Health Practitioners Competence Assurance Bill

Part 6, “Structures and administration”, really gets to the heart of why National will be voting against this bill. One of the issues of immense concern is the power of the Minister under this legislation. It comes down to a fundamental question about whether professions can self-regulate. We either trust them or we do not. Submission after submission expressed concern about the powers of the Minister to appoint to the authorities and determine any dispute over overlapping scopes of practice. If there were a dispute between nurse-anaesthetists and medical-anaesthetists, the Minister would have the final say. There was dispute, because people felt there would be a major decrease in professionalism and that the professions would be disenfranchised. The Health Committee received submission after submission on that.

The New Zealand Medical Association commented on the low morale in the medical profession and amongst primary-care groups today, and it felt that this bill would make that so much worse. It said that self-regulation is a cornerstone of safe practice and that each group of health professionals must be able to elect its professional body. They have been doing that for a long time, and they wanted that to continue. Members should compare that with what some of the officials were saying, which was that they felt that the Minister “must be able to appoint, because you’re not going to get the right people otherwise”. I think that gives a very clear indication of a feeling that there is political interference in the process, and that is one of the major concerns.

We heard from the Royal Australasian College of Physicians, the Royal New Zealand College of General Practitioners, and the Royal Australasian College of Surgeons about ministerial powers, and about their concerns of decreased professionalism. They certainly wanted a majority of elected people, and they did not want scopes of practice to be decided by the Minister. We debated that at length in the select committee after hearing all the submissions. We debated clause 123, “Disputes about overlapping scopes of practice”, and clause 124, “Minister may give directions to resolve dispute”. In the end, by majority, we came up with a new subclause (2A), which states: “A direction under subsection (2) may, without limitation, require each authority to co-operate with a panel of experts”—we could not get much further, as the Minister will still appoint that panel of experts—“and may also require each authority, to be guided by or (as the notice may state) to implement any recommendations of the panel concerning the dispute.” At least we got into the bill a provision whereby there would be a panel of experts that would have some ability to direct the Minister about overlapping scopes of practice. We have not seen before in New Zealand the situation whereby the Minister was able to say that one group may practise one way and another group another way.

There was an immense concern about the Minister being able to resolve disputes in any way he or she sees fit. Clause 123(3) states: “The Minister may assist the authorities to resolve their disputes in any way the Minister sees fit,” and that all he or she has to do is write to the authorities and tell them how to direct their lives. The medical profession is up in arms about that, because its members see this as a huge interference by the Minister, and the ministerial powers given by that provision really do reduce the professionalism in the system. The clause continues: “including, without limitation, by advising each authority in writing of 1 or more options for resolving the dispute”. So the Minister has an absolute hands-on approach in determining how different professions will be able to work it out between themselves. That is pretty new to New Zealand, and there was real concern that it will reduce professionalism, self-regulation, and the professions being able to determine amongst themselves how they practise in this country. If we think about how people do practise, then we will see there is major overlap in scopes already.

When the member began her contribution on Part 6 of the Health Practitioners Competence Assurance Bill, she raised the issue of disputes around scopes of practice, the powers that the Minister would have, how the Minister would be interfering, and how that would not be wanted. I want to relay to the Committee that just a few months ago members of the Australian and New Zealand College of Anaesthetists came to me to ask whether I would be able to intervene in a dispute they were having with the Nursing Council over a proposal that nurses would look at a perioperative scope of practice in anaesthetics. They asked if I could help them to overcome that problem and bring them together with the Nursing Council. I told them that they needed to go away and talk to each other. One needs someone to intervene only when one cannot make a decision.

That is the environment we have now. We have a Nursing Council that is working on a number of issues around scopes of practice. Certainly, a perioperative nurse scope of practice is very much on the modern agenda. I have no problems with that, so long as it is within the competency of a nurse to be able to do that, and that the nurse is trained and has the proper qualifications—the same as a doctor wanting a particular scope of practice. But when it comes to a dispute, there has to be a mechanism. I think the lawyers would understand that. If there is a dispute—and they do occur, have occurred, and are occurring—there needs to be a mechanism to resolve that dispute. One could take them all to court, and I am sure Pita Paraone would be worried if everything ended up in court when there was a dispute.

What has been put in this bill is a provision that, as a last resort, people can go somewhere for resolution. The Minister has the opportunity to work with a panel of experts who will provide him or her with help. Because of the Acts Ministers of Health work under, they receive advice on, and are often asked to make decisions on, all sorts of things that they have not been involved in in their other lives. What has been put in this part of the legislation is a mechanism that provides that whenever there is a dispute that requires consultation and a process, at the end of the day, a Minister—whoever that Minister is—will listen to those who have the expertise. Certainly, this Minister will. I cannot guarantee that if she were the Minister, Dr Scott would do so, but certainly I would listen to expertise.

When we get to the issue of whether there should be elected members, then there is a provision in the bill, and some future Minister may decide that there will be elections. I have said over and over again: who is this bill for? It is for the safety of the public. When this bill was brought in, it had the same number of lay people and professionals. Health professionals are actually in the majority on the bodies, and a majority of health professionals makes the decisions. They are doctors or nurses, and not just people dragged off the street—the majority are the health professionals themselves. In my view, what is needed is a statutory process that is transparent and open, which shows who has been appointed and why.

The member talked about political interference. I have had the experience—and I am sure Georgina te Heuheu has had the experience—of appointing people to those councils. After all, only three have elected members—I think the other eight do not—so I am sure that Georgina te Heuheu would have appointed people to the podiatry board, the physiotherapy board, etc. I guarantee she did not look at the appointments in a political light. The nominations that come in to me are from the organisations, and I make the appointments. I do not wonder whether they are members of the Labour electorate committee, or have another political connection.

What have come in to me from those professional bodies have been their professional nominations, and I make the appointments in a transparent process. Everybody knows that I have appointed those people, because my name is on the document. I believe that gives the public some certainty that this is an open, transparent process. At the same time, it gives the profession self-regulation. After all, the people who are appointed are their own members.

What members will gather from that tirade is not only the concern the Minister has in defending this legislation, but a recognition from her that one can hide the flaws of poor legislation for only so long before they eventually come to the fore, and everyone recognises the legislation for what it is. That is why the Minister acknowledged during the debate on Part 5 that appeals before the District Court and the High Court were more likely to happen under the new legislation than under the current legislation. Members will recall that there are rights of appeal against any decision to decline or register a person as a health practitioner, to decline to issue a practising certificate, to cancel registration with the authority, and on it goes. Scopes of practice were discussed there, as well. It is acknowledged that this bill will lead to more appeals in both those courts, and that litigation is much more probable.

So we come to Part 6, which talks about structures and administration. Throughout this legislation we have seen the Minister decide that she will have more fingers in the pie, more political appointments, and more influence over the process. The importance of clinical safety and the safety of those suffering ill health have been put down the scale of importance. Previously, professional groups set their own codes of ethics. That is what happened in the past, and that is part of being in a profession. All of those professions we have discussed—pharmacists, midwives, osteopaths, GPs, surgeons, or whatever—set their own codes of ethics. However, this bill proposes that the relevant authorities will now set those codes of ethics. Not only that, those sitting on the relevant authorities will be appointed by this Minister, and they will set the codes of ethics. I would argue that the Minister should have an arm’s-length relationship with those authorities, and that certainly will not happen if she appoints her Labour Party cronies as they retire or get kicked out of their seats in 2005. That is a concern for me.

I see that clause 110(1) sets up the Dental Council. Clause 110(2) “establishes a body corporate as the authority appointed in respect of the profession of midwifery;” and that authority will be known as the Midwifery Council. We will see an Osteopathic Council set up as well, and in respect of the profession of pharmacy, we will see an authority known as the Pharmacy Council. All of those will be political appointments by the Minister, who may or may not ask those professions for recommendations. She might decide that David Benson-Pope would be best sitting on an authority when they put him out to pasture, and that is a concern to me and many New Zealanders.

It is inappropriate to have this function performed by a statutory body, whether or not—I have to add—it is politically appointed. It will be politically appointed, but regardless, professional groups should set their own codes of ethics. That is what works in other sectors, so why does the Minister not accept that it can work in the health sector? These two measures destroy an important check on the power of Government. That is what is happening here—we are destroying a check on this Government.

I had better declare an interest immediately. I am a member of a professional body—not a health body, but I am a member of a professional body. [Interruption] No, no, I am a lawyer, so I have an interest in looking at professional bodies and how it should be done. I am interested to see that we are setting up a body that Mr Cunliffe is supporting. That member is not a professional, but he clearly wants the registration of doctors done by lay people, and—worse than that—done by people selected by a Minister of Health who was a dental technician—

💬 Hon Annette King: No.

A dental nurse then, who I think has a heavy chip on her shoulder about professional dentists and doctors.

The Minister said—and I think it is an outrageous public view for the Minister of Health to have—that she believes that there is a tendency for health practitioners to look after their own members and not take the public interest enough into account. She talks as if there were a public interest in having doctors registered who are not properly qualified. I have never met doctors who were not in favour of having the highest quality standards. Whenever I am being treated—or a member of my family, or a member of the New Zealand public—I want us treated not by a quack, but by someone who is professionally competent.

Who is most likely to hold professional standards? They are the professionals themselves. The Minister may not know that, but the professionals themselves will set high standards, and those lay people will try to lower them. Lay people will raise politically correct notions about there not being enough women in this area, or not enough ethnic minorities, and they will want more women and ethnic minorities registered as health professionals.

But it goes further than that. When one reads the clause properly, one sees that the Minister—

💬 Steve Chadwick: Have you read the bill?

I have read the bill, and I am particularly concerned about clause 116. Subclause (2A) states that before the Minister appoints a member to an authority, he or she must publish a notice that: “(i) invites organisations and individuals …” to make nominations. Presumably, that could be the chairman of the Labour Party, who could make a nomination in respect of who could do registrations. Subclause (4) states that the Minister may “… appoint a person who has not been elected as a member of the authority …”, so we could have someone who had not been elected by his or her fellow professionals, who had no standing at all, but was a good friend of the Prime Minister, of Annette King, or just a good party supporter. We will now see that sort of politics in registration.

I say to the Committee that I do not understand why we are putting lay people on those bodies, at all. It appears to me to be a matter of political correctness. I would like the Minister to give us examples to support her public statements, which I regard as a great insult to the professional bodies of New Zealand, and to the doctors and surgeons of this country. I ask the Minister to say where they have been putting their members’ interests ahead of the public interest. She made that statement, and she is putting this bill in front of this Parliament. Where is the evidence for it?

💬 Steve Chadwick: And we’re proud of it.

She is proud of the fact that her Government is denigrating doctors and health professionals, and that Labour Party lackeys will be put on to those committees, which will lower professional standards. That is the comment made by the Government member, Steve Chadwick. She wants her name put across, so that every doctor in New Zealand knows that it is her view that doctors and surgeons have been putting their own interests ahead of those of the public of New Zealand. That is an insulting statement from a Government that makes political correctness its ideology, and is in no way concerned with the real interests of the public.

I say that the Committee should reject this section, and I say to the Minister that it is an insult to every doctor and surgeon in New Zealand. I cannot see how anyone can possibly believe that this bill will result in better health standards in this country.

It is with great pleasure that I take a call to answer Richard Prebble’s comments. He told Steve Chadwick that he had read the bill, but I direct him to clause 116. We are talking about who makes up these bodies, and that clause states that a majority of the members will be health professionals. They are not lay people who are dragged off the streets—old Labour Party hacks—and then put on to some council. The majority are doctors, not people working down at the trade union office whom Richard Prebble does not like. The majority of members must be doctors, if we are talking about doctors.

Let me read the provision to the member. Clause 116(2) states: “… (a) a majority of members who are health practitioners; and (b) 2 laypersons, if the authority has at any time 8 or fewer members; and (c) 3 laypersons, if the authority has at any time 9 or more members.” Mr Prebble said today that he could add up, and that only ACT can add up. I say to him that he should have another go at adding up, and if he can add those numbers up to be a majority of lay people on those bodies, then: “You’re a better man than I am, Gunga Din!” One cannot do so. The majority of the members on those bodies are doctors, nurses, physiotherapists, pharmacists, dentists, etc.

I suppose Mr Prebble is saying that we have so many doctors who are members of the Labour Party that I will go around shoulder-tapping them, and putting them on these boards. If that is true, something has changed. That is not the case. In fact, the member probably does not know that until 1995 all members of these bodies were appointed under the Medical Practitioners Act of the past. They were not elected, and even now a minority is elected. So the majority is appointed. If Mr Prebble would like to look at the membership of those councils, he would see that I have not made political appointments to any of them. Members have been appointed from their professions together with a minority of lay people, and that will not change. Mr Prebble came into the Chamber wanting to make a song and dance. He did not read that clause of the bill, and he got it wrong.

He then said what an insult it was that I said health professionals were more interested in looking after themselves than their patients. I have said on many occasions before about many organisations, including the Medical Association, the Dental Association and the Pharmaceutical Society, that there is a public perception that health professionals look after their own. I have said I do not actually believe that that is the case, but there is a public perception of that. If the member does not want to believe me, he may like to speak to some of those organisations. If he rings them up now, they will confirm that that is exactly what I have said. I have said there is that public perception, and I have to say it comes from cases like that of Dr Fahey from Christchurch. It comes from perceptions about doctors who appear to have got away with things when patients have not been listened to. Perhaps the case of Dr Bottrill is a better example of what has caused that perception, as other health professionals who knew about his practice did not do anything about it. There is a perception that the medical profession looks after itself, and in this part of the bill we want to have a process that is transparent. We will know whom the Minister has appointed. We will know who the people are. They will be there for us to see, with no doubt about it, because that gives a transparent process.

The member may also not know that only 3 of the current 11 boards have a minority of members elected to them. The nurses’ council does not. The council that governs Mr Prebble’s sister does not have elected members. The boards are very happy with the way that the system works, because it is open and transparent. People are nominated for appointment, and they are appointed. So that member’s speech was about nothing. It showed a whole lot of ignorance about what is in this bill and what already exists.

This is a very critical point, I believe. Whether health professionals’ organisations should be entitled to elect some members to their governing bodies is an absolutely critical issue in this bill. The Minister talked about the situation back in 1997 when all the positions were appointments, but we are not interested in 1997. We are interested in 2003, in this bill, and in trying to improve the situation for the future.

The fact of the matter is that this bill gives very wide-ranging powers to the Minister of Health over all the health professions covered by it. In particular, it gives the Minister of Health the right to appoint personally up to 14 members of every single governing authority established by this legislation. If every single member of every health professionals’ organisation is appointed by the Minister, those members are, in a sense, beholden to the Minister for their reappointment. That simple fact can act as a strong incentive to toe the line, and can ultimately undermine the independence of the professions. We have seen that situation with the chief executives of the district health boards. The Minister of Health personally appoints them all, they are beholden to the Minister of Health, and they are given very clear instructions to toe the line in respect of district health boards. That is one of the reasons that those chief executives are so quiet, and that some of them do not even allow members of their boards to speak out publicly.

So the Greens attach great importance to the provision that the health professions should be able to elect some members to their registration authorities. Indeed, allowing the health professions to elect some members to their governing bodies will mean that there is some involvement by those professions, so that they have a sense of ownership of their authorities, and do not feel that the membership is just all imposed on them. The way that this bill is at the moment means that we are not talking about self-regulation, at all; we are really talking about a very, very high degree of control by the Government over those professions.

I have been involved in a marginal way in some of these appointments, and I have seen how very easily such appointments can be really just a matter of dispensing patronage. It is a case of dispensing patronage, and also of making the reappointment process dependent on the Minister, so that everyone knows that, really, they cannot rock the boat. We then end up with a whole lot of compliant authorities that, basically, will all ultimately do the Minister’s bidding.

That is why the Green Party has an amendment to this clause, to make it absolutely clear that upon receipt of a request from an authority to do so, the Minister must make regulations enabling and ensuring that at least half the health practitioners appointed to an authority are elected from among the health practitioners registered with that authority. This amendment goes further than Dr Scott’s amendment. I am perfectly happy with Dr Scott’s amendment as far as it goes, but it states that only the existing health professions should be able to elect half their members. What about osteopaths? They may want to hold elections. What if, at some distant time—say, after another 20 years—acupuncturists are finally allowed to have their authority, and they want to elect its members? I think that most health professions will end up wanting to elect half the members of their authorities when they realise the degree of patronage and control that is exerted by having the Minister make every single appointment to the governing authority of every health profession in New Zealand.

So, in my view, this issue is absolutely critical, and I really urge the Government to support democratic elections. What is wrong with a little bit of democracy in the health professions? The Government has introduced a degree of democracy with the district health board elections, so why on earth should we not do the same thing here and allow some members of the various health professions’ governing authorities to be elected? According to the way that the bill is worded at present, the Minister is not required to allow those professions that wish to hold elections to do so, and that is why we have moved an amendment to require that.

I move, That the question be now put.

I want to take a short call with regard to clause 116, and in particular to respond to some of the comments made by Mr Prebble. Supplementary Order Paper 122 in my name suggests that all the tribunal, or the group, should be health professionals. The Minister used the case of Dr Bottrill, where some of his colleagues knew of his shortcomings. I suggest to this Committee that Dr Bottrill’s colleagues were not part of a tribunal process. I suggest, again, that the people who make up the membership of the tribunal should be health professionals. Of course, that is in keeping with my earlier comment about being judged by one’s peers.

If the Minister is to be part of the appointment process, then the professions themselves should be invited to submit the names and, although that is stated in the bill, I think the professions should have a process of election. In some way, I support the Green Party’s suggestion in Supplementary Order Paper 114 in the name of Sue Kedgley. But the point I want to make is that all the tribunal should be health professionals, with no exceptions. Although I have some difficulty with the authority that lies with the Minister, I believe that whoever is to stand in judgment of their peers should be health professionals from those particular health fields.

I must admit I was somewhat concerned that the Minister of Health must have a sore tooth tonight, because she certainly did carry on a bit when challenged about the membership of the authorities. There are some quite extraordinary ironies about this issue. The Minster has gone to huge trouble in the health and disability legislation to endorse the thought of elected members there—and God help New Zealand in terms of the 21 district health boards that have been personed by Labour Party hacks and various other cronies—and to have an extraordinary mixture of people. But when it comes to professional bodies, the Minister says no, she will appoint the lot. Undoubtedly, that absolutely undermines the independence of the professions. It undermines that whole concept, which is hugely important. An amendment that I put forward earlier on was, sadly, rejected by this Labour Government.

One of the underpinning purposes of this bill should be that professional responsibility and independence is maintained in order to serve the public best. There are two amendments regarding that. One is in Supplementary Order Paper 103 in the name of my colleague Dr Lynda Scott. It is quite right and appropriate, and it states: “Where, under any enactment in force prior to the commencement of this Act, a health profession has elected members of its governing body, that profession may elect 50 percent of the members of the authority or such lesser proportion as the governing body or authority may decide.” I think that is quite appropriate, but I must say that for once the Green member Sue Kedgley has come up with quite a sensible suggestion in Supplementary Order Paper 114 in her name. I must admit that my mind boggles at the thought of a whole lot of osteopaths, but nevertheless the principle behind her suggestion is absolutely right.

Not so long ago, the Hon Richard Prebble mentioned that this Labour Government has put political correctness in front of everything. When we look at clause 114 we see that, no more so than with any other clause. Clause 114, “Functions of authorities”, includes the requirement “to set standards of clinical competence, cultural competence, and ethical conduct”. Well, here we are with a bill in which the Minister of Health cannot even define “competence”, and she suggests that the area of cultural competence can sit well in it. I can tell members that the other day I bumped into a nurse who was coming home from her cultural class at Auckland Hospital, where she works in the intensive care unit. I asked her what her class was about, and she said it had spent the last 4 hours talking about the fourth article of the Treaty of Waitangi. Heaven knows where this politically correct Labour Government is going! Undoubtedly, that really does take the cake. Quite rightly, again, my colleague Dr Lynda Scott, in an amendment, has suggested that paragraph (i) of clause 114 be thrown out.

I want to very briefly talk about clause 123, “Disputes about overlapping scopes of practice”. That is one of the areas of the bill that has all the professions extremely concerned. I put it on the record that I would like the Minister to take a call and tell the Committee what her plans are for nurse-anaesthetists in New Zealand. The history of this issue is that only 5 to 6 years ago, for the sake of maintaining standards general practitioner – anaesthetists, who had a diploma in anaesthesia, were phased out, because we wanted to have increased standards in New Zealand. Here we go! The Minister of Health is suggesting that there be a stream of nurses who can now become independent nurse-anaesthetists. Will the Minister of Health take a call and tell us her intentions?

I move, That the question be now put.

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

During the debate on this bill we have tried to be constructive in the Opposition, and we tried to be very constructive during the select committee process. The Health Committee worked very hard on this bill. We worked very well together across the parties, and that was great. However, Part 6 is the worst part of the bill, and I am appalled that we have it here in the Committee. I will bring up two issues on this particular part tonight.

The first issue relates to the concept of cultural competence. When I have trotted around the country, as I have, and have spoken to people in the health profession business, I have said to them that this bill has some good bits in it, but, unfortunately, it is like the curate’s egg and has some really rotten bits, as well. If and when this bill is passed—and I hope for support tonight for this part not to be passed—it will have the regulators of health professionals concerned not only with the ethical competence and the clinical competence of professionals but also in charge now of their cultural competence. Cultural competence is not defined in this bill, because, of course, it is sort of like the fourth article of the Treaty of Waitangi: it does not exist. We are not even told which particular culture we have to be competent in. That provision is an absolute nonsense and an outrage.

All of us here tonight in the Chamber have been either the patients of health practitioners and/or health practitioners ourselves. At no stage have any of us gone along to our health professionals and said we wanted to know how culturally competent they are. I would like to hear anybody say that he or she cares how culturally competent the people in the accident and emergency department are when he or she comes in from a road crash. Not one person in this Committee with any brain at all would ever want to ask how culturally competent they are.

It is absolutely right that any person who goes to a health professional wants to know that that professional knows what he or she is doing, and is clinically competent. That is fair enough, and it is good that the Minister wants that to be included. Absolutely, people want to know that a health professional behaves ethically. They want to know that they will not be told they have to have a bit chopped off that they do not really need to have chopped off, just to get income coming in for a professional. They want to know that they will not be sexually molested by a health practitioner—and nor should they be. But, for goodness’ sake, I ask whether any members of this Parliament have ever asked an orthopaedic surgeon how culturally competent he or she is. If they have, I hope they had the result that I suspect that they would have had, which was to be told to get out of the surgeon’s office immediately.

This provision is an absolute outrage. We have a health profession that is under much stress. These people are front-line people, and they are struggling to provide the most basic necessities. They have to work in a Third World health system under this Government, and here they are being told to be culturally competent. That is absolutely rich. The Government cannot even tell us which particular culture they are supposed to be going for. That is an outrage.

If we ask who will be in charge of this provision, we all learn that under clause 116 it will be the Minister. The Minister has given us all that stuff tonight about how she will appoint doctors to look at doctors, but they will be her doctors. They will not be doctors who have the confidence of their professional peers; they will be doctors who have the confidence of the Minister. That does not give a lot of confidence to anyone else, and that is one of the problems. The Minister talked to us about how she likes to go and consult with others. I ask the Committee to look at clause 5, where she has chopped that out.

I agree with everything that the member over here in the Opposition has just said, but I will go back and look some more at clause 116, which deals with the election of people to the authorities. I will do that because when Richard Prebble spoke earlier, I think that some members in this Committee did not take him very seriously. I am not looking at anyone in particular, but there were some members who did not take him seriously. The points that Richard Prebble made were right on the dot, because I showed them to him.

Doctors, dentists, and pharmacists currently have elections for their registration bodies and professional bodies.

💬 Steve Chadwick: A good thing, too!

It is a good thing. At the Health Committee the majority of people wanted to retain that, and clause 116(3) states that regulations made under this Act may provide that one or more of the health practitioners who are to be appointed will be elected. But the Minister’s intention has been made very clear in a newspaper article in the New Zealand Herald on 22 July, which stated: “Mrs King said yesterday that she did not favour elections for such bodies”, and she has told us why that is.

We in the ACT party say—and I think the National Party and New Zealand First agree with us, as well—that that is not right. We believe that the elections are very important for a number of reasons, several of which have been outlined earlier in the debate on the bill. We have said that it is very important that the environment needs to be right, in order for patient safety to be paramount. However, something that we have not mentioned previously is the credibility of the registration bodies among the health professionals—the people whom they govern. For the public to be assured of the competence—that term has not been defined, but we will not go there again—of health professionals, the health professions must be able to have professional self-regulation. We have heard a lot about that. The other thing is that the professions have to be satisfied that they are working in an environment that is conducive to public safety.

We heard from many groups at the select committee. In fact, an overwhelming number of the submissions were adamant that holding elections was very important, and that even in the case of those professions that have chosen, for the moment, to nominate people to the Minister for appointment to these authorities, the ability should remain for them to have elected members, should they so choose. The dentists, the doctors, and the pharmacists certainly want to continue in that vein; they have been very specific about that.

It was interesting to hear the Minister, when she jumped to her feet just before the tea break and talked about the doctors. She specifically mentioned doctors. The doctors are so disillusioned with this bill that they do not want to be part of it any more. When the discussion papers before the bill was drafted came forward, and even when the bill was initially put forward, they were very keen to be part of it. They thought the bill was a good piece of legislation, and that it was certainly heading in the right direction. But as time has elapsed and their concerns have not been listened to, they have decided they do not want to be part of it any longer. One of their big concerns is that they can no longer elect their own people to the authorities.

We elect people to the district health boards. I ask the Minister how we know that we are electing the right people to the district health boards. [Interruption] I ask Mrs Pettis, who is trying to interject, whether that means we will have to abandon those elections, as well. If we continue to have elected district health board members, it should follow through that the professional authorities, if they want to, should be able to have elections. But, no, the Minister said that that is no good.

In looking further into this part, and I refer particularly to clauses 119 to 125, we see that those clauses concern the powers of the Minister. I think the Minister was being a bit modest earlier. She said that there would not be great power there, and that even if there was she would not exercise it. However, the fact of the matter is that all the professions are extremely worried about ministerial power in this bill, not just in this part but right throughout the bill. They are worried that—

💬 Dr Lynda Scott: Scopes of practice!

Yes, scopes of practice. They are worried in all areas about the powers of the Minister. The ability is there for an awful lot of political interference. The Minister of Health or future Ministers of Health will be able to make decisions that the Minister cannot currently make.

I move, That the question be now put.

I agreed with the Hon Richard Prebble, who spoke just before dinner. He must have touched a raw nerve with the Minister, so I will try to follow through the theme of what he was trying to say. The Minister of Health became very, very excited at that point. She stood up, and she wants to do so again. We want to encourage the Minister to get to her feet.

Before dinner the Minister said that making appointments for reasons of political patronage was the furthest thing from her mind. So I thought I would do some research on appointments. We have researched a little into what this Labour Government has achieved. We cannot quite see into the future, but I certainly think the past is a good indication of the Labour Government’s performance in this area. The Dominion Post—Wellington City’s authoritative newspaper—has an article stating that more than 3,000 people serve on some 400 quangos funded from the public purse, and up to 900 appointments a year are made without public advertisements. What do we have? Let us look at some of those appointments.

Can members guess the former profession of Chief Human Rights Commissioner Ros Noonan? She was previously a trade union official, and she has also recently been appointed by Labour to a new task force. Wow! There is more. Former Labour Cabinet Minister David Caygill, who has earned over $100,000 from chairing an inquiry into the electricity industry, also picks up $50,000 a year for chairing the Accident Compensation Corporation. He is considered a front-runner to head the new 7-member Electricity Commission, after failing to get the last one off the ground. I see the Minister is getting excited; I am sure she will take a call. A left-leaning former Race Relations Commissioner, Gregory Fortuin, earns $55,000 a year as a New Zealand Post board member.

Let us look at some more appointments.

💬 Jill Pettis: Relevance.

The Minister tried to say Labour would not appoint former party members to positions. How about former Prime Minister David Lange, and former Labour MP Jenny Kirk? I am telling members about all the quangos that are staffed by those people—former Labour MPs Jenny Kirk, Stan Rodger, Jill White, Ann Hercus; the list goes on and on.

Apparently in 2001 Treasury recommended that the process governing political appointments be put into a law, in order to give it more force, and that appointments be done more openly. Treasury put up that paper to the Government. Can members guess what the response of the Labour Government was? The Labour Government said that it had no plans to adopt Treasury’s recommendation. It would not have a bar of it.

Now we have this legislation before us, which once again gives the Minister plenty of opportunities to reward people, and to appoint people who agree with her positions. The Minister is most welcome to stand up and take a call, and to try to reassure us as to why the public and the Opposition parties should have confidence the Minister will not exercise her discretion and appoint people whom she favours.

I do want to pick up another issue that is very dear to my heart. Members who are appointed must be culturally competent.

💬 John Carter: Like my mother.

Oh, John Carter’s mother. I am sure she is a very cultured woman, as far as I know. I wonder how the Minister will satisfy the requirements of a lady of such high standing. But I wonder whether all the different cultures would be included under that term.

I move, That the question be now put.