Health Practitioners Competence Assurance Bill

It is quite disappointing to get only one call on such a comprehensive bill with so many different clauses. It will be really difficult to be able to address, in 5 minutes, all the issues in Part 4, because it is very comprehensive. Part 4 is all about how the Health Practitioners Disciplinary Tribunal works, how complaints are made, how the new professional conduct committees work, and cultural competence, and they cannot be given justice in a 5-minute speech.

I will begin by talking about the situation pre-1996 and post-1996. Pre-1996 any complaints went to the complaints assessment committees, via the Medical Practitioners Disciplinary Tribunal. Post-1966, the Health and Disability Commissioner Act came in and complaints were referred to the Health and Disability Commissioner. Post-1996, people have had a great deal of confidence in the Health and Disability Commissioner Act. It was brought in under National and it has worked extremely well to resolve disputes involving the public, concerning the level of their care. Just about all the complaints we heard in the Parry inquiry centred on how the complaints assessment committees worked. I have also had personal correspondence from people who have written to me and said how upset they were with the complaints assessment committee.

During the select committee process we were quite keen to change the concept that people still had—that under this bill there would be a complaints assessment committee. So we came up with the new name of “professional conduct committee”. Also, I am very pleased that all complaints will now go to the Health and Disability Commissioner, to be dealt with in a one-stop shop. That was the whole crux of the Cull report. Helen Cull wanted a one-stop shop, which this bill will deliver, and it was brought about through the work done in the select committee. However, the professional conduct committee will look at things like fraud and sexual abuse—those types of issues that do not concern a profession’s clinical competence. They will go to the Health and Disability Commissioner, and then to the Health Practitioners Disciplinary Tribunal.

There has also been concern about this issue. Wendy Brandon, who had been chair of the Medical Practitioners Disciplinary Tribunal, voiced this concern most strongly by saying that people have a right to be judged by their peers. There was a great deal of debate about what the representation on the committee should be—how many lay people and how many professional people there should be. But, quite frankly, the profession is harder on its people than lay people are. Being judged by one’s peers means that one’s peers know what the level of competence should be. Concern was expressed that either a group of nurses would judge nurses, or a group of doctors would judge doctors. But if one looks especially at highly specialised areas of medicine, one really does needs one’s peers to be able to judge them. The upshot is that there will be three health professionals, one lay person, and one lay person who is a legal chair, on the Health Practitioners Disciplinary Tribunal. That has been a good decision, and does allow a person to be judged by a majority of his or her peers.

I have put in an amendment to clause 116, which is about members of the authority being elected. People have a right to feel that there will be elected members. The Medical Council has already had elected members, so I hope that having elected members on the authority will be allowed. The ability for the public to feel confident about the competence of health practitioners is essential. It is essential that people in this country have confidence in health practitioners, and that they must feel that if something is going wrong there are competency programmes for each health professional, and recertification programmes.

As the applause dies down, I take the opportunity to speak to Part 4, “Complaints and discipline”. There are two provisions in the bill that have the potential to erode severely—and I do not say that lightly—the advantages to the public of professional self-regulation, which is what we have generally seen throughout different health areas and what we have generally seen historically. The first provision is the removal of the setting of professional codes of ethics, from the various professions to the statutory authority, and the abolition of the right of election to the authorities. Those things are of concern to us. Those are the issues in Part 4 that I put before the Committee. The first is the removal from the profession of the setting of professional codes of ethics, and the second is the abolition of the right of election to the authorities.

This bill, and particularly Part 4, establishes a single disciplinary tribunal—the Health Practitioners Disciplinary Tribunal—to hear complaints against those health practitioners who warrant significant disciplinary action, and are defined that way. It applies to those who warrant “significant” disciplinary action. There is a bar as to what is significant and what is insignificant. Health practitioners, certainly those who work together with those requiring discipline, are the first to recognise that difference and can make the recommendation as to what is significant and what is not.

In the first instance, complaints must be referred by the authority to the Health and Disability Commissioner. After an investigation, which should reach a high degree of thoroughness, with interviews and so on and so forth, and with rights of reply by those being disciplined, charges may be laid before the Health Practitioners Disciplinary Tribunal by the director of proceedings under the Health and Disability Commissioner Act, which was passed in 1994.

There is another option, which applies if the complaint is referred to an authority by the Health and Disability Commissioner by a complaints investigation committee of the authority under this bill. We read about that in clauses 61 through to 100, which make reference to the schedules, which I suspect we will be debating later. Clauses 219 to 238 in Part 8 also amend the Health and Disability Commissioner Act. We will need to look at those schedules and examine them, and ensure that everything that should be there is there.

However, our concern is that the Health Practitioners Disciplinary Tribunal will be made up of ministerial appointees, and that is just one more example of where the Minister has her finger in the pie. There was a high degree of professional representation on the previous tribunal, and I think Dr Lynda Scott alluded to that. I understand that representatives formerly were elected independent of the Minister, but here we have the Minister actually involving herself in the appointment process.

There is no provision for the profession to elect its own representatives, and there is no provision for the profession to judge its own, as there should be. It has worked well in the past. It works in other sectors outside the health sector, so why should it not work here? Why should the Minister have the opportunity to reward her mates by giving them a role on this tribunal? I think it opens up the process to accusations of political interference. I can imagine that happening, because it is the habit of this Government.

I reiterate the comments of my colleague Dr Lynda Scott in saying that I hope there will be plenty of time to spend on this part of the bill, because it is very important.

Progress reported.

The House adjourned at 9.56 p.m.