Medicines Amendment Bill

You can see that I am very eager to speak on the Medicines Amendment Bill, because I have looked forward to this day for 6 years. For 6 years I have looked forward to it. In fact, for 14 years this bill has been in the making. In fact, this bill makes a few changes to the Medicines Act 1981. It is an interim measure, after 14 years. It is a bit of a sticking plaster, a bit of a patch up, until the Government progresses the Australia New Zealand Therapeutic Products Agency under a treaty that was signed between Australia and New Zealand in 2003. So this is not a comprehensive overhaul of the Act; it is an interim measure.

The irony of this is that National, after years of political posturing and shilly-shallying in Opposition, led by Tony Ryall, opposing a joint agency, finally decided in 2011 that it now supports it. That must be the biggest backflip that we have seen on a piece of policy in this House. The Prime Minister agreed in 2011 that National, which was once opposed to a joint agency, would now proceed with the establishment of the Australia New Zealand Therapeutic Products Agency.

The legislation that will bring this agency to life sits on the Order Paper of this House—No. 47, if you want to have a wee look. It is the very legislation that I introduced in 2007, and is unchanged after all the political posturing. Now it is in the name of the Minister of Health, Tony Ryall. I have to say that after 9 years of National being in Opposition, with the most objectionable, obnoxious, and malicious fabrications—full of cant—about a joint agency, we now have a National Government in support of it. In fact, Mr Hayes probably knows quite a lot about it, because it was very much part of a trade deal we did with Australia under the CER and the Trans-Pacific Partnership and he is probably well aware of the negotiations that took place. But for purely political reasons, the National Party opposed the joint agency.

This bill takes out some of the changes that were going to be made, a very narrow range of changes, for an interim measure until the joint agency is set up. I look forward to that day because, as the former Minister of Health who took the heat on that bill and listened to so much rubbish over months and months—in fact, years—I am delighted that National finally saw the light. I have to give credit to the Prime Minister, because there is no way that Tony Ryall would have seen the light.

You see, a regulatory impact statement undertaken by the New Zealand Institute of Economic Research right back in October 2000—13 years ago—confirmed that the Medicines Act 1981, the Medicines Regulations 1984, and the Dietary Supplements Regulations 1985 were outdated and gave rise to significant “safety risks, trade barriers, and costs to Crown and industry.” It proposed in 2000 that the changes to be put in place should be around putting in place regulations to make change and putting in place international best practice.

Well, this bill, which we are now finally debating, modernises the definition of medicine, medical devices, and therapeutic products. We welcome that because it made up part of the negotiations for the joint agency all those years ago. The second thing it does is it changes the approval process for medicines and medical devices by the use of regulations to specify detail. We support that because it made up part of the changes that would have come in with the joint agency all those years ago.

The third part of this bill amends the prescribing framework. We will have three types of prescribers. Authorised prescribers are the ones whom most people are familiar with. They are doctors, dentists, and midwives, and they prescribe within a scope of practice that has been defined for them. Then we have designated prescribers, and they are a restricted subgroup of authorised prescribers. Currently they are optometrists and nurse practitioners. They have already got prescribing rights, and there are some specialised nurses who are also designated prescribers. They are allowed to prescribe only medicines that are on a list, and these are listed in regulations. This bill revokes designated prescriber regulations for nurse practitioners and for optometrists, and now names them as authorised prescribers. So they now join the doctors, the dentists, and the midwives. It aligns them, and now they too will prescribe in line with their scope of practice. They have shown for 7 years that they are totally capable of doing that, so it has taken rather a long time.

The new category of prescriber is the delegated prescriber. This new category is going to enable people to prescribe, under a delegation, an order by an authorised prescriber. That is a doctor or a dentist or a midwife, and in this case it would be a nurse practitioner or an optometrist. In fact, the requirements will be at a lower level, so they will have limited prescribing. But we believe that the changes will enhance the health workforce and also the ability to provide appropriate care within the community. We support all those changes in this bill. The reason why is that they were a Labour Government proposal. It is only 5 years later that, in fact, we are now looking to pass them into law. So we certainly support those changes in this bill.

But because this is being taken as one debate, I have to emphasise again that we should have learnt a lesson about playing political games with major policy that affects the health of New Zealand, our trade obligations, and the economic viability of many businesses in this country. For purely political reasons the joint agency with Australia was held up predominantly by the then Opposition spokesperson on health, Tony Ryall, for no other reason than political purposes. Now, all these years later, having opposed it, National is going to pass the very bill that I introduced. The Prime Minister said that National now supports the joint agency. Can we not learn that there are some things that are for the good of this country and are supported across Parliament, instead of the sorts of stupid political games that were played with this particular policy?

So now, in an interim way, we will make a few changes, a little bit of a sticking plaster, until the agency is in place. I will celebrate that day, as I am sure will the Hon Christopher Pyne, who is now the Leader of the House of Representatives in the Australian Parliament, and Tony Abbott, who was the Minister for Health and Ageing who helped negotiate it—now the Prime Minister of Australia—and who gave so many concessions to New Zealand to ensure that we have an agency that is fair, that is equal, and that enables us to act in a joint way and finally complete the negotiations with the one part that was missing under CER.

Yes, we will support this bill, but the bigger picture needs to be the passage of the Therapeutic Products and Medicines Bill, sitting on the Order Paper with the date on it saying it was introduced in 2007.

As my colleague Annette King outlined, the Medicines Amendment Bill is an excellent bill. It is a very good bill that not only streamlines our prescribing processes and streamlines the way in which we approve medicines and medical devices but also improves access to health care, particularly primary health care. It will improve people’s access to medicines. It will make it an awful lot easier for many people, particularly people with chronic conditions, to be able to access the medicines they require, which is clearly the reason why the National Party has held it up for so long. That must be it. It is such a good piece of legislation, which improves access to health care. That must be why the National Party has held it up for so very, very long.

Here is a little bit of history for those who are watching at home. The National Party has actually known all along that this is a good piece of legislation. It knows that this is the right thing to do, but back in 2007 the National Party—and, in particular, Tony Ryall—saw a political opportunity. People may or may not remember a gentleman by the name of Gordon Copeland. Gordon Copeland was elected to this Parliament as a member of the United Future party. He decided to leave the United Future party, despite being a list MP whose only mandate to be here was the fact that United Future had gained a certain number of party votes and that its leader had managed to win an electorate seat. So Gordon Copeland was here as a United Future member, he decided to leave, and he made it his life’s work to oppose the Labour Government on absolutely anything he could—

💬 Hon Ruth Dyson: When he remembered to vote.

—when he remembered to vote. He did remember to vote against this legislation, which improves access to medicines in primary health care. The National Party members thought to themselves: “Aha! With his vote opposing the Government, if we decide to oppose this, we can actually stop the Labour Government achieving something that is enormously positive for the people of New Zealand.” So, rather than doing the right thing, rather than having the interests of New Zealanders at heart, and rather than doing something that would improve the health of every New Zealander, the National Party chose to play politics and it blocked the Labour Government from passing this legislation.

That was bad enough, frankly, but when National got into Government, the election was done, and the little political power play had had the effect it was looking for—it was just one of the things that led up to the 2008 election. National was now the Government, it had the opportunity to act, and it had the mandate to act. This bill, the Medicines Amendment Bill—which, of course, is exactly the same legislation that Annette King introduced, but it got rearranged slightly and reintroduced in the name of the Hon Peter Dunne—was introduced on 13 October 2011. So it took this Government almost an entire term of Parliament to introduce the legislation. It then got its first reading after the 2011 election in February 2012, it came back from the Health Committee in August 2012, and it finally got its second reading in March this year.

So here we are, in November—

💬 Hon Annette King: Under urgency.

—under urgency, and suddenly this piece of legislation has become tremendously important to the Government. It is so urgent that it has taken the Government only 5 long years to get to this point. And now it is suddenly so urgent to—

💬 John Hayes: Remember the 9 long years.

—pass it through its Committee stage to get to here. John Hayes just tried the “9 long years” line—John Hayes just tried the “9 long years” line. We could have had this done when Labour was in Government, but your party, Mr Hayes, blocked it. Your party stopped it happening. It played politics over it. That is what it did, Mr Hayes. It put the health and well-being of New Zealanders to one side to play politics. You should be careful with your interjections, Mr Hayes.

On this side of the Chamber we wholeheartedly support this legislation. We think it is a great pity that it has taken so long to pass this legislation. It has actually outlasted the Hon Peter Dunne. That is saying something quite significant—that it has managed to outlast the Hon Peter Dunne. But this is good legislation. Annette King has covered the fact that it is the interim phase, before we get to the joint regulator. But, frankly, I am more interested in the prescribing rights—the fact that this bill widens and deepens prescribing rights for many health practitioners. I am particularly interested in that because of the fact that so many people do not have adequate access to primary health care. General practitioners are tremendously important. They will always be an incredibly important component of primary health care, but we simply cannot provide the primary health services that we are going to need in the future if we totally rely on general practitioners to be the sole bastion of all prescribing rights.

We do need to move towards more nurse-led clinics. We need to give nurse practitioners—

💬 Sue Moroney: Paul’s fainting.

—more opportunities. I am looking forward to Dr Paul Hutchison’s contribution on this legislation. We do need to make greater use of our highly qualified, highly educated nursing workforce and, in particular, the nurse practitioner workforce. That is the only way we are going to provide the primary health care services that New Zealand is going to need, and, in particular, that is how we are going to reach into those most deprived communities that simply do not have the primary health facilities that they need.

Dr Hutchison will have heard me talk about this at the Health Committee recently. If you map the location of primary health care services against the deprivation index, you get an almost perfect correlation. The most affluent parts of any community have an over-abundance of general practitioners, and the least affluent—

💬 Hon Ruth Dyson: Do people get more sick in those communities?

I am not sure that people get more sick. Maybe money makes you sick—I do not know. But people in the most affluent areas have an over-abundance of general practitioners, and the people in the least affluent areas have minimal, or sometimes non-existent, services. It is those people who need primary health care services the most, and who often have the most challenges in terms of access. I am thinking about things like transport and the affordability of going to your doctor. So that is why we need to pass legislation like this, and do many other things to free up our health workforce to be able to provide the level of care that New Zealanders demand.

It is an absolute tragedy that this bill is the thing National chose to play politics over. This is the kind of legislation that sits on the back-burner for 5 long years, and then finally gets passed as part of an urgency motion, early on a Thursday morning. I think that speaks volumes about where this Government’s priorities lie. I think it speaks volumes about this Government’s priorities. I know that had Dr Paul Hutchison been the Minister of Health under this National Government, this bill would have been a priority. He would have progressed it much sooner than now. There is a gentleman who will be missed from this Parliament, because he brought some sanity to the health policy of National.

It gives me great pleasure, in fact a deal of satisfaction, to rise to speak to the Medicines Amendment Bill. I had the privilege of being on the Health Committee under the chairmanship of Dr Paul Hutchison when it was debated and reported back in August of 2012, prior to that I was also on the Health Committee in 2005, when this bill was first debated and when it first came into the House. So I have lived with this piece of legislation, albeit on the back-burner, as my colleague has said, for a very long time. Tony Ryall was the Opposition spokesperson on health. We worked on the Health Committee together—or not, as the case may be, but we happened to be on the Health Committee together—and I remember the parade of red umbrellas. It was the red umbrella protest. I am sorry if there are members opposite who have come into this House subsequent to the 2005 election and do not know of that performance, and now have to sit here, listening, while the Labour Opposition rightly sheets home to the National Party the blame for the delay in this legislation. If it is embarrassing for them, so it should be—so it should be—because this bill was in front of the Health Committee in my first term in Parliament, from 2005 onwards.

The Hon Tony Ryall saw fit to side with a set of protesters whose arguments ranged from the patently ludicrous to the quite sensible and worthy of debate, but who gathered together because of a range of measures. They saw this opportunity for a political score against the Labour Government at the time. So instead of looking to see whether the bill was going to benefit the health and welfare of New Zealanders, Tony Ryall saw fit to do what only Tony Ryall does best—that is, calculate the political benefits and ups and downs. I have to say that I consider that to be the way the Minister continues to operate the health portfolio now—that is, with half a dozen measurable outputs into which everything has to be squeezed so that he can sing his sunny song constantly about how well health is progressing. Any other stories—the true ones—about people who cannot get on to waiting lists to get operations or whose blood glucose meters are seriously jeopardising their health do not make it into Tony Ryall’s narrative. They do not make it because he is only here for politics; he is not here for people.

This is a historic reminder that that is this Minister’s modus operandi. He will look to the politics before he looks to the content. We had this ludicrous situation with two new members on the Health Committee—one a former general practitioner, Dr Jonathan Coleman, and one a former breast physician, Dr Jackie Blue—who were compelled by Tony Ryall to oppose this, even though they knew it offended every professional ethic that they had. Jonathan Coleman had no trouble sacrificing his professional ethics, but Jackie Blue did have trouble sacrificing her personal ethics. However, that is history now. But let us not forget it. For those members opposite who do not know that history, it is important that they do understand it, because it is part of the progress, or lack thereof, of this bill.

This Medicines Amendment Bill modernises the Medicines Act. It is only a temporary measure until the Australia New Zealand Therapeutic Products Agency is set in place. When that is set in place, it will overtake the provisions of this bill. However, the purpose of the provisions of this bill was to actually expand the ability of health practitioners to be able to prescribe, so that one did not have to go to a doctor all the time; one could go to a designated prescriber who came under the jurisdiction, the oversight, and the supervision of an authorised prescriber.

I am not going to take up any more time over this. We support this bill because we invented it and because it is good for New Zealanders.

The question was put that the following amendment in the name of the Hon Todd McClay to the proposed amendment set out on Supplementary Order Paper 270 in his name to insert new clause 37A be agreed to:

delete subclause (1).

Amendment to the amendment agreed to.

The question was put that the amendment set out on Supplementary Order Paper 270 in the name of the Hon Todd McClay to insert new clause 37A be agreed to.

Amendment as amended agreed to.

Part 1 as amended, Part 2, schedule, and clauses 1 to 3 agreed to.

Bill reported with amendment.

Report adopted.

Third Reading