Health Practitioners Competence Assurance Amendment Bill

I move, That the Health Practitioners Competence Assurance Amendment Bill be now read a third time.

I wish to start by thanking members across the House for their support for this important legislation, which will amend and update the Health Practitioners Competence Assurance Act 2003. Colleagues from across the House have expressed their support at the first and second readings, and it is appreciated. It’s an example of the Parliament working collectively on what might not be a particularly controversial piece of legislation but is actually an incredibly important piece of legislation for public safety and for public confidence in the services that our health practitioners present.

This bill implements recommendations arising from two reviews of the Act. The first was in 2007, and it looked at whether the Act was really operating as it was intended and whether it needed clarifying in terms of how it operated, and a number of legislative amendments were put forward. That first review, in 2007, was followed in 2012 by a more strategic review of the Act, which examined whether the underlying policy settings remained appropriate. A number of recommendations arose from that second review, which included: providing tangible evidence of responsible authorities’ performance, better visibility of decisions about practitioner practice, greater recognition of the importance of interdisciplinary collaboration and cooperation, and better workforce information. It’s those two reviews which form the substance of the bill that is before the House. It also includes recommendations proposed by the Health Committee following consultation with the public as part of a select committee process that went from May to September last year.

The key provisions in the bill, though, largely remain the same as before they went to the Health Committee for consideration in September. It introduces performance reviews for responsible authorities, and these reviews will mean that the public will know if a responsible authority is carrying out its functions as intended by the Act. The introduction of five-yearly performance reviews means that there is a greater assurance that those functions are being carried out. It’s part of building public confidence in the Act and in its operations and in the professions that are regulated by it. It will ensure that those respective professions are upholding public safety, as they are expected to do.

Changes to the bill mean that we will have better information provided to people who’ve asked responsible authorities to make investigations into decisions about professional competence or conduct. Currently, there’s very limited information available to the public when an investigation is conducted, and, again, this will ensure that there’s public confidence in the system. It also is true that the bill clarifies that the responsible authorities can receive and act on information from members of the public. So it’s a much more, I guess, modern way of doing things and is all aimed at making sure that there is confidence in the Act and that it operates in a modern way.

Responsible authorities will be required also to promote and facilitate collaboration and cooperation between different professions, and there’s plenty of evidence that shows that that is important for health outcomes. In fact, and indeed, many of the complaints that the Health and Disability Commissioner receives are about poor communication between different professions or a lack of teamwork—essentially, where different professions are not cooperating. So the bill contains provisions that emphasise the importance of a cohesive team approach across the health and disability system and in order to achieve those public safety benefits that we know come from that.

Another important thing that’s in there that was in the original bill is the supply of, and collection of, workforce data on health professionals to enable better forecasting and to make sure that we have the right professionals with the right skills in the areas where they are needed. It gives responsible authorities a legal mandate to collect that data, and that includes things like their date of birth, place of employment, and so on. Equally, the bill is clear that that information will be anonymised anywhere that it’s published; it’s not there to identify individual practitioners but to understand workforce trends so that better forecasting can be done in terms of future health system needs.

I’d also like to highlight one of the other proposed amendments that was made after the bill was considered by the Health Committee, and that is that the bill will ensure the Act allows responsible authorities as regulators to act immediately to suspend a practitioner’s practising certificate in instances where there is a risk of serious harm to the public pending a prosecution or investigation. This change will help ensure increased public safety where practitioners may pose serious harm to patients. There has been a lot of backwards-ing and forwards-ing with the different regulated professions—if you’ll excuse my England—in order to reach a point where those who are regulated are comfortable that we have the right regulation in place to make sure that we can ensure that public safety is protected whilst also trying to preserve the natural justice of those who have been complained against.

The bill also moves us into the electronic age. All of the responsible authorities submitted that electronic communications should be allowed in the Act. This is, in one sense, hygiene, but it is important and it means that annual practising certificates can be sent electronically and notices can be served electronically, and it will improve, ultimately, the efficiency of the operations of these regulators. Indeed, that’s one of the overarching purposes: to show that the efficiency and effectiveness of these regulators is being monitored and is suitable.

Responsible authorities will also have specific power to revoke the accreditation of an education institution’s qualification if necessary. That’s another change that has been made. The bill also includes cultural competence provisions, with specific mention of cultural competencies that will enable effective and respective interaction with Māori. Again, there was much submission on this, I understand, at the select committee. Others will, no doubt, speak on this during their turn in this Parliament, but it is anticipated that having an explicit mention of Māori will contribute, in part, to increasing Māori health disparities.

💬 Hon Peeni Henare: Good work, Minister.

The bill includes a discretion—thank you, colleagues—for responsible authorities to refer health practitioners convicted of certain offences, such as drink driving, for treatment or counselling rather than simply referring them to a professional conduct committee. Again, that seems a sensible and modern way of handling things.

So, in conclusion, the Act does already provide a sound framework for protecting the public but this bill updates it. It improves public safety by fine-tuning aspects of the Act, allowing more efficient operation and making sure that it achieves its purpose and is seen to achieve its purpose through those additional transparency measures that have been introduced. The public should have great confidence in the professions that serve them, and this is one way of ensuring not only that they are operating effectively but that that can be transparently seen. So it is my pleasure to commend this bill to the House.

It’s a pleasure to rise and speak in the third reading of the Health Practitioners Competence Assurance Amendment Bill. I do want to start out by acknowledging the Hon Dr David Clark for his contribution and for bringing this bill to the House. I would also like to acknowledge the chair of the Health Committee, Louisa Wall, for her contribution, but also the contributions over a number of years, because, as we know, this has been a bill that has had cross-parliamentary input. I certainly want to acknowledge previous National Governments for the work that they did in the reviews that were undertaken, both in 2009 and then again in 2012, that have led to some of the key recommendations that have been implemented into this bill.

As the Hon David Clark mentioned, this is an important bill. It does tidy up a whole range of regulatory inconsistencies, but it is an important bill to provide the public with assurance and confidence in their healthcare practitioners, and to make sure these practitioners are fit and competent to practise their professions. So that is, essentially, the purpose of the bill. It is a procedural bill. It makes a range of 14 provisions to tidy up the Act and make sure that the definitions are clear. If there are concerns with practitioners, there is now a process in place by which those concerns can be raised with the regulatory body and the appropriate discipline can be sought—but also the collaboration, the cooperation, and the delivery of these mechanisms as well.

So just to go back in time in terms of the reviews that were conducted, probably the most significant review that was conducted was in 2012. The key recommendations that came out of that were around the responsible authorities’ performance, better visibility of the decisions around practitioners’ practice, but also around the better workforce information. That was really key in terms of providing us with the framework by which this bill has come to the House today.

As the Minister outlined, this is really about improving the efficiency and the effectiveness of the healthcare practitioners in the way they go about their business, and ensuring that there’s a process by which discipline can be brought on healthcare practitioners that are not living up to the standard of their profession. That could be in terms of a suspension but it also could be in terms of just a performance review as well. There is now in place a process to examine healthcare practitioners, and that is certainly very handy and very important to make sure that the public has full confidence in the people that are coming to them as registered healthcare practitioners, because that is of the utmost importance for our healthcare system.

There were a number of select committees—we won’t go through them in detail—but the Health Committee, of course, looked at 49 submissions and no substantial changes were made from that. So it is worth that I take the time to just acknowledge everybody who has contributed to this bill in terms of the select committee, the Minister, but also previous National Governments as well, and every official out there who has contributed to making sure that we’ve got the most efficient and effective system for healthcare practitioners. This will make sure that we’ve got confidence in the system but also that there are processes in place whereby we can hold healthcare practitioners to account but also make sure that we uncover any inconsistencies or any poor performance in their work. So it’s my pleasure, in the third reading, to commend this bill to the House.

Tēnā koe e Te Māngai o Te Whare. Tēnā koutou katoa. It is my absolute pleasure to speak on this, the third reading of the Health Practitioners Competence Assurance Amendment Bill. I want to take the opportunity to congratulate the Minister and his officials, because we actually worked incredibly diligently as a select committee, but I too want to acknowledge all the work that was done before the bill was actually presented to the House.

It was presented to the House under three areas: one was to improve the operation of the Act, the second was to protect public safety in an ever-increasing and changing health environment, and it was also to support the development of New Zealand’s health workforce now and in the future. I particularly want to focus on the 2012 review—so there was a review in 2007 and then again in 2012—and we refer to extensive consultation, but I actually just want to briefly outline what that was.

They actually received 145 public submissions—and this is the Ministry of Health—to a document entitled 2012 Review of the Health Practitioners Confidence Assurance Act 2003. I want to highlight that number because it saw 16 of the responsible authorities participate; it saw 34 professional associations, 28 educators of health professionals, and 35 groups of individual health professionals. That gave rise to the piece of legislation that came before this Parliament that we all supported at the first reading. Then what happened in the Health Committee is we did receive 49 submissions and heard from 23 oral submitters and, in fact, we made substantive changes, even then, to the piece of legislation that is before us tonight.

I just want to highlight some of those. So it was, in fact, the select committee that recommended the following amendments: revoking the accreditation of an educational institution; electronic communications; options for dealing with practitioners who have been found guilty of an offence; temporary suspension of practising certificates; professional conduct committee placing conditions on a practitioner’s scope of practice; costs of Health Practitioners Disciplinary Tribunal; wider consultation before recommending that authorities amalgamate; registration to continue when authorities amalgamate; cultural competence issues—that the Minister has just spoken about; performance reviews, and ability to consult on the terms of reference, and annual reports to include information from performance reviews; workforce data should include gender and ethnicity; removal or suspension from an overseas register; orders of an authority; and date when orders can take effect.

That’s a huge amount of work that the select committee did. The reason I wanted to read it out was because we worked really, really hard across the House, and I do want to take the opportunity to thank my colleagues on the Health Committee. We work on issues of this importance in the best interest of New Zealanders. So the impression that we don’t work like that—I think this bill is testament to the fact that the work that select committees do, the importance of New Zealanders making submissions, contributing to the select committee process. I actually think this bill is a case study of the impact that those submissions can have on pieces of legislation. So I want to thank all of those involved as health practitioners in New Zealand because, for all intents and purposes, they could have rested on their laurels after the second review, but they didn’t. They fronted up and they were engaged, and I hope that they have found the process satisfying and that what we’ve come up with as a Parliament is something that they too are proud of, because I certainly am.

Just to remind all of us that the Health Practitioners Competence Assurance Act primarily does two things. It ensures health practitioners are competent and fit to practise their professions, and I think one of the things I have emphasised previously is that it’s not just about the health practitioners; it’s also about those professional organisations, the responsible authorities, the professional associations. What this bill does is make sure that they are culturally competent too. We’ve seen an expansion of this theory of cultural competence from an individual to an actual sector in our society.

So what we’re hoping, through this piece of legislation, is that we have a fit for purpose, culturally competent health practitioner network that is willing and able to meet the needs of New Zealanders. How do we think they best do that? By reflecting the people that they serve. I think this will provide, and this Act eventually, an opportunity for our health sector to be fit for purpose, to meet the demands of this changing environment that actually has changed and is changing because of the composition of New Zealand in terms of our demography.

So I just want to conclude by again highlighting the officials who worked on this piece of legislation. They were amazing, and if they can take this as an endorsement of their work, and certainly if the Minister of Health can take that as an endorsement of those who worked on this bill within the Ministry of Health, then I’m happy for that to be so. So I commend this bill to the House. Thank you, Madam Assistant Speaker.

Thank you, Madam Assistant Speaker. It’s a pleasure to take a short call to progress this bill through its third and final reading. It has been quite a long course for this bill, if we reflect back on the two reviews, 2009 and 2012, that give substance to what this bill is about. And if we look at the departmental disclosure statement, it’s very clear that the purpose of this bill is to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are fit to practise.

As was commented on, we had 49 submissions, and what was satisfying was that it was across a whole range of service providers: 16 of the responsible authorities, 10 medical professional bodies, 17 other professional groups, two individual practitioners, two interested organisations, and some Government agencies. And, as the chair has noted, the bill was improved by those submissions. I’ll come back to one in particular, but if we look at a high level as to what this bill does, or the actors that it operates on, it operates on four main groups. As a consequence of this bill, amongst other things, patients are able to inform responsible authorities of their concerns for a health practitioner. Previously only a health practitioner, employers, or the Health and Disability Commissioner were able to refer people to the responsible authority. This is quite a substantial change. This is a good thing. Providers also are improved or their work is facilitated under this bill by prohibiting the publication of their names, pending hearing charges, and that’s at the discretion of the chairperson. What we found out was that sometimes because the tribunal had to meet to make that provision, which seems eminently sensible and safe, it had actually already gone into the public domain. So there’s something in this for providers. Responsible authorities—they’re now reviewed every five years, and we also did some work on the Health Practitioners Disciplinary Tribunal, on their funding mechanisms.

I think one piece of submission, if you like, that maybe will need some future thinking and some future work—and post the committee we’ve continued to have submissions—is in the area of tele health. The argument made to us during the select committee was that we should legislatively require those overseas individuals or organisations who, for example, view some of our X-rays or scans or whatever to be registered within a New Zealand responsible body. We looked at this quite hard. It was quite challenging to sort of futureproof the bill, and the ministry came back to us and said, fundamentally, that this shouldn’t be legislative; that, contractually, district health boards (DHBs) and the ministry are able to meet the requirements that we think are safe. I think there’s still some work to do with that, but what we were told was that the ministry’s view is that this matter is better addressed through contracts for delivering services. The Ministry of Health can require in its contracts with DHBs and other health providers that services provided by health practitioners be registered with the relevant New Zealand authority or an appropriate authority.

So there are mechanisms here whereby contractually rather than legislatively, which is the tool we have in front of us, we can require those people who are registered offshore—maybe even sitting offshore—to have some relationship with an approved New Zealand body. I think there’s still some work to do on that, but we were satisfied with the explanation we had from officials that this was still safe, that it met the parameters and the scope of what we were looking to do with this bill, but I just put it out there that I think it’s another piece of work that isn’t quite resolved.

That aside, this is a long piece of work that comes to its conclusion tonight—very good work by the officials. It’s quite complex in a large number of sections that they worked on. And again, it was collaborative work by the Health Committee. So all that being said, it’s my pleasure to assist and progress this bill through its third reading.

E Te Māngai o Te Whare, tēnā koe. It’s a pleasure to rise on behalf of New Zealand First in this final reading of the Health Practitioners Competence Assurance Amendment Bill. I’d like to begin my contribution this evening—I am a member of the Health Committee but, unfortunately, I only joined the committee after this bill had gone through the process of the select committee stage, so I missed out on hearing from all those that came and presented to the committee. So I would like to start off by acknowledging the work that was done inside the committee and the collaborative way that they have worked under the leadership of the chair, Louisa Wall, and deputy chair, Dr Shane Reti. It is an absolute pleasure to be part of that committee.

Looking at this bill now, in its third reading, and acknowledging that the Hon Dr David Clark talked originally about this bill being fit for purpose—creating an Act that is fit for purpose and that is relevant to the modern day—when I look at this bill what I think of first and foremost is in terms of “Who does it affect?” It affects New Zealanders. Ultimately, it’s all about the trust that they place in the health sector, the trust that they place in their doctors and their medical practitioners, and ensuring that vital ingredient of trust between our public services and our fellow citizens who actually access that. This, in the health space, is highly important and trust and confidence that patients place in their heath professionals and how this bill impacts on them so that they can continue to have that trust, rather than just relying on Dr Google, as some people tend to do these days.

So what I would like to acknowledge is the length of time that this bill has taken. There were two reviews—we’ve heard that mentioned already—from 2007 through to 2009, and then again another review from 2012 to 2015. So it’s been a long period of gestation to end up tonight finally at the third reading.

The Health Practitioners Competence Assurance Act 2003 was ground-breaking legislation, and that has been acknowledged internationally as being significant for health professional regulation. What this amendment bill does tonight is it brings it up to date. It ensures that as we move forward, this legislation will take us, futureproofed, into the next number of years. There are a number of public expectations in terms of technology and the way that health services are delivered and will continue to be developed and changed, and there’s nothing surer than that—that change is inevitable, and health legislation needs to keep pace with all the changes coming at us left, right, and centre.

A couple of the changes that were made through the Health Committee process by the committee—and I’ll talk to those briefly—were about immediate suspension where there’s a risk of harm to the public pending a prosecution or investigation of a health professional: that they can be suspended immediately. The electronic age, as I’ve just mentioned—making sure that this electronic age that we live in is appropriate, and that the health legislation actually reflects that as well so these organisations, these regulators, will actually be able to conduct their business electronically. That seems really obvious, and it is good to see that is in there. Also, too, the cultural competence that comes into play as well: ensuring that to enable effective and respectful interaction with Māori. That is a vital part of this: to ensure that we continue to address the Māori health disparities that we hear much about.

In conclusion, you know, we have this amazing thing—we had the bill just prior to this one in the House, the Accident Compensation Amendment Bill that we’ve just spoken to. We don’t have all these tort lawyers clogging up our courts with litigation because of our no-fault basis ACC scheme. But one of those things that relate to that is we have that no-fault basis scheme, but, on the flip side, we’ve got to make sure that, in practising health, practising medicine, actually, we have a competent professional who knows what they’re doing and that there is accountability. This bill goes all the way in terms of ensuring that is the case for New Zealanders who engage in the health sector. So that’s why New Zealand First strongly supports getting this legislation—the Health Practitioners Competence Assurance Amendment Bill—passed into law this evening. Tēnā koe, Madam Assistant Speaker.

Thank you very much, Madam Assistant Speaker. National supports this bill at its third reading, and it’s great to see it finally coming through the system, because it’s been a long-time work in progress right back since 2009, and also it delivers on the review of 2012. Of course, this was all National Party work, so we absolutely support it. The bill’s all about providing a mechanism to ensure that health practitioners are competent and fit to practise their professions. It’s really essential that these mechanisms work well. It’s essential so that the public not only have confidence in but they can trust their health practitioners, they can have confidence in their skills, in their abilities, in their practices—what they need in terms of working with patients—but also they can have confidence and trust that they will behave professionally at all times.

To that end, I think one of the most significant changes in this bill is that it amends the provisions in the Health Practitioners Competence Assurance Act so that responsible authorities can receive complaints and information from members of the public: complaints about practice, perhaps conduct and competence. It’s really important that that direct access is achieved, and it’s been something that consumers have been demanding for a length of time. It’s particularly important to family members. When something goes wrong and families feel the health practitioners have not acted competently, they feel very concerned that they haven’t been able to voice their complaints, and this change will make a significant difference to that end. I think this new kind of responsiveness in the Act will improve the transparency of the process, but also the faith that the public can have in the quality and competence of their health practitioners.

I’d just like to take a moment to acknowledge the commitment of health practitioners in New Zealand and also the quality of their work. I think this bill amends the Act so the mechanisms make New Zealanders feel absolutely confident and trustful of their health practice practitioners. If something goes wrong, there is a mechanism there that they can rely on that will give them a good result so they can be comfortable that they’re going to be well looked after. So I commend this bill to the House. Kia ora.

Tēnā koe e Te Māngai o Te Whare. The Green Party is very pleased to support the Health Practitioners Competence Assurance Amendment Bill. The Health Practitioners Competence Assurance Amendment Act ensures that there are 16 responsible authorities, which provide oversight of the competence and safety of 23 health professions, including medicine, nursing, physiotherapy, pharmistry, dentistry, and midwifery. So, as other speakers have noted, this bill, in amending that principal Act, is ensuring that we have a very good health system and that those health professionals are competent and fit to practise their profession.

So the bill’s about clarifying the interpretation of the principal Act and improving its operation. It was interesting, just in terms of reading around the bill, the fact that in other jurisdictions, like the United Kingdom, there is more oversight of these responsible authorities than there is in New Zealand. So the changes that the bill is making are ensuring, as Minister Clark noted, that the public can have confidence in our health system, because some of the changes are about ensuring greater transparency, requiring those responsible authorities to ensure that there are provisions around the naming of practitioners who may be up in front of a disciplinary committee. As the Hon Nicky Wagner noted, the bill also enables people to make complaints directly; that also increases transparency. The bill provides requirements around where a medical practitioner has received a conviction. Then there are provisions that the responsible authority has to deal with that either by referral to a disciplinary tribunal or there are some other mechanisms by ordering that health professional to undertake medical examination or counselling for drug issues, suspending the practising certificate.

There’s a requirement in the bill that the responsible authorities set standards of cultural competence, ensuring that our health system and practitioners respond to the diverse needs of all members of our community. There’s a requirement, which my colleague the Hon Julie Anne Genter has commented on in previous readings, around ensuring that practitioners provide data to the responsible authorities, and that assists in workforce planning. If those sorts of provisions had been in the Act earlier, it may have assisted in preventing the shortages of practitioners in professions like midwifery, for example. So that is a very good initiative in enabling more workforce planning. As the Minister noted, the importance of having the different disciplines—practitioners across the different health sectors, nursing, physiotherapy, and their like—having these responsible authorities work together more. The bill promotes that as well.

So it’s about ensuring that the responsible authorities are looking outward to the public to ensure that the public is confident in those practitioners, rather than looking inward to the professions themselves. It is about ensuring that the legislation responds to changes in the different health professions, that the principal Act is amended in a timely way, and that the public can have confidence in all of those health professionals. So I commend the bill to the House. The Green Party’s very pleased to support it.

Tēnā koe. It is a privilege to stand and take a call on the Health Practitioners Competence Assurance Amendment Bill in its third reading. So many people to acknowledge in this bill—first of all, my own party, the National Party, for the work that went on in 2009 with the Director-General of Health’s review and also the strategic review of the Act in 2012. All the hard work in behind getting this bill to where it is tonight happened back then, and I’m really pleased to acknowledge the Hon David Clark, Minister of Health, for bringing this bill to where we’ve got it tonight, in its third reading. I want to acknowledge the Health Committee. Although I’m not a member of the Health Committee, I want to acknowledge Louisa Wall and Shane Reti for their work in behind ensuring that we came to a great conclusion tonight, with all parties supporting the bill as it goes forward.

The Act provides mechanisms for ensuring that health practitioners are competent and are fit to practice their professions, and that’s really key in this bill, because there have been, over the years, a number of, I suppose, consumers—patients—who have had a rough ride with some practitioners. I’m pleased to see that clause 27(1) actually widens the opportunity for the public to be able to voice their—if they have issues around health practitioner practice and competency. So I’m really pleased to see that in this bill.

I was also delighted to hear tonight from the Minister around the cultural competency part in this bill and his words around ensuring that this bill is responsive to Māori health needs. I guess it’s a great step forward in this bill that we see a section on cultural competency, and it’s also a great start for addressing and reducing Māori health inequalities. I say it’s a great start because there is a lot more to go on within the health sector around addressing Māori health, reducing Māori health inequalities. I guess also around announcing that within this bill was also the area around workforce development, supporting health practitioners through cultural competency workforce issues. So I guess around the area where there’s collaboration, workforce development in this bill, I would like to be confident that cultural competency for health practitioners will be something that will be a strong focus in their workforce development.

There is so much in this bill. The committee, as I’ve said, have done a wonderful job in bringing this bill to the House for its final reading, and as one of the speakers tonight on this side of the House, I too support and recommend and commend this bill to the House, supporting it all the way to Royal assent.

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

Thank you, Madam Assistant Speaker. It’s a pleasure to rise and take a short call on the Health Practitioners Competence Assurance Amendment Bill. I’d really like to acknowledge the Hon David Clark for bringing this bill. It’s been many, many years that there’s been review after review, and, actually, as this Government has done and the Hon David Clark has done, we’ve brought this bill to the House and it has its final reading tonight.

I would also like to acknowledge our chair, Louisa Wall, and indeed the entire Health Committee. We work in a really collaborative way, and this is an important bill. I’d also like to acknowledge the number of changes that we have brought in this bill that the member Louisa Wall had outlined for us. I won’t repeat that very large list, but a very good amount of changes and quite significant to the practitioner community.

This bill, essentially, brings the principal Act, which is the Health Practitioners Competence Assurance Act of 2003, into the electronic age. It essentially enables the use of electronic addresses, it enables practising certificates to be issued online, and, you know, when there are thousands and thousands of these certificates, it’s actually cost cutting and cost saving, and that’s really important for our health practitioners.

The amendment also supports our consumer and patient confidence in the profession, so that if something does go wrong, besides the health and disability complaints process, there is this other mechanism which is available. The bill also outlines the process when there is a serious risk of harm to public safety—that an immediate or temporary suspension is able to occur, and it’s really important while these matters are being investigated, that they’re very time limited and there is natural justice to be observed, because the person is, of course, not convicted.

The other part that I particularly like is where a practitioner has been convicted of an offence—that they have the option to attend counselling or therapy, etc. So that offers some compassion, the ability to manage maybe some relatively minor criminal offending, which ordinarily may have ended their career.

So with that very small, very short contribution, I would just like to, finally, thank the officials for their hard work, and I commend this bill to the House.

The Hon Tim Macindoe—five minutes.

Kia ora, Mr Assistant Speaker, thank you. It’s wonderful to see that peace and goodwill has broken out across the House this evening—certainly making great progress.

💬 Simeon Brown: Always happens when Tim speaks.

Ha, ha! Let me congratulate Parliament’s newest father, since he’s taken a seat beside me.

New Zealanders generally have great confidence—and with very good reason—in our health system. I think that we are generally very well served and have every reason to feel grateful for the fine efforts of members of our medical profession. Unfortunately, however, as we all know, there’s been the odd rotten egg in the system over the years who has otherwise dented that very impressive reputation for our medical profession. So while this bill is largely a procedural one, it is nevertheless an important measure in helping to ensure that health practitioners are competent and fit to practise their profession. None of us would want to be in a position where we knowingly went to see a doctor or were admitted to our hospitals or other aspects of the health system and weren’t going to be treated with the highest skills of competency and professionalism.

Previous speakers in this debate have outlined most of the bill’s main components, so I’ll just take a short call and focus on a couple. It is worth noting, if people have just tuned into this debate, that it is a bill that springs from two significant reviews, I think in 2009 and 2012, so it’s evidence based and borne out of considerable research and experience. The bill amends provisions in the principal Act to clarify that responsible authorities can receive and act on information from members of the public about the practice, conduct, or competence of health practitioners. I think members of the public need to have that assurance that if they have a concern, there is a means for them to air that concern and for it to be taken seriously and acted upon, and I’m pleased to see that that is here.

It also amends provisions in the Act to improve the efficiency of processes, including allowing responsible authorities to delegate to a committee their power to appoint a professional conduct committee and giving responsible authorities discretion as to whether to refer notice of minor offences to a professional conduct committee. Again, that’s a little bit wordy but, certainly, a significant and important requirement. Fine to give notice—it amends provisions to allow a responsible authority to require a health practitioner to be examined by an appropriate health practitioner, other than a medical practitioner, which is already allowed, where the authority considers the health practitioner is unable to perform the functions required for his or her profession because of some mental or physical condition. Sadly, there are some who have previously been competent who, for various reasons, become less competent, and we need to ensure that there are mechanisms to pick that up.

So these are all sensible measures. I don’t need to delay the House any further. I’m glad to see this bill making progress and look forward to hearing that it is enacted.

Thank you, Mr Assistant Speaker. I think the best way to describe this bill would be “Who guards the guards?” As the previous speaker, Tim Macindoe, pointed out, we generally have some faith in our medical system, but it’s a system that has changed considerably over the years. Even I can remember house calls. I remember the local doctor being just that—the local doctor, part of the family, someone that was very much the person you went to. You wouldn’t really consider—maybe the odd locum, but you had your own doctor.

Now, we go to medical practices, and probably we’re pretty lucky if we get to see our own doctor. If we’re prepared to wait, we may, but, generally, we’ll be offered an alternative. It just means that we’re in a system that’s probably become more depersonalised, and as we do that, of course, at the same time there’s all sorts of pressures from drug companies. Every night, our television is full of ads for something as diverse as Viagra, for heart remedies, for hair remedies—all of which puts pressure on the medical profession.

That’s just one part of the medical profession, because, of course, this bill relates to 23 health professions which are regulated, which are overseen by 16 authorities, and this bill is about those 16 authorities who oversee those health professions which are regulated. It’s very important that they are the guards and that they are the ones that we rely on, so that when we do go off to the doctor and, more importantly and more often probably, we are sending our dependants off to those doctors, someone is overseeing it.

One part of it here deals with members of the medical profession who may get themselves in a little bit of an issue with the law—even something like drink-driving. It just goes to the authority to make sure it’s being dealt with, and if they are dealt with—they are convicted of drink-driving, for example—it’s actually quite flexible because it also means that they can enter into some counselling or treatment. It doesn’t necessarily have to go straight to the nuclear option.

So, as I look through this bill, and as someone who will be—probably, maybe sooner than most—needing the medical authorities, I know that someone is overseeing it. Every five years, that body which does oversee it—the health practitioners Act—they will actually be being reviewed, and how important is that to make sure that the profession which we all rely on and that our families rely on is being overviewed and that the guards are being guarded. So I commend this bill to the House.

The bill has been very well traversed here this evening in the House, so I don’t want to go over too much detail, but I do want to start by acknowledging all the amazing health practitioners out there. I’m lucky to have a few in my family. My three sisters are a nurse, a social worker in occupational therapy, and a parents carer and a GP, and I’m actually fortunate enough to be married to a psychologist—not for her, though.

I just want to acknowledge our health spokesperson, Michael Woodhouse, for the excellent work and contribution he’s been making to our party as health spokesperson over the past year. I was just reading through the notes from the Health Committee. Mike Woodhouse has made a huge contribution in that area.

This is, largely, a procedural bill which tidies up 14 provisions in the Act, which is otherwise working well, which is evidenced by the practitioners out there at the moment. Many of the amendments proposed in the bill arise from the two reviews of the Act. They were completed a few years ago, in 2012 and 2009.

One of those I just want to touch on: clause 27(1), which would, basically, widen it so that any person can make a complaint and that that’s followed through, not just by the Health and Disability Commissioner and the relevant authorities; clause 27(2), which inserts a provision specifying that one function of authorities is to promote and facilitate, basically, the delivery of health services; and also, lastly—and in particular—this bill amends those provisions to clarify that responsible authorities can receive and act on information from members of the public. I think this is a very important point, because often you’ll have patients that go to see a doctor or a GP and often there’s a huge imbalance of power, and some patients are a bit less likely to complain to the relevant authorities. I think this tidies it up, and for that reason, I commend the bill to the House.

Thank you, Mr Assistant Speaker. It’s a real pleasure to speak in the third and final reading of this bill. As we know, the original Act was passed in 2003, and what it aimed to do was to make sure that health practitioners are competent and fit to practise. The Act, as a number of people have talked about, covers a whole range of health professionals, including doctors—so, the Medical Council, nursing and midwifery councils, the Dental Council, and Pharmacy Council.

The Act has had a number of reviews, as people have mentioned. One was completed in 2009 and another in 2012. Those reviews, basically, found that the Act was pretty much functioning as intended, but what they did was they suggested just a number of improvements.

So what I’d like to touch on tonight are just a few of those that we’ve looked at as the Health Committee. The first one is the five-yearly performance reviews. Up until now, it’s been really difficult for people to assess how well the responsible authorities are actually carrying out their functions, and so what the bill does is it requires those responsible authorities to undergo independent performance reviews at least every five years, with the first ones starting within three years. What needs to happen is that the Ministry of Health needs to consult with the responsible authority and any other people that they think are relevant, then appoint an independent reviewer and also set the terms of reference, and then the reviewer gets on and does that independent review. But then they need to come back with a full written report, and in that report they need to outline any recommendations that need to be made. Part of this is about transparency, because once that report’s given to the ministry and to the authority, then that authority needs to publish the report on their website.

Within the select committee, there was some discussion about making sure that it wasn’t just something that was done but then there was also due regard to implementation. So what the responsible authorities are required to then do is document any recommendations they propose to implement and also within what time frame, and also, if they’re not going to implement some of those recommendations, then say why not. So that makes it much more transparent in terms of their performance and also where they’re going with the recommendations.

One of the other ones that people have touched on is broadening who can actually talk to or inform responsible authorities if they’ve got a concern about a health practitioner. At the moment, health practitioners’ employers or the Health and Disability Commissioner can inform a responsible authority, but what this does is it broadens it out so that anybody—a member of the public or a patient—can inform a responsible authority if they have concerns about that practitioner. So it makes it a much more straightforward process for doing so.

One of the other ones is naming policies. So what the bill requires is that responsible authorities develop policies that outline what their decision making is around releasing the names of practitioners that they have reviewed in terms of their competence or fitness to practice. It’s important that what they’re doing there is balancing that need for, basically, the public interest—so naming a practitioner if they have failed to meet expected standards—against the rights of a practitioner to have privacy and natural justice, and getting that balance right. But there is greater transparency around that.

Then, just finally, is better workforce data, because we all need to be able to look at where we are currently with our workforce to be able to be doing the planning for future projections. We’ve got an ageing workforce in many areas and we need to make sure that we’re one step ahead in terms of where we need to go over the next five- to 10-year horizon, and so what this bill does is it puts in requirements that responsible authorities provide better information to the Director-General of Health on the registered practitioners. So that’s just things like name, date of birth, and then where they work and place of work. But also, as a select committee, we wanted extra information just on ethnicity and gender so that we could look at our workforce as a whole, and also in thinking in terms of culturally appropriate services and making sure that we’ve got the workforce that we need.

So, just summing up, what this bill does is it makes quite a number of significant improvements to the Act and, basically, makes it much easier and more efficient in terms of responsible authorities making sure that health practitioners are competent and fit to practise. Therefore, I commend the bill to the House.

Bill read a third time.