Appropriation (2026/27 Estimates) Bill

Sorry, Mr Chair, this Minister is responsible for which part of Health?

CHAIRPERSON (Greg O'Connor): Feel free to answer that question.

Hon Dr DUNCAN WEBB: Which portfolio are we examining? All of it? [Minister Simmonds nods]

Hon Dr DUNCAN WEBB: OK, well, in that case, Minister, I’m very interested in understanding, in terms of the Budget allocation, how much of that allocation went into recruitment, and in particular the costs of wages. As recent media has demonstrated, it appears that there has been, if not an actual freeze, clear directives on going slow on recruitment in the health space. We’ve heard about the 54 fulltime-equivalent nurses, and we’ve also recently seen media reports about the under-resourcing at below safe levels in a number of areas. I’d be very interested in understanding whether part of the financial approach of the Government is, in essence, to have a go-slow on recruitment so that that can meet some of the shortfalls in budgeting.

Thank you, Mr Chair. I’d like to briefly acknowledge the Health Committee, and I see my colleague Dr Ayesha Verrall over there, and other members, for all of the work that they have done on this Estimates process.

We had a number of hearings with the Minister of Health, the Minister for Mental Health, the Associate Minister of Health with responsibilities for Pharmac, and the Minister for Seniors and Associate Minister of Health. We covered a number of topics over our hearings, including around the three-day postnatal stay—I see Catherine Wedd in front of me; well done, Catherine, for your work in that space; on primary care; on the workforce; on Māori healthcare; and around the health infrastructure, including some new and upgraded hospitals, including in my electorate of Tauranga. That was very exciting. We discussed mental health, the funding for mental health and addiction services, the funding for youth-specific mental health services and Gumboot Friday, the introduction of the psychology assistant role, and the introduction of crisis recovery cafes.

In our hearings with the Associate Minister of Health with responsibilities for Pharmac, we discussed a $1.8 billion Vote to purchase medicines for patients in the health system, funding for new medicines, and improved access for around 50,000 people. In the hearing with the Minister for Seniors with Associate Minister of Health responsibilities, we discussed smoking cessation and vaping and aged residential care. I’d just like to thank all of the Ministers for participating in those hearings and all of the members of the committee for their hard work and questions and their input into this report.

Thank you, Mr Chair, and I do acknowledge the very good work done by my colleague as chair of the Health Committee. It’s good to have the opportunity to return to the material in the Estimates hearing, because we have some additional information to consider now that it’s been reported that the deficit for Health New Zealand for the financial year 2025-2026 was $350 million against an original budget of $200 million, and the budgeted deficit for the coming financial year is $475 million.

Clearly, my question to the Minister of Health is why is the deficit at Health New Zealand getting worse? Why do we see reported today Health New Zealand quoted in media saying that Health New Zealand has been allowed to run a deficit for longer to enable hospital delivery to be maintained, and then comments that “Health New Zealand and the Ministry of Health”—and this is reported in The Post today—“are coordinating on an agreed future deficit reduction plan to return Health New Zealand to return Health New Zealand to break even. The timeframe and actions for this have not been finalised.”? So a worsening deficit picture from what was expected for the last financial year, escalating in the current financial year, and then, it appears, no plan agreed between the Ministry of Health and Health New Zealand.

Mr Chair, thank you very much for the opportunity to speak to that question, and I appreciate the member’s questions in relation to the Health New Zealand deficit path. Clearly, there’s been some significant improvement over the term of this Government in relation to the deficit path for Health New Zealand. There has been an agreement to allow that deficit to continue for slightly longer in order for the focus to remain on the delivery of key health services, which are needed to meet the health targets.

We are seeing year-on-year improvement against our health targets, which is positive and which is after years of decline. We are now seeing year-on-year improvement, which is a positive thing to be seeing for patients, particularly those on wait-lists for elective surgeries. That is making a big difference, however, there’s still more work to do. We’ve agreed with Health New Zealand for a slightly longer period of time to return to a break-even perspective, but the focus very much is on delivery of services.

Thank you. Further to that, the reporting today on the deficit set out that, essentially, increases in general practice funding were paid for out of subsidies or transfers from the hospital and health services appropriation. There’s this worrying situation in our hospitals at the moment where nursing recruitment is held at a fixed level, a hiring freeze, and then there’s pressure to cut more money because the hospitals are being run at a deficit.

I do not consider it to be, as the Health New Zealand spokesperson said to the press, a positive thing to be allowing the hospitals to run at a deficit in order to maintain services because, fundamentally, it points to either a Government intention to undertake more cuts or an inadequate funding level. I would like the Minister, returning to an item that he didn’t address in my initial question, to outline what is intended to be cut in order to have the hospitals balance their books or Health New Zealand balance their books. If he won’t give an outline there, does he have any intention to bail out the hospitals so that they can recommence hiring nurses?

In response to the question, I mean, the number of issues that she’s raised, I would point out that in accordance with the statement of performance expectations, the budget for hospital specialist services in 2026-27 has increased by $1.24 billion compared to 2025-26. We are putting significant additional funding into our hospitals and specialist services because we know how critically important that it is in order to deliver those services. The focus that we very much have and the expectation of Health New Zealand is that more is delivered for patients to focus on the key health targets that this Government has put in place.

In relation to the question in relation to front-line staff, as I mentioned on numerous occasions during question time, Health New Zealand is currently recruiting for 2,378 fulltime-equivalent nursing roles. Those are actively being recruited across Health New Zealand, including 475 nurses who have already accepted offers. Improving workforce on the front line is a key part of what this Government is focused on.

In relation to the question around the transfer of funding between hospital specialist services and primary care, as outlined in that article, this is about ensuring that we can focus investment on areas which will actually reduce pressure on hospitals, such as in aged care. The deal which was done with aged care this year was around making sure that they can do weekend discharges from hospitals. I think that’s a really positive step because, actually, our hospitals get incredibly busy, obviously, through the week, and then if patients aren’t able to be discharged over the weekend—Monday’s typically the busiest day in a hospital—there are not beds available. That’s a really important step forward.

Likewise, the funding for palliative care. A significant uplift in funding for palliative care is really important so that palliative care can provide those services in the community and likewise take pressure off our hospitals. All of those investments are really important. At the same time, allowing Health New Zealand to run a deficit for longer means that they can continue to deliver more services and, ultimately, over time, they will work towards a balanced approach. But I would note the funding path that was agreed by this Government was set by the previous one when she was the Minister.

Thank you, Mr. Chair. Well, that is not a wholly satisfactory answer. The Health New Zealand deficit, I mean, essentially, amounts to running the hospitals on Afterpay. That explains why hiring is so constrained in hospitals to the point where the last couple of weeks have seemed very difficult for hospitals to manage.

Can the Minister shed any light on what advice he’s received about addressing the deficit and what options there are for addressing this $475 million deficit? Is he planning further cuts in the data and digital space? Will there be further restrictions on hiring? What is the future of the maintenance budget? You know, $475 million having to be made up is not easy, even in a big organisation. In fact, as we started out this debate, we heard that the hospital deficit has got worse.

There’s been a lot of pain in the health system. A lot of people have lost their jobs. A lot of cuts; maintenance deferred. Yet the issue of the deficit is not under control. I think it is fair, with an election coming soon, to ask the health Minister what he is doing about this. Are we just letting the hospitals run more and more into deficit or is there a plan to either bail them out or to find a way of making them actually being able to provide the services they need and stop this hiring freeze?

I appreciate the member’s questions. In terms of the budget for hospitals and specialist services, I mentioned, according to the statement of performance expectations, it’s increased by $1.24 billion compared to 2025-26. That is a significant increase—

Hon Dr Ayesha Verrall: Yeah, and a third of that’s gone on the deficit.

Hon SIMEON BROWN: —increase in funding—no, that is around how much of the funding is that’s available to spend. That is funding to spend for hospitals and specialist services. That is outlined in the statement of performance expectations. Our expectations are that that’s very much—as the member will be aware, when we came to Government the budget deficit was significantly larger. There’s been a lot of work done to ensure that it gets into a better shape. However, the focus is on delivery of services.

I’m not going to stand here as the Minister of Health and say, “Actually, the focus has to be on balancing the books.”, when we have waiting lists of people who need to be seen, following the years of those waiting lists growing under the previous Government. We need to get on top of those waiting lists and the focus is on service delivery, which is exactly what we’re doing.

In terms of data and digital, I’m pleased that in the Budget, there were two elements of investment in data and digital. One was around cyber security, which is correctly important for both our hospitals and the wider health system; secondly, also investment, in terms of a capital operating swap, which will allow Health New Zealand to progress a number of elements of the Health Digital Investment Plan. That’s going to make a big difference for the front line, who work incredibly hard.

Finally, just around recruitment, as I said earlier, Health New Zealand is currently recruiting. As at 14 August, 2,378 fulltime-equivalent nursing roles are actively being recruited to, and that includes 475 nurses who have accepted offers.

The Minister tries to make a virtue of allowing Health New Zealand to run a deficit, but it is, essentially, pushing tough decisions for Health New Zealand into the future and not answering the question of if the Minister is so committed to continued service delivery, why hasn’t he obtained, from the finance Minister, a bail out for the health system? That means that they’d be able to return to normal hiring practices, the hiring freeze could end, and the cost pressure investments could mean that the health system services could grow in order to address the wait-list issue, which we’re all concerned about, but also to make sure that services just grow in line with population growth and with the needs of our ageing population. So why is it that he’s accepted that health services need to go into hock rather than have additional funds appropriated for the health system? Of course, you know, we do hope to be able to see the health system get out of this period of cuts that it’s been going through and be able to actually get on with the business, but with this deficit hanging over them, the prospect of hiring freezes just stretches on into the future.

So can the Minister please answer: why hasn’t the Government bailed out the health system so that it can actually get on and address need? Secondly, if he thinks that cuts can be made internally and there doesn’t need to be a contribution from the centre in order to address Health New Zealand’s deficit, well, can he say what those are? Why is he so confident he doesn’t need that money? What other savings that he’s yet to make—him and his colleague Dr Reti, who preceded him, that are yet to happen—could return Health New Zealand to surplus?

Well, our focus is on cutting the wait-lists and reducing wait times for patients, which ballooned under the previous Government. That’s exactly what she left behind, including a much bigger deficit, which we’ve had to address. The reality of what happened in terms of recruitment when she was the Minister: the number of fulltime-equivalent doctors fell from 10,093 in March 2023 to 9,962 in September 2023. Since then, it’s improved to 10,905 fulltime-equivalent doctors working on the front line in our health system. That is significant progress that has happened under this Government, under our watch, due to the investments that we’ve made to improve health outcomes for New Zealanders.

Thank you. Well, that’s a remarkable diversion, isn’t it? I think what we’ve just had is a Government who likes to give out lectures on fiscal responsibility basically admit that they’re running the health system into deficit to make sure that the things the Minister of Health cares about happen, like providing hospital services. They’re just putting it all on the credit card, putting healthcare on Afterpay. The Minister had no serious answer for that.

So Health New Zealand’s running up a deficit. He won’t tell this committee why he’s so confident that there doesn’t need to be any additional funding put in—he won’t tell this committee. Apparently, he’s got this magical thinking about how he’s going to magically get rid of this deficit without any further compromise for services, and yet on this side of the House, we heard his comments last week in question time: only 54 nurses hired over two years—54 nurses.

You know what? I was doorknocking in Wellington North on the weekend, and I opened the door to a gentleman who says, “Oh, I know you: you got the Minister of Health to admit there were only 54 nurses hired in the last two years.” It does seem to be something that’s reaching out to everyday in New Zealanders and causing considerable concern, so I’m not sure why the Minister won’t answer on this important issue of the deficit. Instead, he’s got some glib confidence that he doesn’t need any additional money for the centre and yet is unable to say how he’s actually going to address it. I mean, it does seem like the Minister really does not care for what credibility he might have as the manager of the health system.

Well, there is significant work under way to focus on the health targets across the health system. They went backwards under the previous Government; they’re making year-on-year improvement under this Government. There is a significant focus on hospital and specialist services, as I’ve outlined. In terms of decisions around future funding, there will be, obviously, decisions made as part of the Budget 2027 process, and a pathway will be agreed around the funding going forward. But, ultimately, the focus very much this year, which is what the Estimates is about, is about continued service delivery, continued improvement in performance—that’s what we’re focused on.

Now that the Minister of Health has repeatedly talked about targets, can he answer why he has agreed, and the Minister for Mental Health has agreed, to count the wait times for specialist services in mental health for youth but is not going to count the declined referrals? In fact, why are declined referrals not counted across the whole of Health New Zealand services, except, apparently, in the South Island? How is that a complete picture of wait times and targets if we don’t know how many people are not being able to be referred?

Can he also answer as to where and what other services people are being referred to, particularly in the mental health space, where I have a document that shows that between 1 July 2024 and 31 March 2025, there was a total of 3,681 declined referrals. This has come from Health New Zealand, but it fails to say where they have been referred to when it comes to mental health.

Thank you, Mr Chair. Look, there’s nothing more comfortable than consistency, as that member reaches for her top drawer and gets her question out at every Estimates we’ve done for two years now, and every annual review, actually. I’m happy to confirm for the committee: when you look at youth referrals, the decline rate is 11 percent. I’ll make it very clear to the committee: that doesn’t mean that when a young person is declined, nothing happens. It is actually the expectation that the most appropriate service is found for that young person. What I would say on top of that: only 3 percent of those referrals are declined because a service is unavailable; 97 percent of times a service is available. If the referral is declined, it’s because a clinical judgment is made that there is another service best appropriate for that young person, and we connect them with that appropriate service.

Can the Minister for Mental Health please tell the committee how the declined referrals that are going to other services—where that information is being collected and stored, so that we can scrutinise that. Secondly, where there are declined referrals being made for clinical reasons, he talked about the expectation. Are they always being made by clinicians, or are there others in Health New Zealand making those decisions at any point?

Clearly, ChatGPT wasn’t working today. Look, in a health system there is no shortage of health information. I’d actually put it to you that in a health system, the opposite is true; we have too much information. I can assure the member that not only do we record declines—because, in fact, that’s why I can come to the committee and say declines are 11 percent and only 3 percent are due to service unavailability. Yes, of course they are a clinical decision, because I would encourage the member to go and visit services where they have a published criteria of the type of referral criteria they would accept for a young person.

Thank you, Mr Chair. I want to check with the Minister on, I guess, in some ways, aged residential care and also in-home care. Now, it is heartening to see an increase—though, one would say, not sufficient—of a 4 percent uplift in aged residential care. However, other than the mileage increase, we have not seen any other significant increase for in-home support and for home and community care providers. Now, we have seen, both in terms of the latest ministerial advisory group report but also in terms of the reports from the Helen Clark Foundation, etc. on the desperate need for us to invest more in home and community care. So could the Minister please elucidate this committee on why home and community care has not received any significant upgrade in this year’s Budget, other than mileage?

The contract negotiations for each year go through a quite a thorough, robust process, and I think just recently the in-home community care budget contract has been finalised and those uplifts will be communicated. The budget uplifts, I think, for in-home community care—funding for the support services has been a 3 percent increase in 2025. The total funding increase for 2025 was a $140 million top-up to the annual increase, so there have been funding uplifts each year for the in-home and community care services.

I would highlight that that is the importance of the ministerial advisory group: to ensure that we have a thorough and robust process around how those services are applied. I’ve been very clear in my position that it is a critical component of the aged-care system to ensure that there are as many options available for older New Zealanders to be able to live where they want to, for as long as they choose to. That illuminates the point that it is “right care, right place, right time”. There has been another component, which was the in-between travel allowance that was applied in April 2026 to offset the fuel cost, which has been retained. That was about a 30 percent increase applied to workers that rely on the in-between travel component. So there have been funding uplifts; there will continue to be funding uplifts.

The contract process is really important in this, but beyond the actual contracting process, it is really important that we recognise that the system is a critical component of our aged-care system. Therefore, we are very focused on ensuring that we have a comprehensive answer to this situation that is a long-term, sustainable component. That is about the other areas that we have been applying, which is important in this space, which is the case-mix model contracting, which was rolled out in the South Island. The case-mix model allows for greater flexibility; effectively, it’s a bulk-funding system which ensures that the services are delivered. That was first rolled out in the South Island. It is being rolled out through the North Island. This is really that opportunity to ensure that those care workers are able to put the person at the heart of the care. It is shifting from that very fee-for-service model to an outcome-based contracting model, which has helped significantly. Those that are working in this space have found it greatly beneficial. Not just for the workforce themselves but for the clients that use the service, it has proven very beneficial. It has been, as I said, rolled out initially in the South Island. It will continue to be rolled out in the North Island, and that was the process under the contract reviews that have been completed.

In short, there have been contracting uplifts, there have been funding uplifts, but, more importantly and most significantly, this Government has invested in a comprehensive solution focus, which is what the ministerial advisory group report has given 40 recommendations around—what the system needs to look like into the future to be sustainable; but, more importantly, as the Minister alluded to earlier, to take some pressure off the system. Those practical components around allowing the system to be funded to receive discharges from hospital over the weekend to actually improve the outcomes and take pressure off the hospital system are, I think, an important component of this solution that we’re putting in place. Really, I recommend that we continue to work in a very bipartisan approach to how we deliver these changes to the aged-care system into the future. We have engaged very closely with the in-home and community support care workers and the aged residential care providers to ensure that we are meeting solutions that are effective into the future.

Thank you. I thank the Associate Minister of Health the Hon Casey Costello for that contribution and, being as it is an Estimates hearing on the Estimates and noting in the Minister’s recent press release that advice has been sought on implementation of the ministerial advisory group’s recommendations, I wonder if the Minister can expand on the immediate term—as in, forecast period—fiscal impacts of those recommendations, and what type of implementation advice is being sought. Is advice relevant to health commitments in the next two Budgets being sought?

As we’ve been very clear about, the 40 recommendations are very robust, and they are quite detailed. There is no commitment at this point. The advice that we are seeking is “How would implementation work? What are those future states looking like?”—you know, the timelines under which they could be applied. We will, of course, always look at opportunities to improve the system through future Budgets, but we aren’t making any commitment to the recommendations made. There is a lot of work, and the ministry is looking at advice around what those recommendations mean and how they would be applied into the future. That is a very comprehensive piece of work, and the ministry has started already on looking at that advice, but we’re not making any commitments into future Budgets at this point.

Thanks, Mr Chair, and I wholeheartedly agree with the Associate Minister of Health the Hon Casey Costello’s comment that it is a comprehensive piece of work, with many detailed recommendations there. Could the Minister clarify, then—and I appreciate there has been work on a bipartisan basis, with the Opposition being kept informed of the advisory group’s direction—is the implementation advice likely to come back to Government before the election, or after the election? I note the Minister’s comment that Government hasn’t taken a position on that; is that because the Government is waiting for that implementation advice before taking a position on the advisory group’s recommendations?

Yes, fundamentally, we have put a relatively high-pressure timeline on the ministry to report back in early 2027, which is what we said in the media announcement. How much time that gives the ministry to answer all the questions that need to be answered, even to the extent they will be able to provide the level of advice needed to make those decisions—we wouldn’t be expecting to see anything in this term of Government regarding that advice, but we will continue to consider all of those recommendations moving forward.

I think it’s clear in the report that they have suggested virtually a 10-year implementation timeline around all the recommendations they put in place. We know this is not a quick fix; therefore, we’re prioritising those recommendations, looking at how that would look, what those impacts are, and what advice they can put back within the time frame that we’ve given. We’re in the ministry’s hands, and I’m confident that they will give us a detailed consideration. This is something that we have said: categorically, we need bipartisan agreement and support. We’ll continue to ensure that we engage to ensure we deliver the very best outcomes into the future.

Thank you, Mr Chair. Following on from those questions, my question to the Associate Minister of Health the Hon Casey Costello is: has she heard any reports that the time frame that was given to the ministerial advisory group to put their report together was a fairly truncated period of time, considering the complexity of looking across the sector and working out what those recommendations might be? And did she feel that was too short for the work that they needed to do?

Then, also, looking forward in terms of the time frame that she feels is necessary for the ministry to come back now and provide advice on those recommendations, is it important that she takes the time necessary to get this right?

The ministerial advisory group was put under a lot of time pressure to deliver a report in the six months. They worked incredibly hard. I have said quite sincerely that I’m incredibly grateful for the professionalism and expertise that they offered into this report. The advantage that we had is that the ministerial advisory group wasn’t starting from ground zero; there was the Health Committee inquiry, which had produced an incredible piece of work with clear recommendations as well. We had the funding model review that had already been reported. There was a lot of information that the advisory group was able to call on to progress this.

I think that this is one of those instances where there is a lot of work. There are 40 recommendations to consider. I think that the time line that we’ve given to report back is sufficient to continue providing us a good direction of travel and a way forward into the future. So I think that the time allocated, although tight, was useful, and I think the time for reporting back is relevant to what we’re trying to achieve at this stage.

You might recall, Mr Chair, around this time last year, there were a number of providers of mental health and addiction services who were really worried about their existence because they didn’t have contracts and were therefore not able to access funding. So particularly for small ones that had been going for a number of years, it was a bit of a dog’s breakfast. I recall the Minister at the time being unhappy with his officials and saying that this wasn’t going to happen again and he’d like to see longer-term contracts.

Looking at this year, I saw in the media recently and we’ve got information that a number of the providers have not received contracts or hadn’t by 1 July. This is to do with moving to longer-term contracts. In fact, I believe the Minister’s office told one of the reporters that some of them could expect their contracts in November. I’m just wondering if the Minister could please clarify how many of those providers are waiting on contracts to be completed, how many didn’t have completed contracts and signed contracts on 1 July, whether that caused any funding problems, and what his attitude is towards officials this year? Is it their fault again or is it something that perhaps should have been sorted out earlier?

Well, I agree with that last member—it should have been sorted out earlier. It was probably six years under a last Government that sat on their hands and did nothing. That’s why, under this Government, we know we’ve increased the mental health and addiction ring-fence. It’ll close to top $3 billion this year—a third of that, $1 billion, is what we call the funded sector: NGO, community, and iwi. So 80 percent of them were on single-year contracts—that’s tough, if you work in those services and you’ve got a mortgage and you need more certainty. We’ve actually reversed that now to give 80 percent of community and NGO services multi-year contracts—80 percent. We did that. It shows you don’t actually need to spend more money sometimes to make a real difference. Not only that, but in another area, we didn’t actually spend any more money; we just changed the settings, and we’ve seen an 82 percent increase in providers offering ADHD assessment and a 44 percent increase in providers offering ADHD prescriptions.

Tēnā koe, Mr Chair. I’m wanting to ask the Minister of Health, in relation to Māori health and the hauora Māori appropriation, and knowing that we saw a loss or a reduction in funding for the last period, but we had heard from Health New Zealand officials that, actually, the risk around the reduction in funding would be mitigated by underspend from the previous year, which is heartening—it’s lovely to hear. What I am keen to understand from the Minister—because, oftentimes when talking about hauora Māori and the gains being made for hauora Māori, we often end up talking about immunisation and Tamariki Ora and the way that hauora Māori have done really well in the immunisation of our pēpē, which is a great win. But beyond the Māori immunisation targets and the mahi being done there, can the Minister please give us an overview of some of the tangible delivery that the hauora Māori appropriation has been delivering within communities across Aotearoa to reduce inequalities for iwi Māori?

Thank you, Mr Chair. Look, I’d like to ask questions about the maintenance spend and infrastructure spend in our hospitals. The Health New Zealand infrastructure plan has been now quite some time ago, but it remains unclear what the funding commitment for that 10-year piece of work would be or how much of it is currently funded. Just to pre-empt where the Minister may choose to go with this answer, I’m not looking for a repeat of every press release he’s ever issued about a segment of a capital works project—that would be extremely tedious. But really, we’ve had the Infrastructure Commission set a trajectory for health infrastructure that appeared to be very well considered. We’ve seen commitments that have not come close—it’s approximately half of that trajectory suggested by the Infrastructure Commission. The infrastructure plan, while being helpful, is a set of PowerPoint slides and has one page on the hospital building programme.

We all in this House repeatedly talk about how we want infrastructure to be bipartisan, but it would be great if we could hear a little more than this about the future trajectory for infrastructure funding and how that matches up against the needs that are identified in the infrastructure plan. I am aware of advice that the Minister has received that states the infrastructure plan is currently not fully funded and that what can be delivered on the level of funding is markedly reduced. If we are to have sensible bipartisan conversations about infrastructure, it should be that the Minister is able to share information on elements of what is a 10-year piece of work being undertaken by the health system.

I’m advised by my whips I’ve got no time left to be able to answer questions, but I would briefly articulate—

Hon Dr Ayesha Verrall: Oh, why are you looking so sad?

Hon SIMEON BROWN: No, I’m not. I’m answering the questions to say that in terms of the infrastructure plan, the answer to your question is that the plan has been published. There are obviously business cases under way which would look at the different funding that is required. Each Budget obviously allocates capital—this Budget did, the previous Budget did.

In terms of hauora Māori appropriation of investment, the answer is there is, of course, additional investment. There are sometimes underspends which get transferred forward. The focus, though, is on delivering results.

CHAIRPERSON (Greg O'Connor): Now, we may have reached a situation we met with the last Minister, where the Minister in the chair has run out of time. This debate is set to go through to 15.42. It does represent an opportunity for any party in the House to speak, so it’s up to members how they use their time. Byzantine use of timings may be required through whips and others here, but the call now goes to Ingrid Leary.

Yeah, Mr Chair, it’s interesting that the Minister for Mental Health talked about the ring-fence and seemed so confident in his numbers about the increase in the ring-fenced funding; because, actually, Official Information Act requested documents show his own officials questioning whether the mental health ring-fenced funding is actually reaching front-line services. If I look at what the correspondence shows, it says that officials can’t fully reconcile financial summaries with the underlying spreadsheets. It says they question how much confidence they should have in the underlying district data used to report mental health spending. They talk about anomalies, including a $50 million difference between budgeted and actual provider payments for hauora Māori services; significant variation in alcohol and drug service spending compared with the plan; and a $61 million shift between mental health appropriations during the year. The officials also confirmed that the mental health “ring-fence” is not a protected budget but the minimum amount Health New Zealand is expected to spend.

The reason this is significant is because it means that the Government can’t actually demonstrate what services were delivered, where the money actually went, and whether ring-fenced mental health service funding was reaching payments. That’s really important, and if we look at one particular example, there’s an official document that has the ministry officials saying that a case in point is with the Gumboot Friday funding wherefore, for some of the accounting, it’s included in the ring-fence and for other parts of the Health New Zealand accounting it is not. My question—and it’s such a shame the Minister won’t be able to respond, but he’s speaking so confidently about additional money into mental health when we know that front-line services are struggling, we know many of them are cut, and we know that there’s been a hiring freeze, and now we’ve got documents that show they cannot track the ring-fence to the spend and where those services are being delivered.

I’d just like to put that question here in the committee for people to consider, because I don’t think that this committee should have the confidence that the Minister does that there’s additional funding for mental health.

Fifty-four—54. Only 54 nurses hired across two years in our public health system. That is the number that this debate keeps dancing around. We’ve had discussions on the number of nurses in the hiring pipeline, the number of nurses hired by Labour—but that spilled over into the period of the first three months National were in Government—we’ve had discussions of other occupational classes, but the number that the Minister of Health does not want to repeat, because he was made to last week, is 54. In a big country like ours, where 29,000 nurses work in the health system, only 54 more for two whole years, as our population grows, as people get sicker, as wait-lists grow, as emergency departments bulge—just 54.

Why? Because this Government has got the health system running on the credit card. It’s in debt. They have cut funding to the health system; they have made debt pile up against it so that the health system is forced to cut and cut and cut. What have they done? Well, they’ve frozen the hiring of nurses, and there’s some complicated shell game going on at Health New Zealand where they only let people be recruited into so-called funded vacancies once people have been delayed in their hiring for so long, so these gaps in the health system move from one ward to the next but the theme is the same: it’s understaffing. If you’re waiting in a queue in an emergency department, if you’re waiting for an operation, the reason for that is because this Government has not funded the health system properly.

Yep, they’ll tell you stories about how they’ve hired X number of people, but they don’t count the ones who have left. They’ll tell you stories about how much extra money they got, but they won’t tell you about the cuts they’re also making Health New Zealand make. Well, let me tell you this: New Zealand cannot afford three more years of cuts like this to the health system, of repeated dissembling and misinformation about what’s happening with the important issue of nursing hiring. Just remember what we were told before the last election: no cuts to front-line services. Since then, repeated denials; repeated denials that there’s a hiring freeze in place. Well, the facts don’t lie: there are only 54.

At this question time earlier today, we went around the country, didn’t we, because in parts of New Zealand, actually, the number of nurses in your hospital has shrunk. If you’re waiting for care in Middlemore Hospital, if you’re waiting for care in Auckland hospital, in Waikato Hospital, well, the number of total nurses employed in those hospitals has actually gone down. This Government has no reason to have the trust of the New Zealand people when it comes to an issue like how they are resourcing the health system, because the fact is that they’ve been talking about everything else other than the actual number of nurses that they’ve employed.

You know what really upsets me about this? What really upsets me is the fact that this whole thing—this whole shell game—is being used to lock out young people, many young women, who have trained in nursing. It might have been during the pandemic that they saw our country struggling and needing more nurses and they thought, “What could I do about that? Well, I’ll train in my community to become a nurse.”, and now those young people cannot get jobs in New Zealand, cannot—

Andy Foster: What you could do is mandate half of them out of activity.

Hon Dr AYESHA VERRALL: I won’t take it from the anti-immigrant party when they won’t—

Andy Foster: Well, why have you mandated some of your own nurses out of being able to do their job? That’s what you did.

Hon Dr AYESHA VERRALL: —stand up for New Zealanders not being able to get jobs here. Absolutely ridiculous. Those young people trained to help their country, and they are locked out of jobs in the New Zealand health system because of the hiring freeze that is in place under this Government. They should be able to get a job helping their community here—the job they trained to do, that they’re qualified to do, that they can do better than anyone else. We know that when we hire our own graduates, they’re far more likely to stay, but what does this Government do? Well, they’ll talk about anything else. They’ll talk about how they’ve hired half of them, and then they make the other ones wait in order to get a job later on in the year. You know, they’re never just straight-up about what they’re doing. It’s always some other thing. They’ll just talk about some other point, because they don’t want you to know the truth. The truth is that there’s a hiring freeze on at Health New Zealand, that our young people are blocked from getting jobs in there, and that we cannot afford three more years of this Government.

I really want to reflect back on hauora Māori services again, because as I spoke to previously, we have had funding cuts in hauora Māori, and with the loss of Te Aka Whai Ora, we have now heard and we have seen in the recent report from the Public Service Association the fact that our hauora Māori services required the sign-off of the CEO for any new roles into positions. I just want to share the fact that I’m, like, aghast. We’ve heard this in the northern region; there were panels set up for our region and then the roles were going to go up to the panel and then they’ve got to ask the panel for these roles to be appointed.

I want to reflect on the kaumātua role in the Regional Rangatahi Adolescent Inpatient Service: it took 25 weeks to appoint that. Māori peer specialist support services in mental health and addictions in Waitematā: that took seven weeks. Smokefree facilitator: for me up in Tai Tokerau just recently, in mid-2025, it took 12 weeks to finally get approved.

So with these types of gaps that are happening in the system, we get stress. We can hear the stress; we can see the stress. When the kaimahi are talking to us out in community about the stresses, it took the report to finally lift the lid, when we know that there had been budget cuts across the board, particularly with the hauora Māori focus, and then these cost-saving issues have come up whereby we’ve been told, “No, there’s kaimahi, there’s nothing wrong, there’s no freezes.” Well, actually, we’ve heard, for example, in the northern region, for us in Tai Tokerau, that we have limits in the way that we can appoint full-time equivalents.

These are some of the concerns that are coming through constantly but now have been validated. So I thank the Public Service Association for bringing this to light, because in talking with kaimahi as of last week—as of last week—in the hospital, they said they are short-staffed, they are stressed, and they need support.

But what can we do? What can we do if regional funding panels or these appointment panels are being established and they are the ones who tick off what positions get filled? There are limits; we’re hearing there are limits, and now we’re seeing the limits. This is my pātai to us as a House as to what we can do to genuinely work together to establish a health system that is stable, that is well resourced, that puts people and wellbeing first across the board, whether you’re rural or urban, so that we all have the ability to access timely, quality healthcare.

So that’s what the Green Party is asking. Unfortunately, the Minister can’t reply, but we’ll take our time to be able to articulate these concerns, because it happened yesterday; it’s still happening today. What are the assurances that we will see the necessary staff filled in these positions that are much needed across the regions?

I mean, 54, I think, is the number of times you say something over and over again and maybe that will convince everybody that you’re right. The question has been answered repeatedly, that there are 1,600 full-time equivalents additional in the nursing staff.

As of 14 August, there were 2,378 nursing roles actively being recruited, including 475 nurses that have accepted offers—this is the reality. Then we have, again—recounted repeatedly—the number of additional doctors. This idea that we can say things in this House and suddenly they become true is just inappropriate. It is wrong to suggest that we have this crisis, that we have funding cuts, all of these things, when we know that this is the Government that actually delivered targets, and accountability, and measures, and performance tracking to ensure that we are doing exactly what my colleague in the Green Party said, which is delivering services for the people—putting the people at the heart of the solution and saying, “What can we do better?” This is exactly what this system is doing. We are delivering outcomes. We are continuing to deliver outcomes. What is important is what the impact of this is. Throwing money around is not a solution; delivering outcomes is a solution.

Across the health system, we have invested. We have invested in mental health, we have invested in aged care, we have invested in ambulance services, we have invested in helicopters—we have delivered things that the previous Government did not deliver, because we see the entire system in its entirety, and this is what we are delivering. We are actually delivering outcomes. We are improving. This is not a quick fix—of course it’s not; there are a lot of things to be done—but to say that we can walk around a hospital and tell people that 54 nurses are all that have been appointed is not the facts. The facts are that we have increased the nursing staff, we have increasing doctor numbers, and we have actually resolved the issues at the heart of our system because we have put in practical measures. We have put in accountability. We have put in targets—that were removed—to ensure that what we spend money on is delivering the outcomes that New Zealanders need for a good health service. This is what is occurring in our health system. This is what needs to be done: to actually have some sensible investment to deliver a sensible outcome that actually puts the person at the heart.

When we do things that are practical, when we do things that are common-sense, when we do things that are right, that is driving the accountability that puts the patient at the heart of the system. That is what health is for: to ensure that people get better, that people get well, and, most importantly, that we actually try and get people out of hospital, back home, and recovering as quickly as possible. That is the investment in medicines, that is the early diagnosis, that is the access to treatments, and that is the investment in rural health. Those are all of the practical things that this Government has delivered to ensure we get a system that works, that is comprehensive, and that is about the people we are trying to serve. I think that this continuing narrative about how dire the situation is—yes, we are in the middle of winter; yes, we have had a huge workload put on our people. But the fact is that we have invested. This concept of budget cuts—this concept of “We’ve cut back”—is just not played out. We have seen significant investment in aged care. We have seen nearly $490 million invested into the aged-care system since we’ve been in Government. That’s nearly $2.5 billion now being spent on aged care.

We have developed good investment systems. We will continue to do that—the work is not yet finished—but ensuring that we continue to drive accountability to our health system is critically important. We will continue to do that, because we have the practical, common-sense solutions to deliver a better system overall.

The practical improvements that many New Zealanders would love to see would be a reduction in the household bills they have to pay, and that includes healthcare services. When I knock on doors around this area, it is the same thing I hear from door to door to door: people pay too much for their everyday items. In fact, in this area, they pay the highest GP costs in the country. Costs for GPs have gone up 15 percent under this Government. Ambulance costs have gone up to over $125 per ambulance callout. Of course, the Government willingly put up prescription charges on everyday people. I couldn’t think of anything that’s more of a tax on being sick than the amount you have to pay for your prescriptions. New Zealanders cannot afford three more years of these escalating healthcare costs.

That’s what’s happening under this Government. They refuse to fund the system, and therefore the community providers—whether they’re general practice, whether they’re aged care—have to put up their bills, on to people. That’s what we’ve seen under this Government. That’s why there’s more pain in your back pocket: because of the underfunding of the everyday services that New Zealanders need and depend on. There is nothing in these health Estimates that’s going to ease the burden on New Zealanders in terms of cost, either this year or in coming years. The Associate Minister of Health in this debate has refused to give any indication that she’s going to take up some recommendations for a report that might help low-income people access aged care in the future.

If you’re struggling, if you’re doing it tough, you’re not going to get funding for access to services; that is all being cut back. New Zealanders cannot afford three more years of National.

CHAIRPERSON (Maureen Pugh): Members, the time for the Minister in the chair has come to an end. We now have the Minister for Energy and the Minister for Resources, and the Ministers are available to speak to that portfolio.

Committee of the whole House—Estimates Debate

Energy