Newborn Enrolment with General Practice Bill

I move, That the Newborn Enrolment with General Practice Bill be now read a second time.

Mr Assistant Speaker, thank you for this opportunity. I’m taking this call with mixed feelings. I’m saying mixed feelings because I’m happy and I’m also sad. I’m happy because this is my member’s bill—because this reflects my passion to do more for newborns and new mums. And I’m sad because this Government, this Labour-led Government, has decided not to support my member’s bill, which is to enrol newborns with a general practitioner before they are six weeks old.

I ask: what’s wrong with enrolling newborns with a general practitioner of the family’s choice before they are six weeks old? Nothing—nothing. I ask: what’s wrong with denying the ability of general practitioners to not enrol the newborns because they don’t know the family or there is debt owed by the family to the practice? Yes, that ability should be stopped, and there is nothing wrong with that.

I ask: what’s wrong with giving the ability to general practitioners to be able to deny a pre-enrolment request received on behalf of a newborn if the general practice is running at full capacity or if there is another good reason? Yes, general practitioners should be able to deny a pre-enrolment request if they are running at full capacity or there is another good reason. There’s nothing wrong with that. What is wrong with having a preventative approach towards the well-being of newborns? Nothing.

There is nothing wrong, so I ask: what is wrong with this Government—that this Government is not supporting my bill, which is to enrol newborns with a general practice before they are six weeks old? This bill exposes the real side of this Government, and that is that this Government is big on talk. When it comes to talking about children, talking about newborns, their talk is really big. But when it comes to action, there is no action, and that is what this bill exposes.

The Prime Minister’s, Jacinda Ardern’s, flagship policy, her bill the Child Poverty Reduction Bill—I have read submissions online for that bill, and I have seen that people are saying that well-being factors should be included in that bill to deliver the full outcome that she wants to deliver. And my bill is exactly about that. So my bill is about the well-being of newborns, and this Government is not supporting my bill.

I want to thank all submitters—those who took time to write to the Health Committee during the submission process and those who appeared before the select committee for oral submissions as well. We saw that most of the submitters agreed with the intent of the bill. We saw nearly half of the submitters actually supported the bill, and some submitters came up with some suggestions as well to improve this bill.

And one common suggestion that came through from submitters was that this process should actually start from the gestation—from the pregnancy phase. And they wanted to make sure that this is actually happening before newborns are six weeks old, and that’s why they were suggesting that we should start this process from the pregnancy phase.

And what I saw during the select committee process was that the Ministry of Health came with their advice at the start. After the hearing of evidence finished, the Ministry of Health came back with exactly what they had advised at the start—to recommend. And I had to push back. I had to push back because it is not acceptable to keep the status quo, because this bill is about moving beyond the status quo. It is about ensuring that newborns are enrolled before they are six weeks, and that is not happening at the adequate rate that we would like it to.

So, after a big pushback, the Ministry of Health came back with a watered-down approach, a completely watered-down approach under the watch of the health Minister, Dr David Clark. So the approach is that they will have two performance measures in the district health board accountability framework. The first is to see that 55 percent—I repeat, yes, 55 percent—of newborns are enrolled with general practitioners before they are six weeks old. We know where most of the births are happening. We know that most of the births are happening in some form of lead maternity facility. So why can’t we see more newborns be enrolled before they are six weeks old? It will need some resources—yes, like every other legislation, this legislation will need some resources as well. We need to streamline our IT process so that our lead maternity care providers are connected to general practitioners so that newborns are enrolled and we can measure the enrolment rate in real time.

So 55 percent of newborns enrolled before they are six weeks old, and this is the measure that the Minister is happy to accept. And this is the measure that Government members voted for—55 percent. We are in a developed country, and we are talking about enrolling 55 percent of newborns before they are six weeks old with general practitioners. And the second performance measure that was recommended by the Ministry of Health under the watch of this Minister Dr David Clark is 85 percent of newborns to be enrolled before they are three months old. That could be already happening. And, if it’s not already happening, that is another reason why we need a legislative framework to see that newborns are enrolled in time.

My bill is in line with the recommendation to the Health Committee in 2013 which was made upon the inquiry into improving child health outcomes, work on findings of the inquiry into improving rates of childhood immunisation in 2011. So two reports—2013 and 2011. And this is also in line with the policy that was put in place in 2012 to enrol newborns with general practitioners—this is through the National Immunisation Register notification.

Ministry of Health accepted there are delays because of the time it takes for the request to go through the National Immunisation Register and also because general practitioners can just deactivate that request. They don’t have to accept or decline. So, yes, this is something that we need to fix, but this Minister doesn’t care about fixing this.

All the three parties in Government supported my bill in the first reading. That was in the last term. Yes, they all supported my bill in the first reading in the last term, and I know why: because they thought, yes, this bill will require some resources, and they didn’t have any hope of being in Government. They thought National is going to be back in Government so the resources will be put in place by the National Government. So now they are in Government, and all of a sudden they have realised that “Oh, actually, we will have to put some resources to streamline the IT system in our health system to ensure that lead maternity carers are able to connect with general practitioners in time for this to happen in a timely manner that this bill requires.” And, all of a sudden, because they realised it will need resources, they have decided not to support my bill.

And this was the exact line which I got from the Minister Dr David Clark when I accidentally bumped into him in Copperfield’s cafe and I asked him about my bill. He said, “Oh, it will need resources.” And I said, “Yes, just like every other legislation, this legislation will also need resources.” And then he said that, “Oh, we might have a better way of doing this.”, and the better way is to enrol 55 percent of newborns before they are six weeks old? It is embarrassing. I don’t accept this to be an acceptable way of going forward.

So this is what this Government is about. This is the ambition they have for newborns. Well, why would they care about newborns? They can’t vote. All they care about is those who can vote, because the tertiary Fees-free policy is about enticing voters. That is the age group that votes. Newborns can’t vote, so why would this Government care to look after newborns? Why would they care about newborns and new mums getting access to several health checks and social services through Well Child? There are 12 very important points of contact for health checks of babies before they start school. Also, mums can get several connections which are helpful to new mums as well through the enrolment of a newborn with a general practitioner. But what I’m seeing is that this Government, this Minister, Dr David Clark, is clearly depriving newborns from having access to health services and having access to so many free social services that are available, depriving so many new mums from having access to so many social services that are available for free.

It’s unacceptable for this Government to come up and give any excuse for not supporting my bill. There is no excuse to not support my bill, except that they have used all the money they had for their spending policies that were to attract votes, and newborns cannot vote. But, on this side, I’ll keep fighting for newborns and new mums. Thank you.

Parmjeet Parmar’s bill is a nice idea in theory, but it’s clear, when you look at it more closely, as many members did in the Health Committee, that it really lacks substance and, unfortunately, will not achieve what it sets out to do. It’s not a resourcing issue; it’s simply not an effective way to achieve the thing it says it wants to achieve. The bill would legislate for outcomes that are already expected, without putting any levers in place to achieve them, without any consequences for their not being achieved. It’s completely toothless. It’s a well-intentioned bill. It’s a nice idea, but I think the facts speak for themselves.

If the previous Government had thought this was a priority and was the way to do things, the previous health Minister would have adopted the idea and would have put the legislation through the Parliament. But, in the previous Government, clearly the health Minister thought this was not the most effective way to do things. It was not a priority. He was happy to let it sit in the ballot and then make its way slowly through the members’ bill process, because he could see it was a reasonably hopeless way of trying to achieve what it said it was wanting to be achieved.

I think members in this House can appreciate that legislation is not always the best way to solve an issue. Legislating for something that is already required doesn’t make anybody want to do it any more; and if there’s no consequence and it’s already required, legislating and having no consequence isn’t going to make any difference, either. It just uses up parliamentary time.

💬 Dr Parmjeet Parmar: The Minister wants to punish parents.

I can understand the member’s disappointment, and I can hear her across the House expressing that disappointment and frustration loudly. This was, I guess, meant to be her moment in the sun. But we have to look at the facts, and we have to make a rational decision about what the most sensible way is to achieve these goals. This Government believes in improving outcomes for young children; that’s why we passed the $5.5 billion Families Package. It was the first action of this Government, actually—the biggest change in income distribution in this country since 1991. Our priority is with children: $60 a week more in the family will make a big difference to those vulnerable families. That is the priority of this Government. That’s why the targets for improving child poverty have been set down. That’s what this Government is about. This Government cares about making a difference. Tweaking something to make it a law when it’s already an expectation and making that law have no consequences is nothing but window dressing, and it’s unfortunate window dressing.

We are more ambitious than that. We as a Government—we on this side of the House; this coalition Government—are more ambitious than that. We don’t just want one enrolment; we actually want a GP practice in there, we want a Well Child provider, we want them to be on the National Immunisation Register, and we want a dental programme. It’s called “quadruple enrolment”, and if you talk to clinicians up and down the country, they say quadruple enrolment is the way to go. So we’re looking at ways to incentivise that, to make sure that primary health organisations (PHOs) are incentivised to actually deliver that, to make sure that the cultural supports are in place, and to make sure that midwives are given opportunities. Actually, this bill would undermine the role of other health professionals, like midwives, in newborn enrolment and their particular role and place. The particular set of time frames could actually undermine midwives’ role in caring for young children and in making sure that they go through those early stages and that mothers are supported to get those right enrolments and to have the right things happen at the right time for that child’s development.

It would place also an administrative burden on GPs because of the requirements laid down in the bill, and these are already stretched GPs.

💬 Dr Parmjeet Parmar: Oh, so who is supposed to provide support to GPs?

I hear the member saying sarcastically, “Pity for the GPs!” Well, they are burdened. The GP workforce works very hard and they do try to make this happen, and they do support this already. Legislating without any consequence achieves nothing in this situation. So I’m afraid that this bill is not one that we can support on this side of the House. We actually think we need to take real steps to improve the well-being of young children. We need to make sure that families are supported, that they have the incomes to make sure that those children can be looked after, that they should actually have quadruple enrolment, and that expectations should be put on PHOs and mechanisms put in place to make sure that happens in PHO service agreements. We’re already working to make that happen. We think the district health boards should be more accountable. There are a number of mechanisms for making this happen that don’t require legislation—toothless legislation, well-meaning legislation that the previous Government wouldn’t even support its own member to get through the House. We believe in making a real difference in people’s lives rather than window dressing.

The suboptimal newborn enrolment rate—and let’s admit that things are not as good as they could be—is something we need to tackle in a serious way, not through window dressing, not through a bill that the member’s own Government, the previous Government, wouldn’t support through the House, not in a bill that might, potentially, undermine the role of midwives in newborn care, not through putting extra administrative burdens on the GPs, who already try to support these young people, these young families, as they wrestle with these issues. So we think that we should get the quadruple enrolment, as I said. We don’t think this is the most effective way to improve newborn enrolment.

We do extend our sympathy to Parmjeet Parmar, who, of course, had the frustration, under the previous Government, of a Government that wouldn’t fund healthcare properly. I understand that; we were frustrated with that when we were in Opposition, because we saw the effects of it. We saw the effects of an underfunded health system. We saw that health system getting run down. We saw it getting harder to get surgeries that people needed. As MPs, we saw people coming through our electorate doors, complaining about the way the health system was being run down, the burden being put on the workforce, the lack of sustainability—we saw all of that, too. We understand the member’s frustration that her own Government wouldn’t support her to make positive change. We understand that on this side of the House, but we can’t support it out of a sense of sympathy. We actually need to see the best policy rationale put forward. We need to put mechanisms in place that will actually work, not just legislate for something that’s already a requirement.

I want to say also that there are other things that can be done to support this, and that is making it more affordable and accessible for people to go to GPs, so that they have relationships with their GPs. This Government, in its Budget, has just passed a measure that will ensure 540,000 people will get access to a community services card that gives them cheaper doctors visits. For many people, that will mean their doctors visit becomes $20 to $30 cheaper—for some, it will be $50 cheaper. That will help them establish a relationship with their GP, where they get the regular care they need. When their child is born, they’ll feel comfortable going to the GP for that enrolment. That will make more difference than this bill here—this resource, going to primary care so that families are getting the support that they need.

That Government had a report, the Moodie report, which recommended this kind of care and support—the community services card extension—but they did not act on it. They simply would not act on it to give people better access to GPs. Instead, they’d rather legislate. The interesting thing is that they won’t legislate to make it compulsory for parents to take their children along. There’s no suggestion they’ll do that; they just want to blame the GPs. They want an extra level of blame on the GPs; that’s what they’re calling for here. Well, we can’t support it, I’m afraid. We supported it to select committee because of the intention. We thought that maybe out of this you could make something reasonable—that you could somehow put something together in a select committee that did achieve an outcome. We thought it needed a good looking over. It’s the right thing to do. If a bill has good intentions, you tend to support it to select committee, but it really didn’t stand up to scrutiny.

It’s well-intentioned, and we have sympathy with the member that she couldn’t get her own Government to make progress in this area. The frustration with the underfunding in the health system was something we shared too—the lack of leadership on these issues by the previous Government—but that won’t stop us being more ambitious. That won’t stop us supporting quadruple enrolment for young children. That won’t stop us getting on and addressing the neglect of the health system, making doctors visits more accessible, making sure that hospitals that have got rot and mould in them are repaired so that we can have the health system and the health services that New Zealanders expect and deserve. This is a Government that believes in action, not window dressing, not good intentions. But let’s get on and make New Zealand a better place, where people can get the health services they need and where we actually see progress on having people enrolled.

I’m sorry to interrupt the member. This debate is interrupted and is set down for resumption next sitting day. The House stands adjourned until 2 p.m. tomorrow. Pō mārie.

Debate interrupted.

The House adjourned at 10 p.m.