Health Practitioners Competence Assurance Bill

I understand that Part 9, if the amendments are passed, will become a separate bill. The Health Practitioners Competence Assurance Bill is going to be split into three bills. Part 9 deals with pharmacies and the way in which they will be owned and operated.

When I was last speaking on this matter, I said I had been in Cleveland, with my good friend Judith Collins. I do not think this Government really understands the pressure that pharmacies and pharmacists are under at the moment. We went to two pharmacies, one of which had just been ram-raided. The pharmacist was shocked. Even though she had put up all the security screens, she then had to pay $45,000, I think, to put up those big metal posts to stop the shop from being ram-raided again.

Parts of this bill talk about pharmacists and pharmacies having to be secure. Believe me, they know the risks and costs of that! We understand the important role that pharmacists play in health care in New Zealand. As a geriatrician, I was very aware that medications, in the elderly, are a big problem and often cause iatrogenic disease. People often get sick because of the pills they take. I was spending a lot of time taking people off those medications. Pharmacists do a fantastic job in this regard. They spend a lot of time looking at the medications that people take—looking at the interactions they could cause. Indeed, every day of the week, pharmacists pick up prescribing errors—all the time. They pick up interactions that may occur.

Those sorts of things that pharmacists do, often are not quantified or paid for. They spend their time learning about drugs and how they work in the body—especially in aged care and with young children. In those groups the medications can make someone very sick, indeed. So pharmacists do a great job in that respect. They are among the most consulted health professionals. People often will go and have a talk to their pharmacist to find out what the pharmacist thinks a problem may be—whether the person needs to go to the doctor. In that regard, we respect the work that pharmacists do and how competent they are to do that.

In the past we have had the situation where a pharmacist could own only one pharmacy, and certainly that rule has caused problems. It has caused problems in rural areas where maybe only part of a practice was really viable, especially in smaller rural areas. So it has been increasingly difficult, with decreasing populations, for those pharmacies to remain viable. On this issue of pharmacists being able to own only one pharmacy, there has been a great deal of debate about freeing up the system. The debate has gone on all around the world about allowing pharmacists to own more than one pharmacy, and whether pharmacists need to own them, at all. Those debates have occurred, and I have looked at all the different areas of the world—for example, in Europe and Britain where they have deregulated but they do have regulations as well that look at local needs. They look at access, they look at improving quality health-care to improve it for the patients who need to use pharmaceutical services, and to see a pharmacist.

That has to be the bottom line, really. It has to be about improving the ability of individuals to get access to medications, in a way that improves their health care. That is what we do have to look for. We appreciate that medicines are not ordinary, commercial items, because medicines have that ability to make people very unwell. There are safety issues around the prescribing and dispensing of medications. The number of people who end up in hospital, every day of the week, because their drugs have made them sick, is pretty extreme. It is always a matter of getting the balance right. We need to know that that risk is monitored and that that is very clear in any changes that one makes.

A big problem at the moment, of course, involves the manufacture of methamphetamine and P. People manufacturing that have got it from pseudo-ephedrine, which is a very common substance in cold remedies.

United Future has given serious consideration to the many opinions offered on the issue of deregulation of pharmacies, and our decision is that, at this time, we will support the intent of the legislation in this regard. Pharmacists have to contend with a range of interventions that involve their profit margins—namely, Pharmac price-setting, co-payments, district health board contracts, and, in recent times, a return to stat dispensing fees. All these interventions serve to cramp the competitive opportunities for pharmacists. United Future feels that the partial deregulation set out in the Health Practitioners Competence Assurance Bill is sufficient at this time.

I take the opportunity to endorse the comments of others who have spoken with high regard of the pharmacy services that are provided by our pharmacy professionals here in New Zealand. We must never lose sight of the fact that that profession is an essential primary health service, and at a time when New Zealanders are facing shortages of staff in certain areas of the health profession, it is important that we look after the interests of pharmacists so that we do not start to face a crisis in that area, as well. United Future will be supporting the bill as is, and we have serious concerns about what the huge step of full deregulation would mean to the industry at this time, with the many issues that it is facing at present.

I move, That the question be now put.

Let me first thank the Minister of Health for standing up and taking the brave and courageous stand, as a Minister of Health, of being on the side of the sick, the elderly, and our young people over the issue of access to drugs in New Zealand—drugs that make people well—and the price of the drugs that make people well. We face a big decision on this bill concerning my Supplementary Order Paper. Are we on the side of a legislated monopoly, or are we on the side of enterprise and freedom? No one is suggesting that one should not have to be a pharmacist to dispense pharmaceuticals, but we are asking ourselves whether we should legislate a monopoly on the ownership of chemist shops. The United Future party and the Government are saying that what we have now is nuts. It is nuts, because now, in order to dispense drugs in New Zealand, one has to own the chemist shop. How stupid is that? One can be a dentist without owning the dental facility. One can be a doctor without owning the surgery. Why limit the ownership of chemist shops to pharmacists? Why limit the use of capital?

💬 Judy Turner: You don’t have to own a pharmacy to work in one.

Judy Turner, the great hope of the United Future party, says that one does not have to own a pharmacy in order to work in one. That is true. But one has to be a pharmacist in order to own one right now, and that is what is wrong. Judy Turner shakes her head and agrees. With this bill, the Government and the United Future party have made it a bit easier and said that one has to own 51 percent only. Where is the logic in that? Why not 49 percent? Why not 47 percent? Why not 62 percent, or better yet, why not do as the Minister of Health agrees should be done, along with the Consumers Institute of New Zealand, Te Puni Kōkiri, the police, and every advocate group of consumers that looks at those issues? Why not come down on the side of the sick, the young, and the elderly and say “None.”? [Interruption] It is all right for David Benson-Pope to criticise the Minister of Health, but he can take a call and make his own speech.

We should do the brave and the right thing. We should join with the National Party, vote for the amendments on my Supplementary Order Paper, and have a Labour Party caucus stand beside its Minister of Health. We should send a message to the chemist shop owners that we respect their work and their professionalism, and that as a Parliament we are not prepared to legislate privilege, a monopoly, or an advantage of a supplier over the customer—because that is what we are doing with this bill. How pathetic is it that a Parliament of 120 MPs should be cowed by 931 chemist shop owners, all scared that someone else might buy into the business, employ them, and offer a better service.

💬 Sue Kedgley: Why would it be better?

We should let the customer choose. What is wrong with customers wanting to go and get their prescriptions from a pharmacist at the supermarket? We notice that chemist shops are quite happy to compete with supermarkets for a whole lot of other goods. It will be interesting that the Greens, the United Future party, and—it looks like—the Labour Party will be sinking the Minister of Health. Members of those parties will be standing up in the Chamber and saying that they favour a commercial monopoly over the sick, the elderly, the young people, and the working families who are the ones who are paying the bills. Let me have someone stand up in the Chamber and say that a legislated monopoly gives cheaper prices and better service. When has that ever happened in the world?

💬 Steve Chadwick: What about professionalism?

Yes, what about professionalism? What about a bit of competition and choice?

I move, That the question be now put.

I want to take a call on Part 9 of the Health Practitioners Competence Assurance Bill, partly because I have put forward a Supplementary Order Paper that I want to take the opportunity to speak to, but also in relation to the Supplementary Order Paper submitted by Mr Hide. I signal that New Zealand First will not be supporting it. We believe that any suggestion of deregulation at this time is not at the right time. That is number one.

Number two is that the bill is subject to review in 3 years’ time. We should look at it then. If the truth be known, some members on this side of the Chamber support the Supplementary Order Paper without really wanting to do so—because of previous circumstances they are obliged to do so. I reiterate that New Zealand First will not be supporting the ACT member’s Supplementary Order Paper.

I want to talk to my amendments to clause 240 on my Supplementary Order Paper. I want to add to the definition of “authorised prescriber”. My Supplementary Order Paper amends the definition by including a little bit more detail as to what the term “authorised prescriber” should mean, or should include. It should include “authorised ophthalmic prescriber”, and again I am referring to the optometrists—following the approaches that members of their association made to me, I was convinced that I should support their call for that.

In addition, I propose another amendment, to clause 240(3), after the words “medical practitioner”, to include the word “optometrist”, with the definition meaning that it is a health practitioner who is or is deemed to be registered as an optometrist with the Optometrists and Dispensing Opticians Board continued by this legislation.

Similarly, that definition should be included within the meanings of “medicine”, “new medicine”, “prescription medicine”, “restricted medicine”, and “prescription optical appliances”. Again, that is in keeping with the approaches made to me by the members of the Optometrists Association. I would like to see a new clause 243A included, referring to the sale of prescription optical appliances by retail. I seek support for that Supplementary Order Paper.

I would just like to say that I am very pleased to see the Minister for Small Business here while we discuss the issue of pharmacy. Perhaps it would be a very good thing for the Minister to examine the 900 small pharmacy businesses in New Zealand. Maybe he could even consider doing a regulatory impact analysis of those businesses, because he would find that under this Government, not only have their co-payments been reduced but 30 percent of their income has been yanked out as a result of stat dispensing. At the same time, we have imposed increasing regulatory and compliance costs on pharmacies in New Zealand. I appeal to the Minister for Small Business, who is sitting in this House, to look at this particular area. There are all these wonderful moves towards reducing the compliance costs of small business in New Zealand, and the Minister has been doing some great work in that area, but I think this is one area he has overlooked.

Turning to this bill, I would like to speak very briefly to Mr Hide’s impassioned speech in favour of his particular amendment. The first thing I would like to say to Mr Hide is that there is absolutely nothing whatsoever to stop supermarket operators having pharmacies in their supermarkets right now—nothing but greed. The only reason they are not doing it is that they want to be able to take all the profits for themselves.

Secondly, I would like to point out that we are not talking about sweeties, confectionery, or cakes, but about medicines and pharmaceuticals. As Dr Lynda Scott has intimated, the fourth major cause of disease is adverse interactions with pharmaceuticals. We are talking about potent and toxic substances, and we cannot just compare them with confectionery and cakes. There needs to be a strong regulatory mechanism, and trained pharmacists are needed to make sure that there are not adverse interactions between medicines that have been prescribed. Just as Dr Scott has, I have had letters from pharmacists pointing out that by checking the prescriptions doctors send in, they have avoided major problems. Doctors, for instance, will dispense 11.9 milligrams of something when it should be 1.19 milligrams and so forth, so pharmacists have a very important role in checking the scripts that doctors write. They have a very important role in the whole ethics of a pharmacy, and in making sure that medicines are not dispensed in a way that could be abused, particularly where those medicines could be the basis for drugs like methamphetamines. Pharmacists who own and operate their own pharmacies have a very strong ethical commitment.

The member keeps talking about a monopoly in this area. If this role were handed over to supermarkets, it would be to a monopoly of two New Zealand supermarket chains, both owned by global multinationals. So instead of going into our community, any profits would be sent offshore. We would be giving up 900-odd small businesses in New Zealand to a couple of global multinational corporations. I cannot see how that would advantage New Zealand—quite to the contrary. I think that small pharmacists have done a magnificent job in New Zealand, particularly the community-owned small pharmacists. They function to a great extent almost as social workers in their communities, and we should be supporting them, not undermining them.

The question was put that the amendment set out on Supplementary Order Paper 115 in the name of Pita Paraone to insert a definition of “authorised ophthalmic prescriber” in clause 240(1) be agreed to.