Health Practitioners Competence Assurance Bill

The title of this bill should definitely be changed. For a start, the term “Health Practitioners” covers a wide number of groups—chiropractors, dentists, dietitians, medical auxiliaries, medical practitioners, nurses, occupational therapists, optometrists and dispensing opticians, pharmacists, physiotherapists, and psychologists. The bill tries to encompass far too much. It tries to be all things to all people. The National Party will be voting against it because it has some significant problems in it.

For a start, this title should be the “Health Practitioners Incompetence in Development Bill” because not enough work was done for such a comprehensive and expansive piece of legislation. This bill is 272 pages long—a massive piece of legislation. The bill’s concept is good—what it tries to do—but it fails in its delivery. The concept was to take very successful legislation, the 1995 Medical Practitioners Act, and to make legislation for all those other health practitioners that incorporated the best of that Act. But the doctors do not want a bar of this bill. They have good legislation now, modern legislation, which they have got to grips with using. That 1995 legislation took about 3 years to really be implemented, but once it started working it did solve many of the issues that had faced the medical profession over the previous 30 years. So “Health Practitioners But Not Doctors Assurance Bill” would be one title for the bill. The doctors do not want to be part of it, and I support them in that.

Some of the other groups that are coming under this bill have very outdated legislation. The Physiotherapy Act dates from 1949, the Occupational Therapy Act dates from 1949, and the Dietitians Act dates from 1950. That legislation did need to come up to speed, to be modern, but the legislation we have before us, which tries to incorporate all these groups, certainly fails to be modern legislation, because these groups are different and have different needs and different wants. Nurses and doctors, for example, have different Acts of Parliament that they have been working under. The Nurses Act dates from 1977, and nurses certainly want more modern legislation, but the doctors do not. They want to continue to work under the 1995 Medical Practitioners Act, and I certainly will be supporting them in that.

The bill contains the brand new concept of scopes of practice, but there is nothing in the title to suggest that something very new and different is being developed here. Many people do not have a firm view of what the term “scope of practice” means. It is a new concept. No intellectual work about what scopes of practice would mean was put down on paper so that it could be reviewed. How this concept will work has been a major issue of concern. When there are conflicts between scopes of practice, how will they be sorted out? Only in the future will we know how this bill is going to work in practice. It is going to have a 3-year review, and I am extremely pleased about that, because I do believe that there will be major hiccups with the implementation of the bill. That is why National will not be supporting it; we think it should have had more work because it is such a comprehensive piece of legislation.

Other problems with the bill, which have been of major concern to people, have been issues around the quality assurance activities.

Tēnā koe ki te hemana. I am pleased to stand to participate in this debate on the title. Like the previous speaker, I have some reservations about this bill, and New Zealand First has already indicated in an earlier debate that we will be opposing it, notwithstanding that there are some Supplementary Order Papers that we support.

I think this bill would be more appropriately referred to as the “Make Believe It Is the Medical Practitioners Act Bill”, because when this bill was first conceived, it was believed that it would replace the Medical Practitioners Act and be in a much better form. Unfortunately, the bill is significantly inferior to that Act as a legislative regime for the protection of the health and safety of the public. In part, this difficulty is probably due to underestimation of the sheer complexity of developing umbrella legislation that covers such a diverse range of professions in one go and within a relatively short period of time—groups like medical practitioners, occupational therapists, and opticians, just to name a few.

A number of those professional groups are somewhat disappointed in the bill as it is now presented to this House. In fact, some of them wish to be exempted from it. I hope that when we come to consider Supplementary Order Papers, some consideration is given to that wish, given that we have a 3-year review of the Act, so we can see for ourselves whether there is a need for those professions to be included.

The bill encompasses a lot of people. It covers a lot of occupations, and I believe that, in essence, it covers too much. The bill is a big piece of legislation, and although it has been around for a couple of years, I think it is too big in its entirety. However, I need to concede that the original intention of the bill was a good one.

The Health Committee reported this bill back to the House with three important and positive changes: a less restrictive, though still bureaucratic, quality assurance model; provision for a majority of health practitioners on disciplinary tribunals; and provision for a review of the legislation after 3 years. Although these changes are welcome, they do not alter the essential nature and direction of the bill.

I know that some professional associations have concerns about aspects of this new legislation that will bring in untested concepts, undermine self-regulation, bureaucratise quality assurance to an unworkable extent, and allow much higher levels of political interference in professional processes. Scopes of practice is a new legislative concept, but it is the basis of the bill. Wide discussion or consultation about this innovation has been somewhat limited. It is untested, outcomes are uncertain, and confusion remains about its definition and utility. I know for a fact that this whole issue of scopes of practice, because of its untested nature in this country, will pose some difficulties for many practitioners operating at the moment.

I was on the Health Committee throughout the many submissions on, and long process of, this particular bill, and I have some concerns about it. One of the things this bill tries to do is to give to the health professions, other than the medical profession, a system along the lines that the doctors have with the Medical Practitioners Act. However, it does not quite do that. Worse than that, it tries to have a one-size-fits-all sort of approach to the many professions and occupations involved in the health sector.

To give the Committee an idea of the groups that submitted to the Health Committee—all wanting to be defined as health professionals under this bill, and all wanting to have some sort of official sanction because they are currently unlicensed and unregulated—I will list some of them. They included acupuncturists, ambulance officers, anaesthetic technicians, applied behaviour analysis practitioners—whatever that is; I am sure there are a few members on the other side of the Chamber who could tell us because they have probably been to them—audiologists, audiometrists, embalmers, social workers, speech language therapists, and traditional Chinese medicine practitioners. There was a huge range, including a whole lot more that are listed in the bill but that I will not read out now. One of the reasons this bill does not do what it is supposed to do is that it does not include any of those particular groups.

It does, however, deal with chiropractors, dentists, dieticians, medical practitioners, nurses, occupational therapists, pharmacists, physiotherapists, psychologists, and a couple of others, including optometrists. Unfortunately, those groups are not always going to be happy with the results of this bill, because they wanted some good legislation that treated them as professionals, but this particular bill does not really do that. It is all about giving a tremendous amount of power to the Minister to control those occupational groups. They really will not be able to call themselves professions when the bill is enacted, because part of being a profession is having a self-regulatory authority. This particular bill should be named the “Minister’s Regulatory Authority for All People Connected to the Health Sector Bill”. It should not be called the Health Practitioners Competence Assurance Bill, because it is all about taking away from professional bodies, groups, and highly trained professionals the right to regulate themselves. There is a reason for that: the Minister does not have any faith in the doctors to know how to be doctors, the nurses to know how best to be nurses, or the occupational therapists to know how best to be occupational therapists. Unfortunately, this bill will not solve the problems of the very many groups that currently work in the health industry. That will be a tremendous disappointment.

This particular bill, apart from being somewhat late in coming back to the House, is a tremendously huge, omnibus bill, and has very, very little to do with assurance of health practitioners’ competence. If anything, it really has more to do with cultural competence. In fact, it should be called the “Health Practitioners Cultural Competence Assurance Bill” because that is, in fact, one of the main requirements of this bill. That is one of the reasons the National Party would not, in a month of Sundays, support this sort of bill or its title. Instead of our just providing for professional and ethical competence, we now are regulating for cultural competence, but unfortunately this particular bill does not say what that is. But the nurses union knows what it is—it means whatever it says it does. That, unfortunately, is a very sad fact. That is why this bill should be renamed, perhaps, the “Health Practitioners Cultural Competence Assurance Bill”, but that might require someone to define what “cultural competence” is, and nobody on the select committee could possibly come up with that sort of suggestion.

ACT New Zealand, like the National Party and New Zealand First, is opposing this bill. It is a large and very ambitious piece of legislation that has been over 3 years in the making.

If we look specifically at the title, we see there is quite a lot to say about it. “Health Practitioners”, of course, is reasonably easy to define, and we know that this legislation, if passed, will repeal 11 other pieces of legislation governing 11 different health bodies. But when we come to the other two words in the title, “Competence Assurance”, I would like to ask the Minister how she will assure that competence does happen. How does one assure competence? It always worries me when a word in a title cannot be defined. Members will see, if they look through the bill, that there is no definition of “competence”. We were told in the Health Committee, when we questioned the absence of a definition of “competence”, that it was too hard. It was too hard to define “competence”, but not too hard to call in this bill for competence. How can health professionals be reasonably expected to meet this standard when we do not even know what the standard is? The standard is too hard to define. What are health professionals supposed to aspire to? What level of practice should they meet? If competence cannot be determined, how can judgments be made of individual health practitioners? How can competence be measured? How can their performance be measured? The answer, of course, is that this is not possible.

We need to look at another title. I think the Government is trying to assure that health professionals will be held to account for every single mistake that is made. We should perhaps call this bill the “Health Practitioners Must Not Get It Wrong Bill”. That would be far more appropriate because that is what the Minister means when she is talking about competence assurance. Competence, as anybody who has worked in the health field will know, is about getting the right environment. We have been told often that the bill is there to protect patients. It is to offer them protection. That is a very noble thing, and something that professions should aspire to. But I would contend that we should aspire to achieve that by using self-regulation. The way to ensure the best possible treatment for patients is to provide a safe working environment for the professionals to operate in, and to leave them to regulate themselves; in that way, the health professionals will provide the best protection for patients.

If we look at the doctors in isolation for a moment, we see that since the Medical Practitioners Act came into being in 1996 they have come a long way. Their self-regulation has developed so that they have a very good set of guidelines for quality assurance and for their vocational training. This legislation is supposed to be modelled on the Medical Practitioners Act. The other professions liked what they saw. They liked the way that things had developed for the doctors, and were very keen to be part of that, and that was quite right. However, what we have now, in this large piece of legislation, is something that does not resemble the Medical Practitioners Act at all. The health practitioners who are currently working under very outdated legislation—the physiotherapists, the dieticians, the occupational therapists, and some of the other health practitioners to a lesser extent—are very keen for change. But change for the sake of change in itself is not a good thing. The environment has to be right, and this bill will not provide the right environment for those practitioners to work in. In fact, it would be better for them if their current legislation were amended, rather than their moving to the Health Practitioners Competence Assurance Bill.

My Supplementary Order Paper, which we will discuss when we come to some of the other parts, removes doctors from this legislation. The New Zealand Medical Association and the Association of Salaried Medical Specialists are very keen to have their members, the medical practitioners, removed from this legislation, and my Supplementary Order Paper does just that. They have decided that their requirements have not been addressed. The professional bodies, especially, found that their issues had not been redressed.

I gladly rise to speak on the title. I would like to shorten the title even more and call this bill the “Incompetent Bill”. I am sure that members on this side of the Chamber would agree that “Incompetent Bill” would be a good title for this legislation. I have heard from throughout the electorate of Whangarei and Northland and from those throughout New Zealand who write to me widely, that this legislation will create chaos in the health sector.

💬 Hon Harry Duynhoven: How many letters has the member had?

Harry Duynhoven, the “Abel Tasman” of the Labour Party, who came to New Zealand and decided that he did not like it and went home, should read the bill before he shouts at this member, who has consulted widely throughout the country on this matter. Health practitioners throughout the country say that there will be chaos in the health system because of this legislation.

I want the Minister to know that I have consulted widely on this matter. Not only have constituents come to me. My family—and I would like the Minister of Health to take this into account—is riddled with health professionals. I am married to a nurse. I have a sister who is a nurse, a sister-in-law who is a nurse, a mother who is a nurse, and a grandmother who was a registered nurse, God bless her soul, and may she rest in peace. Also, my father and mother-in-law are anaesthetists, and my father worked in occupational therapy. So many of my family members are in the health profession, and I have consulted widely at dinner after dinner, breakfast after dinner, lunch after dinner, and on it goes. Out of interest, I can tell the chair that because we have so many health professionals in our family, my wedding day was voted the safest in history—there were so many health professionals there. In fact, to add more to the argument, I point out that my brother-in-law is a funeral director, and should the rest of the family fail, he will pick it up at the other end.

The Minister should take notice of that, and she should know that she is not welcome in my home for Christmas dinner, because she is harming every one of them in their careers as they seek to help New Zealanders. So she is not welcome for Christmas dinner in my home. I have not only consulted widely those in my family who are involved in the health profession but also those throughout the electorate that I represent. I have consulted pharmacists, optometrists, those in the dental profession, nurses, occupational therapists, physiotherapists, psychologists, dietitians, and on it goes, and they are all saying that there will be chaos with this bill, and that is why it should be renamed the “Incompetent Bill.”

I am interested in the slant put on cultural issues and cultural respect in the bill. As if people, when they take their children to the doctor or medical professional, are concerned about cultural issues! They just want their kids to get well. That is all they want. Why this legislation focuses so much on cultural issues, I have no idea. When Māori, Pacific Islanders, and all other New Zealanders take their kids to the doctor, they want their kids to get well, and that is their primary concern—not all the other mumbo-jumbo, which the Minister is promoting, that goes with it. I was concerned to see so many other groups that wanted to line up as registered health professionals in this country. They include acupuncturists, herbal medicine practitioners, homeopaths, hypnotherapists, and on the list goes. They all want to be recognised by this Minister, who, willy-nilly through the bill, has decided to make all health professionals accountable to the nth degree, and wants to stand over all of them, following their scalpels as they repair New Zealanders on the operating table.

It is important to look at the context of this legislation, because it goes back further than people think. In 1999, the Hon Nick Smith, along with 828 other people, petitioned the Government for an inquiry into the decision by the Medical Council of New Zealand in relation to its consideration of one Dr Hornbeck’s approach for medical registration in New Zealand. They believed that the process of registration in New Zealand was an example of how the Medical Council is denying New Zealanders access to specialist medical services through incompetence or anti-competitive practices. The Health Committee recommended that the Government develop a mechanism, and the recommended term for that mechanism was “a scope of practice”. That was to define what a practitioner can or cannot do, and under what circumstances, so that overseas doctors could be used effectively for the benefit of the New Zealand public under prescribed terms.

I now come forward a year or so to 2001 and to a member’s bill, in the name of the Hon Ken Shirley, called the Medical Practitioners (Foreign Qualified Medical Practitioners) Amendment Bill. That bill was considered by the Health Committee, and, again, part of the committee’s report was the inclusion of the notion that if we determined what a doctor can and cannot do, then we could make provision for professionals to work in a limited capacity. Again, the term “scope of practice” was bandied around. There were some genuine concerns about the inconsistent ways in which colleges were interpreting the Medical Practitioners Act. Certainly, the Health Committee’s report in 2001 was clear that the proposed Health Practitioners Competence Assurance Bill would develop the ideas of scopes of practice, and that there would be no fear regarding that because, as the report stated, it was not, as we understand it, to be prescriptive about the registration of practices.

We are now more than halfway through 2003, and the concerns raised by some of the other parties have had their day. This legislation puts in place strategies to more than meet their concerns. For instance, the Hon. Dr Smith’s inquiry recommended scopes of practice, as did Mr Shirley’s bill, and they are both included in this legislation. The inquiry asked for transparent registration processes, as did the recommendation from Mr Shirley’s member’s bill, and those are included in the bill. The inquiry asked for an independent appeals body, as did the report on Mr Shirley’s bill, and, again, that has been delivered in this legislation. We need to look at what is proposed. It does need to be kept broad, because it is determined to include whatever practices impose some risk to the health of New Zealanders.

Some people are concerned that, maybe, acupuncturists, at some time, will be included in this bill. For Pete’s sake! Acupuncturists put needles into people. I imagine that those who submit themselves to the process of acupuncture would like to know that, eventually, these people, because of the practice and the risk involved, will be included under this legislation.

The legislation is open-ended. If a group wants to come in, and it meets the requirements set down by the Minister of Health and by this legislation, it will be welcomed. There is a review clause in the legislation. Some of the groups were concerned that there would be delays after the passing of this legislation. They felt that in 3 to 5 years’ time they might find themselves still not included. The fact there is a review clause means, that, in the worst-case scenario, those groups will have the chance to be included, as they so wish, within 3 years’ time. I expect it to be sooner than that. I look forward to the rest of the Committee stage, and I will leave some of my comments until the appropriate time.

I move, That the question be now put.

I raise a point of order, Madam Chairperson. We have had just 30 minutes of debate on the title. We started at 20 to 5 and finished at 10 past 5. The debate on the title is very important. It sets the scene for the rest of the debate, and I want to register my concern that we heard only six speakers on the title. A number of National members have been seeking the call right from the start. It is not as though they just came in at the last minute. We had members who were seeking the call, and I was one of them. As we move through the next part, I would like to think that you will be fair and equitable, and give as many members as possible the opportunity to speak on this very, very important legislation. It contains 272 pages, and I think it needs much closer scrutiny. When we have speakers who are preparing to go for the call, who are bringing forward new material—

💬 Government Members: New material!

How can they say it is not new material when there have been only six speakers? My point is that it is very important that we give due consideration to the speakers who have competence in this area. We have a doctor who was seeking the call, who understands this issue, and did not get a call on the title. I am asking that you give consideration to this matter.

The CHAIRPERSON (Ann Hartley): I thank the member for his comments. As he knows, he cannot relitigate the closure. I remind him that the title debate is a debate just on the title. I remind him also that this bill has been to a select committee. That is very clear. I assure the member that the points he makes have been noted.

This is a very large, comprehensive piece of legislation, and we must remember that significant amendments have been made to it. Also, there are a large number of Supplementary Order Papers. Many health professionals out in the community are very concerned about the bill. It should not have been a political bill. It should not have had the number of people voting against it that it has tonight in the Chamber. If it had been better organised, if it had been better consulted on, that would not be the case. There are many times around the table at the Health Committee that we do not vote on party lines; we vote on what is in the best interests of the country. We work together. We have had a very good working team. But this bill has seen a large number of members in the Chamber voting against it. Why is that? The reason is that there are significant concerns.

One of the major concerns in Part 1 is about scopes of practice and the fact that they are ill-defined. Setting out to protect the public, when health practitioners are dealing with them, is a very valuable concept, and everybody wants to see that happen. But we may see public safety eroded, not improved, by this bill. We do not know what the term “scopes of practice” actually means. Are scopes of practice to be so broad that they will be meaningless? Are they to be so narrow that there will be an individual scope for every single person? In the past we determined what health practitioners could do based on the exams they passed. People passed an exam, passed a registering authority, and then were able to do a set number of things. Under this bill we have a thing called scopes of practice, but nobody is too sure what that means. Because of that, doctors do not want a bar of this bill. The Association of Salaried Medical Specialists does not want a bar of it. The New Zealand Medical Association does not want a bar of it. They understand. They have been working in here, and the scopes of practice—[Interruption]

The member opposite continually chips in. She has no concept of what this bill is about. She does not understand what scopes of practice are—nor does anybody else. It is about time she stood up and took a call to show us she has actually read something and understands something about health care in this country. It is extremely important that we protect the health and safety of the public, but this bill will not do that. It brings in too many new concepts. It tries to be too ambitious. It tries to bring too many practitioners together under one bill. The Medical Council of New Zealand now has to determine scopes. Will it do that for every individual who comes into this country from overseas? Will it have to determine his or her individual scope of practice? That is a huge task to ask of the registering board.

We also have to look at what will happen if there is a dispute. What will happen when there is a dispute about scopes of practice? The Minister will have the right to determine what happens with overlapping scopes. Scopes are to be quite narrowly defined, and the example used that was of immense concern was nurse anaesthetists. So if we have medical anaesthetists and nurse anaesthetists, how do those scopes interrelate? The Minister, in two of her speeches, has already endorsed nurse anaesthetists. She has already said it is a great concept, that it is a really good thing, and that it should happen. As the Minister has endorsed the concept, I would like her to take a call and tell us how she is going to determine the way these overlapping scopes will be differentiated and how the nurses and the doctors will be able to determine the way a nurse anaesthetist will practise in this country.

I am in a pretty unique position, because I have been both a nurse and a doctor. I can tell members that as a nurse I sometimes thought I had more knowledge than I actually did. When I trained as a doctor I realised that my diagnostic skills as a nurse were not as great, because in nursing it is often done on pattern recognition. One gets to see a lot of people who have certain conditions. But when things are not quite as they seem, then figuring out a diagnosis requires more knowledge.

I share similar views to those of the previous speaker. We are talking about Part 1, where we have the opportunity to define just what different comments mean, and I have noticed that something is missing from the bill. I am concerned by a particular part that is absent, which relates to the Treaty of Waitangi, particularly the principles of the treaty. Why is it that I need to ask this Committee and Government members why this major legislation, unlike a number of previous bills in the health field, does not include the principles of the Treaty of Waitangi? The member for Whangarei made mention of the fact that, irrespective of the culture of the patient, parents are interested only in having services delivered to their children, but where is the relevance in having people who deliver services to those of another culture, particularly Māori, not having obligations to the principles of the treaty? I suggest to the Committee that the principles of the Treaty of Waitangi should have been included in this bill.

The other point I will make relates to scopes of practice. During the debate on this bill much reference will no doubt be made to scopes of practice. They are not the same as the registration provisions of the Medical Practitioners Act—they are inferior to those provisions. “Scopes of practice” is a phrase used by the ministry rather than the health professionals, and it could be replaced by the retention of the Medical Practitioners Act. Some consideration should be given to that.

I also seek clarification of the definition of “professional peer”. In the case where regulating authorities are responsible for more than one group, it is wrong to describe a professional peer as a person who is registered with the same authority. For an optometrist, it would mean that after earning a degree in optometry, following 4 or 5 years at university, he or she would be given the same professional classification as a dispensing optician, who would have had vocational training at a technical institute for around 18 months, including distance learning. Peers must be those who practise within the same scope of practice.

While I am talking about optometrists, I point out that the Optometrists and Dispensing Opticians Act will be repealed by the enactment of this bill. That Act provided protection for the public in respect of both prescribing and optical appliances. The existing legislation defines who can be registered as an optometrist, and what an optometrist may legitimately do, and it prevents anyone other than an optometrist from practising optometry. It also effectively controls prescription optical appliances, which are classified as medical devices within the Medicines Act. As it stands, this bill provides insufficient protection for the public. It replaces only part of the old legislation—namely, that which governs what an optometrist may do. This bill does not provide any controls over the prescription of optical devices or the sale or supply of prescription optical appliances such as spectacles and contact lenses, even though there are grave risks for the public if they are supplied inappropriately.

The bill does not contain an express provision regulating the prescription of medical devices. In the case of medical practitioners, that is covered by other legislation that is not being repealed.

I will look firstly at the commencement of this bill. The commencement is staggered: some parts of bill come into force on the day on which the Act receives the royal assent, but the bulk of the bill comes into force on the day that is 1 year after the date on which it receives the Royal assent. That gives particularly the larger groups, the medical practitioners and the nurses in particular, just 1 year to sort themselves out, particularly with regard to the scopes of practice. I agree with both of the two previous speakers’ comments about scopes of practice. They are untried and untested, and New Zealand patients will be the guinea pigs. It is the larger professions, in particular, that will have a lot of decisions to make about scopes of practice. They will be very difficult to develop, and we will have only 1 year in which to sort them out.

I suspect that the Government thinks that scopes of practice will make New Zealand, and the New Zealand health scene in particular, a world leader, but nothing could be further from the truth. Lynda Scott said that public safety will be eroded, and she is quite right in that. That is my main concern, too. My fear is that rather than enhancing protection for the public, public safety will be eroded as a result of scopes of practice coming into being.

Going back briefly to the comment about New Zealand being a world leader, if we just think for a moment about what it is that holds our health system together at the moment, we will see that it is the health professionals. It is the doctors and nurses who have to hold things together at the coalface, in very difficult circumstances. This legislation will do nothing but make things worse for them. The self-regulation that health professionals have been subject to so far is the professionalism that we see in our hospitals and general practices today, and which we see our health professionals exhibiting whenever we go to visit them. The scopes of practice will make life very difficult for them.

We have much longer waiting lists than elsewhere in the world, and we have much longer waits for radiotherapy and chemotherapy, which put patients under stress. When one asks patients what exactly is good about New Zealand’s health system, the thing they say is the care that they receive from the doctors, nurses, physiotherapists, occupational therapists, and other health professionals whom they visit. Instead of accepting that that is the part of our health system that is good, and which works well and effectively, we are now going to turn the whole lot on its head and change those things for the health professionals.

If we move further on to the definitions in this part, we see that the definition that is noticeable by its absence—quite apart from the definition of the principles of the Treaty of Waitangi, which the New Zealand First member talked about—is the definition of competence, which I talked about in the debate on the title. Where is the definition of competence? It is not there. Why? Because it was too hard to define, but our health professionals will still have to be subject to competence. It will be impossible for them to try to work under that.

Let us now move on to the definition of medical practitioner. Part of my Supplementary Order Paper 111 is to omit the definition of medical practitioner throughout the bill, particularly in this part, and to substitute the following definition, “medical practitioner means a person referred to in section 139 of the Medical Practitioners Act 1995”. Members might ask why I am having that omitted; it is because doctors do not want to be part of this legislation. They can see that it is not going to work for them. They feel that their concerns have not been adequately addressed, and that this legislation will not enhance safety for the public, so they do not want to be part of this bill. Likewise, we have heard that optometrists want to be removed from the bill. They too have grave concerns about quality assurance, scopes of practice, and, in particular, the ministerial control that will result from this bill being made law.

On 22 July the Minister of Health said in the New Zealand Herald that this bill is like “doctors knowing best”, all over again. Well, we are not going to have that. We are not going to have doctors knowing best, despite the fact that they are meant to diagnose problems, and that they have had 6 years’ initial training, and then significant training afterwards. No, instead, we are now going to see the “Minister knows best”. The Minister of Health knows best and she will tell health professionals what they are supposed to do. Ultimately, she will make the decisions about how they go about their practice and how they put themselves into practice, rather than allowing self-regulation, which has worked very effectively, particularly with doctors. If other professions were given that same opportunity, it would work well with them.

The Green Party supports the Health Practitioners Competence Assurance Bill and many of the provisions within it, as we have outlined, but we do have some concerns. I will touch on some of those concerns that relate to Part 1, which sets out the key provisions in the bill.

We are concerned that the bill leaves most of the detail of the new system that we are setting up to be decided by regulation. It sets up a framework but it provides no ongoing parliamentary scrutiny over the implementation of the legislation. We were very happy that we managed to get an agreement in the Health Committee that there will be a review of the legislation in 3 years. We think that is absolutely critical, and without it we would have had very serious concerns about the bill, because this sets up an overarching framework and it leaves all sorts of incredibly important issues to be decided, as I say, by regulation by Orders in Council, which sound very good but are, in fact, a secret regulatory mechanism that does not involve any parliamentary scrutiny. Basically, a Minister has a meeting with the Governor-General and something is agreed to in that so-called meeting of the Executive Council, but it does not involve debate and scrutiny in Parliament.

One of the issues that we are concerned about and which will not be scrutinised by Parliament, is scopes of practice. Everybody has mentioned them. The scopes of practice that this bill sets up are incredibly broad. It is a new concept. I think there is one province in Canada that has something similar, but they are an untried and untested mechanism, which is why so many of the health professionals have real concerns about them. We are concerned about what happens if there are disputes over these scopes of practice—which are bound to happen—how they will be resolved, and what will happen, given that Parliament will have no involvement even if very serious disputes occur.

I give members an example of a potential problem. Say the physiotherapists decide, in their scope of practice, that they would like to do acupuncture. If my amendment is not successful and acupuncturists are not covered by this bill, we will have physiotherapists, for example, and maybe even doctors deciding to include acupuncture in their scopes of practice. How will we be certain that they will not effectively exclude acupuncturists in their scopes of practice, and what will happen if the acupuncturists have a dispute? It will be solely up to the Minister to decide.

Another mechanism is the ability of the Minister to say that certain activities are restricted. That makes sense. It means that only certain health practitioners will be able to perform a restricted activity. It would be quite logical for acupuncture to be one of those restricted activities, because acupuncture does involve poking needles into people and one only needs to think of what would happen if needles were not sterilised, if they were re-used, or if they were poked into the wrong places to realise that it would be quite a serious health issue. Of course, the logical conclusion is that acupuncturists should be covered by this bill. If they are not and it is made a restricted activity, that will mean, effectively, that only health professionals who are covered by this bill will be able to practise that activity. Once again, that could mean that acupuncturists in New Zealand are not able to practise their profession, even though many of them have spent 5 to 7 years learning their practice. So that would be grossly unfair.

That is the sort of anomaly that can very easily occur because so much of the detail of this bill—the scopes of practice, the restricted activities—are all left to be decided by regulation.

I am pleased to rise and take a call on the Health Practitioners Competence Assurance Bill. I want to comment, in the main, on clause 3, “Purpose of Act”, which sets out the principle purpose as “to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions.” There is nothing wrong with the intention, which is why National supported this bill going to the Health Committee, but there is everything wrong with this bill because, due to the way this bill is organised and structured, it does nothing of the sort. Although it is a significant piece of legislation, it deals with the health and safety of the public. No less than that is at stake.

I flag the concern that there seems to be a little bit of a proclivity on the part of the Chair to ring the bell, maybe with the intention of taking early closure calls, and I suggest that that is arrogance on the part of the Government, which does not recognise the significance of this legislation. Members should not forget—

💬 Hon Harry Duynhoven: The bell is on a timer.

Does somebody want to take a point of order? Members should not forget part of the background to this bill, which was the dreadful experience that many New Zealanders went through in this country as a result of practitioners like Dr Bottrill, Dr Graham Parry, Dr Morgan Fahey—[Interruption] The lady member on the other side of the Chamber can shout all she likes, but members should not forget that New Zealand women have been at the receiving end of incompetence in that sector, and that is why we supported this bill going to the select committee. We want to see legislation that ensures the safety of the public of New Zealand and, particularly, of New Zealand women, because it seems to me that they have been at the receiving end of incompetence in the past. This bill does not do it, and that is a great shame.

Clause 3, the purpose clause, states: “This Act seeks to attain its principal purpose by providing … (a) for a consistent accountability regime for all health professions;”. It does not do that. Instead, for that we can read a highly regulated mechanism with no transparency or proper scrutiny. That does not ensure the safety of the New Zealand public. Clause 3(2)(b) states: “the determination for each health practitioner of the scope of practice”. My colleagues and other members in the Chamber have talked about that. It is a scandal that there appears to be no expansive written documentation that shows that the Government did any real work on the concept of scopes of practice.

I am looking forward to the Minister in the chair, Annette King, rising to her feet and expanding on that concept. Scopes of practice is an untried and untested concept, and while it is a great thing for New Zealand to be leaders in the world, we would only want to be a leader if we had done the homework and the hard yards, and it does not appear that that has been done in terms of the notion “scopes of practice”. So the clause fails on its second leg, as well.

Clause 3(2)(c) refers to the fact that no health practitioner can practise outside his or her scope of practice. If we do not know what that means, how are the health practitioners to know? How are they to know whether they are practising within it, or whether they are practising outside it? What safety is that for anybody?

Clause 3(2)(d) provides for the “power to restrict specified activities to particular classes of health practitioner to protect members of the public from the risk of serious or permanent harm;”. The same comment can be made in relation to that. If the preceding criteria for achievement of the purpose are not satisfied, that one certainly will not be, either.

I just want to take a brief call because I have a concern about Part 1 and one of the Supplementary Order Papers. Part 1 refers in clause 9 to restricted activities, and while that term has been left to be defined at a later date by those who should be making that decision, not members of Parliament, Heather Roy’s proposed substantial amendment—which she has very sincerely put together—does not actually make any changes, by my observation, to clause 9. The problem that is then created is that if doctors pull outside of this legislation and stay with their own existing legislation, and then if invasive surgery, anaesthesia, and some of the things that we know are done by medical doctors become restricted activities, anybody outside the Act would not be able to perform those activities. So my concern with Heather Roy’s Supplementary Order Paper is that it could work against the very people I think she is trying to help with her amendment, in that those people could then be unable to perform surgery, unable to give anaesthetics, and unable to perform activities that we can anticipate will probably be listed under the restricted activities, because that is not amended.

I want to draw members’ attention to that because I think it could have serious consequences for medical specialists in particular.

Thank you, Madam Chairperson, for the opportunity to speak on this very important Part 1 of the Health Practitioners Competence Assurance Bill. Those who have to work under this legislation have expressed their lack of confidence in this Labour Government by withdrawing their support for this bill, because of the Government’s gross incompetence in drafting such an inappropriate bill. It is of huge significance that those practitioners—the Association of Salaried Medical Specialists, and the New Zealand Medical Association—have withdrawn their support for this bill because they have no confidence in it. After all, they are the very ones who will be required to take ultimate responsibility when the going gets tough.

I note that the purpose clause states: “The principal purpose of this Act is to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions.” How on earth can an Act protect the health and safety of members of the public? Once again, because the Minister of Health failed to listen to the professions, she has not listened to their suggestion when they said: “We do not accept that this Act on its own will protect the health and safety of members of the public.” This clause, as currently drafted, conveys absolutely that impression. The professionals said: “We suggest that the first sentence be amended to read ‘The principal purpose of this Act is to assist in protecting the health and safety of members of the public.’ ”

The Minister of Health is so far removed from reality that she thinks an Act alone will achieve its purpose. Let us read on a little bit further for some of the purposes of this bill. I note that one of the basic principles of New Zealand professional tradition has been left out of this bill, and that is the concept of professional self-regulation. It has been totally left out of this bill. It is so hugely important and so hugely respected amongst the professions of New Zealand, yet this Labour Government leaves it out of the bill. I intend to move an amendment to subclause (2) of the purpose clause. My amendment would add to the subclause: “(f) the recognition of professional self-regulation as the basis of health practice in New Zealand.” This is highly important, this is highly constructive, and I hope that the Minister and the Government will take note of it.

I did notice that the ACT member Heather Roy pointed out that there is no definition of “competence” in this bill, and she is absolutely correct, because after all, “competence” is supposed to be related to the quality or extent of being “competent”. We have a bill whereby the two major medical organisations have withdrawn their confidence in the Government, clearly expressing that the Government is totally incompetent. I note that in the dictionary definition of “competence”, the “Linguistics” part of the entry states: “A person’s subconscious knowledge of the rules governing the formation of speech in their first language.” Now, I can often, often contrast it with performance. We have had a fair amount of subconscious dealing from Labour Government members, because this bill absolutely encompasses their subconscious Pavlovian reflex to institute as much possible complexity as they can imagine. This bill is supposed to be modelled on the Medical Practitioners Act, which, in a reasonably efficient way, in about 110 pages, has served the New Zealand public reasonably successfully. Here we have a monolith; something like 272 pages that the Labour Government of New Zealand has managed to—

I move, That the question be now put.

We have several concerns about this bill, and in particular I would like to take up the cudgels again on behalf of the health professionals who would like to be called “health professionals”, rather than simply “health practitioners”. That is because this bill, in its definitions, does not actually say what professional competence is. Why should those people, who have been professionals all their lives and wish to be treated as such, now have their activities restricted and defined by the Minister of Health? Health practitioners such as occupational therapists might wish to be covered by this bill, but those professionals who have had a long history of being part of a profession and of defining their own scopes of practice as such, of actually knowing who should be practising in what areas, and what areas should be practised in by their particular professions, want to be treated as professionals and to be accepted as professionals. They do not want to become simply puppets of a Minister of Health who can decide, for instance, that perhaps obstetricians should not now be delivering babies, if it does not suit her scheme of things.

That is the sort of nonsense that this bill would allow. That must not be the case, because at the end of the day, the people who are the best qualified to say what their particular professions are qualified to do are the professionals themselves, not the Minister of Health, who might or might not decide to actually go away and take notice of the consultation process that has been put in place.

One thing we know, after years of being consulted on things, is that members of the public know that the consultation process referred to in this particular part of the bill means nothing. We all know that when this particular Government goes out to consult, it goes out to consult with an agenda, and that agenda has nothing to do with really finding out what people think. It goes out to say: “This is what we are going to do. If you’ve got an objection, now is your chance. We won’t take any notice of you, but that’s too bad—we’ve said we’ve consulted.” That is what this Government does, and this bill is simply another example of it.

It is appalling that the main health professional regulators have come out and said they no longer support this bill. The reason is that they do not want to be controlled by this Minister of Health. These people, who have spent years and years of their lives training, and years and years working as professionals for the betterment of the community for their patients, are being told that they will not decide what they are competent in. No, their professional bodies will no longer be qualified to do that. This Minister of Health, with her massive qualifications in the area, will tell them what they can do. That is appalling.

I would like now to look at the area of punishments for people who work outside their scopes of practice. I am concerned about situations in which some people feel they need to help others in a medical way, but it is not in their areas of practice. There is a clause in the bill that says: “Well, we won’t prosecute you if it’s an emergency.” But what about the situation when the medical person happens to be someone out in the backblocks somewhere, in rural New Zealand—which I know is something this Government knows nothing about—and somebody needs some medical attention. It might not be considered an emergency, but for the person concerned it might become an emergency if he or she is not treated. [Interruption] In respect of that member over there, Jill Pettis, I recall that she used to be a nurse at one stage in her life, so why is she not taking a call? Is it because she, too, like the Māori caucus, has been silenced by this Government? Is she, too, being told to be quiet? Well, we can all understand that, can we not, because who would want to see the paint being stripped off the walls by that particular member?

That is what happens. This Government does not want to hear from the people. It does not even want to hear from its own people, and it certainly does not want to hear from the health professionals.

I move, That the question be now put.

I raise a point of order, Madam Chairperson. This bill is very comprehensive legislation, and in my speech today I managed to talk on only one clause, clause 8. Now, we did not even get on to the issue of restricted activities—

The CHAIRPERSON (Ann Hartley): I am sorry, but that is not a point of order.

I would like to address the concerns that United Future member Judy Turner had about my Supplementary Order Paper. I put forward an amendment to omit the definition of medical practitioner in clause 5, and her concerns were that if the category of medical practitioners was pulled from this bill, then the “restricted activities” provision might preclude them from doing the activities they have in their day-to-day business. That of course is not the case. The legislation has been drawn up very carefully to show that the practitioners want to remain where they are in terms of the Medical Practitioners Act, and the restricted activities are determined by the Minister, anyway. They are not set down at the moment. They will be determined by the Minister, in line with the fact that the Minister will have huge ministerial control over the professions if this legislation is passed. So a simple exclusion would deal with that problem concerning the restricted activities list, and that is not a worry at all. The Supplementary Order Paper is very simple, despite the fact that it is quite lengthy. It has to be lengthy to deal with every single time the term “medical practitioner” is mentioned in the bill.

However, I want to go on to say that this legislation really flouts professionalism. All the medical professions support a clear regulatory construct for themselves, and that was very evident when we heard from each of the professional groups who came along to the select committee, and from the individuals who spoke at the hearings during the submission process. They all support a clear regulatory construct for the professions. “This framework”—and I cannot say it any better than the New Zealand Medical Association—“must however be flexible scaffolding that supports the professions and provides the needed structure, but not an iron cage that rigidifies and stultifies professional functioning.” That is very pertinent, I think. We want something that is flexible and that will allow the professions to go about their business so that they can provide the safety and protection that the public call for, but not something that binds them and stymies the way in which they can practise and provide the professionalism they do at the moment.

Regulation on its own is never going to improve the safety of professional practice. It cannot; it is impossible. The professions are there. They have their own codes of practices and codes of ethics, and they work within those to provide protection and safety for the public. But regulation will do nothing for that. Regulation will not provide professionalism. The two are very different. What is required is an environment—and I talked about this previously—in which professionalism can flourish. This bill will not provide that. It seeks to provide competence by regulation. The environment in which professionals can flourish is one where health workers themselves are encouraged to learn and develop, and one where they can discuss things freely amongst themselves. In particular, I am referring to the quality assurance provisions that we will discuss in another part. If they are to provide that safe environment for patients, they need to develop professionalism.

The Medical Practitioners Act has provided that environment for medical practitioners since 1995 when it came into being. This legislation was supported by all bodies, initially, because they thought the environment that had been created by the Medical Practitioners Act was going to be subject to the legislation too. They felt that that would encourage their own professionalism and encourage their learning and development, but in fact that will not be the case. It can be achieved only by the support of internal professional processes, and not by increasing external regulation and control, which will have the opposite effect and which will see an erosion of the high professional standards that hold our health system together today.

I want to take a brief call, given that I have a Supplementary Order Paper seeking an amendment to clause 8. The effect of clause 8 is to limit, quite precisely, what each registered practitioner can do. That is in stark contrast to clause 9, which imposes penalties for the loose and undefined condition of holding out by unregistered people. Clause 8 is much tighter, and allows for precise definitions of the tasks of registered health practitioners, who are probably a lower risk to the public because they have already qualified as health providers. Clause 9 merely prevents people from calling themselves by a particular title or holding themselves out to be registered health practitioners, and does not specifically constrain the tasks they may do. There needs to be a mechanism to stop, definitively, an unregistered person from doing anything that lies within the scope of any registered health practitioner. Only health practitioners should be able to do things within those scopes, and each will, by clause 8, be limited to doing things that are safe and that they are trained to do. Clause 8 needs to be amended to exclude unregistered people from the scopes of registered health practitioners.

Sitting suspended from 6 p.m. to 7.30 p.m.

It is understood that it will be the responsibility of each regulating authority to take action when a practitioner registered with that authority acts outside his or her scope of practice. This means that if a physiotherapist, for example, engages in actions that form part of medicine but are not part of physiotherapy, then the Physiotherapy Board would be responsible for investigating the breach, not the Medical Council. The function of the regulating authorities is to keep registered practitioners inside the set scope, and not to keep others out of it. By contrast, the Ministry of Health will administer clause 9. The ministry will, firstly, use discretion in determining whether an action constitutes holding out, and, secondly, decide whether to take action, depending on whether there is any risk of harm, and depending on priorities for action and the resources available to investigate and implement action.

Thus it seems that the bill is setting up two levels of compliance. Registered persons will be tightly controlled within a particular scope, regardless of any consideration of harm to the public. Unregistered people will be subject to inherently lax controls, capable of interpretation and avoidance, depending on the ministry’s freedom of choice regarding harm, priorities, and resources at any particular time. Clause 8, as it stands, provides less protection to the public than it could, or should.

I, along with various colleagues, and in particular Dr Lynda Scott and young Heather Roy, also challenge the Minister of Health and ask her why competence is not in—[Interruption] David Benson-Pope might wear a bright green shirt into this Chamber; I tell the Committee that that is the brightest thing about David Benson-Pope. If he could stand and take a call, we would all be the better for it. It would get it out of his system. I ask the Minister whether she will stand and explain to the Committee why competence is not one of the definitions listed in this part. Heather Roy raised this point first and she should take all the credit, but she raised it well over 2 hours ago. Since then the Minister has had a good feed and a rest. I want to see her rise from the chair—I am happy if someone helps her—to take a call and say why competence is not listed as one of the definitions in the bill. I challenge the Minister, and lay that matter to rest. I am sure she will meet my challenge.

I would like to focus now on clause 8, “Health practitioners must not practise outside scope of practice”. This is of concern to members on this side of the Chamber. It is quite a worry for us. I will inform members on the other side, who also take an interest in this bill. This bill introduces the untried and undefined concept of scopes of practice. No one really knows what it means, least of all the ministry. Goodness knows, it has tried. But the ministry does not know what “scope of practice” means. It has done very little work on it. But on reading the bill, and I wish the Minister and members on the other side of the Chamber would also read it, clause 8 comes into effect only 1 year after these debates conclude and this bill receives the royal assent. Very little work has been done by the ministry on what the Minister terms “scope of practice”.

We understand that that is there to govern what medical practitioners can and cannot do, as if the bureaucrats know better than the profession. Scopes of practice will govern what medical practitioners can and cannot do. As I alluded to, the Ministry of Health has done very little work on scopes of practice. Examples of what they might look like are unavailable to members of Parliament—not only to members of Parliament on this side of the Chamber, who work so hard, but also to Government members of Parliament, who are supposed to be inside the tent. The details are unavailable, and that is of concern to us.

I would be interested to hear from the Minister of Health, and to ask her whether she can tell us whether she believes that scopes of practice will be confirmed 1 year after the day that this bill receives the royal assent. I would appreciate it if she would answer that question for me.

I also would like to focus members’ attention on clause 9, which I believe also comes in 1 year after this bill receives the royal assent. This clause is about certain activities that are restricted to particular health practitioners. We are concerned that by Order in Council, following a recommendation from this Minister, or any Minister of Health following her, this bill will allow the Minister to have control over the membership of the Health Practitioners Disciplinary Tribunal. This could erode public confidence in the process. That is one area where the Minister has control, but not only that, she also has control over clause 9. She can restrict activities by Order in Council. Clause 9 states: “The Governor-General may from time to time, by Order in Council made on the recommendation of the Minister,—(a) declare an activity that constitutes or forms part of a health service to be a restricted activity;’’.

She can control, by Order in Council, what a health service can and cannot do. She can also control, through other means, who sits on the Health Practitioners Disciplinary Tribunal. Those are just two areas where the Minister has control over the health system, under this bill.

I move, That the question be now put.

It is with pleasure that I take another call on Part 1, which has nine clauses and deals with some very important issues. I want to talk about something that Judy Turner brought up—that is, the petition concerning Dr Monty Hornbeck. We are talking about scopes of practice, and how they were debated in that petition. Dr Monty Hornbeck is an American dermatologist who had great difficulty getting registration in New Zealand, and the reasons for that were multiple. One of the major problems is that the college will recognise the qualifications of people who become specialists, but it will not recognise their undergraduate qualifications.

💬 Hon Lianne Dalziel: It’s existing law.

Yes, that is exactly right. Perhaps the member would like to take a bit of time to listen and we will get to the point. The statement was made that this bill will improve the whole situation. But the problem is that—

💬 Hon Lianne Dalziel: Who was the Minister who paid for immigrant doctors to get the training they need?

The member over there continually chips away. She does not understand what she is talking about. She knows nothing about health and does not bother to listen. We have to listen to her innocuous laughter all the time, but that is the way she is.

The definition of scopes of practice came up when talking about the petition concerning Dr Monty Hornbeck. I have a friend who is a geriatrician and it was the same for him—his undergraduate qualification was not recognised. This bill is going to correct scopes of practice so that a doctor practises in a very narrow scope, and that is exactly what the medical profession is concerned about—that each individual doctor will have to have an individual scope of practice in which he or she can practise. Imagine the bureaucracy! Imagine identifying every area in which each individual can work, as opposed to other areas.

If we were looking at some professional groups in terms of codes of practice, there may be one broad scope. If we look at this side of the Chamber we see Dr Paul Hutchison, who is an obstetrician and gynaecologist, and myself, who is a geriatrician. The medical profession is very diverse in its specialties. That has always occurred through qualification and development of one’s professional standards and qualification.

The medical profession is extremely concerned about scopes of practice. I will read from what Ian Powell, who is not much of a pal of the Ministers any more, has to say: “Senior doctors are very disappointed that the Government has proceeded with the controversial Health Practitioners Competence Assurance Bill …”. That was said after the bill had had its second reading. “Associate Health Minister Ruth Dyson incorrectly claimed that the Bill was based on the successful Medical Practitioners Act. This is untrue and she has been badly advised. In some key features, especially the untested scopes of practice, the Bill is seriously inferior and risks compromising the health and safety of the public.” That person used to be a very good friend of the Minister, but that is what he is saying.

This bill should have been consulted on much more widely and should have been developed far more, before this happened. We have a bill that nobody will be happy with. The invisible Minister of Health in the chair never takes a call or gets to her feet. Every time anybody rings her up for a comment the Minister is “not available for comment”. The Minister of Health has not overseen this legislation well. Her very best of friends are now saying that it is an incompetent piece of legislation and that the Minister is incompetent to have allowed it to come back into the House, without trying to improve it. This bill should not have been a political bill. It should have been improved upon, and it could have been. Had there been more consultation—consultation meaning that people were listened to and that their concerns were listened to—we would not be in the situation tonight where we have the doctors wanting to be totally out of this bill. They do not want a bar of it.

It will be up to the National Government in 2 years’ time, when we are in power, to sort out the mess when we do the 3-year review. There will be a 3-year review, and there will be an absolute mess to clean up.

I move, That the question be now put.

I want to make one or two comments and ask the Minister some questions about what may happen—

💬 David Benson-Pope: Oh!

The senior Government whip may want to listen, because he may pick up one or two things from some of the questions that I will ask.

First of all, I must say that after listening to this debate so far I am extremely disappointed that the Minister has not taken the opportunity at the start of each part of the debate to make some comments. It is unfortunate that she has not taken a call, because members of the public have a right to know what is in the Minister’s mind. Unfortunately, she sits there silently without responding, and she is reading something. It is probably a Noddy book, a book from Mills and Boon, or something of that nature—who would know? The Minister is not prepared to stand up and defend her own legislation. Firstly, that leaves the public wondering whether she as a Minister has her hands on the steering wheel, and, secondly, it raises questions as to whether the Minister actually understands what is in the legislation. She needs to be able to assure the public that she does have an understanding of it.

I sat through an inquiry, along with Steve Chadwick and other members of the Health Committee, into issues around Colleen Poutsma, in particular, and others who were affected by the circumstances that occurred in that case. One of the things that we found was that the Medical Council, as it is—I now understand that it is to be known as the health practitioners discipline tribunal—

💬 Hon Lianne Dalziel: No.

The Minister could take a call—

💬 Hon Annette King: The member should try reading the bill.

I thank the Minister. At least we have heard an utterance from her, at last. I am interested to know whether that inquiry and the findings of the select committee—which was a combined effort of people who were working to try to solve problems—have solved the problem that one of the constituents whom I represent has. I want to know whether her concerns and issues have been addressed.

The constituent I refer to went to the medical tribunal to ask for support. It said that there was no problem or issue, and found that her case had no substance. She subsequently went to the Accident Compensation Corporation and made a claim. After inquiries and investigation the corporation found that, indeed, there had been medical misadventure. The medical tribunal initially said that there had been none. One of the reasons for the tribunal’s finding was that the Accident Compensation Corporation itself had initially said that there was no medical misadventure. We went back to the Accident Compensation Corporation, and it has since found that medical misadventure did occur.

💬 Hon Lianne Dalziel: But what for?

The Minister should just listen, and I will explain that. The sad thing is that the Minister of Health is not listening. One Minister is listening, but she is not the Minister whom I would like to listen.

We then went back to the medical tribunal, given that the Accident Compensation Corporation had found there was medical misadventure, to ask it whether it would go back and reopen the case, but it cannot.

💬 Hon Lianne Dalziel: But what for—medical misadventure?

I do not profess to be an expert. I am raising the issue, and I hope the Minister may take a call to explain whether this legislation will help my constituent. If the Minister needs more details, then I can get more details on the case. I understand that the law as it stands—or as it stood; I do not know whether this bill will fix it—means that the tribunal cannot go back and review its finding with regard to my constituent. I would like to know whether this legislation will change that. Where the circumstances of a case change, where things alter and the Accident Compensation Corporation subsequently finds there was medical misadventure, I want to know whether there is an opportunity for a constituent to take a case back to the tribunal to be reviewed. That is one of the things that we found from the inquiry was needed. One of the recommendations we made was that the medical tribunal, the Medical Council, or whatever it may be called, should be able to go back and revisit those cases.

I see in the bill reference to the Health Practitioners Disciplinary Tribunal, but obviously that is not the right clause. Can the Minister tell us whether those circumstances will change, so that my constituent will have an opportunity to have her case reheard? Sadly, the Minister sits there looking everywhere else but at me. She has not even taken a call.

💬 Hon Annette King: I was in Australia, and the member knows it.

That may be so. Whether or not the Minister was here then, she is certainly here now, and it would be useful if she took the opportunity to seek the call and make the case.

I move, That the question be now put.