By Tuesday, 16 September 2025, 7:18 Am Opinion: Ian Powell
Copyright scoop
What would I do as a health commentator and health
systems blogger without the excellent daily (Monday-Friday)
online coverage by NZ Doctor with its focussed and
industrious journalists? The short answer is not very
A recent instance was the Steve Forbes paywalled
article (12 September) on the Government’s decision
seeking to amend the Health Practitioners Competence
Assurance (HPCA) Act 2003: Health minister signals sweeping
Purpose of Health Practitioners
Competence Assurance Act
King was the health minister responsible for the adoption of
The Act that Minister Brown
seeks to amend was successfully advocated by former Labour
health minister Annette King.
At the time
I was Executive Director of the Association of Salaried
Medical Specialists. We did have some misgivings about
aspects of her parliamentary bill. However, good engagement
meant that much of this was able to be satisfactorily
Overall, the Act has proven to
be a successful piece of lawmaking. It provides an external
morality that aligns well with the internal moralities
(health professional cultures).
This alignment, in
turn, provides Aotearoa New Zealand’s health system its
greatest strength, especially in today’s despairing
I discussed the importance of aligning internal
and external moralities in an earlier post nearly two years
ago (20 September 2023): Aligning moralities.
is all about patient safety
important to understand what the HPCA Act is and why it is
important. Expressly it is about patient
To better ensure patient safety
the Act provides a framework for the regulation of health
practitioners in order to protect the public where there is
a risk of harm from professional
This framework includes the
scopes of practice for the various regulated health
professional groups. It also includes establishing the
regulatory authorities responsible for their registration;
the largest are the medical, nursing and dental
Ideological based threat to patient
On 12 September Minister of Health
Simeon Brown issued a media release stating the
Government’s intention to amend the Health Practitioners
Competence Assurance Act 2003.
Purportedly, so the
Minister confidently asserts, this is by making workforce
regulation more “efficient and responsive”: Health
workforce regulatory changes.
Brown’s embellished assertions risk greater patient
One thing the health minister is not
short of is embellished assertions. His release includes the
Patients will get faster
access to care under new changes to modernise health
workforce regulation, Health Minister Simeon Brown
“Outdated and bureaucratic
red tape is holding back our health workforce and keeping
patients waiting too long for care,” Mr Brown
“These changes are about putting
patients first. By streamlining regulation, recognising
overseas qualifications more quickly, and making regulators
more accountable, we’ll get more health professionals into
the workforce sooner, reduce wait times, and improve access
to care across the country.
“Regulatory
decisions directly affect how many doctors, nurses, and
other health professionals are available to patients. These
changes aim to speed up access to care and support new ways
of delivering health services, while keeping patient safety
front and centre.
“Right now,
patients and the Government have almost no way to ensure 18
different regulators are working in the same direction.
These changes give patients a voice and let us set clear
expectations across the system, so regulators focus on
improving access to
Superficially this sounds
great. There is only one problem with it – it is complete
nonsense. Instead it is based on simplistic
Christopher Luxon’s promise of
an evidence-based government
In the 2023 election campaign
Christopher Luxon claimed that a government led by him would
be evidence-based.
If this was a genuine claim then
clearly he is not leading his government, at least in
health. His health minister’s own statement is completely
evidence-free.
Even worse but unsurprisingly
consequentially, if implemented, rather than protecting
patient safety, Brown’s initiated legislative amendments
would put patients at greater risk of harm.
features of the health minister’s proposed amendment
fast-tracking registration for overseas
healthcare workers;health regulators would be
expected to follow many of the planning and reporting
standards used by Crown agencies, including statements of
intent, performance and output measures;the health
minister would be able to appoint a committee to
independently review registration decisions without having
to go to court; andthe health minister would be
able to issue policy directions to health regulators, to
help meet politically determined health
The Minister’s
announcement did not come out of the blue. It followed his
release in March of the questionable and unsubstantiated
Putting Patients First: Modernising workforce
regulation discussion document. I discussed this in a
previous post (23 May): Hypotheticals from anecdotes and
The strength of the above-mentioned
Steve Forbes article is not just that he fairly summarises
the health minister’s announcement. He drills down further
into its pitfalls.
This includes reporting the
insights of Otago University Associate Professor Ben Gray
(general practice and public health) who identifies that the
announcement presumes the main barrier to attracting
overseas-trained doctors to work here is delays in the
registration process.
He then states:
if they had listened to the evidence presented during the
consultation [on Putting Patients First], they would know
it’s not the registration process, but the fact overseas
doctors aren’t staying in the country after they are
registered.
Medical Council Chair is
evidence-based; retention is the problem, not
This is consistent with earlier
comments from Medical Council Chair Dr Rachelle Love which
Forbes repeats. Back in April Dr Love confirmed that 60% of
overseas-trained doctors leave New Zealand within two years
of registration.
Over the past two years, only
0.5 per cent of doctors who have applied for registration
have been declined. Over 99 per cent of doctors are able to
get registration. So, the idea that the registration process
is driving people overseas isn’t supported by the data.
We can just fling open the
doors, and that’s what we’ve been asked to do. But I
really want to draw attention to what I think is a far
bigger issue. Why are these people leaving?
Ben Gray highlights danger of political
interference
Dr Gray meanwhile has more to say on
allowing the health minister to appoint a committee to
review registration decisions
independently.
That would bypass the council and
the courts,” he says. “Interfering in the Medical
Council’s registration process is really
This is about politicians
thinking they know better without being cognisant of what
the risks are. And having someone going to the minister to
plead their case is highly
problematic.
That’s why there must be a
clear separation between the public service and regulatory
bodies like the Medical Council and the
Government.
The problem with
What the health minister is seeking to
do is amend the HPCA Act through including additional
factors that are irrelevant to its patient safety purpose
and have no practical benefit to registration
decision-making.
Instead what he is attempting would
have the effect of watering down the ability of the
regulatory authorities to focus exclusively on its current
core function of protecting the
Simeon Brown: no evidence, only
ideology, anecdotes and
The problem is not
just that Simeon Brown has not provided evidence to support
his proposed amendments to the core legislation responsible
for patient safety. Worse still, he has not even tried to
find supporting evidence.
Driven by his
ideologically based ‘values’ he has instead relied on
anecdotes delivered by soundbites. The winner is simplistic
ideology and the loser is patient safety.
be more core to the health system than patient safety? What
could be more core than legislation exclusively focussed on
ensuring that health practitioner regulatory authorities
protect the safety of the
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