Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill

Thank you, Mr Chair. I appreciate that. I am rising to support the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill in this, the Committee stage. What I wanted to highlight was that, of the 28 submissions that we received, only two were opposed. They are not that surprising—well, the first one is not, because it was the Association of Salaried Medical Specialists. Their major opposition was that health practitioners should be doctors in undertaking statutory duties. In fact, that is the whole thrust, or intent, of this piece of legislation. It is to recognise scopes of practice that health practitioners who have the required competencies and knowledge should be able to perform those statutory functions.

Why did we as a select committee, or why has the Minister, proposed this legislation? Actually, it is pretty simple. It is because we want to maximise the skills and competencies of our workforce and particularly, as my colleague Jenny Salesa intimated, within a context of shortages. Those shortages have actually been highlighted by the 2015 Voluntary Bonding Scheme, where general practice has been highlighted as a shortage with general surgery, pathology, psychiatry, and rural hospital medicine. So these changes are actually very good changes because they are trying to create a fit for purpose health system that recognises such qualifications as nurse practitioners, who will be able to sign sick-leave forms, death certificates, take blood, also authorise optometrist certificates, and all those sorts of things that, currently, only doctors can undertake.

There was one other person who was opposed to this piece of legislation, and it was a person called Tamblin Davenport. It was interesting because their primary opposition was in relation to the Mental Health (Compulsory Assessment and Treatment) Act 1992. The changes that were proposed to that specific Act in this legislation, they said, would affect their civil rights. Now, obviously, there were advisers to the select committee, and we have not, as far as I know, made any amendments that specifically address this, but it was just interesting to note that that is where the opposition came from.

In terms of those who supported the submissions of the submitters were nurses and nursing organisations—Nurse Practitioners New Zealand, the Nursing Council of New Zealand, neonatal nurses, and mental health nurses; 100 percent of them support this piece of legislation. There was also good support from the pharmacy sector, from physiotherapy, and also the Public Service Association. So I think, having sat on the select committee during the beginning of this process and during the hearings from the submitters, generally most people agree that this legislation is about time. Some people have been waiting for it for a long time, but it is good to see that the Minister and the Government have introduced a piece of legislation that we can stand up and support. Really, I do not have anything more to add. Thank you.

I just want to make a further short contribution to this piece of legislation. As my colleague has indicated, it really is a sensible piece of legislation that tidies up a whole lot of aspects of the modern workforce. We know that we have had medical practitioners develop in a whole range of ways, and nurse practitioners have been with us for some time. Their ability to work across a range of skill sets has needed to be defined and then provided for within various pieces of legislation. So it is useful and appropriate that we are debating this piece of legislation, to ensure that over those significant pieces of primary legislation that nurse practitioners in particular will work across we are given the ability to define what those areas are and what those scopes of practice will be.

To be very clear, in order that a health practitioner, a nurse practitioner in particular, can work in these scopes of practice they must comply under the Health Practitioners Competence Assurance Act, and that means not only must they fulfil the requirements of training and expertise and have the appropriate training required but they also must have a current practising certificate. So their workforce development must continue to be updated and upgraded in relation to the types of work that they are going to be required to be undertaking.

It is important to realise that the scope of practice has become so broad for our doctors and our primary health providers that it has become a requirement that we have had to allow our health practitioners to work across various scopes of practice. As I mentioned before, there are some important aspects of this that relate to areas that I have worked in prior to coming to the House, in particular in the area of mental health, where the ability to prescribe medication and administer medication is one of those health and safety issues that we in the mental health area wanted to ensure that we got absolutely right. Medical misadventure due to the administration of incorrect medication, or the administration of medication that was at the wrong dose or taken at the wrong time, was one of those things that we really wanted to avoid. So ensuring that we have staff who are trained to the appropriate level and that their scope of practice is measured and reviewed, and that they have a current practising certificate, is very important.

The other area that I want to perhaps discuss and talk about is with regard to the ability to ensure that mental health assessments are conducted in a timely way. It is often very important that those people who are in the middle of a mental health episode are able to have those assessments completed so that they can get into treatment straight away. Often this is to ensure that they are not at risk of harming themselves or other members of the public, so it is important that we provide opportunities for that to happen. The scope of practice around nurse practitioners being able to do that, rather than requiring psychiatrists to do that, is very important in this regard.

We are supporting this piece of legislation. It is good. It is about time that it came to the House and we will be supporting this bill in its passage through the House.

I neglected to add, in my earlier contribution, that the Minister received some advice about this piece of legislation from Treasury. It was one of the 12 recommendations in his briefing. Just to quote from that report, Treasury said to the Minister that to “Identify and remove unnecessary barriers to workforce flexibility, starting by progressing the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill” was important, and the report also highlighted that this was a really good opportunity for the Minister to show some leadership in this area.

I neglected to say earlier that there is a huge imbalance in our country between the number of doctors we have and the number of nurses we have. We have got approximately 14,500 doctors, and we know that in 10 years’ time over 40 percent of those doctors are going to be retiring. We have 49,769 registered nurses and 2,815 enrolled nurses, and there are 145 nurse practitioners.

But what has been interesting to note is that in the nurse practitioner area, actually, it is providing a really good opportunity for Māori and Pacific nurses to take the next step in terms of qualifications. What I have seen from some of the results today is that it means that for Māori and Pacific women who have invested their time and energies into this particular sector there is an opportunity for equity. Because the nurse practitioner vocation will be able to undertake all these previously unlawful statutory functions that were in the domain of only doctors, it has actually provided a huge opportunity, and a huge business opportunity for our Māori and Pacific women, that really, I think, has not been factored into the debate as much as it could have been. I think it is going to be one of those unintended consequences. I do not think Treasury highlighted it and it certainly has not been highlighted in any of the advice that we have received from the officials.

But I think, into the future, it is a wonderful opportunity for Māori and Pacific businesswomen, and actually women per se, to pursue this nurse practitioner vocation. So I will be doing as much as I can to talk about the opportunity, and in fact I think that there should be a paper, possibly prepared for the Minister, about how we promote this opportunity across our communities. From my perspective, I think what will happen through the passage of this bill is it will just provide so many amazing opportunities, particularly for women living in rural communities.

I know that we are all really keen to progress the passage of this legislation, but I just felt I needed to add to my earlier contribution, particularly because our leader, the Hon Annette King, is not here—in terms of our Health Committee and our lead in the health area. I felt she would have wanted me to, at a minimum, put that case to the Committee in terms of our support for it. I am really excited that the public are going to have more competent health professionals from whom they can now access services, and I see this, as I said before, as an amazing opportunity for women and, actually, for women to get some parity and equity. So we will be looking, I think, very closely at how the remuneration for this particular profession progresses. It should become comparable to the salaries of doctors, and I think, again, this provides a really good scope or area for us to really scrutinise into the future. Thank you, Mr Chair.

I rise to take a short call on behalf of the Greens at the Committee stage of the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. This is my first time speaking in the House since the valedictory of my colleague Kevin Hague, who was our health spokesperson, so I would like to start my contribution by acknowledging him. He has followed this bill through Parliament up to this point, and he was a huge asset to this Parliament and somebody who, I think, was generally well respected for his knowledge of health in a community setting as well as for having been the chair of the West Coast District Health Board. He has assisted many pieces of legislation in terms of grounding them in reality, and he will be well missed, including by me.

We are supporting this bill. There are several reasons for that and some of them have been traversed already. One is, I guess, that as we have an ageing population the demands on our health system and financial demands are growing. As the technological supports around health actually also become more advanced, we have another cost pressure on our health system. So we need, as a country, to be innovative, and part of innovation is looking at where we can save money and be more efficient. At the moment it is pretty clear to most people—and I think it was the rationale behind this bill in part—that there are inefficiencies in our system, as we have doctors, on a very high pay rate, spending a lot of their time doing paperwork and signing off things that could be done by somebody on a lower pay rate who has the skill. I think that is probably a driver for this bill and it is a driver that we support.

We want our health dollar to be used as effectively as it can possibly be used. I have worked in a youth health organisation and I know that this is a very important area of health. It is one of those system-wide things whereby now that we have student loans it is actually quite difficult to get young doctors working in those services in the communities—they are needing to look for the higher paid jobs to be able to pay off their loans. Nurses traditionally play quite a significant role in our community-based services. Being able to give them additional functions, as this bill does, actually serves the delivery of services in many of our diverse communities and makes sure that they get accessible and affordable healthcare. We absolutely support that.

I remember that Kevin Hague noted that in a rural setting where we have nurse specialists, many of those nurse specialists are already fulfilling a lot of those functions, and, again, this piece of legislation aids that work and aids our rural communities. The Green Party is very happy to support this piece of legislation. It is sensible and promotes efficiency of a precious resource, where we would like to see more money going in and being able to be used for more significant health outcomes. Thank you.

I would like to talk about the new Part 5A of this bill. It actually gives a new definition to “nurse practitioner”. The new definition in amended section 2 of the Medicines Act, inserted by clause 42B, specifies that it means someone who “… is deemed to be, registered with the Nursing Council of New Zealand [under] the Health Practitioners Competence Assurance Act 2003” as a nurse “whose scope of practice permits the performance of nurse practitioner functions; and (b) holds a current practising certificate”.

I agreed with my colleague Louisa Wall when she stated earlier on that this legislation would probably allow for more innovative models and delivery of services and care, especially for Māori and Pacific providers. We look forward, particularly, to seeing how that model of care develops. This Government talks a lot about innovative care, and it does talk about new models of care, and we believe that this legislation will allow some of that to actually come through and be developed.

A lot of our health workforce works very long hours. They have to do much more with much less. We know that a survey of doctors that has come out recently—they surveyed just over 3,000 doctors—revealed just how overworked our doctors are. Many of them reported that they work 16-hour shifts, and some of them for 12 consecutive days. Nearly 300 of our doctors reported falling asleep, particularly when they drove home. Some of them say that they must actually take a nap before getting on the road.

We believe that this legislation allowing our nurse practitioners to assist should actually help out with ensuring that our doctors, especially our junior doctors, do not work such long shifts—such long hours. It is not in the interest of safety—not for our doctors and our health workforce, and most definitely not for our patients either. Our health workforce deals with life-and-death situations, and when they are overtired it affects the patients, it affects our families, and it affects us as a society. Nurses and GPs deal with much more complex issues right now, and they deal with a lot of specialist assessment that they then have to send back to their GPs.

It was a year ago that we first debated this bill in this House. We know from our health workforce, and particularly our nurses, that they have been frustrated with just how long this legislation has taken to get to this stage. Labour is very supportive of this bill, and we look forward to its passage. Thank you.

Part 1 agreed to.

Part 2 agreed to.

Part 3 agreed to.

Part 4 agreed to.

Part 5 agreed to.

Part 5A agreed to.

Part 6 agreed to.

Part 7 agreed to.

Schedule 1 agreed to.

Schedule 2 agreed to.

Clause 1 agreed to.

Clause 2 agreed to.

The Committee divided the bill into the Accident Compensation Amendment Bill (No 2), the Burial and Cremation Amendment Bill, the Children, Young Persons, and Their Families Amendment Bill (No 2), the Holidays Amendment Bill (No 2), the Land Transport Amendment Bill (No 3), the Medicines Amendment Bill, the Mental Health (Compulsory Assessment and Treatment) Amendment Bill, and the Misuse of Drugs Amendment Bill (No 2), pursuant to Supplementary Order Paper 230.

Bill to be reported without amendment presently.

Just to explain why we are having to go back into the House—when we moved into the Committee, we moved into Committee for only three Committee stages, and we have gone beyond that, so now we have to go back to be recommitted to a Committee stage. So that is the process.

House resumed.

The Chairperson reported the Education Legislation Bill with amendment, the Building (Pools) Amendment Bill with amendment, the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill without amendment, and that the Committee had divided it into eight bills.

Report adopted.