Medicines Amendment Bill

I move, That the Medicines Amendment Bill be now read a third time. This bill streamlines the current Medicines Act 1981 and is an interim measure until such time as the Therapeutic Products and Medicines Bill is passed. This legislation and the Natural Health and Supplementary Products Bill will comprehensively overhaul New Zealand’s therapeutic products regulatory system. Indeed, this bill modernises the definitions of medicine, medical devices, and therapeutic purpose. It also amends the medicines approval process to make legislation less prescriptive, and instead specifies the detail in regulations. It will amend the prescribing framework to name nurse practitioners and optometrists as authorised prescribers, and makes some minor changes to licensing requirements. The bill also adds a new prescribing category: delegated prescriber. The definitions in the bill have been developed to reflect New Zealand’s current regulatory framework and will be reviewed and updated again as part of the establishment of the Australia New Zealand Therapeutic Products Agency.

The changes that this bill proposes are consistent with this Government’s dedication to improving and enhancing access to health services and removing, in a timely fashion, unnecessary red tape while ensuring an emphasis on patient safety. The bill revokes the designated prescriber regulations for nurse practitioners and optometrists, and names them as authorised prescribers. This will align their prescribing rights with those of medical practitioners, dentists, and midwives by enabling them to prescribe all medicines appropriate to their scope of practice. This move acknowledges the safe and appropriate prescribing practice of these groups over the past 7 years, and will support timely access to care for New Zealanders. The bill also creates a new category of prescriber, the delegated prescriber, who will be allowed to prescribe under a delegated prescribing order issued by an authorised prescriber. This bill also enables a licensing authority to take into account previous convictions when considering an applicant’s fitness to hold a licence and to impose conditions either when issuing a licence or at any other time while the licence is in effect.

The default commencement date for the definition, prescribing, and other minor technical provisions will be 1 July 2014. The bill removes provisions in the Medicines Act that deal with medicines approvals and will replace these with a regulation-making power. The default commencement date for the medicines approvals provisions is set at 1 July 2017. This anticipates that the medicines approvals process provisions in the bill are likely to be superseded by the establishment of the Australia New Zealand Therapeutic Products Agency, but provides a backstop should the implementation of the agency be delayed. This bill provides an opportunity to amend some specific provisions of the Medicines Act in advance of the comprehensive overhaul of the therapeutics legislation that will occur via the Therapeutic Products and Medicines Bill. This is timely legislation and a big priority for this Government. I commend it to the House.

Labour will support this bill, the Medicines Amendment Bill. It is an interim measure, it is a sticking plaster, it is a patchover until the Government progresses the Australia New Zealand Therapeutic Products Agency, which was to be set up under a treaty that was signed between Australia and New Zealand in 2003. So it is not a comprehensive overhaul of the Medicines Act, but a couple of little measures to progress it along the way after being delayed by political posturing for almost 7 years. Why was there a need, in fact, to even look at a joint agency? I did mention some of this in the Committee stage. We needed to resolve a special exemption for therapeutic goods under the Trans-Tasman Mutual Recognition Arrangement in a manner that facilitated trans-Tasman trade and to enhance Closer Economic Relations (CER) between Australia and New Zealand. You see, it was one part of CER that had not been resolved in the late 1990s, and the New Zealand system and the Australian system for regulating therapeutic goods were so different that it necessitated a special exemption. That special exemption was given in 1997-98.

We were then required to work on getting rid of this exemption, and we could have done it in three ways. It could have been a mutual recognition, a permanent exemption, or a harmonisation of regulation. It was decided by the then National Government in 1999, when the New Zealand and Australian health Ministers agreed that they would go down the harmonisation track for regulatory requirements for therapeutic goods as the best option under the Trans-Tasman Mutual Recognition Arrangement. So the then Minister of Health, Wyatt Creech, started the process towards having a joint agency between Australia and New Zealand. That was when the National Party had members of Parliament who were sensible and who were prepared to look at the trade issues and the health issues and to progress them in a sensible manner. But, unfortunately, when there was a change of Government and a change of spokespeople, the bill became nothing more than a political plaything for the then National spokesperson on health, who is now the Minister of Health. And play with it he did, to the extent that he was able to delay the passage of any part of this bill until today, under urgency.

Maryan Street set out a very good record of what happened when she was a new member of Parliament coming into the Health Committee, with Tony Ryall there as the Opposition spokesperson, and watching how National had gone from supporting an agency in Government to opposing it when in Opposition. The irony of this—and I am sure members who were on that committee will understand the irony—is that the bill on the Order Paper that will set up this agency, the very bill, was in my name in 2007. Not one word of it has been changed. The very thing National members railed against, which they went out on the street and argued against—and said that it was evil, it was bad, and it could not be done—is the bill that is No. 47 on the Order Paper. My name was taken off and Mr Ryall’s was put on. Well, what an irony that is. It must be one of the biggest U-turns and pieces of political cant that I have ever—

💬 Hon Trevor Mallard: An S-turn.

It is an S-turn—an S-turn. Well, it is; I think that is right.

💬 Hon Trevor Mallard: Two U-turns.

Yes, it was an S-turn, and it very much suits this particular Minister.

You see, the shame of this is that many of the good things that are in this bill could have been done all of those years ago. I agree with my colleague Iain Lees-Galloway that we have got some wonderful health professionals in New Zealand. With the changes made to prescribing in this bill, these health professionals could be out there providing enhanced services—particularly in rural and provincial New Zealand, and in specialised areas of health—but they have been held up because it was not important enough to pass. But under urgency today we now need to pass it in a hurry. It makes a nonsense of this Government’s legislative timetable, but it makes an even bigger nonsense of its hapless Minister of Health, who, for purely political reasons, held up this joint agency.

I will be interested to see whether the Hon Christopher Pyne, who is now the Leader of the House in Australia, and the Australian Prime Minister, Tony Abbott, who gave so many concessions to New Zealand to ensure that we had a fair deal, will be prepared to sit round the table and give those concessions back to us again. They are going to say: “Hey, can we be sure that you will do it this time?”. I think that they will be very reluctant to go down this track unless there is some assurance. The assurance that we can give the Government is that we will not be playing politics with the joint agency. We will be looking at the greater good for New Zealand. That is what this Government ought to do. All I can say is, shame on Tony Ryall. This delay is his delay.

This Medicines Amendment Bill is a good bill. It is largely technical in nature and it is one that we are happy to support at its third reading. But, like the Hon Annette King, I want to provide a little bit of context, as is appropriate at the third reading. As Iain Lees-Galloway described in the Committee stage, the progress of this bill has been extraordinary, and also chaotic. Certainly, this morning I had to refresh my memory on much of the content of the bill because it has been so long since we last debated it in the House, and to now be progressing it through all of its remaining stages under urgency is a little extraordinary. One of the things that I noticed was the commencement date, and the change to the commencement date made by the Health Committee, which has turned out to be fortuitous. If we had not done that, the bill was due to have commenced in July of this year. At the time the select committee was considering it, we had no idea that it would take the Government this long, in fact, to come to finalise the bill.

It is hard to know whether that chaotic nature is a reflection of Minister Ryall’s political lens, as Maryan Street has described it in the House. He is a Minister whose first instinct is to ask: “Does this win my party votes, or does it lose my party votes?”. He is not a Minister who asks: “Is this measure good for New Zealanders’ health or bad for New Zealanders’ health?”. I think that is a sad thing, but we do not know whether the chaotic nature of this bill is a reflection of that or of a more general incompetence, either in the health portfolio specifically or around the Government’s management of its House programme more generally.

Part of the context for this bill that I want to talk about is the workforce. Minister Ryall has, for example, trumpeted an increased number of doctors, an increased number of nurses, both of which have been shown to be outlandish claims that are not supported by the evidence. For example, when asked about increased specialist numbers, he included in his new doctor numbers a very large number of junior doctors who are not, in fact, specialists. His increased nurse numbers include a very large number of nurses who previously worked in our hospitals under contracts and are now employees, so do not reflect any increased nursing capacity. It is a certain disingenuous use of data. Neither of those numbers reflects the maldistribution of those health professionals.

Why this is important is that New Zealand is going to be facing—and, indeed, already is facing—a massively increased burden of disease, particularly associated with chronic conditions. I have used diabetes in this House on a number of occasions as an example of an area where New Zealand is already facing this massively increased burden. If New Zealanders today require renal services they will be lucky to receive them. They will be lucky to receive them because those services are already being overwhelmed by the burden of disease associated with diabetes. That burden of disease is due to increase even more rapidly both because of the ageing New Zealand population but also because of the burgeoning incidence of type 2 diabetes. It is burgeoning to the extent that it seems likely, based on the PricewaterhouseCoopers projections and based on the work done by the University of Otago researchers on the current prevalence of type 2 diabetes and pre-diabetes, that in just 8 short years—by 2021—New Zealand will have moved from spending around half a billion dollars currently to spending around $2 billion each year on type 2 diabetes treatment alone. That is a massive increase in the burden of disease that our health services will face. It is an increase that we are ill-equipped currently to bear, and this Government is doing precious little about preparing us for that impact. In fact, in the face of that impact, this Government and this Minister of Health, Tony Ryall, have actually slashed spending on preventing type 2 diabetes, which is a massive, massive problem.

Against that extremely worrying picture, the one bright light that I can pick from the Government’s performance is, in fact, this bill, because clearly one of the things that New Zealand will need to do in the face of this impact from chronic conditions is to use our health workforce more intelligently and more flexibly. That will mean health professionals doing things that they are competent to do and that lie within their expertise, but which they are not currently doing. Part of the recipe for reaching that point is to change the regulatory framework that may be preventing them from working to the full scope of their expertise. That is one of the things that this bill does accomplish. It will see a wider range of health professionals being able to prescribe and actually use a greater part of their expertise to the advantage of New Zealanders’ health. I already see it in the rural area that I come from, the desperate need—and I spoke earlier in this contribution about the maldistribution of health professionals around the country—to be doing that in order to provide for the needs of rural New Zealanders. But that need in rural New Zealand is effectively the thin end of the wedge. What we are experiencing in rural areas will be experienced right through the country as a result of this burgeoning chronic disease burden. A bill like this, which enables that stretched New Zealand workforce to work to the extent of its capacity, is a welcome contribution and the Green Party will vote for it.

It is my pleasure to take a call on behalf of New Zealand First on the Medicines Amendment Bill. New Zealand First supports this bill. This is a bill, as others have said, that has languished—

I am sorry to interrupt the honourable member. The time has come for the luncheon break.

Debate interrupted.

Sitting suspended from 1 p.m. to 2 p.m.