Third Readings

I rise to take a short call on the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill—or the bills that it has been split into. The Green Party has supported this bill from the beginning. We had some questions during the Health Committee process, but all of those were resolved satisfactorily.

The main purpose of the bills is changing “medical practitioners” to “health practitioners” in a range of legislation so that it provides greater flexibility and, potentially, allows us to use our health resources more efficiently, because it enables health practitioners other than medical practitioners—that is medical doctors—to be responsible for a variety of things that they are qualified to do. I think it is quite practical. It recognises the skills of people like nurse practitioners and physicians’ assistants, as well as other types of practitioners who are able to deliver critical health services and who should be recognised as such.

I believe the bills have unanimous support within the House. This has not been a particularly controversial change, and, as I said, the select committee process was robust and we congratulate the officials who helped us navigate our way through the bills.

I guess there are two concerns that I have—one was raised by my colleague the Hon Annette King earlier in this debate, which is that this change has been mooted as something that will save vast amounts of money because it will enable physicians’ assistants, nurse practitioners, nurses, and other health practitioners who are not medical doctors to undertake a range of actions and responsibilities, and since, generally, they are paid less than medical doctors that, therefore, it will cost the health system less. That may well be true and that may be appropriate in some cases, but any additional responsibilities that health practitioners are undertaking should also be reflected in the pay of those health practitioners. So it is not just that we are going to get things cheaper; we actually need to reflect the skills and responsibilities of those health practitioners who will be undertaking additional responsibilities.

That brings me to my second concern, which is that our health system is increasingly stretched and under financial pressure. We have had 8 years of a National Government that has prioritised tax cuts over investment in the health of our society. The fact that we have had rapid population growth and we have not had a matching increase to health funding is becoming more and more obvious as people working in the health sector, across all areas in the health sector, are increasingly overworked and find themselves stretched for resources.

This is particularly true in the area of mental health, where in some parts of New Zealand the mental health system is stretched to breaking point. We have severe problems with staff morale because of the ways in which they are overworked. People are not able to receive the help that they need in time when they reach out, and that is why we have not made any improvement to the tragic levels of suicide in this country, which have stayed at the same elevated level because there simply has not been the investment in the mental health services that they need. Young people all around the country are having to wait as long as 8 weeks for a follow-up mental health appointment, and that is simply too long when people are experiencing significant issues and pressure.

So, I guess, although the Green Party supports this legislation, and although it is a practical endeavour to use our resources more efficiently, we also simply need to resource the health system better and we need to focus more on prevention and the areas in which Government can get better health outcomes outside of the health portfolio—you know, by reducing inequality; by alleviating child poverty; by investing in smarter transport; having warmer, drier housing; and having more affordable housing. There is a whole range of ways in which the Government can influence the health of a society, and I simply think the National Government is failing to do that. It is failing to invest properly in the health system.

Our own health Minister has admitted to the media, in an article to the Listener, that the health system is stretched, and it will continue to be stretched as long as we continue to experience this high population growth, because this Government has no intention of increasing the amount of funding for medical services and the health system. Instead, it is talking about tax cuts. Well, that is a very short-term approach, and I think it is very indicative overall of the ideology of this National Government, which is a very short-term approach to managing the politics day to day, trying to give tax cuts where it can rather than investing in the long-term health of our society, which I think is what most New Zealanders would like to see.

Most New Zealanders want to live in society where we are looking after our environment and we are looking after our people, where we do not have this tragically high suicide rate, and where we do not have people struggling to receive the health services that they need. Fundamentally, it will require a paradigm shift and a completely different approach—one that puts people and the environment first before the profits of large corporations and before the interests of the highest-income earners and the wealthiest people in this society.

Thank you, Mr Deputy Speaker.

💬 David Bennett: Barbs, you missed on a question; now you’ve got a speech.

I am definitely speaking on this. I rise on behalf of New Zealand First to speak on the third reading of the legislation arising from the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. As others have said, this was a massive bill divided into eight separate bills, and, basically, the purpose is to increase the range of statutory functions that can be performed by health practitioners, who previously have only been referred to as medical practitioners. So, in this legislation, references to medical practitioners will be changed to references to health practitioners.

We are happy to support this legislation in their third and final readings, and we are very pleased to see the legislation reach this point. It has been a long time actually getting to this point in the Parliament. We would like to reassure the public that this legislation is not about short-changing those people who want to visit the doctor by visiting someone who is not qualified to carry out the task. These nurse practitioners are very capable, they are trained, and they have got the skills and expertise to carry out these particular jobs. It is more than just relieving doctors of time-consuming paperwork. We want to ensure that, basically, those practitioners who have got the skills and the expertise can actually use those skills and that expertise for the betterment of the New Zealand public and New Zealand patients.

This legislation is needed—very much needed. We do need to change with the times, and we know that if we are to have a health system that responds to New Zealand’s healthcare needs, it does need to change. Many of the changes just remove bureaucratic barriers to providing care, such as the current situation of a doctor needing to sign off an assessment carried out by health practitioners. As we have heard many members of this House mention on previous occasions, this can be particularly burdensome in rural areas where doctors are scarce.

We are very concerned as to why paramedics are allowed to continue unregulated. We believe that paramedics provide a brilliant service to New Zealanders, carrying out advanced medical care in very trying conditions—often on the side of the road—yet there are no regulations to cover this. Their role in patient care needs to be recognised. So they need to become registered medical practitioners. New Zealand First will continue to advocate for the registration of paramedics as professionals in their own right. We see this as an urgent priority, and we are disappointed that at this point in time they are not included in this legislation, yet we hoped that they would be.

We know on this side of the House that we have got a looming workforce crisis, and we hope that this legislation will actually ease some of the pressure. Forty-four percent of GPs intend to leave the profession in the next 10 years, with the number increasing since the previous year. In 2015 Health Workforce New Zealand reported that there were 52,729 registered nurses and 14,678 doctors. So this legislation is very important to enable nurses to carry out further duties. And, of course, we are all very aware that there is a shortage of doctors in rural areas. As was mentioned by the Green Party and Labour, nurse practitioners do need to be paid more for their skills and so this is an area that we will be following very, very closely.

We know too that our medical workforce is ageing. Health Workforce New Zealand reported that, as of 2015, 40.1 percent of doctors were aged 50 or over—up from 35.3 percent 6 years previously. The situation, unfortunately, is very similar for nurses: 45.2 percent of nurses were aged over 50—up from 40 percent in 2009. So it is very clear to us that we do need to develop a more flexible and adaptable workforce. We have got a workforce in crisis. We all witnessed the junior doctors’ strike recently, and that is just one example of this.

I would like to conclude by saying that although this legislation may ease a certain amount of pressure on our workforce, which is one of its intended goals, it will not solve the issue of an underfunded health system. Also, it will not have an impact on the concerns that we have in regard to the capacity of the workforce—now and in the future—to solve the needs of an increasingly ageing population. And, of course, we have got the chronic conditions that are part of the health scene these days, with obesity and diabetes. We have got high rates of immigration, and we have got a crisis just waiting to happen, unless something is changed.

In New Zealand First we are very pleased to support this legislation, and we look forward to its passing into law. We know that it will be of great benefit to Kiwis. Thank you.

It is good to get to this final reading of the legislation arising from the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. If I think about the health needs of my large, diverse constituency, it is becoming very apparent that the way we deliver health services in New Zealand needs to rapidly change and is rapidly changing.

If we are not to leave smaller, rural communities behind in terms of healthcare, then we do need to change the way that health is delivered. At the same time, the scope of practice of many medical staff—whether they are doctors, nurses, or other clinicians—is widening and strengthening. So those factors are now coming together in the provisions around this legislation, which is a cognate bill to deal with eight different pieces of law.

We have had a number of readings for this, so I do not propose to go into those eight pieces of legislation, but in amending these eight statutes we do enable a wider range of suitably qualified health practitioners—and I will pause just there to also say that those practitioners will be suitably qualified. This legislation will not pose an increased risk of harm to the public with the scope of practice widening, because those scopes of practice are set with the relevant responsible authority, and the professional accountability of each of those practitioners is to the responsible authority, which is established under the Health Practitioners Competence Assurance Act. So it is good news that the scope of practice is being strengthened and broadened, but we do have that assurance that there will be no increased risk of harm to the public.

I was delivering a lecture to some final-year nursing students in Christchurch a little while ago, and I was excited to see how much they are looking forward to this new environment upon the passage of this legislation, and also the other provisions and the focus on health and primary care that this Government has brought to health in New Zealand. There was excitement from those students to move into employment with those increased responsibilities, but increased opportunities. So it benefits patients in all corners of New Zealand and benefits health practitioners.

With those words, I commend the legislation to the House.

I call Jan Logie—5-minute call.

It is with pleasure that I take a short call for the Green Party on this legislation, which was previously one bill but has now been divided into eight bills addressing the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill.

Firstly, I just want to acknowledge how important issues of health are to New Zealanders. It is kind of a no-brainer, really, that our health impacts on every single part of our lives and is a foundation for our ability to participate and live fully. We also need to recognise the changing circumstances around the health needs across the country. In New Zealand we have an ageing population, which of itself increases demands on our health system. We have, as has already been mentioned, an ageing health workforce, which we need to be very aware of in planning to prevent that impacting negatively on our systems.

We have had significant advances in health technology, which has put a cost pressure on our health system, and we have a growing pressure on our health system from diseases that have been created as a result of poverty, of our sick homes that are putting people into hospital, and of the obesogenic environments that we all live in. These are very, very significant pressures that should be addressed at the point to prevent people needing to be pushed into our healthcare system. But some of these things, obviously, we cannot prevent. We cannot prevent ourselves ageing, as much as I would like to some days. We know that we need to be thinking really creatively and be forward thinking about our health system.

This legislation is actually catching up, I would say, with some of the changes that have already been made within our health system. I will take nurse practitioners as an example. Since the 2000s registered nurses have been able to become nurse practitioners, which means that they need to be registered with the Nursing Council, that they need to have had a minimum of 4 years’ experience in a specific area of practice, and that they need to have completed a clinically focused Master’s degree on top of their degree to become a registered nurse. With all of that training, those nurses have not been able to do some pretty basic functions. So this legislation is helping us catch up to enable them to do what they are trained to do, which really does make sense in our system.

I think it is useful to have a bit of a feminist analysis around this, because it has been a battle for this women-dominated profession to be able to have recognition for their skills and be able to work at their level of competence. The competency of nurses has always been undervalued in our health system, and I think it is really good that we are, in some way, catching up. But, as has also already been mentioned, this cannot be done to say that they can do the work that would otherwise cost the system more when being done by a doctor for less money because they are nurses. That would be unjust, and that would feed into more of an equal pay problem—our pay equity issue, which we already have. So we need to be resolving those issues, and we do hope that the Government is not going to exacerbate them in its actions following the passing of this legislation.

I would also, again, like to particularly note the importance of this in terms of rural health and specialist health areas, where there are practitioners currently operating under the guidance of a GP who will often come in on particular days when they are available to travel around to sign off, and they will spend so much of their time signing things off when, actually, the practitioners had the competence and supervision to be able to make the decisions in the first place. We are wasting their time—their precious time—signing things off when they could be face-to-face with people doing what is specific to their role.

So, in conclusion, the Green Party is very happy to join with all the other parties in this House in supporting this legislation.

I too am delighted to join other members of the House in supporting this legislation, but, before I make my contribution on that, can I say that today there is huge celebration in the suburb of Redcliffs in Christchurch because the Minister of Education has finally made the decision to allow our school to come back to our community. It was a well-deserved victory for the Redcliffs community. Thank you for that indulgence, Mr Deputy Speaker, and now I will speak directly to the legislation.

We certainly support this legislation from a Labour perspective. It has taken a long time for the Government to get around to it. I cannot imagine why the Minister of Health was not able to put a bit of time and energy into this earlier, but it is here now, we are up to the third readings, and I am keen for it to progress. As my colleague Jan Logie said—there are two points I want to pick up that she mentioned.

The first is that this is about the law catching up with the training and qualifications of nurse practitioners, in particular. They are trained to be able do all sorts of things that the law does not allow them to do, and that is just a nonsense, particularly with the challenges that face us with the number of GPs who have indicated they will be retiring over the next little while, and our increasing population, and an increasing percentage of that population being older and potentially needing more access to health services. So we are just making the law catch up with the reality, the qualifications, and the training.

Jan Logie also mentioned that this legislation does nothing to address the causes of illness. That is something that not just the Minister of Health but all the Ministers in the current Government have neglected, and it is foolish. It is foolish from a social point of view and it is foolish from a financial point of view. It costs our country more because we have sick people whose illnesses could be prevented if the Government put on a smart, longer-term thinking cap instead of the poll-driven, short-term thinking under which it currently operates. So many people could be better off in terms of their well-being, and the country’s finances would be better off if we had a health-promotion, disease-prevention strategy, which we do not have.

This legislation also recognises a societal undervaluing of nurses. I remember when Annette King was Minister of Health, and she got a huge amount of money in the Budget so that she was able to give the nurses the pay jolt that they deserved. That actually largely addressed the pay gap, the pay inequity, between a female-dominated occupation—nurses—and comparable male-dominated occupations. Since the end of 2008 with the change of Government and the leadership—so-called—of the National Government, nurses have just reverted to being undervalued, not by society, but by the Government. So their pay, every year, has slipped behind, as has the pay and working conditions of junior doctors.

So although we support this legislation, and it is a good move forward, it does not go anywhere near addressing the issues in the health sector. We have had two Ministers of Health who have really paid lip service to their job. They have tried to get a lot of photo opportunities cutting ribbons or opening a new integrated family health centre or a new ward somewhere, but have never addressed the primary issues in our health system. I hope, now this bill is going to be passed this afternoon, that the Government turns its attention to dealing with the serious health issues that still face us. We are now $1.7 billion underfunded in the health system—$1.7 billion has been taken out of the health budget in the last 8 years. Mr Simpson, I am on a 5-minute call, so just relax. It is all right. Even though the clock is on a 10-minute call, I am taking the other half of the Green Party’s 10-minute call. That is $1.7 billion that should have been in the health system if the National-led Government had kept up with health inflation pressures and population growth.

In every single part of the country, we can feel that pressure growing. I certainly know in Canterbury, where we have additional health needs because of the mental health concerns and our increased population with people coming from overseas and from around the country to help with the rebuild, we have fallen further behind than even other district health boards. Despite that, I commend the progress of this legislation. It is good legislation. It is not enough, but at least it is something.

I would like to join with others in supporting this legislation in their third readings. I had the privilege and pleasure of sitting on the Health Committee as we considered the original bill, and it is a very good, practical piece of legislation, which clearly has the support of the entire House, as far as I can see.

Much has changed over the years since the original legislation that created a special role for medical practitioners—essentially, GPs—that allowed them to do certain things in our health system that only they could do. As the Hon Ruth Dyson has indicated in her speech, much has changed in the roles of medical practitioners: the way they cope, the way they work, and the way they attend to people who are ill in our communities today. So this piece of legislation does some really good work, in a pragmatic, sensible way, in expanding the range of people who are going to be able to do work that was previously done by general practitioners.

It is electorates like mine and the electorate of my friend and colleague Jacqui Dean—large rural provincial electorates—where the benefits of this legislation will be felt most positively, because these days modern medicine focuses on caring for people in their own homes as much as possible and on not institutionalising them, and that means that our medical people have to go to people’s homes. That is a very good thing. There are many good reasons for that to occur.

So, by passing this piece of legislation, it is going to mean that the current 14,000, or thereabouts, people who have medical practising certificates as GPs and doctors, some of the 50,000 registered nurses, the 200 practice nurses, the 4,500 physiotherapists, the 3,700 pharmacists, and some of the over 2,000 occupational therapists—not all, but some—will be able to take over those duties and roles and help people to get good, reliable, and professionally trained medical support and assistance, often in their own homes. This is a good piece of legislation. It is well-thought-out. It is timely. I commend the Minister of Health, who I think is doing an exceptionally good job, for introducing it to the House and bringing it to the House, and I support it and commend it.

Tēnā koe, e Te Mangai o Te Whare. It is my pleasure to speak on this, the third readings of the bills divided from the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. I want to, as always, commend the work of the Health Committee. I think it is a committee that works diligently on behalf of New Zealanders, and so I acknowledge its work on this particular piece of legislation.

I just want to reaffirm, for those who are listening, that what these bills do is remove references to medical practitioners in eight pieces of legislation to allow other suitably qualified health professionals or health practitioners, like nurses, to perform tasks that they are skilled in that they are not empowered to do under current legislation. Some of those things, actually, I think, should be highlighted. They are about, for example, the ability to sign death certificates; they are about the ability to take blood specimens from drunk drivers; they are about being able to declare people unfit to drive; they are about signing sick-leave certificates; they are about prescribing controlled drugs; and they are about issuing a certificate to accompany an application for a mental health assessment.

Currently all those tasks are only able to be performed, under legislation, by medical practitioners. What this piece of legislation will do is enable nurse practitioners, health professionals, and other health practitioners, who, under their learning and under their scopes of practice, have the competency—they too will now be able to perform those legislative functions.

I want to acknowledge the fact that the first nurse practitioner graduated in New Zealand in 2001. And actually, it was in 2005, under my colleague the Hon Annette King, that we first started to look at expanding the legislative responsibility of nurse practitioners. We did that under a piece of legislation that enabled nurse practitioners to prescribe medication. What this piece of legislation does, essentially, is look at the whole nursing area—and there are over 50,000 nurses in our country—and look at their skills and look at their ability to provide better services to the New Zealand population. At the heart of this piece of legislation, it is about maximising the strengths of the health workforce.

I particularly want to focus on the issue of pay equity, actually, within this whole area. I think it is really important now, with the expansion of the legislative scope that our nurses have, that we look at remuneration. For example, practice nurses in New Zealand earn between $31,000 and $45,000 per annum. If you are a registered nurse, you can expect to earn $65,000. If you are nurse practitioner—who, we have heard, has to undertake a Master’s, essentially, so it is an extra 2 years’ worth of study—you can aim to earn over $90,000.

If you look at medical professionals or medical practitioners, a junior GP—so this is someone who spent 5 years studying at university and at medical school, and then takes another 4 years to qualify—can earn between $75,000 and $90,000 a year. I am sure that other people will be able to talk more specifically about the remuneration, but a senior GP is someone who, after 10 years of both qualifying to be a medical practitioner and then working in the field, can look at earning between $180,000 and $250,000 a year. That is a huge difference between a senior GP and a nurse practitioner, who, you would say, is a senior nurse. So a senior nurse earns $90,000 a year; a senior GP earns between $180,000 and $250,000.

I think some of the implications of this piece of legislation, based on my quick research of how much people are remunerated, are that I think in the future we are going to see that our nurse practitioners are actually hugely underpaid. If they are now performing a whole lot of statutory functions and statutory responsibilities that previously only our medical professionals—our doctors—have been able to do, then, actually, there needs to be a reflection of that in their anticipated salaries.

The reason I am bringing this up as quite a big issue for the House in the future is that, obviously, nursing has tended to be an area or a domain that women have chosen to study in and to practise their skills and contribute to providing the New Zealand public with the health services that they need. I am highlighting it now, because I think it is something that in the future we are going to have to address. This has not been about being pragmatic. This has actually been, I think, about fully utilising the skills of our entire medical workforce. I certainly am—and I know after listening to Barbara Stewart from New Zealand First that it is something that is also now on their agenda.

I only want to highlight the fact that there is overwhelming support for this piece of legislation. There were 28 submissions, and only two opposed. One of those was from the medical practitioners themselves. I think that from their perspective, obviously, preserving their status within the whole medical workforce was something that they were particularly concerned about. That is probably the best way to describe it. I do not think that they were trying to undermine the nurses’ position, but I do not know. For people who have worked in the medical area, doctors always seem to have been at the top of the hill, or at the top of the tree, and the nurses were seen as subordinate.

Under this piece of legislation, actually, I see parity. I see our nurses and our doctors actually complementing one another, and doing their job hand in hand and side by side—not one above the other. I think that in some of the roles that our nurses will play in the future—and particularly in rural communities, they will be leading the provision of health services. I think that this piece of legislation is only really the beginning of another process, and another evolution of how our health services are provided in our country.

From the perspective of all nurses—the Nursing Council of New Zealand, Nurse Practitioners New Zealand, neonatal nurses, mental health nurses—and from the pharmacy sector, physiotherapy, and even the unions who chose to make a submission on this piece of legislation, there was widespread support, and I think that support from the submitters is being reflected in the House.

I will not take up any more time. I commend the bills to the House.

It is a pleasure to take this last call on the legislation arising from the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill. This legislation recognises the increasing skills and changing range of skills in the health workforce. I think enacting this legislation will do several things. First of all, I do believe that it will improve the efficiency of the health system. It will also advance the career pathways of many, and I believe it will improve job satisfaction as well.

There are several Acts that this legislation changes, and I have looked at what the key change is, in my mind, that is enacted within each of these Acts. The Accident Compensation Amendment Bill (No 2) changes the terminology from “medical practitioner” to “health practitioner”, which is the core function of this legislation. In the Burial and Cremation Amendment Bill, a certificate of cause of death may be undertaken by a nurse practitioner who attended the last illness and has this role in their scope of practice. The Children, Young Persons, and Their Families Amendment Bill (No 2) will enable suitably qualified health practitioners to undertake and manage medical examinations of children and young persons. The Holidays Amendment Bill (No 2) will enable a health practitioner to complete a sick note, and I think this part of the legislation will probably touch more New Zealanders than, maybe, some of the others. I see this as a real efficiency in my clinical hands, and I think this is a really good piece of legislation. The Mental Health (Compulsory Assessment and Treatment) Amendment Bill will require engagement with a primary healthcare provider. The Misuse of Drugs Amendment Bill (No 2) clarifies the use of controlled drugs as it relates to import, export, and prescribing.

I think that widening the scope of practice for health practitioners, overall, will not increase the risk of harm to the public. I know this was a concern from the Medical Council of New Zealand and the Medical Association. I think that the concern of risk to the public is addressed by two prime mechanisms. First of all, appropriate scopes of practice are determined by the Health Practitioners Competence Assurance Act 2003. I think this is very important, to reassure the public and to reassure the profession. Secondly, as I think has already been commented on, there is oversight by regulatory bodies such as the Nursing Council of New Zealand and the Medical Council of New Zealand.

It has taken a long time to get these bills here to their final readings, but it is with great pleasure that I commend them to the House.

Bills read a third time.