New minister advised to speed up bill to remove nursing barriers

13 November 2014

Both Treasury and the Ministry of Health are advising the new health minister to push ahead with the long awaited bill to remove barriers to health workforce flexibility.

This week both the Ministry of Health's 35 page and the Treasury's 41 page briefing papers to new minister Jonathan Coleman were publically released.

One of 12 recommendations made by Treasury is for the Minister to "identify and remove unnecessary barriers to workforce flexibility" by progressing the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill.

The Ministry of Health also highlights progression of the bill as one of its about 30 "opportunities you may wish to consider" outlined in its briefing to the minister.

The Treasury noted that the bill had been "under development for several years" and there was frustration at the lack of progress, "particularly amongst the nursing profession".

Nursing Review first reported in April 2008 on the work of an expert advisory group reviewing health law to remove legislative barriers to "innovative practice" by removing references to medical practitioners when suitably qualified health professionals – like nurses – were also competent to perform the role.  The bill has been in the offing ever since. Coleman said in late October that the bill is still currently being drafted.

"Updating this legislation carries a low risk to public safety as the Health Practitioners Competency Assurance Act ensures that only those health practitioners who are competent to perform an activity are legally able to do so," says the Treasury briefing notes.  "Enacting this legislation would contribute to improving access and managing costs."

It points to the example of the Burial and Cremation Act 1964 which requires that a Medical Certificate of Cause of Death can only be signed by a medical practitioner which can lead to delays where doctors are not available – particularly in rural areas and after-hours.

"The effect of this delay is that a funeral director or undertaker does not have the legal right to remove the body of the deceased to prepare for burial or cremation,"says the briefing. "In aged residential care settings, nurses are more likely to be on site and will often have the best knowledge of a resident’s medical history."

The Treasury briefing also says the increased focus on primary and community-based care required a more flexible workforce and there was scope for nurses and other health care workers to carry out a wider range of functions.  It points to a number of general practices already using nurses to triage care and deal with minor, non-complex issues and the use of nurse practitioners who "practice independently and in collaboration with other health professionals".

Download here: Treasury brief to incoming Minister of Health 2014

Ministry of Health briefing to incoming Minister of Health 2014


Excerpts from the Ministry of Health's briefing:

  • The health and disability system has generally performed well in tight financial times.
  • While the health and disability system performs well for most New Zealanders, persistent inequities exist. A number of groups have significantly worse health outcomes.
  • Population-based funding and additional sources of targeted financial assistance aim to reduce the various barriers to access. However, access to health care continues to be an issue for some groups, with cost affecting some people’s access to primary care and prescription medicines.
  • Significant gains could be made by developing a longer-term focus on preventing disability and illness in the first place.
  • New Zealanders are living longer, but over one third of the additional years gained are spent in poor health. By age 75, two-thirds of adults have at least two long-term conditions; 15 per cent have four or more 
  • By 2016, it is projected that high body mass index will overtake tobacco use as the leading risk to health, making obesity a significant issue for New Zealand.
  •  By 2016, it is projected that high body mass index will overtake tobacco use as the leading risk to health, making obesity a significant issue for New Zealand.
  • DHBs meet the health needs of their populations while operating within tight budget constraints. DHBs have reduced their deficits from a forecast of $200 million five years ago to approximately $19 million in 2012/13. 
  • The Ministry has reduced departmental spending from $189 million in 2011/12 to $176 million in 2012/13, to release resources for reinvestment. 
  • However, continuing this level of fiscal constraint will be harder in the future without changes to how the system operates.
  •  Like the population it serves, New Zealand’s health workforce is ageing. For example, 46 percent of the nursing workforce is aged 50 or over and some regions have significantly larger proportions of older nurses.
  • Changes in the international labour market affect us. For example, a shortage of nurses in New Zealand is expected, prompted by a projected Australian nursing shortage in the near future.