Health Practitioners Competence Assurance Bill

Schedule 1 is about the provisions applying to the Health Practitioners Disciplinary Tribunal. As we know, this bill was supposed to be based on the Medical Practitioners Act, but the medical practitioners do not want a bar of this bill any more. They want out of it completely because they do not like what has happened to it. They do not think it will be anything like as good as the 1995 Medical Practitioners Act, which was, of course, brought in under a National Government, a very good Government that brought in the Health and Disability Commissioner Act and the Medical Practitioners Act and solved the problems of 30 years, which had been happening in relation to dealing with complaints, quality assurance, and credentialing in our hospitals.

We have heard a bit of concern about this bill, with its provisions applying to the Heath Practitioners Disciplinary Tribunal, from the groups included. I am talking about the physiotherapists and the occupational therapists. They were really concerned about the cost. I bet members do not know how much it costs to run the disciplinary tribunal per day. It costs $20,000 to $25,000 per day. That is a lot of money. [Interruption] That is what they told us. So they were really concerned, as were the 12 groups that will come under this bill, that they would face the major costs involved in running a Health Practitioners Disciplinary Tribunal. They were saying they did not want to come under one tribunal. They actually wanted to have their own smaller tribunals that could reduce the costs for them.

The decision was that there would be only one tribunal, but some changes were made to the schedule to allow for a reduction in costs so that the occupational therapists and physiotherapists would not face the huge costs that occur, like the costs that doctors are faced with when appearing before the disciplinary tribunal. It is a very big event, not just for the doctors but also for patients and their families, to go through the process that gets them to the Medical Practitioners Disciplinary Tribunal. It takes some years to work through the gathering of evidence and the investigation. This schedule deals with the powers to summon witnesses, the powers to investigate, witnesses’ allowances, privileges and immunities, and contempt; all the things that are the legal status of a disciplinary tribunal.

We were concerned that there is now only one level of charge. The National Party does not believe that that is the way it should be. We do not think that there should be only one charge. That means that somebody who may be found guilty today of professional misconduct, which is a much lower charge than disgraceful conduct, will be all lumped together under one charge now. That will put extra stress upon the medical profession and the other health practitioners who come under the disciplinary tribunal. It is far better to have two or three levels of charges so people know the degree of severity, though we do have the profession being able to look at cases of fraud or sexual abuse—that sort of thing—under a separate category.

The chair of the tribunal is appointed for 3 years, and can serve no more than 9 years. I think Wendy Brandon did an extremely good job when she was chair of the tribunal. It was her view that we should have more than one charge, but that was not listened to. Changes were made to the fees that will be available. The chair and deputy chair are paid a fee at a rate fixed by majority of the chairpersons of all authorities under this bill. That was something we added. What was struck out was looking at fixed remuneration. We do not want the costs for the other professions that now come under this Act to be too high. Witnesses do get paid allowances, and we did make changes to legal and medical assessors. The words “the tribunal may from time to time appoint a legal assessor” was struck out. What we put in place was that “the tribunal may from time to time appoint a technical adviser.”

These schedules represent the unpleasant ending of a bill, which the chief executive officer of the Association of Salaried Medical Specialists described as a dog’s breakfast. These schedules, indeed, are a veritable dog’s breakfast, and how unpalatable! Here we have this whole bill—a monolith of 270 pages, including 90 pages of schedules, just to sort out the huge complexity within which this Labour Government insists on entangling the health services of New Zealand.

In looking at schedule 1, “Provisions applying to Health Practitioners Disciplinary Tribunal”, once again one has that awful déjà vu of the Minister of Health who insists, rather than having the professionals elect their own members, she wants to appoint them.

We go on to schedule 4, and I just happen to see some of the Acts that are being amended, including the Human Tissue Act. In that Act the definition of the term “medical practitioner” is being repealed. The bill goes on and talks once again about this question of competency. Yet here we have a bill where the Minister of Health has failed to define competency, which is what this bill is all about. Despite this monolith of 270 pages, the Minister of Health, once again, has failed to define one of the most elementary features of it.

What a huge pity it is that the medical profession lost confidence in the Minister of Health, Annette King! What a pity that she could not even define competence, let alone carry the medical profession of New Zealand with her in terms of what should have been a very important bill that was based on the Medical Practitioners Act! That is a good piece of legislation that was brought in by the last National Government, yet what a tragedy it is that the Minister of Health lost confidence in those who have to take the ultimate responsibility for the highly complex cases that do come into the health arena in New Zealand.

I go on to discuss the Trans-Tasman Mutual Recognition Act. I was interested to see, once again, stated in the Government’s commentary to the bill that: “The objective of the Trans-Tasman Mutual Recognition Act is to reduce regulatory barriers to the movement of goods and persons in registered occupations. ... The Act does not currently apply to medical practitioners. The Act takes precedence over this bill, as stated in clause 154. This means that health practitioners (except doctors) who are registered in Australia, must be granted registration in New Zealand when they come to work here, if they have complied with competency requirements, including cultural safety.”

Once again that phrase “cultural safety” brings up a déjà vu nightmare in my mind, when I think of that poor nurse I met the other day struggling home from Auckland Hospital where she had undergone her cultural safety day.

She bemoaned to me that she had spent several hours being talked to about the mythical fourth article of the Treaty of Waitangi. Here we are, the Minister of Health of New Zealand, wanting to impose on the poor old Aussies the New Zealand standards of cultural competence; competence that she cannot even define, let alone this concept of cultural safety, which seems in her mind to be focused on the fourth article of the Treaty of Waitangi.

We must finish at schedule 5, bemoaning, once again, what a shame it is that this bill has not received multiparty agreement, due to the failings of the Minister of Health.

The question was put that the amendment set out on Supplementary Order Paper 111 in the name of Heather Roy to omit the item relating to the Medical Council of New Zealand from schedule 2 be agreed to.

Amendment not agreed to.

The remaining amendments to schedules set out on Supplementary Order Paper 111 are out of order, in that they are inconsistent with previous decisions of the Committee.

The question was put that the amendment set out on Supplementary Order Paper 115 in the name of Pita Paraone to insert new regulation 41A in the Medicines Regulations 1984 be agreed to.

I move, That the Committee divide the bill into the Health Practitioners Competence Assurance Bill, the Health and Disability Commissioner Amendment Bill, and the Medicines Amendment Bill, pursuant to Supplementary Order Paper 105.