Newborn Enrolment with General Practice Bill

I move, That the Newborn Enrolment with General Practice Bill be now read a first time. I nominate the Health Committee to consider the bill. I would like to start by acknowledging and thanking everyone who has been a part of discussions with me while I was drafting this bill and also since this bill has been drawn from the ballot.

The purpose of my bill is to improve health and social results for infants, by requiring that newborns are enrolled with a general practice and/or a primary health organisation before the newborn reaches 6 weeks of age. High rates of newborn enrolment with a general practice will reduce the risk of their falling through the gaps for immunisation and also allow for earlier detection of health and social issues. I want to acknowledge that a lot of work has been done to improve the enrolment of newborns with general practices, but there is more that can be done to improve the enrolment of newborns with general practices as early as before 6 weeks of age, which is the intention of my bill.

I want to acknowledge the work that the Ministry of Health has been doing since October 2012. It has been pushing for newborns to be enrolled with a general practice soon after birth so that they can receive essential healthcare, including immunisations on time. Yes, we have seen some good progress, as prior to this push from October 2012 fewer than half of newborns were enrolled with a general practice at 12 weeks—that is, around 3 months of age. At the fourth quarter of 2015-16, 77 percent of newborns were enrolled with a general practice within 3 months. This is based on children born between 20 February 2016 and 19 May 2016.

The question is then about the possibility of getting more newborns enrolled with a general practice as early as before 6 weeks of age. To answer this question, I looked at a lot of information, and I would like to share the information about the number of women giving birth, by birth settings. I looked at these numbers from 2004 onwards, and what I saw was that around 97 percent of births happen in a maternity facility—a maternity facility could be primary, secondary, or tertiary care—and around 3 percent of births are home births. When I say home births, they are not necessarily unplanned emergencies; there are some planned home births too. We also know that many home births are attended by at least one midwife.

The point I am making is that we know where births are happening, so we should be able to bring these newborns into the system. We should be able to get them enrolled with general practices before 6 weeks of age, so that we can help them with immunisation calls and various other services they can be eligible for. As we know, over the first 3 months of life, infants and their families are eligible for a range of services, including maternity care, primary care, immunisation, and Well Child / Tāmariki Ora. Well Child / Tāmariki Ora services are expected to link families with primary care and immunisation services, and also other services—for example, for social services or housing support with the Ministry of Social Development. Or it could be a completely different kind of support needed—for example, breastfeeding support, or a general assessment of development and growth.

Currently newborn pre-enrolment requests are sent to the nominated general practice through the National Immunisation Register. It is not currently possible for the responsible practitioner to ensure that the pre-enrolment request has been made to the nominated general practice before the newborn is discharged from care, because the transfer of the information through the relevant electronic systems can take several days, and can be longer for home births. But it is possible for the responsible practitioner to ensure that the information is entered into the relevant system before hospital discharge.

The most common delays in the current preliminary newborn enrolment process occur when a general practice declines the initial request that comes through the National Immunisation Register or when the practice fails to act on that request in a timely manner. To fix this, my bill proposes that before a newborn is discharged from maternity care, the newborn’s mother and any other family members be consulted and a pre-enrolment request be sent by the maternity carer on behalf of the newborn to the nominated general practice, and so it is ensured that the request is entered into the maternity system. Then the general practice nominated as the primary healthcare provider is to ensure the pre-enrolment process of the newborn is actioned within 2 weeks, and prior to the 6-week immunisation pre-calls and the immunisation event.

The Ministry of Health’s expectation is that all pre-enrolment requests are accepted by general practices, but general practices are not required to do so, and, as far as I have heard, general practices may decline a pre-enrolment request if they are not familiar with the family or if the family has a debt with the practice, which is contradictory to the ministry’s advice. To fix this, and to allow general practices to be able to decline pre-enrolment requests, my bill proposes that a nominated general practice can decline pre-enrolment only if it is working at full patient capacity or there is another good reason why enrolment cannot be completed when it receives a pre-enrolment request made on behalf of a newborn. In that case, when the general practice is unable to proceed with the pre-enrolment request, the nominated general practice should consult with the family and find another general practice that works for the family.

But if the nominated general practice is unable to assist the family in finding another primary healthcare provider for the newborn, it must refer the pre-enrolment request to the relevant district health board within the time line of 2 weeks. A district health board or primary health organisation that receives a referral in this way will then be responsible for assisting the family to pre-enrol the newborn with another provider prior to the newborn reaching 6 weeks of age.

I want to acknowledge that while enrolment is a parental choice, it is not a legal requirement. I know that newborns can make families really busy, and they can lose track of time. As I have been through that twice, as a mother of two, I want to see that a system is able to follow up these families, follow up newborns, to ensure that they are enrolled with a general practice. As I said before, we do not want to see them falling through the gaps for immunisation calls or the earlier detection of health and social issues. I believe that the 2-weeks time line for the nominated general practice to act on the pre-enrolment request is sufficient. I believe that all newborns should have the best possible start in their life. I believe that my bill will help us achieve better long-term outcomes for newborns throughout New Zealand, and I highly commend my bill to the House. Thank you.

Can I say from the outset, just to be clear, that Labour will be supporting this bill to select committee. The idea within the bill is one that is hard to dispute, really, and I congratulate the member on bringing a sensible bill to the House that deals with a problem that is real. I do have some criticisms of it in its current form and I will lay those out—well, concerns, really—because, hopefully, we will be able to address these things at the select committee, and I do look forward to that experience. The Health Committee is generally a productive select committee and a well-led select committee, I have to say, looking across the House at Simon O’Connor, the chair of the Health Committee. It is a select committee that works well together and is ably led.

So it will be good to sit down and have a look through this piece of legislation. It is actually pretty short—the member who drafted it will notice that I am holding it up for anybody who is following this at home. I mean, the active clauses really are less than one page, and it is kind of a list of instructions as to how a GP will—

💬 Hon Simon Bridges: No, they just turned the TV off—your mum and dad just turned the TV off.

—follow through to carry out the required process. The member Simon Bridges has got his earpiece in there. I think his folks have just tuned in, he is telling me—good on him. That will double the audience tonight, I am sure. The thing that this bill does, though, is something that we would hope will be happening anyway.

The concern I have—and I suspect many on this side of the House will share my concern—is that part of the problem here is that GPs are incredibly stretched and they are underfunded. This year alone they have been significantly short-funded by tens of millions of dollars. The GPs themselves estimated it was about $45 million they needed to meet existing cost pressures, but in the Budget they got only $9 million, and that means, of course, that they are having to cut their levels of services, and we know that there are underserved communities in South Auckland, in our rural communities, and so on that are unable to get GPs. So talking about what those GPs do—the niceties of when they have got to refer a child on for a specific treatment, when they have got to have an enrolment completed, and so on—is kind of important, but in the bigger picture, where nearly half of the GP workforce is expected to retire in the next 10 years, it is really playing at the margins.

If this was obviously the Government’s main priority, it could pop it through in a moment as a piece of Government legislation. But, instead, we have it here as a member’s bill, and in its current form, I have to say, it is a toothless bill. That is one of the things that I hope we will look at at the select committee, though I would be keen to see the initiative that is described in this particular bill properly funded, and I am not sure that is something that is on the Government’s agenda. But we may hear more of that as the debate progresses.

The bill is toothless, because it describes what has to happen if the GP cannot enrol somebody. The GP is required to consult with family members to consider the appropriate general practice provider, supply a list of general practices in a newborn’s area of residence, if so requested or if the general practice provider is full, and help them find another place where they might take their child if a particular practice is full. These are requirements placed on the GP, who is already stretched, and there are no penalties whatsoever for a GP who does not carry these things out. In the bill, there is no response if somebody says “Look, I can’t do it. I’m too busy.”, and there are no penalties for patients who do not do their part in this process on time.

The bill is completely toothless. It reads like a wish list of how GPs ought to best enrol newborns in their practices, and of course the GPs already know that. The GPs are not stupid. They are smart, they are medically trained, they know what best practice looks like, and, really, this bill amounts to little more than a best-practice guideline in its current form.

So I would say that while the idea is good, what it needs is financial support and it needs incentives, and, if it was properly funded, then you could put sanctions in place for those who are not compliant. But in its current form, it has little more merit than Nuk Korako’s lost luggage bill.

Here we are debating a bill in the House that has no teeth and that is simply a wish list of things that the member would like GPs to do, and there is no funding following it, there is no incentive to do this, and there is no sanction for those who do not do it, so there is no penalty for not doing it. To take legislative time in the House for this bill—

💬 Hon Simon Bridges: Is a really good idea.

—seems a very strange thing to do. The Leader of the House says it is a really good idea. He is trying to fill up the legislative schedule to make it look like his Government is busy and has got good ideas. But it has been here 9 years, and if this really is the best idea that it has, then I think that is pretty concerning.

In good faith—as I said at the outset—we will be supporting it because we think it could have teeth added. It could have funding that comes in behind it. We could actually make this into a good thing. But in its current form, if this is the best thinking the Government has had after 9 years and the Leader of the House says this is a good thing for the House to be debating, then I think that sends a signal to New Zealanders that this is a Government out of ideas and out of time.

What we really need is a fresh approach. We need a fresh approach to these issues, one that actually says: “Let’s fund this adequately. Let’s make sure that general practice has enough GPs to carry these things out in South Auckland. Let’s make sure that we have a plan for retaining our rural GP workforce or for building it over time.” There is no plan laid out for that—there is no plan—because these GPs are the people who are supposed to deliver this bill, and if half of them are retiring in the next 10 years, they will not be able to do that. That is the ridiculousness of what we are being asked to look at here in the House today.

Of course it sounds fine. It sounds sensible. You know, if there is no room in the practice, find another practice, and give a list of other practices in the area to the person coming in and seeking to enrol their child. That is not very practical, though, if you are in a small town in the middle of nowhere and there is no GP for hundreds of kilometres. That is the situation that could be brought up in the situation described in this bill, if there is no GP there to carry that out. And there is no penalty. As I said earlier on, there is no penalty for the GP who does not carry out these things.

💬 Hon Simon Bridges: You should suggest that at select committee.

The Leader of the House is suggesting that we bring this in at select committee. I think the Leader of the House knows that this bill has got a few wee holes in it as it stands. I think he senses that it is not a great tome. It is a light bill and it expresses an idea, and in those few short paragraphs we can see that there is the seed, perhaps, of an idea. But it does need to be fully funded, and I think that is the point I would like to emphasise in this first reading speech.

If the health system is not fully funded, we cannot expect these GPs—who are actually not even there in great numbers—to continue doing more with less when there is no workforce to deliver it. We are using the House’s time to argue something that really, really is a little bit trivial.

I am sure others will have something to add to this as well, so I shall not talk too much longer, other than to say I do look forward to having the debate in the Health Committee. It is a very productive committee, and the member Simon O’Connor at the back chairs it well. We will, I am sure, have a lively debate about this, and I hope the Government can be persuaded to put a little bit of money behind this. The health system is being underfunded by $2.3 billion, by our count, and—

💬 Mr DEPUTY SPEAKER: I think this is about the fourth time you have repeated that point.

Not the $2.3 billion, Mr Deputy Speaker. That—

💬 Mr DEPUTY SPEAKER: If you are done, you can take your seat.

That is a serious amount of money, and if money does not go into the system, we cannot expect it to continue to deliver on these things.

I am pleased to take a call on the first reading of the Newborn Enrolment with General Practice Bill in the name of my colleague Dr Parmjeet Parmar. I am hoping, if I am not being presumptuous about the vote, that this bill will come to the Health Committee and we can give it our consideration. I think the intention of this bill is excellent. I think the way it has been initially drafted is very good, but I would say too that there is some work that we will, as a committee, need to do to tighten this up. I think that is actually quite appropriate in a select committee process, and we have often found that with members’ bills. I can think of an organ donation bill recently where we had to do some work on it, and of some other members’ bills that have come before us.

No one here will disagree about the importance of our young ones—in fact, I find it a little refreshing. Today, I have just come from a talk on the other side of life, if you will, around issues of death, so, actually, it is a real refresh to come into the House at the moment and talk about new life—it is quite fantastic, and a nice contrast. No one would disagree that we need to look after our young ones, and one of the best things we can do in healthcare, and particularly in the primary care space, is to get our young ones—our newborns—enrolled as quickly as possible. It informs a relationship, which often becomes enduring, but primarily it is important for the health of the child.

We know already—in fact, there has been some argument that we should be trying to pre-enrol children, particularly so that they can get their pertussis injections early. This bill, obviously, does not go that far, but what it is doing is saying that once a baby is born, the lead maternity carer must, basically, send in a request to a general practice and say that this baby has been born and needs to be enrolled, and the general practice then has a time limit imposed on it to reply, in order to say yes or no. Anyone who is involved in the health sector—and I do acknowledge my colleague David Clark—will know that some general practices have full books and, in fact, a number of GP practices have very full books; some do not. It is really important that the parent or the parents know whether the child has been enrolled or not. I suppose that begins to set up part of the problem that we face in this dynamic.

Currently, when a child is born, the lead carer—more often than not, if not almost exclusively these days, a midwife—will put that baby’s name into the National Immunisation Register. That is an excellent thing in and of itself, but in many ways the parent or parents begin to lose a little bit of control at that point. So once the baby’s name is in the register, if it is declined—so if a general practice says “Look, we’d love to take little baby George on, but we’re too full.”—that is never really informed back to the parents, nor is it informed back to the midwife. So there is always a chance that the child, effectively, gets lost in the system, and the problem that happens there is that, really, when the child becomes sick—which is not, of course, something that we want—it is only then, usually, that a parent or parents will seek out a GP and seek out a practice and seek to get assistance.

That is particularly important when we come back to the whole question of vaccination. So, of course, we are talking about not only looking after the child for a health need but actually getting it its vaccinations at the right time. It is not that you absolutely need to get your vaccinations on the exact day, but, generally, when we say there is a 3- or a 6- or a 9-month vaccination, that is when it should happen for the child.

So Dr Parmar’s bill is addressing this. It is fixing up a process issue, I would suggest. Again, as I said at the start, it is asking that the lead maternity carer identifies where the parent wants to send their—[Bell rung] Sorry, Mr Deputy Speaker—point of order.

💬 Mr DEPUTY SPEAKER: You have got 1 minute.

One minute? Sorry, I was never sure whether it was a 5-minute or a 10-minute—oh yes, the clock. Right, thank you, Mr Deputy Speaker. The key, critical element here is that the lead carer informs the general practice. They identify with the parent what they want and they inform that general practice. The general practice then has 2 weeks, I believe—2 weeks—to either affirm or decline the decision. Really importantly, I think, and really critically within this bill, it is—[Interruption] Oh, really critically in this bill—sorry, I am getting mixed messages from across the House here, which is a little bit concerning to me. But anyway—

💬 Mr DEPUTY SPEAKER: They do not look very mixed to me.

Look, the critical element is that, actually, the general practice needs to inform the parents of whether their child is or is not actually enrolled in the programme, and that ultimately enables the child to get the care that it sufficiently—

I am sorry, but I do not know what it will take to make the member sit down, other than me standing on my feet.

Kia ora. The Green Party congratulates the member on having her bill drawn. We support the bill as it will, hopefully, improve immunisation rates.

Debate interrupted.

The House adjourned at 10 p.m.