New Zealand Public Health and Disability Amendment Bill, Hon Tony Ryall, 2R; Tuesday 12 October 2010

Rahui Katene, MP for Te Tai Tonga

The Bill amends the New Zealand Public Health and Disability Act 2000 to face the challenge of providing high quality health care and disability support services that are affordable.

The goal of the legislation is therefore pretty straightforward.

It amends the New Zealand Public Health and Disability Act 2000 It encourages - or forces - DHBs to work together with the ambition of creating and achieving cost efficiencies. And it allows the Minister of Health to step in and 'sort out' conflicts between DHBs - to "enable these powers to have wider application, particularly where there are disputes between district health boards about how national, regional, and local requirements are best provided for". In the aftermath of other recent legislation suggesting extraordinary and exceptional powers for legislation - such as in the case of the Canterbury Earthquake Recovery, or the Rugby World Cup - I have to say that we looked into these new amendments very quickly. And so we welcomed the move from the Select Committee to clarify the directive powers of the Minister - to amend the respective sections to clarify that the Minister has the same directive power as they would under the Crown Entities Act 2004 (essentially that they can't get involved in operational matters). But there is another section in the Bill which we want to give particular priority and that is the DHB public consultation requirements. The Select Committee's view was that the bill will likely weaken the consultation element of the act being amended. Presently, the act requires the same standard of consultation as section 83 of the Local Government Act 2002. The bill would require consultation but the standard of consultation is not defined.

This weakness, as the Committee reports it, worries us.

And it worried Women's Health Action who told the select committee that they hold

"serious concerns about the fate of public consultation in the proposed changes to the Principal Act outlined in this bill ... Women's Health Action strongly recommends that consideration be given to strengthening consultation requirements in this bill".

The New Zealand Council of Trade Unions also shared these concerns. In their submission they noted:

"The CTU recommends that the consultation requirements on DHB annual plans are retained and that there are provisions in the Bill to ensure that the Ministerial power of direction is used sparingly".

The Bill, as it reads, determines that the Minister may give directions to all DHB's to comply with stated requirements for the purpose of supporting government policy on improving the effectiveness and efficiency of the health and disability system.

Before giving any direction, the Minister must consult with all DHB's and any persons that may represent the interests of people likely to be substantially affected, but only if the Minister "considers (it) necessary in the circumstances",

And so we come to the crunch issue that the bill could, if the Minister so desired, be implemented in such a way which serves to undermine DHB consultation with communities.

There is no specific clause to require DHB or the Health Quality and Safety Commission to consult with Mana Whenua.

Another aspect of this issue is around consultation with disabled people and their families.

In the submission from IHC they provided a very strong statement about the relationship between the models proposed in the bill and the model that might work for disabled people. This is what they said:

"IHC is concerned that the proposals for change contained within the Bill infer that the same approach will benefit both the health and disability sectors on an equal basis. IHC cautions against this approach.

Given the social model of disability and the aspirations for disabled people to live "an ordinary life" we believe that the medical context and models proposed within the bill may not be appropriate for disabled people

The Maori Party supports proper recognition of disabled people and their families in the context of whanau ora. We believe that disabled persons have the right to participate in decision-making, be protected by law, and have control of their lives. If IHC's submission is a reflection of the disability sector than this bill might not actually benefit the sector as much as it could; if the model doesn't fit

We note that although some Select Committee members had concerns about this whole aspect of consultation they were satisfied that clause 92(1)(g)(16) would impose sufficient procedural requirements for consultation.

I would have to say we will be watching this issue very closely.

A key development that we are very interested in, in this bill, is the establishment of the "Health Quality and Safety Commission" .

And I want to say that we support the intention of the Select Committee to elevate the status of this Commission by including specific information in the Bill which itemises key functions such as:

* providing advice to the Minister on health epidemiology, quality assurance, mortality, and how to improve quality and safety * determining quality and safety indicators * providing public reports on quality and safety * promoting and supporting better quality and safety * disseminating information about quality and safety

We note the strong support from both the Combined Trade Unions and the Medical Association for this Commission; and it is an area that we in the Maori Party are also very supportive of.

This is an issue that we have canvassed strongly in our policy manifesto, He aha te mea nui.

We have promoted the policy line that the community must receive accurate information about the performance of hospitals, PHOs and DHBs, including adverse events to be reported publically every three months.

And I remember a Lancet article a few years ago, in 2006, of a sample of 6579 patients admitted to thirteen hospitals in New Zealand. That study concluded that Maori patients "had a higher risk of preventable adverse events in hospital than did patients of non-Maori, non-Pacific origin".

In fact the study concluded that Maori were more likely to receive sub-optimal care; receiving poor quality practice that harms patients and could and should have been prevented.

Our biggest concern with this report, was the impact that such information has on Maori confidence in the public health system.

And so, it was that basis that we argued that adequate information about health status must be a priority that the health system should attend to.

We will support this Bill. I do want to alert the Minister, however, to what will be a key focus for us as to how this Bill affects the appointment of Maori representation in regionalisation. It is our policy that we support the separation of the funder/ provider roles of the DHBs. We also entered into Government with our position being that we sought to review the duplication of corporate and administrative functions between hospitals, PHOs and DHBs, and whether there are any savings available if duplications were removed.

Efficiency, effectiveness, quality, accountability - all matter to Maori - and to the Maori Party. But most of all, I return to our key policy mantra - he aha te mea nui o te ao - he tangata, he tangata, he tangata. Our long-standing concern will remain with the people.

ENDS

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