put up with me for a few meetings whilst we worked through this piece of legislation together. I commend its chair enormously, my colleague Marja Lubeck, and, of course, acknowledge Minister Sepuloni, who from the very beginning has been absolutely determined that this legislation will ensure that all birthing injuries be covered.

This is why so many of us are here. We want to be here, I hope, to work together to ensure that things are made better for the people that we serve. What I saw in this committee was total commitment across all parties to ensure that the overall aim of this bill was fulfilled. That aim, as I’ve said, was to ensure that all birthing injuries are covered by ACC, and I truly believe this bill will do that. It’s intended as a pragmatic bill, and it will enable 28,000 birthing parents a year to receive prompt and effective care that is long overdue. That’s 76 a day who will get the care that they need as a result of our work over the past few months and of our time here this evening.

We deliberated long and hard, as you’ve probably gathered. The officials deserve medals or sainthoods, at the very least, for the amount of work that they put into ensuring that every question that we had was answered. We deliberated long and hard, in particular, over whether or not we should land on a list or a more broad form of cover. We landed on creating a list of covered injuries, which we expanded substantially in the course of the select committee process. This was done with extensive consultation with obstetricians, physiotherapists, midwives, gynaecologists, and, obviously, taking into account the very many moving and courageous submissions.

We futureproofed this with a review clause in the bill, and we also called for a briefing with the anticipation of the 54th Parliament also calling for a further briefing to ensure that this legislation is doing what we hope it will do. We also intended, as I said, that it would cover consequential injuries following a listed injury. Incontinence, for example, will be covered as a result of a listed injury. We did this so that court processes wouldn’t be engaged with. We didn’t want to have delays caused by arguments about eligibility. We wanted to ensure that the pathway for birthing parents was clear to get the care that they need while we address the embedded sexism. Thank you so much. I commend this bill.

Thank you very much, Madam Speaker. I too rise in support of the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill in its second reading tonight. Although I haven’t sat on the Education and Workforce Committee, I have listened with great interest over the first and second readings to the content of this bill, and it’s been clear from the contributions made from the members of the committee that they are obviously very pleased with the outcome of the select committee process. I think one of the things that impressed me about the contribution that the community has made is to attract 794 submissions, which is no small feat indeed, and so that obviously shows the level of interest in the community for this bill.

As we’ve heard, there have been some inclusions made in the bill, additional to what was first in the draft. Six new injuries were added to the bill at the select committee process, and I’ll just go through those six: anterior wall and posterior wall prolapses, post-partum uterine inversion, coccyx fracture or dislocation—and, actually, a friend of mine did suffer from that, and I can tell you it’s very uncomfortable and takes quite a bit of diagnosis—pubic ramus fracture, symphysis pubis capsule or ligament tear, and obstetric anal sphincter injury tears and urethral tears. Speaking of tears, they all make your eyes water.

One of the things that I did have particular interest in was a comment made by my colleague the Hon Michael Woodhouse, when he talked about the ACC cost for hearing aids and that level of hearing loss from 6 percent down to 5 percent, and the concern around having had no cost-benefit analysis for that. So that led me to look at the costs potentially associated with the rest of this bill. I note in a ministerial statement that the Hon Carmel Sepuloni made, she talked about tens of thousands of New Zealanders standing to benefit from the changes to this legislation, and some of the Labour Party members have mentioned numbers around 28,000 potential claims.

But the regulatory impact statement only did what was described as a rudimentary costing of around $25 million annually. I say “rudimentary” because there was really no way that you could gauge what the level of claim may end up being in any particular year. So the Government, I think, needs to be really cautious about how then they are going to fund these approximately 28,000 extra claims a year, because, unlike the Labour Government—they just think you can keep spending money and keep dipping into the public purse, but this all comes at a cost and somewhere that cost is going to lay. That is going to, obviously, mean increased fees for someone somewhere, because unlike what happens in Disneyland, you cannot keep printing money.

There are some definitions in the bill that—or one in particular that is an obviously simple one, and that has been to make the alignment with other Acts so that the language is consistent. That was the Land Transport Act—just aligning mopeds and motor scooters, I think it was.

But the other one that I’d like to turn to is section 30 and an amendment that’s being made to section 30 regarding personal injury caused by work-related gradual process, disease, or infection. And I did speak to this in the first reading speech because it’s one that is of particular interest to me and, indeed, to the National Party, because it was included in our policy proposals that we put out pre-election. And that is to do with injuries that are work-related and that gradual process for hearing loss or illness, disease, or infection, which is described in section 30. One of the cohorts that will be affected by that will be our firefighters, and I know that the firefighters have been battling this for quite some time to have recognition of this gradual process that happens especially in the field that they work in where they are often exposed to toxic fumes. Over time, there is clear statistics that show that they are more likely to incur other illnesses far in excess of the normal range that would be expected with people outside of their workforce. So it’s good to see that that is going to be addressed.

But it is quite confusing when you read the wording in the bill in section 30(2)(c) is being replaced with this: “that, if the particular property or characteristic is present in both the person’s employment tasks or environment and non-employment activities or environment, it is more likely that the person’s personal injury was caused as a result of the employment tasks or environment rather than the non-employment activities or environment.” And I guess that’s spoken in legalese, and maybe my legal colleagues will be able to interpret it a bit better. But the other one that is relevant to that is (2A): “even if it is established that a claimant’s personal injury was caused in the circumstances described in subsection (2), the Corporation may decline the claim if the Corporation establishes that the risk of suffering the personal injury is not significantly greater for persons who—(a) perform the employment task than it is for persons who do not perform it; or (b) are employed in that type of environment than it is for persons who are not.” So if they can work their way around the meaning of those clauses, I hope that there is some advantage to our firefighters because they are a very important part of our volunteer service and our paid firefighting force, and I pay tribute to them, tonight.

The other thing that this bill will do is to make clear that this bill does not apply if the death was a result of suicide or of assisted dying in accordance with the End of Life Choice Act 2019. So I think it’s important that as we update legislation, we also incorporate other legislation that has gone before it. And, clearly, the select committee in its wisdom has done exactly that. I did in my first reading speech query the title of this bill, and perhaps I will be creative and put in a Supplementary Order Paper (SOP) around the title, because it does beg the question about why we call it “Maternal Birth Injury”, because my understanding is that unless you are a seahorse, it’s only women that can have a birth injury because they’re the only ones that give birth. So why do we have “Maternal Birth Injury and Other Matters”? So maybe in the interests of saving ink, we could reduce the title name, and I’ll give consideration to that at the committee of the whole House and maybe put in an SOP to that effect.

Andrew Bayly: What a great idea.

MAUREEN PUGH: I think it’s a great idea, too. Thank you, Andrew Bayly. So we’ve heard tonight that there’s a great deal of interest in this bill and especially from our midwives, doctors, etc., who are literally at the coalface of these injuries, and they do see the impact that it has on their patients, their clients, and have given it their support, and so too does the National Party. Thank you.

Tēnā koe, Madam Speaker. What an absolute pleasure to round out the debate this evening on this important bill. I congratulate the Minister, the select committee, and our expert in the room, Sarah Pallett, for shepherding this bill through the House.

So how do we know when a system and laws need to change? Well, we listen to the simple truth of bones. There’s a profound power in hearing people’s accounts of their own experience, and I’m an advocate for maturing our domestic legislation so it develops on the foundations of international law such as UN conventions that protect the quality, that protect the highest attainable standards of health.

But it’s people’s accounts and experiences which tell us whether rights are actually being upheld; it’s people’s experiences that help us navigate our understanding of what section 65 of the Human Rights Act means when it prohibits indirect discrimination.

Given how many people are affected by these injuries, I suspect many of us have heard these simple truths in quiet circles with our friends, with constituents, with professionals. For some in the select committee room, the changes we are making through this bill are rights-affirming changes. They’re included in 3A, and I’m also very pleased to see that they affirm the right to protect mental health when it arises from one of those injuries that’s resulted in the list as well.

Again, the changes in this bill will make a difference for thousands of people in New Zealand. I commend this bill to the House.

Motion agreed to.

Bill read a second time.

I declare the House in committee for consideration of the Data and Statistics Bill, the Three Strikes Legislation Repeal Bill, the New Zealand Bill of Rights (Declarations of Inconsistency) Amendment Bill, and the Plant Variety Rights Bill.