Health Practitioners Competence Assurance Amendment Bill

I move, That the Health Practitioners Competence Assurance Amendment Bill be now read a first time. I nominate the Health Committee to consider the bill.

The Health Practitioners Competence Assurance Act 2003 was groundbreaking legislation, acknowledged internationally as being significant for health professional regulation. With a focus on protecting public health and safety, the Act provides a consistent accountability regime for practitioners’ practice, conduct, and competence. Currently, there are 23 health professions regulated under the Act. The Act protects the health and safety of members of the public by ensuring health practitioners are competent and fit to practise their professions. In order to claim to be members of their profession, health practitioners must be suitably qualified and registered with an appropriate responsible authority, such as the Nursing Council of New Zealand.

There have been two reviews of the Act, an operational review and a policy review to explore the underlying principles of the Act. The reviews found that the Act was working well but that a number of improvements could be made. Sadly, these changes were not made under the previous Government’s watch.

This bill will implement recommendations arising from both reviews. In particular, the amendments will improve the operation of the Act through providing tangible evidence of responsible authorities’ performance, better visibility of decisions about health practitioner disciplinary proceedings, greater recognition of the importance of interdisciplinary collaboration and cooperation, and better workforce information.

I would now like to outline some of the key changes covered by the bill. The first change is the introduction of performance reviews for responsible authorities—that is, the authorities that register and certify the competence of health professionals within their scope of practice. Currently, there is no way for the public to be certain that responsible authorities are carrying out their functions as intended by the Act and regulating their respective professions to improve public safety. This bill will introduce five-yearly performance reviews for responsible authorities to provide the Crown and the public with an assurance that those authorities are carrying out their functions effectively and efficiently. These reviews would be carried out by independent reviewers against a set of indicators developed by the Ministry of Health in consultation with each responsible authority. The resulting reports will be published on the authorities’ websites.

Performance monitoring will enable continuous improvement within the regulatory system, make it easier to promote good practice, and increase consistency across responsible authorities’ policies and processes. This will assure the public that the regulatory framework for health professionals is operating as it should.

The second key change involves better information about disciplinary decisions. Currently, there is a limited amount of information available to the public about responsible authority decisions in relation to complaints about registered health practitioners and the processes for making those decisions. This bill will require responsible authorities to release information about decisions they have made on practitioner practice to the person who has notified them about concerns relating to a practitioner’s competence.

It will also require responsible authorities to develop policies that set out how they make decisions about releasing the names of health practitioners whose competence, fitness to practice, or conduct has been reviewed or investigated. Health practitioners whose conduct has failed to meet expected standards may be named when it is in the public interest, but this will be balanced with practitioners’ rights to privacy and natural justice.

Greater transparency about decision making will improve public confidence in the process. This approach is consistent with protocols followed by the Health and Disability Commissioner, the Health Practitioners Disciplinary Tribunal, and overseas regulatory authorities.

The third key change is to support better teamwork among health practitioners. Many complaints to the Health and Disability Commissioner arise from failures in teamwork and inter-professional communications. A cohesive team approach across the health and disability system is integral to public safety and achieving better health outcomes for New Zealanders. This bill will provide greater recognition of the importance of teamwork and inter-professional communications in order to support integrated healthcare for New Zealanders. Responsible authorities will be required to promote and facilitate interdisciplinary collaboration and cooperation in the delivery of health services. This will support the one-team approach of the New Zealand Health Strategy.

The fourth key change is to support better workforce information for health workforce planning and forecasting. Having good work information is critical to ensuring we have sufficient health professionals with the right skills in the areas where they are needed. This bill will give responsible authorities a legal mandate for collecting data, such as date of birth and place of employment, and providing this to the Ministry of Health to support workforce forecasting and modelling. This will enable better planning for developing the workforce that will meet New Zealand’s future health needs. Whenever workforce information is published, it will be anonymised or summarised to protect health professionals’ privacy.

This bill includes a number of other amendments that will clarify the operation of the Act, improve efficiency of processes, and ensure consistency with other legislation. These amendments include the following: clarification that responsible authorities can receive and act on information from members of the public about the practice, conduct, or competence of health practitioners; reducing the administrative burden of reporting relating to quality assurance activities; providing for the amalgamation of responsible authorities when it is in the public interest; and clarification that the responsible authorities are responsible for meeting the administrative costs of the Health Practitioners Disciplinary Tribunal.

In conclusion, public expectations, technology, and the way health services are delivered will continue to develop and change. Health legislation needs to keep pace with those changes. I must commend the previous Ministers for progressing the reviews as required by law, but we do need legislation to update our health law so that we can make sure that it’s up to date and fit for purpose. The amendments included in the Health Practitioners Competence Assurance Amendment Bill will contribute to delivering a flexible integrated health workforce, safe practice, and a regulatory system the public can count on. I commend this bill to the House.

Well, that wasn’t very lively, was it? I thought we had some sort of rule about reading speeches out in the House. I mean, that was delivered very much in the tone of a parent reading a bedtime story to a small child. I’d be very interested, if Dr Clark was able to throw aside his notes for a moment, if he could tell us anything about what was in that bill, because this is a very technical bill. It’s a tidy-up, effectively. It’s an amendment bill, and I’d like to say at the outset that the National Party will be supporting the Health Practitioners Competence Assurance Amendment Bill (HPCAA bill). As Dr Clark said, but probably can’t remember because he was just reading by rote, this was actually the result of two reviews into the original Act from 2003.

Those two reviews first looked at the implementation of the Act. That was the first one that was done, published in 2009, and that brought about a few legislative changes, which are incorporated in this bill. Then there was the strategic review in 2012. So this really is going to clarify a few points around the implementation of the bill and it will just make things a bit clearer, both for those responsible authorities who are administering it—there are 16 of them administering 22 professions—but also greater transparency for the public around how the professions are regulated.

But I will tell you what is concerning. It is, you know, I mean, you’d think a new Government would be pretty busy. You’d think there’d be a major agenda to push through, but this is all that they can bring to the House. What are we in? The third week of February. You’d think they’d have many more important things to do. You’d think they would want to really crack on with some serious legislation in terms of the health portfolio.

I mean, I was asking the Minister of Health today if he’d given any specific instructions around the establishment of a third medical school, because that is, of course, a matter that is of wide public interest. It’s a matter on which the health Minister, as the then Labour spokesman, made a number of statements. You know what he said when we asked him if he’d issued any plans around a third medical school? He said, “It’s not in the public interest to answer that.”—it’s not in the public interest.

ASSISTANT SPEAKER (Poto Williams): If I could just bring the member back to the substance of the bill.

I must say, this bill is in the public interest, but I think there are matters that are more in the public interest than this particular one. It’d be interesting to see if there could be any further amendments to the bill. It will be interesting to see if the Minister brings any more legislation to the House, maybe describing any plans he might have in the health portfolio. Of course, often plans may just be the result of policies, which you then implement. They may not necessarily need legislation. But one of the things that could be amended, be here, and added in a Supplementary Order Paper in this Health Practitioners Competence Assurance Amendment Bill is that maybe the Minister might want to actually legislate for some changes that he may wish to make. Maybe he has some ideas other than those of the previous Government, and maybe there might be an opportunity at the committee stage for the Government to amend this bill, because by then I think the Minister may actually have had time to read it, and I’m sure, at the second reading, Madam Assistant Speaker will be far less generous than letting the Minister just come here and read his speech by rote. It’s very important that the Minister actually understands what he is spouting there—

💬 Hon Dr David Clark: I raise a point of order, Madam Speaker. I think there is a well-established convention that where there are technical issues in the bill it is very important to have them read correctly into the record. I take offence at the Minister implying that I have not read the bill I’m bringing to the House and that I’m ignorant of it. That’s plainly not true.

Speaking to the point of order, whether he’s ignorant or not is a debating point.

ASSISTANT SPEAKER (Poto Williams): Right, OK. [Interruption] No, we won’t have any more points of order on this matter. Do you have any more contribution to make?

I do, actually—quite a bit. The great thing about this current health Minister is you bait the hook, you cast it out. I didn’t think we were going to get a bite, but he couldn’t help himself. He took it hook, line, and sinker, fell into the trap, and he’s getting up and telling us that he is not ignorant. Well, the one thing that is clear is that if he did know about what was in this bill, he wouldn’t have actually got up and read a speech by rote, which, of course, is very poor convention. He did do, though, when he was reading what was there, what he said, although he wouldn’t actually—

ASSISTANT SPEAKER (Poto Williams): Order! [Interruption] Order! Look, I have asked the member to come back to the substance of the bill. Can we?

Madam Assistant Speaker, I was actually saying that what he read out was correct. It would have been better if he had spoken it, but actually his description of what is in the bill—even though he doesn’t understand it, quite clearly—is actually correct. But, look, it’s very important that the public can have confidence in the standards of practice of health professionals in New Zealand. They’ll soon learn that they can’t have confidence in this new Minister of Health, but they will be able to maintain full confidence in New Zealand’s health professionals, because we do have excellent health professionals in this country, but it is important that the public is protected.

What I’m really disappointed about is, as I’ve known for the past four months, it’s quite clear by the presence of this legislation in the House today that the Government has no pressing legislation that they want to push through this House, and they’re resorting to scraping the bottom of the barrel, looking for the scraps and the leftovers that the National Government left them as we departed office, and they’ve thought, “Gee, we’ve got to fill this Order Paper up. Thank goodness, we can do that HPCAA bill. We’ve got something to talk about on a Tuesday night.” But I’m going to be really interested to see what they’ve got coming up after this. I’m sure the Labour research unit will be upstairs packing themselves, knowing that soon their members are going to be running out of material. But what we can say is, National will be supporting this bill.

I’m happy to make a contribution to this bill, and I want to acknowledge the Minister of Health because not only has he produced a comprehensive bill to this House that incorporates the recommendations made in the reviews of 2009 and 2012, which they should have done something about but they did not—not only is the bill made available for the Opposition to see—but you also have a departmental disclosure statement as well as the regulatory impact statement, which I think will help members of the Opposition to make a meaningful contribution to this particular debate.

I think it’s important for the House to note that we are debating amendments to the 2003 Health Practitioners Competence Assurance Act, an Act that was introduced by a Labour Government, I might say, and an Act that, when it was introduced by a former Labour Government, was considered groundbreaking legislation and was recognised internationally as being significant for health regulation. The focus of the Act was about promoting and providing public health and safety, and it provided for consistency in accountability regimes for practitioners’ practice, conduct, and competence. The Act regulates, as my colleague the Hon Dr David Clark said, 23 health professions, and is considered as a significant piece of legislation aimed at protecting and providing public safety.

The Act does ensure health practitioners are competent and fit to practice their professions and requires that in order for people to claim to be members of their profession, they must be suitably qualified and registered within that particular authority for their particular profession. So the origins, as my colleagues have previously said, go back to the original review in 2009—and then again in 2012. The 2009 review found that the Act was generally operating as intended but recommended a number of legislative amendments to clarify the Act’s interpretation and improve its operation. The recommendations from the 2012 review aimed at providing tangible evidence of responsible authorities’ performance, better visibility of decisions about practitioners’ performance, greater recognition of the importance of interdisciplinary collaboration and cooperation, and better workforce information.

So the first change that this bill is introducing is the performance reviews of responsible authorities. Many of us that use our public health system or our health services often don’t know that there are these health practitioner authorities that register, and have an obligation to regulate, health practitioners—we don’t. From time to time, my office in Māngere has received a consistent flow of complaints. They’re complaints about our health system, and that occurred right through the nine long years that this Opposition were in power. The complaints were often about the lack of services or lack of accessibility of service, but from time to time I would often receive a complaint about how they were treated by a health practitioner.

Now, one of the things I learnt when I first came into Parliament was from the former Minister of Health Annette King, who said, “We don’t want to create an environment where we’re constantly blaming our health practitioners. We have to create an environment where our health practitioners can own up to mistakes that are made and look at making changes.” And so there’s a bit of a balancing act that has to be acquired—the right to make complaints, absolutely, but also the right to recognise that we’re all human and that we will make mistakes. But I think the challenge that we have—an ongoing challenge—is to make sure that the environment is such where people can own up to their mistakes and look for ways of improving. I would hate for our country and for our health systems to get to a point where—I’ve seen reports from other countries—they deliberately hide the mistakes that are made and only years after do we ever find out about it.

So the authorities that register and certify the competence of these health practitioners, they will now be under a regime where their performance and them taking greater responsibility for ensuring that the health practitioners are carrying out their functions as intended by the Act—are actually able to do that. The bill introduces five-yearly performance reviews for responsible authorities—and I’m talking about authorities such as the Nursing Council of New Zealand and other medical groups. This will provide the Crown and the public assurances that these authorities—which we are asking them to—take on board the watchdog role on our behalf. And so it gives us some assurances that these authorities are carrying out their functions effectively and efficiently.

The reviews will be conducted, as I understand, by independent reviewers. Those reviews will be against a set of indicators developed by the Ministry of Health in consultation with each of those responsible authorities. The resulting reports from these reviews will be published on the authorities’ websites, which is the same thing that the Education Review Office does when they conduct reviews of our schools and our educational facilities. Those reports are often published on each of those schools, and that gives us some confidence about what is happening within those organisations. So this performance monitoring will enable continuous improvement within the regulatory system, and I think it will make it easier to promote good practice and increase the consistency across the board within these responsible authorities.

So the second change is making information about an authority’s decisions or orders about disciplinary decisions more widely available. This goes back to my previous point that the public has to have confidence that our health practitioners are competent and have the ability to be able to carry out the practice to make sure that people are safe. Making information about the authorities’ decisions and orders—particularly when somebody has been disciplined, making that available is going to be important. Currently, limited information is available to the public. The bill will require authorities to release information about decisions on practitioner practice to the person who has, firstly, notified them about the concerns, and it would also require authorities to develop policies that set out how they make their decisions about releasing the names of health practitioners whose competence or fitness to practice or conduct has been reviewed or investigated, and the names of health practitioners whose conduct has failed to meet the expected standards may be named when it is in the public interest.

I note that with the Law Society, when they discipline somebody, that is made publicly available. We see it in the newspapers, and sometimes they won’t reveal the name of the lawyer that has been disciplined, but, certainly, having that information, knowing that, really gives the public confidence in the role that these authorities play. It also gives us confidence about the people who are charged with the responsibility to provide health and protection to our general public.

There is one other thing that I wanted to just point out, and that is that in the regulatory impact statement there are five recommendations that are pointed out there. There is one that makes reference to changes to enable interdisciplinary communication, and the point that was made there is that often mistakes are made because there’s the lack of communication between the practitioners that are dealing with one patient. Now, that makes sense, because here in this place we all are trying to get the Government to provide this whole-of-Government approach to service our families—

I apologise to the honourable member. Your time has expired.

Oh, what a disappointment, Madam Assistant Speaker, I must say. In fairness to that member who just sat down, Aupito William Sio, I do enjoy when he gets up and speaks. It’s just his tone: it’s so welcoming, it draws you in, and just for a glimpse, a fraction of a moment, you believe him, until you realise his stories are very much like the fisherman’s tales and they get bigger and they get bigger and then you realise that all he is is just a great storyteller.

It’ll please the House to say that I won’t take much of its time up. I’ll be very brief. This is a technical bill. What I’m looking forward to, as I look over at the Government backbenchers and see the whites of their eyes—who would have looked over this technical bill on the weekend and thought, “Oh, that’s OK—only a couple of minutes.” And then today, the chief whip of the Government would have come in and said, “Righto, 10 minutes”—10 minutes—and they’re all thinking “How am I going to speak on this for 10 minutes?” So we’re looking forward to that. We’ll be watching. And what’s really good in the House is that Hansard records everything and those speeches will be locked in for life as part of your parliamentary record and your history—back to the bill.

This bill is at the heart of our health system, and for someone who’s worked over two health systems—one here and one in the UK—I must say what a great health system we do have. The trust and the confidence our public has in our health system—and, really, that is primarily to do with our health professionals. They are hard-working and committed. In a field I used to work in, in mental health, where you don’t have much consumables and you don’t have much technology, you strip it back and all it is to do with is the health professionals. So what we need to do is make sure that that trust and that confidence are at the heart of our health system and the quality assurance.

Now, this bill will pass in the first reading, so what I want to do is just quickly outline three key points that I think in the select committee we need to look at. The first is: how do we ensure that as much of this information that gets collated around competency, fitness to practise, and scope of practice is available to the public? There’s a real issue around information in health being asymmetrical, where it’s only the provider’s side that holds on to it, and I think that by giving the consumers more information it provides more trust and confidence. The second is: how do we ensure in this bill that the mechanisms are in place that they will intervene quickly when there is an issue around competence, scope, and fitness to practise? And, finally: how do we make sure the data we collect is shared appropriately to make sure those mechanisms come in at the right pace and, equally, shared upwards to inform workforce planning? Thank you very much, Madam Assistant Speaker.

Thank you, Madam Assistant Speaker, and thank you for the opportunity to stand and speak on behalf of New Zealand First on the Health Practitioners Competence Assurance Amendment Bill. New Zealand First will support this bill and would like to also congratulate the Minister of Health for finally getting these much-needed amendments before the House. So we acknowledge you, the Hon Dr David Clark, on doing that.

Now, these amendments have been through a number of reviews and have been widely discussed amongst the public and with various health practitioners and the regulatory bodies that are affected, but they have languished for years. Somehow, the amendments seem to have suffered the same fate as the previous Minister’s leadership aspirations. We waited a long time for this legislation to come before the House, and it’s a credit to the new Minister that he has managed to get things moving quickly.

One of the most treasured aspects of our accident compensation scheme is that we don’t have great piles of litigation by tort lawyers clogging up our courts, suing doctors and medical institutions. Under ACC, we have a no-fault basis, which means, in most cases, we have forgone our privilege to sue at-fault parties. Now, the flipside of this, though, is that we better make sure that anyone practising medicine is a competent professional who knows exactly what they’re doing. That is why New Zealand First strongly supports getting the Health Practitioners Competence Assurance Amendment Bill passed into law.

The Health Practitioners Competence Assurance Act 2003 provided a framework for the regulation of health practitioners. The law is designed to protect the public by preventing unqualified people from claiming that they’re registered practitioners. It regulates those health professionals where there is a risk of harm from malpractice. It doesn’t regulate professions considered to have low risk of harm, like traditional Chinese medicine, for example.

The Act also established separate regulatory authorities, like the Medical Council of New Zealand to enact legislation for each group of health practitioners. The associations cover chiropractors, dentists, dietitians, radiographers, doctors, midwives, nurses, occupational therapists, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists, psychologists, and psychotherapists, and these health practitioner authorities were tasked with describing their provisions and scopes of practice and determining what qualifications are appropriate. They were also required to register and issue practising certificates, review and promote ongoing professional competence, and judge whether practitioners are unfit to practice by establishing professional conduct committees to investigate misconduct and set the standards for clinical and cultural competence and ethical conduct. This is why this Act is such a critical part of the health system in New Zealand. This is where the rubber hits the road when it comes to whether we can trust the health system is safe for all of our fellow citizens.

What the amendments are seeking to do is make sure that the Act is working and that it can be seen to be working. We want to know that the responsible authorities are performing and that their decisions are visible and clearly understood. By adopting many of the suggestions in the 2009 and 2012 operational reviews, we believe the amendments will ensure the various professional associations will be much more transparent with the decisions that they make. The amendments also encourage the various health disciplines to collaborate so that there is more information about the people providing the health services. It is long overdue.

Now, more specifically, the amendments will require the health practitioner authorities to develop naming policies that will determine the circumstances in which practitioners whose competence has been investigated by the authorities are published. Furthermore, we want people who may be affected or professionally interested parties to be notified about these decisions.

The bill also requires the professional associations to provide the Director-General of Health professional and basic personal information about registered health professionals. This will help with workforce planning and development. As part of the drive to produce clear evidence that the associations are meeting their expectations, regular performance reviews will be undertaken, and these reviews will also encourage the various authorities to collaborate with the others. The bill also requires the authorities to fund the general administration costs of the Health Practitioners Disciplinary Tribunal.

New Zealand First generally supports the amendments, but we do have a few concerns, and we hope that these could be ironed out in select committee. The Act still doesn’t prevent unregistered practitioners from setting up shop and offering health services outside the associations, so we’d like to see if an ambulance can be placed at the top of that particular cliff. We also want to make sure that health-associated occupations that, on the face of it, carry a low level of risk are not exempt from the regulations if there are indeed real risks in carrying out their services. Now, take an example of the beauty therapy industry injecting facial filler. That’s now quite common, but it does have the potential to cause blindness and blood clots if the beauty therapist is incompetent. Beauty therapy does carry serious risks, and the public should feel confident that the therapists are in fact well-trained.

New Zealand First would also like to look at the status of paramedics and where they fit within the framework of this legislation. In fact, we know that the paramedics themselves want this to happen. Paramedics Australasia is the professional body representing paramedics in New Zealand and Australia. They want the title “paramedic” to be protected in New Zealand law so that it can be used by those who have attained a nationally recognised standard of training. Now, it’s pretty obvious that a paramedic who hasn’t been properly trained poses a serious risk. Paramedics—they’re the first responders and usually the people that are there in those vital minutes between an incident and hospital. At some point, it is likely that paramedics will be regulated under the Health Practitioners Competence Assurance Act, and we would like to see this happen.

We’re also concerned that some practitioners who provide services to the disabled—the people providing the various services are subject to the Code of Health and Disability Services Consumers’ Rights whether they’re regulated or not, and the trouble is that if something goes wrong, some practitioners may not belong to a professional body that can take action. Home-care workers may not pose a significant risk, but people receiving care should be entitled to know that the caregivers are capable. So a wider discussion on who needs to be regulated and how we regulate health professionals in New Zealand should be had, but we believe this could be achieved during the select committee process.

So, in conclusion, New Zealand First supports the Health Practitioners Competence Assurance Amendment Bill. Kia ora.

Thank you, Madam Assistant Speaker. It’s a pleasure to offer a few comments on this bill, the Health Practitioners Competence Assurance Amendment Bill. As I look around the House, there’s probably a few practitioners who will be directly applicable to this bill, myself included, and I think we have that unified voice to progress this legislation along.

The legislation primarily reviews the strategic review from 2012. In 2003, the Act came in. There was a review in 2009, and then in 2012. Fundamentally, there were five recommendations coming from that review, as is shown in the regulatory impact statement. The first recommendation was a five-yearly performance review of the authorities. The second recommendation was for the responsible authorities to make their findings public. The third was for the responsible authorities to set standards of skills. The fourth was to include a statement in the Act aligned to the purpose, which is around transparency, and really, fundamentally, the fifth recommendation was to require collection of workforce data.

Now, that was the 2012 review. The regulatory impact statement (RIS) came out in November 2015. From then till a few weeks ago, when the departmental disclosure statement came out, there have been three additions to that, which I just want to touch on. First of all, what has been added since the RIS came out is (1) a defence of “without reasonable excuse” has been incorporated into new section 92A in clause 16 and section 95 in clause 19; (2) the bill now includes a penalty in new section 92A; (3) the proposed amendment to the Act to have regard to the importance of principles and transparency; and the fourth recommendation has actually been incorporated in other legislation.

So I really just wanted to highlight very briefly the main recommendations coming out of the review, as per the regulatory impact statement, and the new ones that have been added since then, in the departmental disclosure statement. We’re looking forward to this bill going to select committee. Thank you.

Tēnā koe, Madam Assistant Speaker. Tēnā koutou e Te Whare. I am very happy to be speaking on this bill this evening, the Health Practitioners Competence Assurance Amendment Bill. What I will note, just in response to remarks made by the Hon Jonathan Coleman at the beginning of this debate, who was complaining that the bill is technical in nature and asking why the Government doesn’t have more substantive bills in the House—actually, I think that this says a lot about the previous Government. This Government has come in and we do have a lot of substantive work that we need to do, and the process of good lawmaking is such that you can’t just rush legislation to the House. We actually have our work cut out for us in order to—

💬 Hon Nicky Wagner: Nine years.

No, actually, nine years in Opposition, Nicky Wagner. You may not realise you’re not in control of the Government departments, who actually have to go out and consult and do the work. And, of course, the Government departments have been horrifically run down by the previous National Government—totally under-resourced—and haven’t been able to do the good policy work that this Government is planning to do. So here we are. We’ve got a mountain of excellent policy work being done, and it’s going to take some time to get robust, well done legislation before the House, but in the interim we can finally catch up on the housekeeping that the National Government never got around to.

Perhaps, if the National Government actually had acted on this minor, technical amendment bill earlier—because there were two reviews, of course. The first review was back in 2007—

💬 Hon Nicky Wagner: 2009.

—and there were a number of changes recommended—2007 to 2009 there was a review, and by the end of 2009 there were a number of operational amendments that needed to be made. But then, instead of making those amendments, we had to wait till there was a substantive policy review in 2012—2012. That was six years ago. What was the last National Government doing? Why didn’t they get these changes made? If they support them, and they were important changes—perhaps, if they’d made these changes, particularly around the workforce planning, so that the Ministry of Health was able to collect good data on the workforce, we wouldn’t be having the crisis that we’re having across many areas in the health system right now. Like, for example, midwives—it’s pretty clear that there hasn’t been sufficient workforce planning around midwives and a whole raft of other professions in the health sector.

So now this Government, which is absolutely committed to finally fixing the problems with our health system, is left with quite an enormous task of having to do the work that the last National Government didn’t do and to make up for nine years of underfunding our core public services. We’re seeing every day—I think there’s going to be another front-page story about a crisis in midwives, that there aren’t enough. And, of course, as many people in the Chamber will know, suddenly I’m very, very interested, personally, in the availability of midwives. Going through the public system, I am very much aware that the Auckland District Health Board (DHB) is struggling, but there are stories around the country of there not being enough midwives, and we know that there is a significant number of workforce planning issues that could have been dealt with if this bill had been progressed under the last Government. Well, luckily, it is going to be progressed now.

Speaking to the specifics of the workforce data and how that’s going to work, basically what this bill does is it has to do with the responsible authorities for different aspects of the professional bodies in the health sector. This bill will give those responsible authorities a legal mandate to collect a range of data, which will help the Ministry of Health to support workforce forecasting and modelling. This will assist better planning for developing the workforce required in order to deliver on New Zealand’s future health needs.

Given that we have a population that’s growing very rapidly in some parts of the country, particularly in Auckland, it’s extremely important that the Ministry of Health is able to have the data on what is happening in our workforce so that we can be planning, ensuring that there are the right places at university and other tertiary education providers and that we have the right immigration settings so that we’re able to prioritise those professionals who we have a significant lack of here in New Zealand, and so that we can be forecasting and modelling the budgets that are going to be required to ensure that we have training places. For example, we have a shortage of nurses in many parts of the country. There are unfilled vacancies in many of our DHBs, and yet there are graduate nurses who come out and they don’t have places for their first year. There aren’t enough jobs for them. So we need to be able to match up Government policy and funding to ensure that we have the pipeline of jobs available for graduates so that they can advance, and then we have qualified nurses. It’s not rocket science, but there is a lot of work to do because of nine years of mismanagement. It’s important to note that wherever workforce information is published, it will be anonymised or summarised to protect individual identity, so the Privacy Commissioner is across this.

The bill is also aiming to support better teamwork amongst health practitioners, and I think this is something that we could all really benefit from. I know that an integrated health approach will often be more than just a GP by themselves or a specialist by themselves. We actually need to have an integrated approach where you might have the GP working alongside a midwife, for example, or a GP working alongside physiotherapists and psychologists. They can get quite good outcomes when it comes to things like pain management simply by taking a much more integrated approach. Many complaints to the Health and Disability Commissioner arise from failures in teamwork and inter-professional communications, so this bill supports a one-team approach under the current New Zealand Health Strategy. I think that’s definitely going to be a benefit.

The previous speaker, Dr Shane Reti, gave a very short speech, unfortunately, but it was very accurate, and he summarised the five recommendations that came from the second review of this legislation. So I don’t know that I need to go through all the specific details of that, but people at home might be interested that the bill will also introduce performance reviews for responsible authorities. Those are the ones who register and certify the competence of health professionals. Currently, there’s no way for the public to be sure these authorities are carrying out their function as intended by the Health Practitioners Competence Assurance Act, and so this bill introduces a five-yearly performance review for those responsible authorities. This provides the Crown and the public the assurance that the responsible authorities are discharging their functions as they should be.

Reviews are going to be done by independent reviewers, assessed against indicators developed by the Ministry of Health in consultation with responsible authorities, and they’ll be publicly accessible on the responsible authorities’ websites. Monitoring performance will allow for continuous improvement within regulatory frameworks. This will make it easier to promote good practice and increase consistency across the responsible authorities’ policies and processes, because at the moment there isn’t that consistency, necessarily.

Information about disciplinary decisions will be public. At the moment, the public has limited information about decisions that are related to complaints about registered health practitioners and the process that was used for making those decisions. This bill will require responsible authorities to release information about the decisions they make on a practice to the person who has notified them with concerns about the practitioner’s competence.

All in all, I think probably the most important part of this bill, and why it’s so critical, is the ability for the Ministry of Health to collect that data for the purposes of workforce planning.

I think it is going to take a long time. I mean, if there’s one thing that I’ve realised since becoming part of this fantastic Government, it’s that it’s going to take a certain amount of time for us to undo the damage of the last nine years and to build back up the Public Service to where it should be. It’s going to take time for us to get robust, quality legislation that is evidence-based, ready to be in front of the House, and it’s going to take time to build up the capacity of our health sector, in particular. It breaks my heart to have to say to people that there’s no quick fix to this midwife crisis—there is no quick fix—but it’s something that we’re absolutely committed to fixing over time, and we will be involving all of those in New Zealand who are working in this sector, listening to their views, and ensuring that they are taken into account. Thank you, Madam Assistant Speaker.

Thank you very much, Madam Assistant Speaker. This bill, it focuses on ensuring public confidence and trust in our health professionals. It’s designed to protect the health and safety of New Zealanders by providing a mechanism to make sure that our health professionals are competent and that they are fit to practise their professions. As has already been mentioned, it implements practical recommendations from two reviews over the original 2003 Act. It’s a mostly technical and procedural bill and it really tidies up about 14 different provisions.

National is very happy to support this bill, because it is another example of the coalition Government bringing our legislation into law. The bill provides for a number of operational efficiencies, but I think its real strength is about engaging and ensuring and encouraging new ways for health practitioners to work. It requires an authority to promote and facilitate interdisciplinary collaboration and cooperation in the delivering of health services, and it wants health professionals to work collaboratively to assist with workplace planning and development. So, overall, it supports a more sustainable, integrated, more convenient and patient-centred health system, and we support this bill. Thank you.

I call Angie Warren-Clark. I understand this is a split call. You have five minutes.

Thank you, Madam Assistant Speaker. I’m delighted tonight to take a call on the Health Practitioners Competence Assurance Amendment Bill. You may note tonight that I rise having a bit of a chesty cough. I apologise in advance for any unseemly coughing during this call tonight.

💬 Hon Michael Woodhouse: Do you know a good health practitioner?

Ha, ha—health practitioners bill. The Health Practitioners Competence Assurance Act 2003 was ground-breaking at the time of creation. The focus on protecting public health and safety by providing a consistent accountability regime for practitioners’ practice, conduct, and competence was and still remains crucial to public perception of health and to practice within our health system. We have heard tonight from the Government on the reasons this bill is useful and that this bill is a response to the operational and policy reviews carried out in 2009 and 2012. Those reviews found that the principal Act was working primarily well but that improvements could be made. This bill implements those recommendations.

What we have heard tonight is very little from the Opposition. We’ve hardly heard a thing, actually, about this bill. We’ve heard short calls, we’ve heard the tired old song that this was on National’s agenda and that this bill is their work, etc., etc. Well, that’s really a joke. We are here progressing this legislation because it is needed to keep pace with the changing face of our health system. In 2009 and 2012, you missed your chance to put people at the heart of our health system. Health is something that affects all people in this country, and here is a perfect example of nine long years of ignoring good advice in the health system.

I’d like to focus tonight on some of the key changes. Many key changes have been traversed by colleagues across the House, and I’d like to focus on the aspect of public trust and confidence. Justice must not only be done but it must also be seen to be done. This bill proposes changing the principal Act to improve information to the public about disciplinary decisions—in short, what happens to complaints about registered health practitioners. Essentially, information will be released to the complainant or the person who has notified the responsible body about the concern relating to the practitioner’s competence. Why is this important? Quite simply, complaints made or concerns raised deserve a feedback loop. The public or the person with the complaint needs to know that the concern was taken seriously. Mistrust exists where there is no or very limited response. This bill addresses this issue.

Crucial to this process, though, is that the relevant responsible authority must also develop policies to support natural justice and the practitioner’s right to privacy. So there is a fine balance to support transparency of outcome versus the individual’s rights. This bill also ensures that where sanctions are in place and are addressing the conduct and practice, that information is given to the practitioner, it’s given to who they are practising with and their employer—really key and important to have that feedback loop happening. I commend this bill to the House.

Kia orana, Madam Assistant Speaker. Please indulge me for 15 seconds, first, to congratulate you on your superb performance in the Coast to Coast recently, and also to congratulate Julie Anne Genter and her partner on the wonderful news that they shared with the nation at the weekend. I have to say I was really excited. Despite whatever else I may have done in my career, I still think that being a parent is the most exciting and the most important job, and I wish them all the very best.

For the reasons that have been articulated by my National Party colleagues, I have great pleasure in supporting this bill.

Tēnā koe, Madam Assistant Speaker. Kia orana. It’s a privilege to stand and speak on the first reading of the Health Practitioners Competence Assurance Amendment Bill. Can I remind the House—because we’ve heard a lot of accolades being accorded to the Opposition in terms of this being their idea—that the Health Practitioners Competence Assurance Act came in in 2003, and, according to the Hon Aupito Su’a William Sio, I understand that it was a Labour Government that brought in this Health Practitioners Competence Assurance Act in 2003.

Can I remind the House that the purpose of the Health Practitioners Competence Assurance Act of 2003 is to “protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions.” So it’s not a mere technicality, which some of the people on the other side spoke about, as in “It’s technical and it’s not important.” The purpose of this Health Practitioners Competence Assurance Amendment Bill implements the recommendations, as has been spoken of, of 2009 and 2012. It repeals the Health Practitioners Competence Assurance 2003, as I’ve spoken about.

My conversation tonight is about the changes that this will bring about, but before I do that, I want to talk about a personal experience I had yesterday in terms of entering the health system. I don’t have medical health insurance because I believe that we have one of the best health systems in the world. That’s why I don’t have medical health insurance.

So yesterday—I just want to acknowledge the cervical screening system in New Zealand, where women get a notice about when they’re due for a cervical screening. So yesterday, it was my turn. I got my notice—time to screen—so I took my health as a priority, just like it’s a priority for this Government to ensure that New Zealand’s health is provided for by practitioners that are credible through a system that ensures that those people who say they are practitioners are also credible. So I went into my GP to get my cervical screening done.

I’m not sure about the male gender of this House—about how they might feel about the vulnerability one has when you’re going into the general practitioner to conduct a smear test. When you are in the presence—I was advised when I first went for the screening, actually when I first had a child, that you leave your modesty at the front door and you pick it up on your way out. Yeah, you pick it up on your way out—when you leave. But what they don’t tell you when you do that is what happens—who is the person who is in charge of you?

You are so vulnerable. You want to ensure—which is what this amendment brings about. You want to ensure that when you’re at your most vulnerable—we have one life, and health is important. If we don’t have good health, actually, we can’t live as normal human beings.

So what we want to know when we’re going in to see our doctor is (1) that they know what they’re doing, (2) that there’s an authority that tells us that these people know what they’re doing, (3) that there’s a place that we can complain to when we feel that this practitioner is not providing a service that is a credible service, and (4) that there is a place that has authenticated a practitioner to be a credible practitioner—that they actually too have a health check. So I see this amendment, the Health Practitioners Competence Assurance Amendment Bill, as a health check of (1) the practitioner, (2) a health check of the system, and (3) a health check of those authorities that are charged with ticking that my GP actually meets all the qualifications to have a look at every part of me when I’m leaving the modesty at the front door.

So the things that this amendment will do—I think I’ve spoken enough about my personal experience. And, might I say, my doctor, Dr Soshamma George at the Mt Wellington Family Health Centre, did a wonderful job, because while I was at it, she said, “OK, while you’re here, we’ll get your annual warrant of fitness check done.” So we got my warrant of fitness done—tick, tick, tick, tick, tick—and, well, I think that I trust that every general practitioner does that to everyone. When you’re going in to just see one thing, she’ll see that you haven’t done your bloods and everything else, and they’ll say, “Oh, while you’re here, we’ll do that as well.”

So what the recommendations of the 2012 strategic review aimed at providing were (1) tangible evidence of responsible authorities’ performance, (2) better visibility of decisions about practitioner practice, (3) greater recognition of the importance of interdisciplinary collaboration and cooperation, and (4) better workforce information.

I just want to start by talking about tangible evidence of responsible authorities. It talks about the responsibilities of authorities—those who register and certify the competence of those health professionals. Currently, there is no way for the public to be assured that these authorities are carrying out their functions as intended by the Act. So the bill will introduce a five-yearly performance review for these responsible authorities. Not only just that, but the bill will allow the review to be conducted by independent reviewers, who are assessing it against the indicators developed by the Ministry of Health in consultation with the responsible authorities.

I reckon the underpinning aim of this bill is that the health profession or the health sector should not work in isolation, in terms of providing measures to make sure that those people, that those agencies who are to certify the health professions are actually reviewed by independent people that we can trust and rely on their recommendations once they’ve done the review.

The second point is about the better visibility of decisions about practitioner practice. As a registered social worker, I have a competency certificate that says that I can practise as a social worker in this country. I went through a whole process to get to that place. So I speak from a place of understanding, bringing an insight of what one needs to do to be competent, to be clear, and that’s certified to be a confident practitioner.

So what this bill will do is it will ensure better information about disciplinary decisions. At the moment, the public has limited information about responsible authority decisions as they relate to complaints about registered health practitioners and the process for making these decisions. The bill will require responsible authorities to release information about decisions they make on practitioner practice to the person who has notified them about the concerns about the practitioner’s competence. So basically, what that means is that if I make a complaint about my GP, I get the information about what’s happening with the complaint. So that is about continuing on what the aim of this Government—the direction this Government is going in. It is about transparent government, which means a transparent health sector, and that’s what this amendment intends to do.

Ultimately, the greater transparency about decision making will improve public confidence in the process of responsible authorities and is consistent with protocols followed by the Health and Disability Commissioner and overseas regulatory authorities. What I also like about the amendments to this bill is that the authorities that had—I’ll just get that one through before my time is up, because I think it’s important. It clarifies that the responsible authorities are responsible for meeting the administrative cost of the Health Practitioners Disciplinary Tribunal. So that would mean that the cost, in terms of the practitioner, will be fair and that actually the responsibility of the cost lies with the health practitioner’s authority.

Thank you, Madam Assistant Speaker. It won’t take a lot of time for me to support this bill. If you took the nine minutes of window dressing off the last speech, basically, I agree with a lot of what Angie Warren-Clark said.

As one of those whose association with the health system becomes more frequent by the year, I’m very much in support of this bill. I trust my health professional, I believe in what they say, and I hope what they tell me is right. If it’s not right, then I’m in trouble.

So I think the premise of this bill’s pretty good, and as a consequence of that, I support it as it goes through the House. I think that we all need safeguards, and for those of us who rely on the health system, even though we think we don’t, it’s critically important that it’s right. So thank you, Madam Assistant Speaker. I commend this bill to the House.

Thanks, Madam Assistant Speaker. It’s an absolute privilege to speak in some detail on this bill, which amends the Health Practitioners Competence Assurance Act 2003. This is actually an Act that I’ve practised under for the majority of my career.

As we know, the Act as it stands aims to protect the health and safety of members of the public by ensuring health practitioners are competent and fit to practise in their professions. What I want to talk about tonight briefly is just to go over why we need the Act in the first place, and then, secondly, a bit more about what this bill actually adds.

So why did we need the original Act? I want to think about three scenarios. I think the first one is John. So John’s recently moved to New Zealand. What he wants to do is he wants to earn a bit of money doing cut-price vasectomies. So it’s the Act that empowers responsible authorities, here the Medical Council of New Zealand, to decide what qualifications John needs before he can set up as a registered medical practitioner.

The other thing, though, is it’s also the Medical Council of New Zealand who’ll determine the scope of his practice, because, unfortunately, if John happens to be a psychiatrist who’s qualified in the United States, even if he gets registered here in New Zealand, it doesn’t actually mean that he can start performing surgical procedures out in our community.

Another scenario that’s governed by the Act: Susan qualified as a GP in 1980, and she’s been working as a sole practice practitioner and a rural GP all by herself for a number of years now, so she’s way, way too busy to be reading any medical journals and she hasn’t been able to go to any conferences. So what’s happening with Susan is she’s starting to lose touch with all those developments in terms of diagnosis and best treatment, and her patients really risk not getting access to the best of care. So, again, it’s the Act that empowers the Medical Council to make sure that Susan does some professional development, and also, if they’ve got concerns, they can require her to complete some competence or recertification programme. So it gives them the teeth to be able to do that.

The third scenario is Bob. Bob has been having a bit of trouble at home, and, as a result, he’s coming to work and he’s smelling of alcohol. On one occasion recently, they had to cancel his list because the operating theatre staff decided that he was not sober enough to actually practise. So it’s the Act that empowers the Medical Council to start taking complaints and receiving them from either concerned members of the public or other colleagues and then to refer them to professional conduct committees so they can have a proper look at it, and then, if they think it’s warranted, they can pass that on to the Health Practitioners Disciplinary Tribunal. So what this Act does is it makes sure that medical practitioners are competent to practise in our country and the public is assured that the relevant authorities have got oversight into all of those areas.

But then what does this bill do? What we want to start with is a bit of history. The Act was passed in Parliament in 2003 and it really came into full effect in 2004, and it now covers 23 health professionals. It includes medical practitioners—so, doctors overseen by the Medical Council—but also the nursing and midwifery councils, dental council, pharmacy council—a whole raft of practitioners. Section 171 of the original Act required that the director-general carried out a review of the Act in 2008, so that’s 10 years ago—just noting—and since then there’ve been two reviews. The first was completed in 2009, and that just looked at whether the Act was operating as intended. The second one, completed in 2012, was more policy focused, and it was really trying to work out whether the Act was still doing what it was meant to be doing given the changes in the health system. That reported back in 2012, and both of those reviews recommended a number of improvements. What they were saying was the Act was functioning as intended but they said there were areas that we needed to make a number of legislative changes on. So that was six long years ago, and, finally, we’ve got around to it as a result of an incoming coalition Government.

So there were four main areas where they recommended that changes were made, and the first one was making sure that responsible agencies could actually demonstrate that they were doing what they were meant to be doing. The second one was making sure that they were transparent in their processes so that those who referred concerns in and those people employing people that were being reviewed actually knew what was happening. The third one was looking at how we do interdisciplinary collaboration, because a lot of balls were getting dropped from passing from team to team, so looking at how we actually do seamless communication so things don’t get missed. The fourth one was looking at better workforce information, and I just want to go to each of those in a little bit more detail.

So the first one was looking at whether responsible authorities were actually doing what they were meant to be doing. What this Act introduces is five-yearly performance reviews for responsible authorities. These reviews will be conducted by independent reviewers but they’ll be assessed against independent criteria that are determined by the Ministry of Health, under consultation with the authorities. The whole aim there is to make those reports publicly available on the authorities’ websites so that people can be assured that they’re doing as intended.

The other one is greater information about disciplinary decisions, because sometimes it was a bit opaque about something getting referred to one of these authorities and then not quite knowing what happened to the complaint. It seems quite obvious, but what this bill requires is that responsible authorities have to release information about their decisions back to the person that notified the concern in the first place, and also in terms of their employer as well, because that’s quite pertinent information if you are employing somebody whose performance is under review.

The other issue is about publication of names of those undergoing disciplinary proceedings. You’ve got health practitioners who may have failed to meet standards, and the question is: are those names able to be released to the public, and in what way? I think even though medicine now is very, very much evidence-based, as a practitioner it’s still very much an art as well as a science. Basically, mistakes do get made, and, I guess, what we’re looking at here are not those one-off mistakes but those systematic mistakes that are going to make practitioners a risk to their patients. So it’s always the balance between the public’s right to know and public interest, and the practitioner’s rights for privacy and natural justice. What the bill requires is that the responsible authorities develop policies about how they’re going to notify, whether they’re going to name the health practitioners, and the reasons for those decisions, and put those up on their websites.

Inter-professional communication’s been touched on by a number of people, and this is an area where often it’s not individual practitioners that are making individual mistakes, but it’s where bits get missed in between handing over from one team to another—blood tests don’t get followed up, information’s not passed on about someone being at risk. So this is where the bill provides greater recognition for teamwork and inter-professional communication.

The fourth one is workforce data, and making sure that we’ve got the right data so we can have the right staff with the right skills in the right places at the right times. This is entirely feasible. Every year that I’ve had to renew my annual practising certificate, I’ve had to do a workforce survey, and all the stuff you put on your annual practising certificate renewal about your occupation and who you’re working for—that gets supplemented with how many hours you’ve worked and also what your intentions are for the next year of practice. So that information’s really valuable, but it’s not being collected consistently across all professions, so this bill gives the responsible authorities a legal mandate to collect that data and then to pass it on to the Ministry of Health to use for workforce planning. What will always be the assurance, though, for the privacy perspective—it’s always going to be presented as aggregates or anonymised data.

There’s a range of other changes that the bill proposes. Some of them are just straight clarification about the responsible authorities’ ability to receive complaints from members of the public. Some changes are about reducing administrative burden on reporting requirements for quality assurance procedures. Some changes allow amalgamation of responsible authorities when it’s useful, and some look at making sure that it’s very clear that the administrative costs of the Health Practitioners Disciplinary Tribunal are met by the responsible authorities.

So this is a really great bill, and it makes sure that those responsible for keeping our practitioners competent and practising to the top of their scope are also themselves under scrutiny. Therefore, I commend this bill to the House. Thank you.

Bill read a first time.

Bill referred to the Health Committee.