Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill

I present a legislative statement on the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill.

ASSISTANT SPEAKER (Hon Jenny Salesa): That legislative statement is published under the authority of the House and can be found on the Parliament website.

I move, That the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill be now read a third time.

This is a very important day for the future of ACC. About 50 years ago, the Accident Compensation Act 1972 was passed. This established ACC, which has become an integral part of the social support system in Aotearoa New Zealand and has become part of the fabric of our country.

Fifty years later, however, we see that women make fewer claims to ACC than men, have fewer injuries covered by the accident compensation scheme than men, and each woman’s claim costs the scheme a third less than a man’s, on average, in entitlements. We know that these inherent gender disparities in the accident compensation scheme are the result of, amongst other things, its focus on accident-related physical injuries, which are more common among men and in male-dominated types of work.

I think it’s really important to note that the evidence that outlines the disparities that exist within the scheme for women and other population groups was not something that was accidentally come upon. It was information that I had requested because I wanted to understand, as the Minister, how ACC serves all of the population groups in New Zealand. And the reminder that this serves to all of us is how important it is to ask for that equity data, how important it is to ask questions with regards to how well women are served and how well other population groups are served, because it does help to inform very important decisions that need to be made.

We also know that Aotearoa New Zealand looks very different from what it did 50 years ago. I’m very proud as the Minister to have introduced this bill and of the progress that the bill has made through the House. This bill is a first of its kind. It brings all maternal birth injuries under the cover of ACC. This change will ensure that approximately 28,000 birthing parents each year will be able to access the support they need. Expanding ACC cover to maternal birth injuries will improve the support available to birthing parents who suffer childbirth injuries and, in particular, more timely access to surgeries and to pelvic physiotherapy. This delivers on the Government’s 2020 election manifesto commitment to returning ACC to its original purpose of assisting all New Zealanders who have had an injury.

I really want to recognise all those who submitted to the Education and Workforce Committee on this bill. I want to thank those people who very bravely came forward and shared their stories. I also want to acknowledge all of the medical organisations that brought their expertise to the committee. All of these contributions helped shape the excellent bill which was reported back.

I must acknowledge the members of the select committee, who diligently considered the large number of submissions on the bill, whose hard work resulted in two very sensible changes to the bill, which I wholeheartedly endorse. These changes ensure that the cover for maternal birth injuries is, and will continue to be, comprehensive.

I do also want to acknowledge the Labour Party women’s caucus. They were alongside me around the time that Radio New Zealand had shone a light on birth injuries and the inability for women to get cover for those birth injuries unless it was caused due to a treatment issue. It was a great example of us all being very passionate about a particular issue. Before I’d even made any progress with officials, we had already discussed it as a women’s caucus, and they have followed the progress of this bill the whole way through and enthusiastically supported me as the Minister who has had the privilege of leading this work. So I acknowledge the women’s caucus in the Labour Party.

The bill’s committee of the whole House debate was very robust. I want to again take this opportunity to reassure everyone that the bill is intended to cover all maternal birth injuries that can be caused by childbirth. The bill’s approach to covering maternal birth injuries is the best approach in ensuring that birthing parents have the support that they need to recover as quickly as possible in what will already be a time of great change in their lives.

As well as the expansion of cover to maternal birth injuries, this bill also addresses some of the changes National made when last in office which unfairly disadvantaged tens of thousands of New Zealand workers. This bill provides more clarity on what is involved for gradual injury claims at work and more equitable cover for claimants. This includes bringing back the more claimant-friendly version of the test for work-related gradual injuries. The change will put the onus explicitly back on ACC to look into these claims and make it clearer to claimants such as firefighters what happens when they make a gradual process injury claim to ACC. We’re also reducing the threshold for injury-related hearing loss cover from 6 percent to 5 percent hearing loss. This means that more claimants can receive the care they need.

I recently introduced another change in this bill as part of my commitment to remove access barriers to ACC and improve fairness and equity within the scheme. ACC claimants who are unable to work as a result of their injuries and are on very low incomes are eligible for a top-up to a minimum weekly compensation rate which is linked to the minimum wage. Currently, these people must wait until 1 July each year for any increases in the minimum wage to be reflected in their weekly income. In 2022, this meant these people missed out on about $500. This change will mean these people will receive any planned increases to the minimum rate earlier, at the same time as the minimum wage increases.

This bill marks a step towards improving the gender balance, fairness, and equity of the accident compensation scheme. People giving birth in Aotearoa can be confident that they will be better supported by ACC with the expansion of cover provided by this bill. The bill also provides more support to injured New Zealanders, more clarity of what ACC covers, and equitable cover for claimants. I commend this bill to the House.

The question is that the motion be agreed to.

Thank you, Madam Speaker. I join the Minister in acknowledging that today is a milestone day for ACC and the ACC framework that has been in place for 48 years on 1 April this year, and was the result of a royal commission report that was released in 1967—long before many of the people in this House were even born. It has endured. It is a world-leading scheme, but it was certainly written for a time and in a language that reflected the attitudes of the day. Indeed, if one reads that royal commission report, women are only mentioned in passing and to the degree where Justice Woodhouse publicly pondered what to do about the housewife that gets injured.

💬 Erica Stanford: In the kitchen!

It’s on about page 115, Mrs Stanford, if you want to go and have a read of it. It is a remarkable reflection of the time. But times change, and this is an appropriate change to the legislation. As I said in my second reading on the Minister’s comments about equity—while I support this and this is a very much a step in the right direction in terms of gender equity in the ACC system—I do urge caution that we try and equalise the number and cost of claims that ACC pays out across the gender divide, because, actually, we know that young men particularly are much greater risk takers and will harm themselves at greater rates and to a greater extent than their female counterparts. On the other hand, sexual violence and the sensitive claims that are lodged with ACC as a consequence are disproportionately women. Actually, the solution to both of those inequities is to have fewer claims because fewer injuries are occurring. I think we should all agree that that is the equity goal that we seek.

In that regard and in relation to maternal birth injuries, it’s important to acknowledge that, on a world standard, we have one of the safest obstetric-care frameworks in the developed world, and it is certainly much, much lower than it was generations ago. But having achieved, I think, quite significant improvements in care for mothers and babies, we have plateaued somewhat over the last 30 to 40 years. And I think it’s important that as we collect more data within the accident and compensation system, we identify—while it is a no-fault system—what the causes and the potential avoidable causes of harm are so that we can reduce the impact of injuries both to mothers and to babies

I mentioned babies in the first and second readings because I believe that there are a number of harms that occur through the birthing process that are not yet covered by ACC—even though I think they should be. And it’s incredibly difficult to determine whether or not the sequelae that the baby experiences is a consequence of the labour or birth, or existed prior to the birthing process. Now, one could argue that the distinction is arbitrary and perhaps shouldn’t be there. I think it is important that while we have an excellent scheme, we do cover for accidents, but there needs to be another look at that. It won’t be easy, but I think we do need to have a look at how we cover for babies who are born with injuries or with at least sequelae that could be caused by an injury.

We heard so many stories in the Education and Workforce Committee of harm, and it is a great day because mums will get better care. But I do worry that ACC is becoming, in many parts of our health system, the default physical and mental health provider. And it’s happening because there is, frankly, better cover and better support if one is able to get a claim accepted by ACC. Now, the levy payers are paying for that—and willingly, I think—but they’re also paying for a health system that, I think, should be delivering more than it is right now. We are seeing too many examples of waiting and failures in our health system that this Government needs to address. It can certainly celebrate today, but it can’t celebrate what we are seeing in a growing and increasingly inert health system.

Now, there were some process questions that I was going to raise in the committee of the whole House. I won’t traverse why that wasn’t the case, but I think we need to actually have a look at it. Now, this could be homework for the ACC officials who I know will be listening, and the policy team either have or will—or I hope will—address them between now and when the Act comes into force. The first one is in reimbursement for our obstetric professionals where there is a birthing injury in a public hospital. Now, it’s a bit pointy-headed, but, normally, if one suffers an accident and is taken to a public hospital, acute care is provided and ACC doesn’t have to provide a direct payment. That’s covered by something called the public health acute services levy, and ACC is not obliged to pay any more than that. Alternatively, a treatment injury occurs while a person is in a public hospital and ACC doesn’t pay for that care either. That also goes to the public health acute service levy. With a birth injury, what tends to happen is, even if it’s in a public hospital, the person providing the primary care—the lead carer—is either an independent midwife or a private obstetrician.

Now—I think, quite rightly—if an injury has occurred and a claim has been accepted, they have a right to be reimbursed for the extra costs that they have undertaken, but the current Act prevents that, and I think that needs to be looked at. There is the ACC treatment reimbursement-of-costs regulations, and, I think, maternal care should be put on that list. And a further amendment is required, I think, to enable obstetricians and midwives to be able to claim for those extra costs. Currently, under section 88, they feel pretty unloved, by this Government anyway, and they’re not being sufficiently reimbursed even for the normal labour and birth—much less, the many abnormal labours and births that they’re going to have to do, and the travel. ACC is now covering for acute care and I think they should have a look at that.

The other thing is in weekly compensation. We’ve talked a lot about treatment and rehabilitation, but, actually, a mum who’s had a baby and suffers an injury that prevents her from going back to work in the time that she should is eligible for weekly compensation. But what’s clear—and I don’t think the select committee actually dived deep enough into this—is that there needs to be a reconciliation between that and our paid parental leave and our 52-week unpaid parental leave. Very often, mums will apply for the maximum parental leave but have no intention of using it at all. They’ll probably go back to work in a couple of months—in less than a year or less than the 26 weeks of paid leave—because it’s less than the normal income. If they are injured and unable to do that, how is ACC going to distinguish between when they would have gone back and when they’ve applied for leave? The other thing is: what if the other partner takes the unpaid maternity leave? Is the mum then still eligible for weekly compensation? I think they should be, but I don’t think we—as a House or, certainly, as a select committee—had enough of a conversation about the logistics of weekly compensation. It is an issue, it will emerge, there will be serious harm that will prevent mums from going back to work at the time that they wanted to, and that needs to be accommodated. On the other hand, we don’t want any gaming of the system either, and I’m sure that’s a very rare thing, but it is possible that if somebody could be earning weekly compensation that is greater than the 26-week paid parental leave payments, that also needs to be had a look at.

So it’s a good day, but I think there’s some work to do. I’ll leave it to my colleagues to talk a little bit about gradual process and disease, because I was surprised that the Minister talked about firefighters. I would have thought that she might have actually just let that sleeping dog lie. They are not well treated by the scheme. I have said that we should look at a list of conditions where the science is showing that firefighters, due to their occupational exposure, are at a greater risk of getting cancers than the general population and that they should be included in an ACC scheme. I’m keen to have a look at that when we do get back to Government. But let’s finish on a positive: this is a really good bill, and I look forward to it passing.

Thank you, Madam Speaker. I’ll pick up that positive note from the previous speaker, the Hon Michael Woodhouse, because this bill makes several changes to current legislation. I just want to make mention of a couple.

Firstly, I’ll pick up the challenge put on the floor by the previous speaker when he talked about gradual process injuries, because that is one thing that this bill does. It does make some changes—well, actually, it reverses changes that were made in 2010 by the previous Government, where, in a bid to save cost, the onus was reversed from being on ACC to prove that a gradual injury was, in fact, not work-related to deny that cover. A change was then put in place to make sure that the actual claimant had to prove that the injury was work-related. So that is a change that we are reversing, so it makes it a lot more “claimant friendly”, if that’s what you want to call it.

The bill also reverses the threshold put in place in 2010, where the hearing loss of a worker for a work-related injury had to be 6 percent; that is reversed back to 5 percent. So that is a good change, because it makes sure that there is more of an opportunity for Kiwis to receive fair access to cover.

Secondly, and it has been talked about most in this debate, is, of course, the extension of the compensation scheme to cover birth injuries. In fact, the majority of the nearly 800 written submissions—including 46 oral submissions—that our committee dealt with, were heard on this particular topic. As the Minister already pointed out, there were very personal stories showing that birth injuries can be extremely serious and debilitating. They were very personal stories shared very bravely by our submitters, and we’ve done it again, but I want to pause and really put on the record a massive thankyou to all of our submitters who took the time and who were brave enough to come before our committee and share those stories. I remember one of the submitters really specifically saying that while this bill would not apply to her personally, she said that she was speaking up in that select committee process about something to make a difference for others. That is, I think, a really significant and brave thing to do of people not thinking of themselves.

There’s a review clause within this bill that the Minister spoke about and that is to ensure that the list of birth injuries is futureproofed in this bill.

But additionally, what our select committee did, because the intention is for all birth injuries to be covered by this bill, is that our select committee, opened the briefing into the scheme for maternal birth injuries cover. What we actually put in our report was the line: “We hope to see the briefing reinstated in the 54th Parliament by the Education and Workforce Committee”, and through this briefing there will then be an opportunity to review the way the bill is working in practice. That will then start before the formal ministerial review process, which kicks in three years after the bill comes in place. So, basically, we strongly urge that next committee to pick up that briefing and examine that list of maternal birth injuries.

Now, when this bill is passed, 28,000 more women will benefit from the improved legislation. It’s significant legislation. I want to thank the officials and advisers for their work on this bill; my colleagues around the House; a special mention to Sarah Pallett, as our subject matter expert doing her great work; but definitely thank you to the Hon Minister Sepuloni for her bringing this bill to the House. Thank you, Madam Speaker.

Thank you, Madam Speaker. I’m very pleased to take a call on the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill. This is my first opportunity to contribute to this debate, even though I was a member of the select committee.

I want to just start by picking up on something the previous speaker, Marja Lubeck, pointed out. It’s been made very clear in the initial briefing to the Education and Workforce Committee—that Marja is the chair of—that, actually, prior to 2010, there was no threshold for hearing loss. So it wasn’t that National shifted it from a certain percentage to a certain other percentage; we introduced the percentage and we did this in line with other countries like Australia and the UK. We did this in 2010. So contrary to what Marja Lubeck has just stated, we introduced that percentage; we didn’t change it. It’s interesting to note that, actually, official advice says—there are several studies that suggest that hearing aids don’t have any benefit until a person has between 5 percent and 6 percent hearing loss anyway. That was some of the information that we got at select committee. So the benefits of this change will be marginal, and, really, at best—and this has been mentioned by previous speakers—this is a bit of window dressing.

As has been mentioned in this bill in prior readings, the ACC scheme will soon turn 50; 50 years since a relatively unique piece of legislation and world-leading piece of legislation has been introduced. But it is interesting to look at it and read some of the old documents—that really does date it. If you fast forward to today, where woman are working far more than they were in the seventies—Carmel Sepuloni mentioned in her initial speech today that women make fewer claims than men and, on average, their claims are about a third of the value of what men make. Now, it’s interesting to note that, and this bill is really important today in the fact that it goes some way to adding more ability for women to claim on maternal birth injuries. But as my colleague Michael Woodhouse has pointed out in this reading today and in previous readings, what’s really important to note as well, actually, is that the reason that men claim more and have higher claims granted is because of the risk taking that is inherent with young men. I can see this because I’ve got a son and I can see this because I played hockey for many years with men, and they are inherently greater risk takers, far more reckless. But also you can understand why it is that they claim more often and that their claims are much more. So it’s really important, as Michael Woodhouse pointed out, the equity needs to be gained from both sides, not only in increasing the cover to woman—importantly, as we’re doing today—but also in making sure that men are claiming at a far lesser rate by better prevention measures.

But it is very important to note that there are some historical discrepancies as to why women don’t claim as much. And that’s why this bill is so important. It’s been mentioned many times that we know that about 85 percent of women—most woman—will experience a maternal birth injury, ranging from things that are very minor to things that are very severe and life changing. Many women in the past have struggled to get treatment and support. We all know someone who’s been in this situation or it may have happened to one of us. For me, it was a friend of mine in a coffee group who suffered an extremely severe prolapse which had huge impacts on her bonding with her child and caused severe pain for a really long time—and she wasn’t able to get any of the support that will be offered through this bill. So while the bill will change this, and it may be too late for my friend, it will aim to help 28,000 women. Again, important to note that that number has increased by about 18,000 since the first reading—from 18,000 to 28,000 as new information arose.

This bill will allow women like my friend and those other 28,000 women to access surgery and pelvic physiotherapy, cover which ACC has previously denied to many woman, resulting in pretty negative effects. And there have been a load of petitions on this case. At this point, I want to acknowledge some of the people who need acknowledging, given this is the first time I’ve spoken on the bill that was at my select committee. Firstly, we need to acknowledge Kirsty Watt, who petitioned Parliament back, I believe, in 2020—the last two years are a bit of a blur, but I believe it was 2020—to make improvements to care and rehabilitation for women post-birth. Her petition has made a difference. I want her to know that it’s made a difference. She shone another very important bright light on this issue, and here we are today. So petitions do make a huge difference, and I would encourage more people to do them.

We also need to thank the submitters, the 46 that came to our select committee, and the nearly 800 that wrote in. But for those who turned up to select committee, it was very personal and very gruelling for some of those women who needed to go into quite graphic detail in front of strangers at the select committee. Their bravery needs to be acknowledged, because, actually, that graphic detail was really important for the deliberations of the bill. So I want to say to each of those women who came in front of our select committee, thank you very much for sharing your very, very personal stories. And it’s important to note here, given their stories, that these maternal birth injuries can cause a huge amount of mental anguish, a lack of confidence, lack of bonding with the baby—as what happened to my friend—and difficulties with relationships as well. This bill will go some way to helping those women.

It was discussed in the bill around whether or not we should have a list of injuries or whether or not we should just have the words “maternal birth injuries”. What we’ve settled on, I think, is the right way to go, with a list of injuries, as the maternal birth injuries definition was too broad and could be applied inconsistently. I know that the Green Party disagrees with this view, but I think that we got it right. It was really important in the deliberations of the select committee, actually, and, at this point, I probably should thank Sarah Pallett as well, because it was very useful having a midwife on the select committee who could actually say to us, well actually, what we thought was a definition that covered lots of injuries, in fact, didn’t. And so many of the things that the officials had thought were covered in this list of definition weren’t. So there were a number of cases where we added—certainly around tears, I believe—words to make sure that all of those individual injuries were covered, even though, as the Minister has said, she intended all maternal birth injuries to be covered. And so we very thoroughly went through and made sure that they were, in fact—not only that, there were other injuries that were thought to be consequential injuries and would therefore be covered by the Act, but, again, the officials and Sarah explained to us that, actually, some of these injuries could be caused during the birthing process and weren’t always consequential. So we’ve added those in as well. So there was a lot of work done to make sure that we got that list right.

I do understand the Green Party’s problem with the bill and that it should just be a bit broader. But that’s, I think, been covered in the fact that we’ve got this review built in that needs to take place three years after the bill has been introduced, to make sure that there aren’t any maternal birth injuries that aren’t being covered that have slipped through the cracks, which may happen. And, look, I hope not, because we did go through this with a fine-tooth comb, but the officials did fill us full of confidence that they would take this review seriously and add in any maternal birth injuries that hadn’t been covered in that three-year period.

I just want to pick up very briefly on something that Michael Woodhouse, my colleague, has mentioned, and that is around the injuries to babies. I also think this needs to be looked at, and the reason I think that is because when I go into schools and I talk to teacher aides, they say to me, well, this child is fully covered under ACC because of a domestic violence incident that happened when they were a baby and the injuries that they got mean that they are covered by ACC, but this child over here is not covered because their injury happened at birth. And as we know, getting covered by ACC at birth can be a bit difficult and it’s not always clear, as Michael Woodhouse has pointed out. I do think, in line with what Michael said, that this needs looking at, because it’s pretty heartbreaking when you’re in a classroom and two children with exactly the same needs are being treated extremely differently.

I will just finish, again, by saying thank you very much to all the submitters, thank you to Kirsty and also to Sarah on our select committee for giving us a hand with this bill. I’m very happy to commend the bill to the House.

Thank you, Madam Speaker. It’s a pleasure to take a call on this bill, the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill.

It’s a very proud day for us, today, to be passing the third reading of this important bill. I’m very proud to live in a country that has an accident compensation scheme that’s been in place for over 40 years now. That scheme provides help to thousands of New Zealanders. It’s not perfect, but it is certainly a lot better than the absence of such a scheme. Today, we are improving this scheme once again by making sure—the most salient change in this bill will mean that when people give birth, if they are physically injured as a result of that birth, they are entitled to compensation. And I think this is really the basic thing that we can provide to people doing such an important role for the future of our country.

Again, I think it’s important to emphasise, and the Minister has said it in previous readings of this bill and today again in the House, that her view and also the shared view of this House that these changes are intended to cover all physical maternal abuse injuries caused by birth. It is a significant change to the current system where we don’t have that cover for people who can sometimes go through—what we heard in select committee and what others have spoken of—an extremely difficult physical process of birthing a child.

And I also want to join other colleagues in thanking the brave submitters for coming to our committee. It’s difficult that those people won’t be covered by this legislation, because it isn’t retrospective. But as soon as it’s commenced, which will be at the beginning of next month, the mothers and parents and babies who are injured through birth will be entitled to ACC cover. So I say it’s very much time for this bill and I commend it to the House.

Thank you, Madam Speaker. It’s with real excitement and pleasure that I get to take a final call on the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill. As others have said, this is a very significant day for us as a country. We’ve had this cornerstone social insurance scheme in the country that’s provided compensation and rehabilitation and support for thousands of New Zealanders every year, but it has excluded the injuries and the experience of thousands of birthing parents because it was designed in a time when the experience of birthing parents and women was not in the mainstream political discussion. It was an addendum way down in that report, as already mentioned by a previous speaker.

I’ve got to say, as a feminist who has been active on issues of equality for decades now, it’s been shocking to me to hear the submissions come through this process of the extent of pain and injury that has been suffered by birthing parents and women and their whānau, and how much that has been covered up and silenced in our society. So I do want to offer my thanks to everybody who submitted, and also to the 40,000 New Zealanders who signed the open letter to Minister for ACC in September last year, including almost all of our children’s organisations and women’s organisations and many of our health organisations, calling for this comprehensive cover, and, most particularly, the 900 birthing parents who shared their specific stories of injury.

I know that this has been traumatic for so many people, and this is a warning for anybody who may be listening who may have been affected by it that I am about to share some of those stories now, because I believe that it is important that some of the extent of the injury is on record in this House because it’s become very apparent to me the level of shame that’s been held by people who have experienced these injuries. We need to do more to break that shame and destigmatise these injuries. So I am going to share some of those stories in the House today.

I’ll quote: “I suffered from third-degree tears through my clitoris and anus during my first birth. The anaesthetic hadn’t kicked in yet. I was sewn back up by hand. I requested a female and was given a male. I already had PTSD before this, so it just added to the trauma. I felt every stitch until the last few, when the anaesthetic finally began kicking in. I couldn’t walk unaided for days. For six months straight, I couldn’t feel when I needed to pee and had accidents multiple times a day until almost nine to 12 months after birth. I couldn’t participate in any sexual activity. I found physically walking painful, but had to as I had no vehicle. It’s been nine years; I wear a pad every single day because accidents are still happening. No pelvic floor exercises ever worked. This should have been covered by ACC. I am shocked and appalled that it isn’t already. This needs to happen as soon as possible, and all historic traumatic births need to be covered.”

Then, from another woman: “In October 2020, I gave birth to my daughter and sat on a wheelchair in the car park, lobby entrance of Middlemore Hospital. Because of the position I was in, my daughter left me suffering with severe tailbone pain. Doctors say there’s nothing I can do. I applied for ACC, but it isn’t covered, but giving birth on a wheelchair was definitely an accident. I suffer with pain every day. I can’t sit for long periods of time. I need an X-ray and treatment for it as it’s really affecting my mental health.”

Another story: “In September, I gave birth to a baby that was 8lb 3. My baby was two weeks early due to a rare pregnancy complication. I’m now five weeks post-partum and have developed pelvic organ prolapse. This means that my uterus is bulging out my vaginal opening. This is treatable with physiotherapy. ACC will not cover this. If prolapses are left untreated, they get worse and the organ protrudes further until the point of needing surgery, which can cause infertility. Once a prolapse gets to a moderate stage, it’s unlikely physiotherapy will do anything. To fix this, I have to spend more than $100 per session to help with this condition, but being on a low income, I cannot afford this. This means I cannot go to physio and my condition is only going to get worse over time. This will lead to surgery and a high chance of infertility.”

These stories are hard to listen to, but, boy, they’ve got to be much, much harder to live, with that reality. So today is a milestone that birthing parents, women in this situation from 1 October, will be able to reach out and get the support that they need to prevent many of those consequential impacts in terms of their mobility, in terms of their relationships, and in terms of their ability to parent, their integrity of their bodies, and their life choices.

This is hugely significant, and I do want to acknowledge Sarah Pallett and others on the committee for the work that we did to ensure that the list was extended so that now anterior wall prolapse, posterior wall prolapse, or uterine prolapse; coccyx fracture or dislocation; obstetric anal sphincter injury tears or tears to the perineum, labia, vagina, vulva, clitoris, cervix, rectum, anus, or urethra; post-partum uterine inversion; pubic ramus fracture; and symphysis pubis capsule or ligament tears will also be added to the cover where they were not initially. So that is a significant extension to the bill because of the contribution of people with lived experience in this area, and I hope that that gives them hope in our democratic processes as well as the ability for Governments to catch up with the real world and respond when voices are raised that harm is being done.

Of course this bill—as we have raised many times—is not perfect in the view of the Greens. We wanted more general cover rather than a list. We wanted to ensure that injuries to babies are covered where they are excluded from this, and it was fantastic to hear that the National Party is now considering that. My understanding of Labour Party direction is that it is also to remove those inequities in coverage for support services for disability as a result of accident and disability as a result of birth, and that has been signalled by a previous Minister. So it feels to me as if we are building—partly through, hopefully, submissions—consensus across the House for that next step. That is critically important, because those inequities are just unjustifiable.

We also wanted stand-alone mental trauma to be covered, and it’s great that it is now on the Minister’s agenda to be looking at the mental health boundaries more broadly in the legislation, because that really does need to be done. She has also signalled that in respect of the Nick Smith changes, there are more changes to come to overturn those contractions—that was probably an inappropriate word in this context—or the bringing in of the purpose of the bill that happened in 2010.

I do just, finally, want to say that the hearing loss threshold—I was not convinced that the threshold is necessary. While it says that hearing aids may only be valuable from 5 percent or 6 percent, somebody can lose 17 percent of hearing or most of the hearing in one ear and it won’t reach that threshold and they would have value. We don’t support the arguments from the officials in keeping the threshold that high, and there’s more I could say on gradual process, but I won’t. Today is a day primarily to celebrate, and I am.

Thank you, Madam Speaker. I’m proud to stand here, on behalf of the ACT Party, on the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill. As previous speakers have said, this is definitely a great day for birthing-women in New Zealand. It’s something that has been overlooked for many years, and, especially, that’s become very apparent when we had all our submitters come to the Education and Workforce Committee and give us their stories of very uncomfortable lives, which some of them still carry to this day—and some of these injuries occurred up to 40 years ago. So it’s sad to say that they are not going to be recognised. However, from 1 October on, women shall be recognised and looked after.

The other thing is, again, I’d also like to thank Sarah Pallett, who is a midwife, because she helped guide us through these very interesting injuries, which I will not list. But, most of all, I am very proud to say that the officials sat, listened, and came back with a revised list for us. It was great to hear that they were listening to the lovely submitters, even though their circumstances varied. The other thing is that the officials had a three- to five-year review. As most of us said, we thought five years was just a little bit too long, so I was very pleased for them to come back with the three. They also mentioned to us that they were going to be monitoring the system and, hopefully, they’re going to put a robust monitoring system in, so if anything does show up sooner than the three years, it will be added to the list. Now, that’s very important because, as we all know, there are things that constantly happen that we, who are not experts, would not know, but we would hope the medical profession would be able to do that.

Also, with my other colleagues, especially with National and the Greens, around injuries to babies—you know, the hard thing is also knowing what is natural and what is an injury. There’s so many grey zones, but there are so many babies that have come away with injuries from birth that have not been picked up and looked after by ACC, which is very sad to say that these kids then continue through their lives having difficulties in many different forms. So, again, I would actually support this bill to see how we can improve it. But the biggest thing of all, I foresee, is we’ve got to make sure that our health system and ACC are communicating a bit better. We know there is that grey zone between what is medical and what is an accident, but, the thing is, if we don’t know, then we can’t know, but if they report it, we can find out and we can add these things.

Now, the other thing I’d like to bring up is I know that we wanted to get this bill through by October. However, I felt a little bit disappointed that the select committee, of the whole debate—there were some questions that we still wanted to get a few clarifications around. It’s not because we were opposing things, but just to get some clarifications on a few things that were in this other matters bill. However, I felt that it was not given its due course. I don’t think it would have gone on for long; however, it’s just sad that it was closed down, I felt, a little bit too soon, and we could not debate a few things, which is what I thought we were here—and because, also, there might have been something in that that they would be able to—

ASSISTANT SPEAKER (Hon Jacqui Dean): Order! Can I just ask the member to come back to the third reading.

Thank you, Madam Speaker. Also, as they estimated, because we added to this bill more injuries, around 28,000 birthing women would be included in this—a lot greater than what they thought. Also we know that that’s going to be another huge expense on all this, but, hopefully, it’ll be a great expense to make women feel a lot more comfortable, and, also, for women to be able to possibly go back to work sooner, if they wish to, because they have had the right treatments to fix the problems that can occur during birthing.

The other thing is, mostly, that the other matters, as Michael Woodhouse said—there are a few things in it that we could have debated a little bit more, but because the majority of this bill was around the maternity injuries, it took up most of our time at the select committee for the hearing. So we missed out, I think, as Jan Logie said, around hearing—there could have been maybe a little bit more robust information around hearing—as well as, again, what’s considered of long-term effects in section 30, and, also, as the Hon Carmel Sepuloni mentioned, about firefighters, which has been a hugely contested thing, as Michael Woodhouse said, around cancers that have been proven around the rest of the world. So it would be very interesting to see if some of these things could be possibly taken up in the next round, if not by Labour, maybe National in the next few years, if they become Government.

But, overall, I’m very pleased to say that this bill is, hopefully, going to give around 28,000 birthing women a greater opportunity for a better future for them in the long term. So I commend this bill to the House.

Thank you so much, Madam Speaker. I am so proud to be standing here this afternoon as part of a Labour Government that has brought this bill to the House. I can attest to the fact that, as chair of the wāhine caucus—Labour’s women’s caucus—I am so proud of our Minister Carmel Sepuloni for bringing this to the House.

This bill will benefit, as we’ve heard, 28,000 birthing people. That’s 76 a day who will benefit from this piece of legislation. And, I have to say, the vast majority of those will be women, but we must remember in this conversation that non binary, transgender, and other gender diverse folk also give birth, and it’s really important that we continue to acknowledge that in this House. I was struck, listening to the heartbreaking stories that have been shared—some of them this afternoon, in select committee—that, actually, many of them should have been covered as treatment injuries. So I can really appreciate that the intention of this bill is that all physical birthing injuries are covered. It takes away any ambiguity, it takes away any capacity for argument, and it allows those birthing people, those women, to receive the care that they need at the time that they need it, without delay.

So I am incredibly proud to be bringing this to the House in its third reading, with my colleagues. I can only imagine the benefits that it will bring. I’d also like to thank all of the select committee, which I am not a part of, for their incredible work in making sure that this bill did do exactly what was intended to do: to cover all physical birthing injuries. I just want to thank everybody that has been involved. I commend it to the House.

Harete Hipango—five minutes.

Thank you, and following on from my parliamentary colleague Sarah Pallett, in her previous profession as a midwife, I certainly acknowledge the contribution given to the Education and Workforce Committee, and also the submitters, members from the public who genuinely expose ourselves. And not having sat or served on the select committee, but having read the report and the detail of the submissions that have been made, particularly for the amendment within new Schedule 3A, inserted by Schedule 2 to the bill, specifying—with clarity, with specificity—the nature of the injuries to women who are birthing children to now be covered and treated under this Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill.

Being a short call, and being one of the last speakers in the House to address this matter today, I’ve listened with particular interest and note the debates, the contributions of previous speakers. I harken back to the days in the 1980s, when I studied law and the Accident Compensation Corporation Act—as it was then—we studied that. And my colleague the Hon Michael Woodhouse made mention of the royal commission inquiry in 1967, which initiated the bill that was passed into law—the Accident Compensation Act—on 1 April 1972, 48 years ago, which came into operation on 1 April 1974. So hearing my colleague Michael Woodhouse talk about the royal commission of inquiry—the chair of that inquiry, I do recollect as a law student, was Sir Owen Woodhouse. And the legislation of the day—internationally, New Zealand was a trailblazer in that regard.

I always try and make a correlation from personal experience too, and having listened to Sarah Pallett, as a former midwife, speaking—I remember when I gave birth to one of my three children over 30 years ago, and the midwife who was helping with his delivery. He was an unexpected home birth, my son—and the midwife, regrettably, as a result, put her back out; so no doubt she lodged a claim for ACC as a result of a slipped disc.

But little did I know that my son, at the time, had a heart defect and that was detected later. And the law didn’t allow at the time—and certainly, he received the appropriate treatment. However, a number of we women in the House who have birthed children, some of us have been physically traumatised; some of us have been mentally traumatised. The mental trauma can prolong and endure, and those elements have been addressed in the minority view of the Green Party. And appropriately, I raise that because this week is Mental Health Awareness Week. So those are elements to factor in perhaps in due course; in time.

But I do commend the members from the public who have been through those personal experiences. And harkening back again as a woman, as a mother, there was some physical trauma that I endured that, perhaps if this legislation were available at the time, the treatment would have been made available.

I’m just going to move on again to something else. Just in terms of the process, as a lawyer, I represented a number of ACC claimants, and I had a brief word with my colleague the Hon Michael Woodhouse, a former Minister of the ACC. And I acknowledge Minister Sepuloni in terms of leading this legislation with commendable amendments—particularly addressing the birth trauma and what people go through. I picked up the reference to babies who suffer injuries as a result of the birthing process as well, but I’m going to come back to matters of process.

As a lawyer representing claimants, but also having lodged a claim as a practising lawyer myself in medical misadventure—the process wears many people down. And undoubtedly there’s a correlation between whether people have a valid claim or not. And speaking with my colleague in the hall before coming into the Chamber, there is an issue that does need to be taken into consideration. Many people are not eligible for legal aid when appealing decisions by the ACC authorities. So that’s something to harken and bear in mind in due course.

In finishing off on a positive note, I commend this bill to the House, commend the members who served on the select committee, and commend the members of the public who exposed their vulnerabilities and submitted to pass this into law.

Barbara Edmonds—five minutes.

Thank you, Madam Speaker. I’m incredibly grateful to be able to take a call on the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill.

I’m incredibly grateful to our Minister the Hon Carmel Sepuloni for her fortitude and ability to act. When the issue was raised with her, she acted and as a member of a proud Labour wāhine caucus, I’m incredibly grateful to our sister and Minister for her kindness, and am grateful for all the 28,000 birthing parents who will be covered by this bill. I don’t have any experience on the select committee, any personal experience, but throughout this debate I’ve listened to the numerous members and so I am incredibly grateful to the Education and Workforce Committee members for the work that they did on this bill. I’m incredibly grateful for Sarah Pallett for her experience. She is one of our strongest wāhine members, who is constantly driving for wāhine measures and, as a midwife herself, she knows exactly what she was talking about. So I’m grateful to Sarah Pallett for her work.

What I can speak to is my personal experience. Having eight children within a period of nine years, I’ve got a bit of experience! So if you put them back to back, apparently I would have been pregnant for a period of six years. But, nevertheless, I was also very grateful to the medical help I had at the time that I never experienced an injury. I know that for a lot of women and for parents it is such a vulnerable time having a child, it is such a traumatic time, and it can also be a quite beautiful time.

So, on that note, I’d like to, again, thank the Minister, thank the members, and thank our Labour wāhine caucus for making sure that for 28,000 parents, when this bill has commenced, they now have an opportunity to be able to recover with the integrity and the respect that they deserve, under this bill.

Thank you, Madam Speaker. It’s a pleasure to take a call on this, what is quite a technical piece of legislation. Before I begin my contribution, I would like to acknowledge the Minister who has brought this piece of legislation to the House, the Hon Carmel Sepuloni, the Labour wāhine caucus, who worked with her prior to it coming in to the House, but mostly I want to acknowledge the nearly 800 woman or people that submitted on this piece of legislation. We heard from Jan Logie about some who had some pretty horrific stories to tell us, and they opened up, as we’ve heard, basically, to strangers, to the select committee, to the public, because a lot of it was live streamed, etc. So that’s a pretty big deal for people to do that, and open up knowing that they were not likely to be covered from this piece of legislation because it is not retrospective, but they wanted to do their bit to ensure that, going forward, women would be able to be covered should something happen during their birthing experience.

What we heard a lot of is that—and we’ve heard people talk about this before—often, men make claims to ACC and they have a lot more coverage than what women have previously, and for, sometimes, similar issues beyond the incident that happened. I mean, for example, we heard from one submitter whose husband had been out socialising at night and happened to have a slip at the end of his socialising, and he caused himself to have a strain, and yet when she had a similar injury through childbirth, she was not covered. So that’s been where the system has been quite, quite unfair.

What we also heard in the select committee is that around 85 percent of women suffer from an injury during their birthing experience. That is a heck of a lot of people. We’ve also heard from—as part of the submitters and submissions that we heard, there were some changes made to the piece of legislation, and one of those changes was that additional injuries were going to be added to it to ensure that, actually, all childbirth injuries will be covered.

So I’m really proud of this piece of legislation. There are other parts to this bill, but the part I wanted to focus on was around the maternal birth injury. So I’m very proud to commend this bill to the House.

Thank you very much, Madam Speaker. I’m happy too to stand, on behalf of the National Party, in support of the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill in its third and final reading here today. I think some of the debates that we’ve heard here, some of the speeches from members across the House, remind me of a conversation we had this afternoon at the Commonwealth Women Parliamentarians event, where we talked to the National Student Commonwealth Heads of Government meeting. In that conversation, we talked about the work of select committees, where a lot of the grunt that happens in this place happens—at the select committees. I think what we’re seeing today is that collegial experience, where everybody is aligned and so the very best comes out of the parliamentary system.

I too congratulate the members on the Education and Workforce Committee. I was not privileged to be part of the interrogation of this bill, but I do acknowledge the contribution that the team members have made, and also the submitters, on what is a very sensitive topic for many of them.

I’d just like to go back to part of the process that we’ve been through in the debate on this bill. Sadly, in the committee of the whole House, there was a truncated debate, and there were some parts of the debate that weren’t able to be expressed and aired for the public’s feedback. But I note that—I think there was something like four of the Green Party’s Supplementary Order Papers that were unable to be debated; there was certainly one from the Hon Michael Woodhouse. Minister Sepuloni’s—

ASSISTANT SPEAKER (Hon Jacqui Dean): Can I just reminded the member, this is a third reading speech. So passing reference to processes around select committee—yep. But the main substance should be the third reading and the bill.

Absolutely. Thank you for your guidance, Madam Speaker.

Earlier this afternoon, the Green member Jan Logie mentioned that she would have liked to have seen more general cover from this ACC bill. But I also note that the bill itself does have a three-year formal review process. So where we have a list of conditions that are mentioned in this bill—and I won’t repeat them; I think Jan Logie did a great job of mentioning them. Some of them actually are very difficult to get your tongue around. But they all certainly are very difficult for women to deal with at the time, and, you know, in my own personal experience, they do take some recovery. So even though we have these six new conditions listed in the bill, I have confidence that the formal review process three years after the bill is enacted will allow for further conditions perhaps to be identified and added.

As Sarah Pallett, who spoke very recently and is certainly the member of the committee with the most experience in this field, mentioned before about the 28,000 claims, we know in the report that the 28,000 claims was an estimate. There is not any sort of real data that could back up what that might be. So, on that basis, we know that there could be around 28,000 extra claims made to ACC for this, and that, we hope, will be financially manageable by ACC.

But I’d also like to use the opportunity to work through one of the other clauses in the bill, clause 8, which was about work-related gradual process, disease, or infection, including occupational noise-induced hearing loss and accidents such as explosions. I realised, in reading the report, that it is quite a technical assessment that is made about hearing loss. It was mentioned earlier on that if you have a 17 percent loss of hearing in one ear—excuse me, it’s a total loss of hearing in one ear, that is a 17 percent bilateral hearing loss; whereas if you have a 17.4 percent hearing loss in one ear, that is a 5.2 percent bilateral hearing loss, which would have fallen under the current 6 percent threshold. And that is why the bill reduces the hearing loss from 6 percent to 5 percent, so that if it is a gradual process, it will be covered by this bill.

But the other issue that has not been clarified—and we ran out of time in previous debates to get some kind of feedback or assurance—was around that gradual process and whether ACC in this bill would indeed cover it, and that was in relation to the exposure over time, which would be the gradual process, that our firefighters have when they are undertaking their job in fighting the fires, because as we know, the firefighters who attend these fires have often no idea what it is they are walking into, because they don’t know what equipment is inside that house, what materials, what the furniture is made of, etc., etc. The constant exposure to these toxic fumes has now been noted by the World Health Organization as carcinogenic to humans, and as—

ASSISTANT SPEAKER (Hon Jacqui Dean): Order! The bill.

—Michael Woodhouse mentioned earlier, this is something that could be looked at in the future in terms of getting some further cover for our firefighters.

The bill itself has clarified where ACC cover is going to be implemented, but it also clarifies where it is not, and so we have made clear in this that it does not apply if death was as a consequence of suicide or the assisted dying in accordance with the End of Life Choice Act. Maybe that’s just a clarification that may not have needed to be made, but we do have it in this bill.

I commend the process that we’ve been through with this debate. It’s always good to see the cooperation across the House. It’s always good to see that this House is not always divided on the bills that come in front of it. We are very happy, as the National Party, to support common-sense legislation, and, as a consequence, I commend this bill to the House. Thank you.

It is my honour to take the last call on this amazing process—a very short one; that in no way reflects on how important the mahi of the last 18 months has been. I just need to acknowledge a group of people who we haven’t acknowledged at this stage, and that is our officials from the Ministry of Business, Innovation and Employment and ACC. It wasn’t even on their work plan, and when this issue was raised, they stepped up, they were nimble, they were responsive, and within 18 months—it sounds like a long time—they’ve managed to get us here today. They didn’t do it alone. Many have acknowledged the expertise that we were lucky to have at the select committee, the Education and Workforce Committee, with Sarah Pallett, the leadership and courage of our Minister the Hon Carmel Sepuloni, and our colleagues across the House who sat in on the select committee and really took this challenge on and made sure we ended up in a pretty good place. I just want to acknowledge that select committee process for a moment, and the magic is that we have the expertise that comes to the select committee—not just the professionals but those women who shared their stories—and that is why I am very pleased and honoured to commend this bill to the House.

Motion agreed to.

Bill read a third time.

Talk about brinkmanship, members. Well done. The time has come for me to leave the Chair for the dinner break. The House will resume at 7 p.m., and congratulations, Minister Sepuloni.

Sitting suspended from 6 p.m. to 7 p.m.