Political Interference threatens Health Regulation in NZ

Proposed amendments to the Health Practitioners Competence Assurance Act (HPCA Act) would allow greater ministerial direction over health regulatory authorities. Critics argue this risks undermining the Act’s core purpose: protecting public safety.

The Health Practitioners Competence Assurance Act 2003 (HPCA) is legislation that Aotearoa New Zealand’s health system can’t function safely without.

I have previously discussed on this platform the importance of health systems having their external (legislative) and internal (professionalism of health professionals) moralities aligned (20 September 2023): Aligning health system moralities.

What Is the HPCA Act and Why It Matters

Clause 3 defines the Act’s principal purpose simply and firmly. It is to:

…protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions.

The clause then outlines various ways of attaining this principal purpose including:

• Consistent accountability regime for all health professions;
• Determining for each health practitioner of the scope of practice within which he or she is competent to practise;
• Systems to ensure that no health practitioner practises in that capacity outside his or her scope of practice; and
• Power to restrict specified activities to particular classes of health practitioner to protect members of the public from the risk of serious or permanent harm.

How Regulatory Authorities Protect Public Safety

The Act establishes ‘responsible authorities’ (more commonly referred to as regulatory authorities) tasked with ensuring that all health practitioners registered with them are fit to practise and fully competent in the practice of their profession.

There are currently 18 authorities covering medical, nursing dental, allied health professional, and scientific and technical occupations.

Every health practitioner who practises in a regulated profession must be registered with the relevant regulatory authority and hold a current annual practising certificate  issued by that authority.

Each authority is required to specify ‘scopes of practice’ for each registered health practitioner who must not perform activities that fall outside their scope.

For doctors the regulatory authority is the Medical Council whose overriding purpose is to protect the health and safety of the public by ensuring doctors are competent and fit to practise. Other authorities have similar purposes.

The strength of this ‘external morality’ is the overriding legislative requirement for public safety in the health system. This strength is given operational teeth by the establishment of these regulatory authorities.

Although the members of these authorities are predominantly appointed by the Minister of Health they have generally been ‘politics free’. There has not been a practice of political pressure being used to interfere with their decision-making.

The closest example of political interference, albeit lawful, was when Minister of Health Simeon Brown required the Medical Council to take statutory responsibility for physician associates (around 50 American trained allied health professionals).

This was despite the Council previously determining, based on its expertise, that this was not appropriate.

Ending the ‘Politics-Free’ Zone?

However, this ‘politics free’ zone is intended to end soon if Simeon Brown gets his way. Thank goodness the health system has the vigilance of NZ Doctor and its top-notch investigative journalism. The health system would be poorer without it.

Fiona Cassie’s vigilance evident on attempted political interference in regulatory authorities

On 27 November this vigilance, via journalist Fiona Cassie, revealed (paywalled) that the ‘politics free zone’ of the regulatory authorities is likely to come to an end: Health Minister seeks more government power over public safety workforce regulation.

Cassie reports that the health minister wants to amend current legislation so he can direct regulatory authorities like the Medical Council to align with Government policy.

Back in September last year, Health Minister Brown had signalled this publicly arguing (without evidence) that ‘red tape’ was failing to put patients first and amending the HPCA Act was therefore necessary.

Proposed Changes to the HPCA Act

The key features (none were evidence-based) of his September announcement were:

• 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; and
• The health minister would be able to issue policy directions to health regulators, to help meet politically determined health targets.

I forcefully rebutted this at the time in an Otaihanga Second Opinion post (15 September): Patient safety threatened.

What would the proposed HPCA amendments allow?

• Ministerial policy directions to regulatory authorities

• Independent review committees appointed by the Minister

• Alignment of regulators with Government health targets

• Inclusion under the Crown Entities Act

Political interference update

Fiona Cassie updates in her article that Simeon Brown has taken to Cabinet a paper seeking approval to introduce a parliamentary bill amending the HPCA Act.

The Government has already shown its hand by taking the core function of  teaching registration away from the statutory Teaching Council and transferring it to the Ministry of Education.

Unsurprisingly this action has rung alarm bells among doctor and nursing professional bodies.

Cassie reports College of GPs President Dr Luke Bradford, in noting the teacher registration changes, warning that:

We have to make sure that patient safety and professional standards are not sacrificed in the name of political expediency.

She also reports nursing anxiety:

College of Nurses executive director Kate Weston is similarly concerned about the teacher-registration changes, calling greater ministerial involvement or political interference in the day-to-day regulation of nurses and other health professions “problematic”. Concerns have already been raised about pushback on cultural competencies.

Ministerial Direction vs Independent Regulation

In his Cabinet paper seeking approval for his HPCA Act amendments, the health minister claims that while the existing legislation had “contributed to high-quality and competent” health practitioners, changes are needed to ensure:

…regulation aligns with patient needs, health system policy and Government targets.

Consequently, Fiona Cassie reports that Brown:

…proposes amendments that would bring regulatory authorities (RAs), such as the Medical Council, under the Crown Entities Act 2004, enabling the minister to “direct an RA to give effect to Government policy.”

Cassie also notes Brown arguing that:

 Ministerial “power” would be “constrained”, the ministry’s regulatory impact statement says, as the act’s overarching purpose of assuring public safety would prevent regulators from being directed to make “unsafe decisions”.

Constraining ministerial “power” by the Act’s “overarching purpose of assuring public safety” is quite a stretch; in fact, it is unconvincing.

Is Public Safety Being Diluted?

In a word, Brown’s justification is unconvincing. At the very least it will create uncertainty and inconsistency for regulatory authorities operationally responsible for an Act that would no longer understand itself.

There is no logical connection between the responsibilities of the regulatory authorities and meeting ministerial requirements in respect of the Minister’s above-mentioned features released last September. Worse than this these features were not evidence-based.

The Health Targets Debate

Even worse still, they are disingenuous particularly in respect of the highly politicised health targets.

I have had published three critical pieces on the current government’s enthusiasm for health targets since the 2023 general election:

1. BusinessDesk (26 January 2024): Challenges over setting health targets.
2. Otaihanga Second Opinion (27 February 2024): Missing the health target.
3. Newsroom (15 August 2025): Target placed on patients’ heads.

The targets themselves are not necessarily bad and several have merit. The problem is the accompanying government narrative that seriously embellishes their role in both health system performance in general and workforce performance in particular.

The targets only cover those non-acute things that can be readily counted. They exclude non-acute things that can’t be readily counted and much of ongoing chronic care. Much of what public hospitals do is excluded.

Even more revealing, while acute (unable to be deferred) hospital admissions and discharges can be counted (and are), these are deliberately excluded.

And yet, acute care discharges are rising at a greater rate than population growth; a tipping point for hospital and emergency department overcrowding.

Alongside severe widespread staffing shortages, it is the biggest driver of increased health demand and the biggest obstacle to achieving many health targets.

What Should the Government Be Doing Instead?

All these things are outside the ability of the regulatory authorities to influence. Only the government can.

Furthermore, if they were politically instructed to try, there is a high risk of compromising the principal responsibility of their governing legislation (public safety).

If the government was genuinely concerned about improving health system performance it would focus on two critical measures.

First, address a key driver of rising acute health demand; that is, the external social determinants of health including poverty and poor housing.

Second, develop and implement realistic and practical strategic plans for addressing the widespread workforce shortages, including the fatigue and burnout that they continuously generate.

In other words, good leadership based on commonsense instead of nonsense. Simeon Brown might benefit from having a natter with Annette King!

The HPCA Act was designed to ensure health practitioners are competent and fit to practise, independent of political pressure. Election 2026 may determine whether that independence is preserved or reshaped.

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion.