Pae Ora (Healthy Futures) (3 Day Postnatal Stay) Amendment Bill

Committee of the whole House

Well, this is probably the biggest change from the original bill. It’s a change that pushes the start date out to 1 July 2029, which I suppose is—you know, we’re no longer writing science fiction about 1 July 2029, but it still is relatively far in the future. It seems unusual to pass a bill about an entitlement that we can’t yet operationalise, but here we are.

I think the point that really is relevant to this Schedule is to understand from the Associate Minister of Health is how she has sought assurances that this can be delivered. Really, what I would expect in terms of an answer here would be about what service planning is under way. We’ve seen the budget as it relates to this. The substantial funding really only comes in in the financial year that starts July 2029. Our new primary birthing unit is being commissioned, does that require new building? Are any of those private or are any public? Has an assessment been done of maternity ward capacity in the public system, and any need for expansion there?

Of course, not everyone would be well enough to be cared for in a private centre outside of a hospital. So presumably there are some implications for maternity wards in hospitals as well. So it would be good to hear an explanation of how these entitlements will be realised in 1 July 2029.

Committee of the whole House

Thank you, Mr Chair. I’m looking at the planning, and I think a lot of new Part 5 of Schedule 1, inserted by new clause 6, looks at implementation. It talks about, at new clause 55, the “Preparation, approval, and publication of inpatient postnatal care plan”. I don’t see anything in here about consultation. I’m really worried about that, because it sounds like Health New Zealand is just required to come up with a plan—maybe interview its typewriter, as we sometimes say. That could be monocultural. That could be focused around a major city—Auckland or Wellington—that may fail to take into account the kinds of things that need to be included in good planning to ensure that care can happen in other communities. When I say other, I don’t mean to other those communities, but in our rural communities, my electorate in Taieri; in Māori communities and ethnic communities and disabled communities.

If we think about the very special context of our disability community and having babies and the type of planning that needs to go into that and the type of care. How is that accounted for in a bill that does not have anywhere, from what I can see, a requirement to consult. It doesn’t even have secondary legislation in there, which we’re so used to seeing in this House from this Government, where it’s kind of, “let pull the substance out do it via regulations, and then we don’t have to debate it in the House”. It’s not in there at all, so there’s these very strict assumptions and deadlines that completely fail to connect with the reality of the front line and what birthing means to particular communities.

So is there going to be consultation with clinicians? Assumedly, there will be. What about with parents? What about in the different scenarios that I have suggested? One of the worst things I think we could see is that a health plan, a post-natal care plan is provided for that completely straitjackets clinicians and the medical providers and is completely inappropriate to the parents that it is supposed to be helping. I think about my own birthing experience and what an incredibly special time it, what an important time it is for bonding with the baby, and that was very much what we heard was motivated by Catherine Wedd. That was what motivated her to want to bring this initially as a member’s bill.

That could go horribly pear-shaped if the planning wasn’t done properly. People say, “Nothing about us without us”. We see it all the time happening in this House through the disability legislation changes. It looks like we might be seeing that again unless the Minister can reassure me that there is some other place that this consultation will happen.

The impact of that is very real as well. We have some of the worst suicide statistics for post-natal mothers, post-natal parents in New Zealand through mental health issues. This care in the planning and the ability to actually include really strong mental health supports and to identify vulnerabilities and to be appropriate and culturally appropriate—even though the health Minister himself won’t acknowledge cultural factors as a clinical factor and neither will Vanessa Weenink, apparently, when I spoke on a panel with her the other day. Nevertheless, most clinicians—in fact, all clinicians—do see that, and that is completely absent from this.

So could the Minister please tell us: have they considered whether they’re going to consult? Where is the requirement to consult? How is that going to be mandated? How is anyone going to be accountable to that? And what will happen if something goes wrong and somebody is given a post-natal care plan that does not take into account their specific needs? These are very real consequences of this bill.

Committee of the whole House

Just to the Hon Dr Ayesha Verrall’s questions, in terms of the planning process, as I said, this will be a system that is commencing from the commencement date of the bill and running through to 1 July 2029. So it definitely isn’t waiting until 1 July 2029. The clause requires Health New Zealand to prepare an annual in-patient post-natal care plan for the three-year transitional period. That plan must be approved by the Minister of Health. Once approved, Health New Zealand publishes that plan on its website. So that creates the visibility this is about developing, and, as I’ve said in my earlier answers around this process, using existing capacity and building on commissioning tools to add additional capacity, and that is with a provider mix that best meets the community needs.

In terms of Ingrid Leary’s questions regarding the consultation process, does Health New Zealand have to consult with these communities, Health New Zealand has a range of planning and consultation requirements under the healthy futures Act—for example, the code of consumer engagement. These obligations also apply to planning for maternity services.

Committee of the whole House

I want to ask a few questions in this part. One is stymied a little by not being able to find in the earlier part what the Associate Minister of Health assured me was true, which was that there is still an obligation to inform the mothers of this right but that is not the lead maternity carer—that’s what I understood that she said.

When it comes to a plan, I’d like to know what she intends to be in that plan. I’d love her to tell me where in the legislation that remains, because I can’t find it. It seems to have been all crossed out. Is the plan envisaged to have that level of quality of detail in it? Will it say, “This is how we’re going to tell people that we’ve got this right. This is who is going to make sure that we’ve got this right”? Will it have an articulation of the level of support that they will get. Is that envisaged? Because when resources are squeezed, it’s very likely that people will find creative ways to call something “in-patient support” but it might be at a lower level than people are envisaging. It’s obviously critical in those few days that it’s a high-quality level of support. So there is that issue. And again, I think that that is critical that a plan would involve that kind of thing.

This is not a committee that I sit on, but I did come in and sit for a little bit of time on submissions. One of the things that came up that I thought was really interesting—it was a debate around the issue over whether a hospital might incentivise people leaving early by carrots. So things like giving people nappy nanny services or giving them bonuses, basically—things that they could take home if they left within that period. Is there any guidance going to be given about what is inappropriate in a plan when predicting numbers—for example, of people? Is that a problem for the Minister? I’d really like that on the record, because I think it’s very important that, in the Hansard, the Minister says it’s not appropriate if she considers it not appropriate. And, if she does consider it appropriate, we’d like to make that very clear too. It’s a reality out there—this kind of incentivisation—that, if you go home now, you’ll get all these things. It does put pressure particularly on families without a lot of money to go home early.

I know we all get tempted to tell our own birthing stories, but I actually went home well within the three hours with my second baby. I didn’t even stay three hours. It’s a really critical time for making sure that this is a real right for people and that the plans themselves create that real right, rather than it becoming something that becomes just exclusively for people who articulate or have money. That’s obviously a huge deal for our party. I’d love her answers on that. What’s the detail in the plan? What is she expecting out of the plans, and how does that guidance get made? Thank you.

Committee of the whole House

Sorry for the confusion for the member. The part that we’re talking about is in the Amendment Paper, so it’s not part of the substantive bill. It’s part of the Amendment Paper, which is this new part—

💬 Helen White: Could you just point to where?

It’s Schedule 1, new Part 5, clauses 53, 54, 55, and 56. In that part, you’ll see that this is the plan that Health New Zealand has to produce around building capacity. The plan must set out how Health New Zealand will progressively increase maternity services to meet obligations. Health New Zealand must submit the plan to the Minister for approval as soon as reasonably practicable, and Health New Zealand must publish the approved plan on its internet site. That has outlined the positions that we’re talking about. In terms of that quality of care within that 72 hours, I have full confidence in the quality of care that our clinicians provide.

CHAIRPERSON (Tom Rutherford): The question is that the Minister’s amendments set out on Amendment Paper 647 inserting new clause 6 be agreed to.

Amendments agreed to.

CHAIRPERSON (Tom Rutherford): The question is that the Minister’s amendment set out on Amendment Paper 647 inserting the Schedule be agreed to.

Amendment agreed to.

Bill to be reported with amendment.

Building (Earthquake-prone Buildings) Amendment Bill

Committee of the whole House

Part 1 Amendments to Building Act 2004, and Schedules 1 and 2

CHAIRPERSON (Tom Rutherford): Members, the House is in committee on the Building (Earthquake-prone Buildings) Amendment Bill. We come first to Part 1. This is the debate on clauses 4 to 13—Amendments to Building Act 2004—and Schedules 1 and 2. The question is that Part 1 stand part.