Health Practitioners Competence Assurance Bill

It has been very interesting to listen to the debate so far on the short title and Part 1, to listen to the Opposition’s speeches, and to realise that although its members sat on a select committee and heard evidence, and although they are supposed to have an understanding of the bill, there is one large, collective amount of ignorance being spoken on the bill in this House today.

I would like to start with some of the issues that have been raised. This bill is for the safety of the public of New Zealand. Is it not interesting that throughout the debate we have heard so far, what has been spoken has been about the health professionals? Certainly they are important, but this bill is not only about health professionals, it is also about the safety of the public. We have had these statutes for many years in New Zealand, and they were put in place for the safety of the public of New Zealand. That is why every profession is not registered under such statutes. Not every profession causes harm to the public in the way that the professions we register do, so their statutes were put in place for the safety of the public. It would be very nice to hear some debate about the public, rather than it always being about the health professions. I would like to put that on record. This is about the public’s safety. It is how we ensure that our health professionals are competent to provide the health services that people need, that they are registered properly, that they are properly monitored, and that the public is safe.

One of the issues that has come up over and over tonight is scopes of practice, and this particular part mentions scopes of practice. It is very interesting that members of the Opposition do not know what scopes of practice are, but the Medical Council, whose job it is to handle scopes of practice, has said that it is very aware of what they are. I thought that Judy Turner made an extremely good contribution when she set out what came out of Nick Smith’s petition and Ken Shirley’s bill. Back in 1999 they were talking about scopes of practice. If we ask the Medical Council whether it knows what scopes of practice are, not only does it know what they are, it has gone through most of the specialities and asked what areas need new scopes of practice developed, changed, more work done, or already done.

So let us run down the scopes of practice that already exist. Breast medicine, for example, does not need any change to its scope of practice; it is already defined. Accident medicine does not need change; it is already defined. If one goes through the whole list, one sees that the Medical Council knows exactly what a scope of practice is, and so do most other people. But Opposition members have chosen to make it sound like something foreign, something new, and something scary. That is a totally erroneous portrayal of what scopes of practice are.

I know that the opposition to this bill, particularly from ACT and National, has nothing to do with the quality of this bill. It is about political opposition for the sake of political opposition; there is no other reason. I know, for example, that Ken Shirley’s bill, which came before this House, wanted to put in place far more draconian things than this bill does. That bill wanted to ensure that doctors were registered under the New Zealand Qualifications Authority. That was not done, but Mr Shirley had the very good idea that we ought to ensure that medical practitioners can practise within their ability. They were the overseas doctors, and that is why Mr Shirley brought that bill to this House in the first place. The back-off from that bill, and ACT’s opposition to this one, is very interesting indeed.

I want to mention a couple of other things. For example, much has been made tonight about the New Zealand Association of Optometrists pulling support for this bill. I assure members that the chair of that association, Andrew Sangster, has told me that that is not correct. The association was worried about parts of the bill and raised those issues, but it did not pull support from this bill. It supports it.

There are other issues that I think are worth mentioning, as well. One of the things that Lynda Scott talked about was that in the old days the way to decide whether a person was capable of practising was for him or her to sit an exam. Well, I have always remembered something that a health professional told me. He said that a qualification received 20 years ago was a qualification received 20 years ago—it does not make one competent to practise. The whole basis of this bill is to ensure that health professionals are competent to practise. It is based on the Medical Practitioners Act, and I do not think that members opposite know that the basis of that Act is the competence to practise.

The issue of who decides that was raised. The health professionals’ own registration bodies decide whether they are competent to practise—not the Government, not the Minister, but their own bodies. The Opposition has tried today to say that it is the Minister who decides whether health professionals are competent, but their own registration bodies—their own councils—decide whether they are competent. Georgina te Heuheu, for example, raised the issue of whether there is protection for women mistreated by some of our health professionals. This bill ensures that the bodies that decide whether health professionals are competent to practise, ensure that they are competent to practise—not because they received a qualification 20 years ago. They are assessed and checked to ensure that they are allowed to perform whatever they are registered to perform on patients.

Rather than peddle misinformation, it is really important that members opposite tell the truth about this bill. It is based on the Medical Practitioners Act. Who said that? It was not the Minister, but the Medical Council, which has to work with the Medical Practitioners Act. It was not members of the Opposition, but the council that works with it every day, that said that this bill was overwhelmingly the same as the Medical Practitioners Act. This bill has been widely welcomed by many health professionals. Nurses, for example, have been waiting since 1988 for their Act to be updated. A whole decade went by, and nothing was done for their statute.

What I think is really important about this legislation is that so many health professionals bought into the concept of one bill to cover all health professionals. Why would one not do that? After all, doctors are not better than nurses. Nurses are not better than optometrists. Optometrists are not better than podiatrists. Podiatrists are not better than physiotherapists. It is all about health professionals who provide a service to the public. Why should there not be a common bill that covers them all? Some members here tonight would like to make the bill elitist. It is not elitist; it is a bill to ensure the safety of the public of New Zealand—a comprehensive bill that includes most of the elements of the Medical Practitioners Act.

The bill also addresses some of John Carter’s concerns—he just happened to be looking at the wrong part of the bill. If he looks at Part 8, “Amendments to Health and Disability Commissioner Act 1994”, he will see that the things he was interested in are addressed. Many of the issues raised by the public have been addressed in this bill.

I would like to thank the Ministry of Health for 3 years of hard work. It has done a superb job not only of getting the bill together, but working with so many health professional groups—

💬 Dr Paul Hutchison: Tolerating you!

Yes, tolerating me, and fortunately not having to tolerate Paul Hutchison. The ministry wakes up every day and thanks God that it does not have to tolerate him.

I would like to say to the members of the Committee who have made a constructive contribution to this bill that they will be proud of it in future. It is visionary bill, and will lead the way for occupational statutes for years to come.

I am so pleased that the Minister finally got to her feet and took a call. What a load of rhetoric that was! I have never heard anything like it. I tell the Minister that the devil is in the detail, and the devil will come back to bite her on this one. The detail is where the Minister will be tripped up. This bill is too big. The Minister has tried to put too much into it. When the Minister talks about nurses saying that no one is better than anybody else, I think she demonstrates that she has a chip on her shoulder. I think she demonstrates a Freudian slip when she keeps saying that no one is better than anybody else. I think she has an underlying concern about doctors. She thinks that they are better, so one has to bring them down to all being one and the same.

As a medical professional, I can tell the Committee that nobody quite knows what it is like to be a doctor and to carry the final burden—and one does. The doctor carries the final burden of life and death. I do not think that anyone else in this Committee, apart from Paul Hutchison, actually knows what that is like. It is actually the doctors who make the final decisions. I have been a nurse and a doctor, and I know how much more of a burden one carries as a doctor. The extra training that a doctor does is all about the ability to diagnose. So when the doctors say that they do not want a bar of this bill, and that they were very happy with the Medical Practitioners Act, I think the public—and the Minister was talking about the public—will take some notice of what the doctors say. Doctors are the ones on the front line. They are the ones who take the rap. They are the ones whose professional competence has to be assured.

I agree that the aim of the bill is very worthy. Of course we should be trying to protect the public. Of course we should be making sure that every health practitioner who engages in any sort of practice that could harm an individual should definitely be keeping his or her competence up to speed. Yes, if a health professional was registered 20 years ago, his or her credentials should be kept updated. The Medical Practitioners Act corrected a lot of the problems of the 30 years before. It was working really well. Other health practitioners thought that this bill was based on that Act. However, they have found that the Minister has massive powers under the bill, and there is concern about new concepts in Part 2, and about scopes of practice and how they will work. The public does have some concerns.

The Medical Council says that it knows what scopes are. If nothing is to change from the Medical Practitioners Act, how would that help Monty Hornbeck? It would not. It could help him only if the Government were to say that there would be very individualised scopes of practice for individual doctors, as opposed to broad scopes. That is the only way it could help, so I would like the Minister to explain that. Ken Shirley’s bill was thrown out. They did not like it. Labour voted it down. Now the Government says that there were a whole lot of good things in it. Some things in that bill were trying to break down the patch protection that happens. We know that that happens. Medical specialists have said that medical patch protection does occur. However, that can be changed by the way doctors are registered through a committee. In Britain the Calman Committee is used for that. It has a committee of people that decides.

💬 Hon Lianne Dalziel: Nine long years.

The member has been in for 4 long years and health care is an absolute mess. This Government has a bill that is an absolute mess. It will not protect the public. The Medical Practitioners Act was legislation that did not have political spin around it. Everybody agreed with it. It did an extremely good job to register doctors and have credentialing. That member who is continually screaming across the Chamber should go back to her knitting and reading, because that is all she is good for.

On behalf of New Zealand First I am pleased to speak to Part 2 of the Health Practitioners Competence Assurance Bill. No doubt this very important debate will affect health practitioners in the medical profession and the public for the next 15 to 20 years. In particular, I want to focus on clause 15, “Fitness for registration”. This clause is a lawyer’s dream! New Zealand First will not be supporting it.

All members of the House would agree that our health professionals have to be of the highest calibre. We want New Zealanders to have the best possible health treatment available. However, clause 15 will present some large challenges for the employing authorities of the many people who are covered by this legislation. New Zealand First believes that further definitive work is required on that clause. It makes really broad sweeping statements that will be difficult to implement and define, and therefore difficult to enforce.

Clause 15(a) states that applicants for registration must be able to “communicate effectively for the purposes of practising”. But nowhere in this hefty document are there guidelines as to what “communicate effectively” means. That term is really subjective, and everyone can interpret it differently. Those guidelines are totally lacking from this document. I realise that members opposite will have a totally different idea about communicating effectively. It will be quite different from the view of people on this side of the Chamber.

Clause 15(a) will also require a really big decision to be made by the responsible employing authority, and, of course, by the doctor, nurse, or other health practitioners in different areas. The big challenge will arise when an applicant disagrees with a ruling. How can that person appeal a ruling? Where are the definitions in this bill? They are totally lacking.

Clause 15(b) states that prior to registration the applicant must satisfy the employing authority of his or her ability to communicate and to comprehend English. What does that tell us? We know that at present some of our health professionals do not meet that standard, at all. That is something we hear quite constantly from the public of New Zealand. They just want to take their children to medical centres to get them well, or to get well themselves. Does that clause tell us that New Zealanders can expect to see a whole heap more health professionals for whom English is a second language? We do not object to that, if those people are competent, because we do want our health care. But we must ask what has happened to our New Zealand doctors for whom English is a first language. They must still be going overseas.

Clause 15(e) is also fraught with big challenges. We can really admire the sentiment behind the phrases used in that clause, as there is no doubt that the health and safety of New Zealanders are being looked after. I do not think that anyone coming to this country would tell any employing authority that he or she is the subject of disciplinary hearings or proceedings. Nobody who is desperate for a job ever tells an employer of any shortcomings.

💬 Judith Collins: Mr Zaoui would.

I doubt it. He did not say anything. We know where he is. We also know that a fair share of New Zealanders have left our shores and are practising overseas—after a disciplinary proceeding. It has often taken a long, long time before some of them have been caught. In a recent case a doctor went from New Zealand to Australia to practise plastic surgery, because he was not allowed to practise in New Zealand. No doubt there are health professionals practising in New Zealand who should not be practising.

We all know that references can be easily fudged. How on earth will the authorities check up on some of those references? If one writes one’s own reference, of course it will be glowing. So the various authorities will really have to check out that aspect thoroughly. How will they monitor the provisions of clause 15? In theory it all sounds really good, but in reality the lack of clarity and definition will be the total downfall of that clause. I know that Mr Benson-Pope will find that difficult to believe.

I thank the chair for the opportunity to speak on Part 2 of this very important Health Practitioners Competence Assurance Bill. A few minutes ago we were treated to an unmitigated conglomeration of verbosity from the Minister of Health signifying absolutely nothing. She tried to remind this Committee about the purpose of the legislation, and that is to protect the public, and for once I can agree with her on something. However, I cannot agree with her explanation of why those who are responsible for the ultimate health of the public—the professionals at the foot of the cliff—have expressed an absolute lack of confidence in her bill.

It is remarkable when we see the media statement made by Ian Powell, with the headline: “Senior doctors very disappointed with Government action over flawed health bill”. The Minister must take a call to address seriously what Ian Powell is saying. He says: “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 statement comes from Ian Powell, on scopes of practice. That issue is absolutely integral to Part 2—in fact, integral to the whole bill. [Interruption] Those comments, in reply to the Minister, are from someone whom she has tried to work with but who, at the end of the day, has rejected her process. There is no doubt that the medical profession would have loved to see this bill come in with support right across the board. It is, indeed, an omnibus bill. We on the National side were very keen to see the problem solved.

This is what the New Zealand Medical Association said about scopes of practice: “Scopes of practice already exist within the profession of medicine and other professions, but they have never before been required by legislation to be codified as this Bill does. The introduction of codified scopes of practice is likely to have significant, long-term implications, but neither the intentions behind the introduction of scopes of practice nor their potential outcomes have been properly debated. Indeed, an Official Information request of the Ministry of Health in respect of discussion papers on the issue of scopes of practice revealed that no serious internal discussion or debate has taken place.” It is an indictment on the Labour Government and on the Minister that she has failed to consult properly on the absolutely vital area of scopes of practice.

I go on to the nurses’ submission, which states: “Specific recommendations were made on the basis of … principles and previous policy. An issue that is fundamental to NZNO”—the New Zealand Nurses Organisation, which has 32,000 members—“is the need for increased consultation on specific clauses of this Bill. It is our contention the Bill in its present form will not develop the culture that is required to prevent the incidence of errors, or that it is fair for health professionals and health workers.” The first of its major recommendations is: “The inclusion of consultation with professional bodies before scopes of practice are introduced into legislation”. The Minister might say she has achieved a victory by bringing the nurses on board, but what are they interested in? They are interested in increasing their scopes of practice, and they are particularly looking at the area of nurse anaesthetist practitioners. General practice anaesthetists, who were well qualified, were phased out only 4 to 5 years ago, because of the increasing standards required by the Royal Australian and New Zealand College of Anaesthetists.

I would like to start by responding to some issues that the Minister of Health raised. She said we should all be focusing on putting in place a system for public safety, and on ensuring that we have a system that New Zealand consumers can trust. I think we all agree that consumers in this country are disillusioned with the health system and the complaints system, as a result of the endless stream of inquiries—the Gisborne cervical cancer inquiry, the Parry inquiry, and so on. So we have a great deal of work to do to restore consumer confidence in our health system and in the complaints procedures surrounding the health professions. There are some very serious problems that we have heard about—in particular, in the Parry inquiry. We hope that some of the issues covered in this bill will go a long way to address those issues and enhance consumer confidence in our health system.

But I cannot resist responding to that the Minister’s point that the whole legislation should be based on public safety. Well, if that is the case, if this legislation is consumer based, if its objective is to protect the public from harm, then acupuncturists should be included in it. The Minister said that public safety is the sole thing we should be looking at. I have already pointed out that acupuncture involves poking needles into people, and if those needles are not sterilised, or if they are poked into the wrong place, there is a serious risk of harm to the public. So why are acupuncturists not included in this bill?

The Minister said that nurses have been waiting since 1988 for their statute. Well, acupuncturists have been waiting for two decades for their statute. They have been traipsing up to this Parliament, and requesting that they be covered by statute, for decades. They have written, requesting legislation, so why are they not included in this bill? One of the major reasons they want to be covered by statute is their concern about what could happen to New Zealanders, and to the reputation of their profession, if irresponsible acupuncturists who are not competent set themselves up in practice and poke needles into people. It would be a disaster. The acupuncturists recognise that risk, and that is why they have put such passionate submissions to us, to be included in this bill.

So why are osteopaths included but acupuncturists are not? It is simply for one reason, and one reason alone: Labour made a political commitment, for reasons best known to itself, to osteopaths in the 1999 election, but it did not make such a commitment to acupuncturists. Let us at least have a level playing field. I am quite happy that Labour made that political commitment, that promise, to include osteopaths, and that they are included in this bill, but if they have a case to be included, acupuncturists have an even stronger case. It is extraordinary that the Government is refusing, for no good reasons that have been advanced, to include acupuncturists. Acupuncturists are doing their bit, they are undergoing consultation, they are doing all the things that are, supposedly, required of a group if it is to come under this bill, yet the door is firmly shut on them, whereas osteopaths are included. If this legislation was, as the Minister said, genuine, consumer-based legislation whose overriding objective was public safety, then acupuncturists would be included, and we would not have this seemingly political decision not to include them but to include only osteopaths.

This part deals with scopes of practice. The other problem is that the omission of acupuncturists could cause very serious anomalies in the future, because if acupuncture is made a restricted activity—as it ought to be, if we are concerned about public safety—then only medical and physio acupuncturists will be able to practise.

It was hard work getting the Minister of Health to her feet, but eventually she did get there and she made some quite interesting points. What she called for was some truth, some facts, in the Opposition debate. In fact, that is what we have been dealing with all along. I suggest that she tries listening to us and listening to the professions. They would like to have been consulted a lot more than they were. They felt they were not listened to enough. The Health Practitioners Competence Assurance Bill incorporates a significant shift in the approach to registration of health practitioners that has not been debated, and that did not originate out of a process of engagement between the Ministry of Health and the professions.

The Minister also mentioned the word “competent”. I lost count of how many times she used that word, and it was telling how many times she did use it. I ask the Minister to stand and define the word “competent”. We have the word “Competence” in the title. She said “competent” dozens of times, but did she tell us what she meant? No. What exactly are people to measure themselves against? We have been told time and time again by officials that the words “competence” or “competent” are too hard to define. What exactly are the health professionals meant to measure themselves against? How are health professionals supposed to be disciplined, when we cannot even determine the level of competence that they are supposed to achieve?

If the Minister were really concerned about the safety of the public, she would have spent more time listening to the concerns of the professional bodies. After all, we do have patients, and we want public safety. The National Party speakers have said at length that patient safety is paramount, and I have said the same thing in some of my previous speeches. We want protection for the safety of the public. But who provides care? Who actually provides a safe environment for patients? It is the health professionals. In order to operate effectively, they need to have an environment in which it is safe for them to work, so that they can provide the best possible treatment for their patients. But this Government has a very anti-professional attitude, which is becoming more and more apparent as this debate goes on. It is an anti-professional attitude from an authoritarian, bossy, “we know best” Government. We are seeing proof of that in this legislation.

We have heard about scopes of practice already, but it is worth mentioning them again. The scope of practice concept is a new and untested concept that has been described as cutting edge; apparently, we are going to be world leaders in scopes of practice. The only place in the world where scopes of practice have been previously trialled is British Columbia. The Health Committee spent a bit of time looking at where this concept has been tried, and British Columbia is the only place in the world where scopes of practice have been tried before. Guess what? It has canned them because many people felt they were a failure. So what are we doing in New Zealand? We are adopting them and putting them into place. There was much criticism in the submissions that the scopes of practice were ill defined and ill tested. We heard that time and time again from many submitters.

If we look at the scopes of practice in a practical sense, we see that the equivalent provisions in the Medical Practitioners Act are the specifications for the various types of registration of vocational branches, which, incidentally, work very well. Although there is a requirement for consultation, the decision rests with the politically appointed authority. When we come to scopes of practice under this bill, we are told that they will be enabling and broad, but when we look carefully at the legislation we find that, certainly, the professional bodies are not reading them as being broad at all; they are concerned that they are actually very narrow. If we look at clauses 20(1A) and 20(1B) of the redrafted bill, we see that they are certainly very suggestive of narrow scopes of practice.

I think we heard from just about all the professional bodies involved with this bill, and the smaller bodies were not so concerned about scopes of practice. The occupational therapists stick in my mind, because we had quite a long discussion about what they would do when it came to instituting scopes of practice. They had already done quite a lot of work, and had decided that they would have only one scope of practice. So there will be very little change for them. They will carry on pretty much as they are now, and the work they do now will just be defined as one scope.

I raise a point of order, Mr Chairperson. I wonder whether conversations that are not about the bill, and are happening quite close to me, could be carried out in the lobby.

The CHAIRPERSON (Hon Clem Simich): The member is quite right. Conversations should be held outside the Chamber.

I move, That the question be now put.

This bill, on which the Opposition has spoken so well tonight in its usual united way, is a massive bill, and it will be of huge cost to the public. There is no reason to regulate health professionals other than for public safety. It is not all right to regulate health professionals in order to create some sort of patch protection, and it is not all right to regulate health professionals to destroy a profession, as has been done to the general practice profession by this Government. In this particular part, I am concerned that the fitness for registration and scopes of practice will bring an incredible amount of cost not only to the professions but also to the public as a natural, flow-on effect.

As a member of the Health Committee, I sat through the many and varied submissions on this bill, and one of the things that came out quite strongly was that some of the smaller professional groups were very much concerned about the cost of this bill to them and their professions and occupations. Not all health professionals are highly paid people, and that is a point that needs to be brought home. We can say almost without exception that the more unionised the workforce, the poorer paid it will be, because that is a natural consequence of the lowest common denominator on which unions exist, which is what they promote.

One of the concerns in this part is that in the provisions dealing with the fitness for registration and the scopes of practice there is a tremendous amount of over-regulation that will severely impact on the ability of some health professionals to get registered and to operate within their chosen professions. Quite a lot of those professions comprise women, who are often mothers working on a part-time basis, and that is particularly the case for those who work with schools. They are people who are often getting no more than, say, $25,000 or $30,000 a year, and they will be regulated as though they are neurosurgeons, which is just ridiculous. That is the sort of silly thing that is in this part.

I take up the point made by my colleague in New Zealand First in relation to clause 15, which deals with the ability to communicate in, and comprehend, English. I am concerned to know how the Race Relations Conciliator, Joris de Bres, who called my ancestors “the Taliban”, will interpret that. I cannot help but think that he will come out and say that this sort of provision is discriminatory, because it is—it is discriminatory against people who do not speak and comprehend English. That might be considered a good thing by some people in this Committee, but I have to wonder about some of the practitioners of Chinese medicines who deal with people who are speakers of the many dialects of China. I wonder why it is that we will require them to be able to communicate in, and comprehend, English if they are practising solely in their own field, among people who understand them.

💬 Dr Lynda Scott: Will that be a scope of practice?

As Dr Lynda Scott correctly asks: will that be a scope of practice? We will have to find out from the Minister. That is one of the awful things about this part—it does not say what those scopes of practice are going to be. We are being told by this Minister and this nanny State that we simply have to wait and trust the Minister, which is a bad, bad thing. We are being told that we cannot trust the health professionals but we can trust the Minister. Well, I think not—I would rather trust the health professionals any day, because one of the surest ways to find incompetence in a profession, or its members, is to over-regulate it to the point of death.

I move, That the question be now put.

In the earlier debates on the Health Practitioners Competence Assurance Bill, Opposition members certainly showed that they knew exactly what this legislation is about: public safety. It was neither necessary nor appropriate for the Minister to give us a tirade on what the bill is all about. We are acutely conscious of what it is about, and that is why we express the concerns we do. As far as I am concerned, I have tried to express concerns that have been given both to the select committee and to me as a member of Parliament. They are not concerns I have made up out of my own head, although, as a woman, I am certainly worried about any potential for incompetence on the part of health practitioners, given the history behind this bill. We are acutely aware that this bill is about public safety. We are also very aware that public safety cannot be assured without the assurance of competence of health professionals.

Although Part 2 sets out the responsibilities of each authority to carry out the registration of professionals, the issue of practising certificates, and so on, in my view the part does not contain anything to assure the public that, henceforth, all those who practise in the health sector can be deemed to be competent. I say that because there is no definition of competence. Perhaps there is a very good reason for that. Is it that competence will be different across each of the scopes of practice? Or is it that people within the profession have an idea of what competence is, anyway? I would like the Minister in the chair, Annette King, to talk to that issue. She was good enough to answer my issues from previous speeches. Maybe she will give some reassurance on the matter. In the end, regardless of whether we in this Chamber are confident about this legislation, it is the public that needs to feel confident that its health and safety is assured by what we do in this Chamber.

It is easy enough for the Minister to stand up and quote the Medical Council of New Zealand, but we on this side of the Chamber can do the same. When I read in a briefing note of the Association of Salaried Medical Specialists last week that the issue of scopes of practice remains unresolved, and that it particularly has a concern that the intention for broad scopes of practice is watered down by other wording, implying narrower personal scopes, I want an explanation from the Minister as to what she thinks of the association’s response. Is it right or wrong? Only she knows, because this is her bill and she is promoting it as the right thing to do. Therefore, we look to her for an answer. The issue of what characterises competence and what it is made up of remains unresolved. The issue of scopes of practice is clearly still a significant unresolved issue.

My honourable colleague Dr Paul Hutchison referred to the Medical Council making comments about the fact that no work has been done on either the potential or the outcomes of scopes of practice. That is appalling, and the issues we raised and the points we made in the debates on the title and Part 1 remain appropriate and legitimate. The issue of scopes of practice, notwithstanding the Minister’s rhetoric, still remains unresolved, untried, and untested. The public seems to be the guinea pig here. I do not know how that reconciles with us trying to reassure the public of its safety, but an explanation from one of the bodies concerned is not sufficient.

I move, That the question be now put.

Mr Chairman, welcome to the Chair. The Committee is honoured and privileged to have such a fair and objective Chair.

I raise a very serious issue about the Health Practitioners Competence Assurance Bill, and I think the Minister in the chair, Annette King, should take a call on it. Clause 19(2) states: “If the scope of practice that an authority proposes to authorise for an applicant differs from that indicated by the applicant under section 16(2)(b)(i) … the authority must inform the applicant”. The public would be very, very concerned to learn that, although a health professional has armed himself or herself with the information and the qualification to be registered under clause 16 under a certain scope of practice, we are now told that the authority can actually decide that that applicant might have to be admitted under a different scope of practice.

I hope the Minister will take a call and answer that, because I get very worried. First of all, we do not know what the details of the scope of practice are, and I have a horrible feeling that, as an ordinary layperson, if I turn up to see a heart specialist, I would have to ask that specialist whether he or she had been ordered to practise as a heart specialist by the authority, or whether he or she had originally applied under a different scope of practice. I thought a scope of practice was quite specific to that particular skill. A person applies to be registered and admitted under that scope of practice, and the factor that should be taken into consideration is competence. If a heart surgeon applies under a scope of practice to practise as a heart surgeon, the authority should only be able to decide whether that person is qualified or not qualified.

I would be horrified if the public thought that the authority could say that it did not believe that that practitioner should register under the scope of practice of heart surgery, but it would recommend or authorise that practitioner to register under the scope of practice of another specialty. To me, it is incredible to think that the health and safety of the public is the foundation of this legislation, yet this particular clause provides, as I read it, that when a health professional, knowing his or her own competence, goes to register under a specific scope of practice, he or she can be ordered by the authority to register under another scope of practice. What Mickey Mouse legislation this is! I thought that this was serious business concerning people’s health. I would hate to think that, if I turned up to see a heart specialist, the specialist would tell me: “My dear patient, I was originally wanting to be an ear and nose specialist, but I was ordered by the authority to register under a different scope of practice.” It is absurd, but that is exactly what clause 19(2) provides for, as I read it.

The Minister should take a call and explain to us why that clause, stating that the authority can authorise that an applicant who applies for a certain scope of practice could be registered under another scope of practice, is included. We really want to know the answer. I am getting very anxious. If I turn up to see a specific health professional, I will not be confident that registering under that scope of practice was that specialist’s original intention. The Minister should stand up and tell us why the scopes of practice have so much flexibility as to allow the authority to make those judgments.

I move, That the question be now put.