Urgent Debates — Health—Death of Patient at Middlemore Hospital

I have received a letter from Brooke van Velden seeking to debate under Standing Order 399 the findings of the independent inquiry into the death of a patient at Middlemore Hospital. This is a particular case of recent occurrence for which there is Ministerial responsibility. Public confidence in the health system and in the Government’s response to any problem with it is an important issue that warrants setting aside the normal business of the House to debate. Before I call Brooke van Velden, I have also received a letter from Jan Logie seeking to debate the report of the Ombudsman on the murder of Malachi Subecz. There can only be one urgent debate on a sitting day. However, I am willing to consider Ms Logie’s application tomorrow if she wishes. I call Brooke van Velden to move that the House take note of a matter of urgent public importance.

Thank you, Mr Speaker. I move, That the House take note of a matter of urgent public importance.

Every day, New Zealanders engage with our healthcare system. Thousands of people actively seek help from other New Zealanders who go to work to help make people better. We, most of the time, hope that other people can solve our problems because of the knowledge that they have and the care that they have for us. On very rare occasions, people go to the emergency departments and they need desperate help. They are really in the time of their most vulnerable point of their life, needing assistance from other people to help them get better.

Now, in the case of this 50-year-old woman who went to Middlemore Hospital, she was turned away from the care that she needed because the hospital was under such pressure. I’m sure there will be many New Zealanders up and down our country who are wondering: could they possibly be put into the same situation as this poor woman who lost her life because she did not receive the care that she needed when she was at her most vulnerable?

People often go to the emergency department not even for themselves but for their children or for their husbands and wives when they know that they are desperately needing somebody else and they have no idea what’s gone wrong. We put our faith in the fact that we pay our taxes so that we have a public healthcare system that will look after us when we desperately need care.

When we have children with broken limbs that need to be set immediately, we hope that the emergency department can be there for us. When we have something desperately wrong with our heads, in the case of haemorrhages going on—or strokes; I know a lot of elderly in particular encounter the emergency departments in times when they’ve had a stroke—it’s so vital that they get really good-quality and very time-sensitive care to make sure that they can extend their lives and live a long, healthy life.

We often encounter the healthcare system in a time of anxiety, when we really do need care from other New Zealanders who get up every day and work hard to keep us safe and keep us healthy. But there is this poor case of a woman desperately needing help, and it wasn’t received.

So, on behalf of New Zealanders who have read this inquiry or have heard about the inquiry into Middlemore Hospital and wonder if this will change anything or things will simply stay as the status quo, it’s important that the Government is held to account and is able to answer questions that New Zealanders will have about our healthcare system. Will this report into Middlemore Hospital actually change anything? Will we see wait times decrease? Will we see the number of beds in our hospitals increase? Will people know that when they need to go hospital, there will be workers who are able to answer their call for help?

The issue here, under this inquiry, says that they found an overcrowded emergency department and a hospital well over the acceptable capacity. They found that only the hard work and dedication of Middlemore staff was keeping it from more serious incidents, and the environment is unsafe for both patients and staff and it’s not sustainable.

There are wonderful New Zealanders who work in our emergency departments. They are often stressed, they are often overworked, and it’s because we have a healthcare crisis. We don’t have enough people working in our emergency departments or across the entire healthcare sector to care for the number of people that are often looking for care.

We need to know from the Government what they are doing to make sure that there are adequate numbers of workers in our emergency departments, that people aren’t overworked when they’re needing to create diagnosis, and that in the future, we can be guaranteed that there will be enough doctors and nurses and triage staff there to make the right decisions in a good amount of time, rather than making decisions based on the fact that they are overworked, overtired, and too stressed to make a good decision.

We also need to know what the Government will do to increase the number of bed capacity in our country. It’s not just contained to Middlemore; we have this issue across our hospitals in the whole country. When we were talking about the COVID response in particular, we had lockdowns because the health Minister and the Prime Minister and everybody involved with the Government told us we don’t have enough beds to care for the number of people who are needing care during the COVID pandemic. Well, most of that is over, but we still don’t have enough beds for the flu season. What is happening to make sure that in ongoing years, we are going to have enough bed capacity for the people who need our emergency departments on any given day? We can’t keep blaming it on COVID; we need to have an adequate response to what the acceptable level of care that a New Zealander can expect in their healthcare system is.

We need to know that when a kid is really hurt and their parents are stressed and worried and they are taking them in a car or in an ambulance to hospital, they can get the care that they need, that they can get a bed in a hospital that they need and they’re not going to have to wait overnight, then over days, or go back home to then come back the next day and be in a constant state of stress. We need to know that they get the care as quick as humanly possible without overworking the staff that we currently have.

We rely on public confidence for our entire democratic institution. Every day, people get up and work and pay their taxes because they know that they’re contributing to the Government taking our money and spending it on things that people know that they can collectively contribute to—things like the police, things like health, and making sure that we have an education system. I don’t think New Zealanders would be happy to know that we are spending, wastefully, millions and millions and millions of dollars on projects that don’t deliver any benefits for people. And yet at the same time, we have a healthcare system that is crippled. We have a healthcare system that can’t give adequate care to people in their time of need. That’s a basic role of this Government—that people put our faith in our institutions. We collectively work together to become a community, and pay our taxes so that we can help each other in our time of need, and that’s not happening in this case. We have to do better.

I think people would also ask the question of what this means for our immigration settings. You know, we have a lot of people internationally who do work in the healthcare profession, and we know that they should and could come to New Zealand to help our overburdened healthcare workers. Why has the Government not responded adequately to allow nurses, for example, on the fast track of the Green List for residency? That is a barrier to helping to reduce the issues within our emergency departments. It’s one simple point that the Government could make and one that we’ve been calling for in the ACT Party.

We also need to know why the Government hasn’t been adequately addressing the need for more productivity and more economic growth so that people can become wealthier and, over time, pay more taxes. Over time, that means we can actually increase the amount that we spend in our healthcare system without overburdening everybody else’s need for funding within the Government departments. We know that we are not as wealthy as some of our OECD comparative countries, and that means that we can’t spend as much on healthcare as other countries. It’s a shame that we don’t put enough emphasis on the need for economic growth and the benefits that this could provide to our entire economy—but importantly, how much we can spend on giving people valuable care in their time of need.

We also need to train more doctors. What is this Government doing to make sure that we’re not just bringing in people from overseas to help with our workforce shortage but that we can train people here in New Zealand who want to be trained? We’ve had a cap on the number of doctors that we train every year for quite a while. Is the Government seeking to increase this so that we can actually have more people in our emergency departments and more people who can help people in their time of need, or does the Minister of Health believe that the number of doctors that we have currently being trained in our country is adequate? Because, looking at this report saying that it’s an overcrowded emergency department, hospitals are well over capacity, and it’s unsafe and unsustainable, surely that means there is need for change. Or is there? I question the Minister about whether or not this Government believes it’s important to train more doctors. Do we need to train more nurses? Same question. Are we training enough people in this country who genuinely want to work in the nursing profession to give people care in their time of need? That’s the same issue. We are just so overburdened and over capacity within our healthcare system that there has to be a better way.

I think that we need to acknowledge the tragedy that’s occurred and make sure that this doesn’t happen to somebody else, and that if it was a preventable death, those deaths remain preventable. It is a tragedy to the family members and the friends of this woman who lost her life because she didn’t get the care that she needed when she was desperately in need of it. It’s important that our healthcare system learns from this incident now, and that we don’t just have a report and it goes into a filing cabinet somewhere and nobody ever reads it—nobody from the Government departments reads it, nobody from the new Te Whatu Ora reads it. It’s important that this loss of life doesn’t go nowhere. There are New Zealanders who will be reading and hearing about this poor woman’s case and wanting to know whether or not this will happen again in the future. Will they get the care that they need, will their children get the care that they need, will their family members and friends get the care that they need, or would a preventable death not occur? Would it happen? It needs to remain preventable if at all possible.

I want to end by acknowledging, once again, this woman who lost her life. We’re very sorry that that happened, we share our condolences with her family and friends, and we hope that our healthcare system and the Government can learn from this report. Thank you, Mr Speaker.

Can I begin by once again acknowledging the family who are at the centre of this report and now at the centre of this debate. I acknowledge the grief that they have suffered through the loss of a loved family member.

Can I also pay tribute to our health workforce—those working in Middlemore Hospital, but also those working right across our public health system and who have had one of the most challenging three years, and then on top of that one of the most challenging winters that we have seen, or that our health system has experienced, for many, many years. In fact, every clinician I talk to says of this winter flu season that it is the worst in living memory.

Those were the circumstances in which Middlemore Hospital and the rest of our health system was operating in June this year, when this patient presented herself at about 1 a.m. one morning in June. It’s interesting to note in the report that even the report author acknowledges his—and I think it is a “his”—limitations in preparing the report. He opens the report by saying “I have not received or read any clinical notes. I have not reviewed any policies regarding the triage process or escalation procedures.” So that is a matter for the independent reviewer. The independent reviewer is independent and is entitled to access to information; that’s how the independent review process works. But this independent reviewer decided to write the report not on the basis of that clinical information, but on the basis on whatever information he had.

I say for the benefit of the member who has brought this urgency motion, the report is also very clear in that they thought that even had this patient been triaged in the way that they ought to have been, notwithstanding that the independent reviewer did not have access to triage policies, it may not have prevented the outcome. Indeed, the reviewer goes on to say of this event that it was “unfortunate”, that it was “unpredictable”, and that it was “unavoidable”, and just as the hospital’s own review of the incident concluded, it could not be concluded that, were circumstances different in terms of the numbers of patients in the emergency department and the number of patients in the hospital, the outcome might have been any different.

I think it is important to note, too, that we can look at an isolated event, and this report deals with an isolated event and it would be simplistic to draw conclusions without looking at the context. This is a health system that after two years of dealing with COVID—and its resources are somewhat stretched to deal with COVID because you had nursing and other health staff redeployed to run the amazing vaccination programme that vaccinated such a large proportion of our population; they’re managing those turning up to hospital with COVID and the extra special care that they needed. And then we’re faced with a winter with the borders open and a flu season unlike anything anybody had ever seen before.

Those were the circumstances in which these events happened. They are not the only circumstances, and the reality is that ours is a health system that has been run down; run down for years—underfunded and under-resourced. The National Party, when they were in Government or at least when they’re in Opposition, still will not take responsibility for the appalling and disgraceful under-investment and under-resourcing of the health system. You know, it’s interesting how right now, this is a Government that in five years has committed $7 billion for the upgrading and rebuild of hospital facilities that we desperately need. You compare that to the nearly $1 billion that was put in in the previous nine years. You compare that to two years—2015 and 2016—when no money was allocated to hospital facilities in this country. And so we are in a desperate catch up mode.

In addition to that, this is a Government that has, in its five years, funded an additional 5,000 nurse positions in our hospital system because they desperately needed it. The previous Labour Government committed to a Safe Staffing Accord with the New Zealand Nurses Organisation. That led to the Care Capacity Demand Management programme, and it was left to the previous National Government to implement it, and by the time they ended their term nine years later, it was in disarray. Most hospitals had not fully implemented it, despite having had nine years to do so, and one of the hospitals—from my home town, Taranaki Base Hospital—was one of the early starters, and by 2017 was one of the laggards in terms of implementation, because they were not interested in it.

That’s what happens when you have a party that just neglects health—a party that just neglects health. This is a Government that has funded our health system to an extent that it has never been funded before; increased funding by nearly 45 percent. Now, we know there are challenges in the rest of the health system too: challenges in primary care, challenges in aged residential care, and we’re working on all of those areas. So when the National Party complains about “not enough doctors”, they did nothing to increase the number of medical students.

I’m very proud to have announced, a couple of weeks ago, a programme for more medical graduates to train as GPs and to train in the GP context, and to lift those numbers, and to do that in collaboration with the Royal New Zealand College of General Practitioners. So these are the initiatives that are needed. And then we also know we’re a system that has always been dependent on immigration, and that’s why we have changed our immigration settings to make it easier for health workers to get here. Even during the time that our borders were closed, 5,000 health workers were able to cross our border to be part of our health system—many of them health care assistants working in aged residential care.

But that’s not the only place where we need to fill the gaps; we have a lot of gaps in the public health system as well. We now have the Accredited Employer Work Visa; we’ve had, in fact, over 500 applications of that, now. That follows on from the critical work visa that had been in place during COVID and ended at the end of July. I’m pleased to report to this House that, since July, 381 nurses, ready to work, have crossed the border to come and work in our public health system—most of them on the critical work visa, because that’s what was available at the time—and a growing number, now, on the Accredited Employer Work Visa. And for those that think that, you know, you change the immigration setting and, the next day, thousands of people turn up—that’s not how it works. These are people who are applying for a visa that guarantees them residency, so they are here for the long term. They are recommitting their lives in coming to New Zealand, and so it takes some time for them to close out their affairs where they are, shut down their lives, and shift it all to New Zealand to start here. And that is what is happening.

We have a lot of trained nurses coming here on visitors’ visas, doing the Competency Assessment Programme, and then converting to one of the other visas—it will now be the Accredited Employer Visa—and we’re seeing that happening as well. Hundreds of nurses—hundreds of nurses—queuing up, getting their visas, getting their approval, and coming to work in our system; that’s what they’re doing, and that’s what they do. Since July, 381 crossed the border—that’s what they are doing.

So I am satisfied that Te Whatu Ora – Health New Zealand is doing everything they can to recruit and to get nurses and other health workers here. Very shortly, they’ll start up their dedicated immigration desk, have immigration officials, amongst others, working on it, and they will manage the process—right from the recruitment ad that goes out overseas, to dealing with a contact, dealing with the application, dealing with the visa application, and helping them with their airfares and resettling to New Zealand to fill those gaps. But to not make that change quickly when you have nine years of under-investment, nine years of running down the system, and two years where you don’t invest anything at all in the facilities and our health system—it takes a while to turn that around, and we are in major catch-up mode.

But here’s the extra thing: when the ACT Party talks about “We need more productivity”, all they talk about is doctors and nurses. Well, the reality is that health care is changing. We saw during COVID, and we saw with the vaccination programme, the brilliant effort that went in—for a whole bunch of people who know about health care, who know about health work, and with just a little bit of micro-credentialing, a little bit of support, and some good leadership, we’re able to pick up tasks that, previously, we would have relied on nurses to do. The challenge for the health system of the future is not for doctors and specialists to insist that they do everything, not to have nurses doing a whole lot of tasks that other good, skilful, healthcare workers can do, but to actually make sure we have a health system that is about the right health professional doing the right thing, for the patient, at the right time. That’s the magic we have to achieve. So much of the health workforce gets it, and they want it, and we are going to deliver it.

That’s why there is a health workforce programme of development under way at the moment. That’s what has informed the initiatives that we’ve started implementing—ones I announced on 1 August and the ones that I’ve announced since then. Very soon, we will start a dialogue with the health workforce on what else it is that they want to see that’s going to help us fill those vacancies, but, most importantly, make sure that their working lives are as satisfying as they can be, that they are able to work at the top of their scope, and exercise the skills that they’ve got. For those who want more qualifications and more training, we will provide them the opportunities to do that, and have a health workforce that is relevant to the needs of New Zealand, today.

One of the other incredible things is the kaiāwhina workforce that was stood up during COVID-19, many of them so keen to continue to work in our health system. Some interests within the health system don’t want them. I remember the words of Professor Des Gorman, in a presentation he made earlier this year, “There is privilege in our health system”—there is privilege in our health system. Part of the challenge is to break that down and say, “Actually, we’ve got to distribute these important health tasks for skilful and qualified people. But, most importantly, if we’re going to make the difference and have health services that are easily accessible—accessible to people who have not had, or who struggle to get, access to health services—having the right people sitting in front of them, providing them comfort to be there, and the skills, then, to address the health needs that they’ve got. That’s the direction that we’re in. That’s the path that we’re on. And I’m confident that Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – Māori Health Authority are doing amazing work and will get us there.

But I, again, conclude by paying tribute to the incredible health workforce that we have, a health workforce that is dealing with literally—well, in any one night—7,000-7,500 patients staying overnight in our hospital system, and thousands more turning up to the emergency department (ED). You know, in June, at the peak of the COVID and flu and the staff absenteeism, over 100,000 people—I said 90,000, on the radio this morning—turned up to a New Zealand ED in the month of June. Normally, it’s around 80,000—between, sort of, 70,000 and 80,000. Over 100,000—that’s the pressure that the system was under at a time when we are still trying to fill the vacancies, still trying to fill the gaps, and working very hard to do so. But we were left in that position; our health system has been left in that position because of those long periods of under-investment.

And it is important we rebuild our facilities; there are EDs that are in desperate need of attention. You visit Hawke’s Bay, you visit Hastings hospital, and you see the ED there, and the folks, there, tearing their hair out about the environment they have to work in. We have to change that. But we’ve got hospitals—you know, Whangārei hospital—neglected for years by the previous Government. The MP at the time couldn’t even persuade his colleagues to invest in upgrading the hospital. Fortunately, Whangārei has an MP, Dr Emily Henderson, who cares about people and their healthcare, and has persuaded this Government to make the investment.

Now, I’m confident that Whangārei is going to have an outstanding, world-class hospital, thanks to the advocacy of the member for Whangārei; the member for Northland, Willow-Jean Prime; and the member for Te Tai Tokerau, Kelvin Davis—great advocates for their people, in their part of the country. I pay tribute, also, to the member for Nelson, Rachel Boyack, who has advocated strongly for the long overdue upgrade of the hospital in that region, too—even the former MP for that area, Nick Smith, was unable, and he sat around the Cabinet table, to persuade his colleagues to invest in health services.

This is a Government that takes health seriously. This is a Government that is investing in health to a level and extent that this country has not seen before—not just in services, not just in the workforce, not just in the personnel but in the buildings and the facilities as well. And we will continue to do that. The great thing is that we now have the ability to manage the system as a national system, and to manage it on a regional basis, so hospitals within regions can make sure that, where there is a need in one place and there’s capacity in another place, they can support each other to deliver on that. There’s amazing coordination happening across the hospital network to make sure that that happens and to lift the performance of our health system.

The independent reviewer’s report tells us we have more to do and that we have change to make. I’m confident that with the system that we have in place, with the leaders we now have in place, and coming in place, with the dedication of the workforce that we’ve got, with the initiatives that we have under way, and, principally, those workforce initiatives, we will have that world-class health system that every New Zealander will be very proud of. Thank you, Mr Speaker.

On June 15, at 1 a.m., be in no doubt, Minister Little, that Middlemore emergency department (ED) was in crisis. The health sector is in crisis. I have said for some time that there are two parts of the sector that particularly worry me—aged residential care and emergency departments—and here it is. The chickens have come home to roost. This independent report is a damning indictment of Andrew Little’s failure to address health workforce shortages, to heed ED warning signs, and to maintain health targets.

What happened here? Well, the first thing that happened was there was overcapacity in ED. On the night involved, there were 46 patients for a room that sits 30 people. There were 94 people waiting for bed placement—a whole ward, presumably in corridors, waiting to get up to a hospital that was 98.2 percent full at capacity. The report tells us there was understaffing. There were three nursing vacancies, including the critical waiting room nurse: the nurse who triages patients, the nurse who says what the waiting time is, the nurse who coordinates those who are the most urgent—that was a vacancy. A critical vacancy, and do you think the reviewer had the privilege of a job description for that nurse? Not at all. Look at the report—not at all. There were warning signs. The weekly census report the week before, the independent reviewer said, showed the worst ED wait times to target—a week before June 15.

The fourth point I’ll make is the outcomes. I will come and contest the point that the Minister has made that it was unavoidable, and raise some challenges to that conclusion. How did we get here? We got here because the Minister refused to address the health workforce shortage that has been blazingly obvious for years. We got here because the Minister ignored warning signs. He was warned there was a health workforce crisis. Keriana Brooking, on behalf of all of the DHBs, when she was chief executive, wrote a letter in July last year saying, “Minister, we have a health workforce shortage and if we do not address immigration settings, several things will happen”, and in the appendix she even put graphs. She said, “First of all, ED wait times are ballooning out. They will get worse.” She said, “Planned care, our elective surgical lists, are ballooning out and they will affect New Zealanders for generations to come.”, and then almost her final sentence in that letter was that if immigration settings are not attended to, we will not avert a health crisis.

Keriana Brooking, on behalf of every single DHB, warned the Minister in July last year there was a health crisis, that we needed to attend to the health workforce, and that we needed to use immigration settings to do that, and the Minister pretends he didn’t even receive the letter. I don’t think so. Ashley Bloomfield did, senior people and deputy director-generals did—of course the Minister did. I asked him parliamentary questions on it, and he replied—of course he saw it. No one believes that.

The Minister today disputed the fact that he had retired ED targets. That is not tenable. As I quoted in the written question, where he states that he has retired the ED targets—in fact, I’ll go on for the whole sentence. What he says is, and this is written question No. 14016: “The previous Health Targets were retired in June 2021”—and here’s the next part that I didn’t say in my supplementary—“and public reporting of results was discontinued”. He took down the public reporting of ED wait times. It wasn’t until May or June, with consistent pestering by myself and colleagues on the health team, that he decided to put them back in public domain. He removed them from visibility because they were so bad he wanted no one to see them. In his own words, “The previous Health Targets were retired in June 2021 and public reporting of results was discontinued”.

He makes the claim that health indicators have taken them over, the 12 health indicators named in December last year. Do you see ED wait times in those health indicators? No. Most other sophisticated health systems recognise that ED wait times are a good snapshot of how the system is doing. It represents a primary care that is struggling, so they make ED their home. It represents a hospital system where the wards are full and you can’t move them out of ED. It’s an important measure, and the Minister refused to make it a health indicator, or, indeed, to support the health targets that National set.

To everyone in the health sector and at the ED interface, here is what the Minister told me in oral questions in the week of June when this tragedy happened. To John Bonning from the Australasian College of Emergency Medicine, who said the wait time crisis was the worst in his career, this is what Minister Little said; to Dr Kate Allan, the chair of the Australasian College for Emergency Medicine, here is what Minister Little said; and to every single person working in the ED sector, here is what Minister Little said the week that this tragedy happened at Middlemore. What he said in parliamentary questions was—and the primary was around emergency department wait times—“but as a whole, the system is coping”.

At the same time, in the same week that this independent report is making statements like “ED overcapacity and an incredible 94 patients in ED awaiting bed placement”, the Minister says the system was coping. An overcrowded ED, a hospital well over acceptable capacity, and subsequent system dysfunction, and the Minister says the system was coping. The reviewer says it was a desperate situation; that same week, the Minister said the system was coping. The independent reviewer said this is an unsafe environment for both patients and staff and is not sustainable, and that very same week, the Minister said to this House the system is coping. No, it has not been coping, Minister Little. No one believes that.

Let’s look at the time frames. If we look at ED wait times, let’s see what we’ve got. The target is to wait less than six hours—95 percent of people to wait less than six hours in an ED. Six hours is a long time with a child with a burst eardrum, with an inflamed knee that may be septic, or with a spinal disc that’s protruding on your sciatic nerve. Six hours is a long time, but it was an international target that we all accepted. What we know is that when we handed over target times in October 2017, that figure was around 91 percent. Today, it’s around 78 percent, which is what the Minister is telling us. It has got worse every single year that the Labour Government has had responsibility.

If you think six hours is worse, what about 24 hours? Surely people can’t be waiting 24 hours! Yes, they can. Minister Little wrote in parliamentary questions that hundreds of people are waiting 24 hours, but surely that’s not the worst! Oh yes, if you ask Minister Little how many people are waiting in emergency departments for more than 48 hours—two days—would you believe there are dozens who wait more than 48 hours? You had the 12 ED specialists from MidCentral, and I commend their bravery for putting this out in an open letter to the Minister a few months ago, saying that we have people with urgent critical conditions waiting in wheelchairs for more than eight hours. That was a brave statement from those 12 ED doctors.

What we also know is that, just like this unfortunate woman, people leave when the waiting time is too great, and what we know is every single month in New Zealand—and I know this because the Minister has written it to me, and I can tell you exactly which hospitals are involved—5,000 people leave. They leave before they’re seen, and they don’t sign the indemnity form because they cannot wait any longer.

The Minister said, “Oh well, the report came up saying it was unavoidable.” There are things we need to think about there, Minister, actually. What happened was that this person was hypertensive, and they hadn’t been taking their Losartan for about two years. When you have a brain bleed, maybe if you check blood pressure, maybe if it’s high, you would restart their hypertensive medication, and maybe the outcome could have been different. The neurologist raised this point as well.

The Minister blames COVID; we’ve just heard a respected ED person saying this is no COVID blip. Oh, and, by the way, I’m tired of that being a sad excuse for every bad behaviour from this Government. Go back before COVID even arrived. Look at the ED wait times from October 2017 when we handed over to before COVID even arrived, and they were getting worse.

The Minister’s new excuse is flu. That does not stand up, and he’s had to change his tone from it being the worst ever in memory, because it turns out the Institute of Environmental Science and Research can’t back that statement. This has not been the worse season ever, actually, when you look at the data, and when I inquire of him in ministerial questions how does he substantiate that fact, he says, “Oh, of the people I’ve spoken to, they tell me it’s the worst flu season in memory.” Unbelievable. How can that be statistically significant, or any sort of science whatsoever?

Come up with another excuse, Minister, because they’re tired and worn. New Zealanders don’t believe you. You are responsible for this crisis. You are responsible for the health workforce shortage. You are responsible for removing targets. It’s a sad indictment—it’s a sad indictment. Be very clear, Minister: this is a crisis. Call it what it is, and show the sector you understand them.

Kia ora, fakaalofa lahi atu e te Māngai me te Whare. Anā te mea tuatahi e mihi aroha ki te whānau pani i tēnei wā pōuri.

[Thank you, and warm greetings to the Speaker and the House. Firstly, I would like to extend my condolences to the bereaved family at this sad time.]

I mihi to the whānau, friends, and workmates of someone who’s been lost in really, really awful circumstances—being told that something is a preventable death, that if they’d been seen in time, things might have been different, but we can never know. Assurances that things might not have made a difference do not help. I just acknowledge the anger and the frustration, and, of course, the grief of the whānau who are left to deal with this.

Secondly, I acknowledge the staff at Middlemore Hospital. No one wanted this. We know that our emergency department (ED) staff especially, and our healthcare workforce is so, so under pressure, and they are just really, really tired, really exhausted. Our health system wasn’t doing great before COVID—it has exacerbated everything, and even though we don’t have to wear masks all the time everywhere and mandates have been reduced, the impact of COVID will stay with us for a very, very long time.

The fact that the report seems to suggest that they did their best because the patient was not declined care or asked to leave seems to me to be a very, very low bar. I have been the auntie inside a waiting room, trying to keep a young person and a child quiet while we’re waiting to be seen. I’ve been a patient myself not that long ago, sitting in a queue of hospital beds, waiting to be seen while people are crying, hurt, and clearly suffering around me.

The Green Party has spoken out consistently through the Pae Ora (Healthy Futures) Bill, through any of the health initiatives that are coming around, and we know that our health system is under massive, massive stress. Pae Ora itself we supported—it’s still a vision of what we would like our health system to be, and we are not anywhere near that.

We would like to see that hospitals are resourced to provide the minimum care that they would expect of themselves, that there are enough staff to go around to meet the minimum requirements, but we also understand from the review and the situation that’s happening across the country that, actually, a lot more has to be done to meet patient demand. We know that during COVID we relied so heavily on our local communities, our iwi, our community Māori and Pasifika providers to connect into communities with people who weren’t necessarily using the health system except in that final emergency.

We support that more resourcing and more effort goes into making sure that people can be seen when something first happens, that they can go to their local GP without barriers of cost, transport access, and that they can go to their local community providers because they’re resourced to see them and that connections that have been made through marae and all those places can easily refer someone to a local place, so that the first time that something major happens, they’re not turning up to an emergency department.

This is a short call, but we just want to see that no matter what your health condition is, no matter the symptoms that you’re presenting with, when you go into any part of our health system you’re treated with dignity and what is going on for you is respected and investigated in a timely manner. No one goes to ED expecting to be seen immediately, but six hours is not an acceptable time—five or four is still not acceptable. We want people to be treated with the care and dignity they deserve and with the appropriate level of urgency. We cannot tell by looking at someone what is going on for them—that is why we do all the tests.

Finally, to those whānau, to those healthcare workers, we acknowledge the huge stress that everybody is under in our healthcare system. We need to see some urgent relief for you. There is no doubt that this will happen again if we don’t. Kia ora.

Thank you, Mr Speaker. I rise to make a contribution to this urgent debate this afternoon. Following on from colleagues, can I firstly acknowledge the whānau, the loved ones, of the person whose experience at Middlemore was far from ideal and certainly meant that they are no longer with us. Anyone in this House, I think, would reflect on opportunities and occasions like that and it’s appropriate to acknowledge the loss of life that’s been sustained on this occasion.

I want to also follow in the footsteps of colleagues in acknowledging the workers; certainly the workers at Middlemore Hospital in Auckland, but also those within our healthcare system generally for the outstanding work, the outstanding service, that they provide on a daily basis, 24/7—individuals who, I’m sure, we all have in our own families, members of our community who we know who have, over the last few years, shown enormous strength when they get up in the morning or in the evening, depending on shift work, and make their way to work, in order to serve and help others, within the health system.

Earlier, my colleague Minister Little talked about context, and I want to spend a little bit of time on that this afternoon, because context is important in any situation. And, in the context of this incident in June, at 1 in the morning, it’s clear that we all expect that when we front up to a hospital—certainly to an emergency department (ED)—there will be policies in place; that there will be support that is given. It is the role of a reviewer—in the words of the Minister, the independent reviewer, which I agree with—to make some decisions, to form some judgments, to have fulsome access to evidence and information, whether they be policies or other forms of record, to inform the report that they may write.

I agree that there is a basic expectation in this country—and, indeed, in our community—that people should be able to access healthcare on a 24/7 basis, and particularly when it is of an urgent nature that the individual or their family thinks that they need to go to the ED, to hospital, or whatever service is provided in local communities, whether they be urban, provincial, or rural, to get the support that they need. But it’s also worth noting that isolated events do occur from time to time, and so, with that backdrop of context, that’s particularly important.

For the folk at Middlemore and elsewhere around the country, I don’t think we need to look too far to see or to understand that we have experienced, for quite some time, a global pandemic; that we are in spring but for many it still feels like winter, and there are staff members in any workplace who are away sick. If we reflect on our own workplaces in our own communities, or here at Parliament, we know the toll that COVID, that winter illnesses, do take. And the sense of protection that people have in a workplace as well is also something that is quite important.

But, in terms of a hospital, I think there are often—and I reflect on my own hospital in Palmerston North and the fantastic work that the folk there do—additional layers of protection, particularly in circumstances where health is a significant issue, where there is additional resource at the front door, where there are limitations on the numbers of people that perhaps can be accompanying someone who is fronting up to a hospital. All of these things, all of these factors, do point and paint a picture of context that I think is really, really important.

After many years of underfunding—and Minister Little touched on this, much to the chagrin of those opposite—for the first time in decades there has been a significant increase and uplift in the funding that Government have put within the health sector. I can tell members of this House, and I will tell others who wish to listen or ask, that that also filters down into my own community of Palmerston North. When I think about the investment in Palmerston North Hospital, when I think about the medical assessment and planning unit suite that’s been invested in—those that drive down Ruahine Street on a regular basis will see the work that is being undertaken; the first bit of kit and infrastructure that has been delivered in Palmerston North Hospital for many, many years. I’m proud to be part of a Labour Government that is investing in health, investing in infrastructure, investing in making a difference for people for whom it really makes a huge difference in their lives.

I want to acknowledge the COVID workforce, the individuals who tirelessly, over many years, have got up and gone about supporting our community. They don’t ask for much, actually, because they want to support their loved ones, their own communities, whether it’s in the face of COVID, through vaccination of workforces and loved ones—and I think of the efforts of those who either have retrained in order to deliver that service in our community or are wanting to start out in that particular space. I think of those community organisations—our Māori and Pacific community organisations who are connected on the ground; also, with new migrants, certainly in Palmerston North and other places as well, who are connected to be able to deliver those services. They have worked extremely hard in terms of painting a picture of context in Aotearoa New Zealand over the last 2½ to three years.

We have made no secret around the fact that these changes are good and great, but they are not going to deliver wholesale changes overnight. Anyone who thought that come 1 July and the clock ticked over and suddenly it was no longer June and we were 1 July, that suddenly healthcare in New Zealand would be much, much better is dreaming. We are on a journey. We are on a pathway to deliver an increase in improved healthcare for New Zealanders, and that is something that I am extremely proud of.

Just last week, I know many of us were out on recess and had an opportunity to spend some time with St John Ambulance, and this, to me, indicated the pressures that our healthcare system has been under for quite some time. I was thankful that they were able to show me around their particular site, and, in the process of that, the pager went off and the first responder and the emergency paramedic or technician were dispatched to a job, and then about three minutes later a loud audible siren started and then the emergency care paramedic jumped in his vehicle and off he went, and then about two minutes later another siren went off and a visiting paramedic who, I think, was actually from the Horowhenua, from Ōtaki, was visiting, and they were dispatched. Then I said to the person who was showing me around, “What happens next?” He said, “Well, next it will be me, and after that it’s the manager.” I said to the manager, “Well, what sort of training do you have?”, and he said to me, “I’ve got a basic level of medical training that will allow me basically to hold the fort until the paramedics arrive.”

So it’s clear to me that even in Palmerston North—a provincial city that is in desperate need of the increased funding that this Government has delivered to meet the needs of my community—even in my city, there are pressures that are apparent. They tell me that a lot of the calls are from people because they can’t access a GP service, and I know that is something that has been an issue for quite some time. But context is so important—context is so important. Minister Little touched on the immigration changes that have been made and, yes, the 381 nurses that have been ready since July, and the changes in terms of the specialised unit that will, effectively, have a real focus on the way in which those applications are processed and considered, will no doubt make a difference. But when Minister Little talks about the month of June here in New Zealand and over 100,000 people turning up to an ED here in New Zealand, that indicates a huge level of pressure. Actually, 80,000 just in a general month on its own indicates a huge sense of pressure as well.

So these wholesale changes are coming, but they’re also a result of professionals within the sector who are working extremely hard to support patients, to support whānau, to support others in their time of need. I agree with Brooke van Velden when she says that we pay taxes for a public healthcare system and it’s about the best use of resource. Well, I reflect again on the largest investment of a Government in recent times, and it’s come from a Labour Government because we have acknowledged that the system is broke and it needs to be fixed. Now, that’s not going to be a small comfort for the woman and her experience at Middlemore, but it is some comfort for others. Thank you, Madam Speaker.

Well, thank you very much, Madam Speaker. That last member who has resumed his seat should hang his head in shame as the chair of the Health Committee. Here we are in an urgent debate, debating a report of a New Zealander who died because they could not get access to timely healthcare, and all he was intent on was trotting out the Labour Party talking points—the Labour Party lines.

Let’s go to the report—let’s go directly to it—which says, “It is important to note that at no stage was the patient at fault here. The overloaded and under pressure health system failed her.” This is every New Zealander’s worst nightmare: that one of their loved ones is going to go to the emergency department in a time of need and not find the access to the care that they need. The report says an overloaded and under pressure health system failed her, but listen to all the Labour callers today and all you hear is the good things they’re doing in the health system. Well, that might be true. I suppose that is the role of the Government to do some good things, but don’t gloss over the huge cracks that are in the health system today.

I challenge the many New Zealanders listening to this urgent debate today to go back and listen and watch the call of Andrew Little, the Minister of Health, and then compare it to Dr Shane Reti, the Opposition health spokesperson. I say to New Zealanders, who do you want as your next Health Minister: a doctor or an angry trade unionist? He was warned that his reforms that he pushed through in the middle of a pandemic would undermine the health system, and that’s what they’ve done. Their own Heather Simpson report said to reduce 20 district health boards down to eight to 12, and what do they do? Twenty to zero, in the middle of a pandemic, and they’ve got the gall to call into question the last National Government.

Well, under the last National Government, when you look at the six-hour waiting time target, 91 percent of New Zealanders were getting through the emergency department (ED) in six hours. That was in 2017. Five years later, it is only 78 percent of New Zealanders—78 percent. That’s what we’re seeing under this Government that will come to their five-year anniversary in the next few weeks: five years of failure. What they did is they repealed those health targets that incentivised and drove the right behaviour. How can you defend a reduction from 91 percent of New Zealanders who pitched up to ED and were getting seen in six hours, and now we only have 78 percent? On top of that, as Dr Shane Reti has revealed today, 5,000 New Zealanders a month are just walking away from the ED and not even being seen, and do you know what? When you look at the evidence and the research behind that health target, the evidence showed that that target saved 700 lives a year—700 lives—and this Government came in and scrapped that target.

Let’s remember Ms A, which is the name they’ve given in the report to this lady who, sadly, passed away when she didn’t get access to the timely care she needed. She turned up to the emergency department. The report says there were only 30 seats in that ED. There were 46 people already in there—a huge over-occupancy. There were three nurses down that morning—a 10 percent vacancy—and, basically, what they were saying to New Zealanders who were turning up in that emergency department that morning was that the wait time was some hours. That’s what it was—some hours. As Dr Shane Reti has rightly pointed out in the report, this was highlighted a week before, as the pressure grew on this emergency department. What we know about emergency departments is that they are a barometer for that health system. That is the access point that people need for that acute care.

What we know in New Zealand today is, sadly, thanks to this Government—because I tell you what, what’s propping up the health system at the moment is hard-working Kiwis in the health workforce. But slowly, under this Labour Government, we are seeing our health system turn into a second-world health system, because of five years of mismanagement from this Government. We desperately need more health workforce in New Zealand. We can’t sustain this level of vacancies and the reduced access to vital healthcare. We need to retain our health workforce. We need to ensure we’re working with them, because of course, if we’ve got our health workforce having to cover vacant roles, and they’re already stretched, we’re just burning them out. We need to train more of our health professionals.

I’m sure that the callers from Labour will get up and say what they’re going to do in the future. Well, that’s fine, but you’ve had five years and what have you done? Why have we got skyrocketing vacancies in our health workforce?

What’s galling is just the ideological position this Government’s taken around skilled migrants. New Zealand is a popular destination for an international health workforce, but you’ve got to be more than popular. You’ve got to be competitive, and we’re not competitive. Canada, Australia—they’re all cutting our lunch at the moment, and that workforce who would like to come and live in New Zealand are getting attracted with better entitlements in other countries. We’re just not there because this Labour Government ideologically refuses to accept that part of the solution—yes, let’s retain our workforce and let’s re-train our locals, but we need to attract skilled migrants, and that’s what we’re not doing at the moment.

It’s hugely concerning when we look at our health system that is under so much pressure, and we see that in our reports. The report we’re debating today says, “Research has repeatedly shown that ED overcrowding leads to increased morbidity … and increased mortality. Of note, ED overcrowding leads to an increase in patients not waiting for assessment and/or treatment.” That’s exactly what happened in this case when you read the report. A person turned up to an overstretched ED, where the warnings had been there the week before in their reports, but they had no ability to respond. A New Zealander turned up in the early hours of the morning and left because she couldn’t get the care she needed.

The person who wrote the report goes on to say, “The evidence provided to me strongly reflects an overcrowded ED, a hospital well over acceptable capacity and subsequent system dysfunction. I strongly suspect that it is only through the exceptional hard work and dedication from staff that there are not many more serious incidents occurring that affects patient safety. This is an unsafe environment for both patients and staff and is not sustainable.”

So what New Zealanders want is a health Minister who is going to take some responsibility and is going to take some accountability, show some leadership, and accept the crisis that we are in today. There is an ability to respond quickly if this Government accepts the position we’re in, but when you listen to the Government callers today in this urgent debate, there’s denial. There are heads in the sand. There’s great hyperbole about what they’ve done. Well, if it’s that good, why are the numbers of New Zealanders who get seen in six hours dramatically reduced under this Labour Government?

Thank you, Madam Speaker. I start my contribution to this urgent debate, as many of my colleagues have already done, by sincerely acknowledging the life lost—the person whose death has been the impetus of the report that we are now debating in this House this afternoon. I extend my condolences to the family and to all the loved ones involved.

As several colleagues have also mentioned, I think it’s important, in times like this, when the health workforce will be the ones most acutely feeling this incident, in terms of their response, to acknowledge that we do have a world-class health workforce, and it’s incredibly, incredibly—potentially—easy to lose sight of that at the moment, whilst we talk about all of the stresses that the health system undoubtedly is under. It’s easy to lose sight of the fact that we have an amazing, world-class health workforce, and as a Government it is up to us to support them and to fund them and to ensure that they’re able to work the way that they do.

Before entering this House, I did a variety of things, but the role that I performed most recently before being elected to this House was that I worked for the New Zealand Nurses Organisation (NZNO). As someone who worked for the New Zealand Nurses Organisation, I had, I believe, a relatively broad view of what our health system looked like—certainly across the main sectors of the primary healthcare, the district health board healthcare, the aged-care sector, and our private hospitals and hospices. I do agree somewhat with the member who’s resumed his seat, Matt Doocey, in so far as acknowledging that we do need more people working in our health workforce, and we have done for a number of years. We certainly needed more people several years ago, when I was working in this sector.

I also want to acknowledge that, every day, I was privileged to work with amazing nurses and healthcare assistants, who were incredibly dedicated. And I acknowledge all of the delegates in particular, who took on those extra roles to advocate on behalf of their colleagues, many of whom, back in 2013, ’14, ’15, were already tired of having to advocate for shortages in the healthcare sector. As others have acknowledged, you can’t magic up a nurse overnight. These people are highly trained, and it takes time to address those shortages, let alone the shortages with positions and various other medical people in the healthcare sector.

Two things come to mind when I think back about that time at NZNO. The first one, in relation to comments that were made earlier by members of the Opposition, was about CCDM—the Care Capacity Demand Management system—that has been funded quite some time; conceived of by the Opposition, but never funded appropriately. Personally, I worked on the implementation of that in one small hospital for five years, and do you think we could get to the bottom of it? No, because it was never funded enough. Just as perfect policy may exist—and there are plenty of really good examples of that—they will always fail if they’re not funded appropriately. I am still rueful of the opportunities that the previous Government overlooked in terms of getting this system off the ground properly and what a difference that would have made to our current workforce today.

The other thing that strikes me is that I also worked on aspects of High Performance High Engagement, and the thing that I will always think about our workforce is just how incredibly clever they are. There are some amazing skills out there, and if we were to resource them properly and to afford them the clinical freedoms to do things differently, again, we can build a better health system. But what I am particularly proud of is the fact that this Government has been the one to acknowledge that things do need to be done differently. We have made record investments in building a new system. It won’t happen overnight, but we are absolutely moving in the right direction—a nearly 45-percent increase in funding, which has equated to 5,000 new registered nurses, and that’s just one aspect of the workforce. The independent review has undoubtedly brought up some useful recommendations, and we thank all those people involved with that as well.

Thank you, Madam Speaker. Well this, today, is a call that I’d rather not have to be taking. This shouldn’t be happening in New Zealand today. A woman with severe headaches told she would have to wait eight hours at Middlemore Hospital’s emergency department (ED) left because of that wait time, in extreme pain, and, tragically, passed away from a brain bleed.

What we do know is that on that day, Middlemore was short-staffed. They were three nurses down, and—importantly—one emergency department nurse. What is important to note, though, is it wasn’t only on this day and it wasn’t only at this hospital. This was happening around New Zealand, and we know that because around the same time—in fact, I think in the same month—Wellington Regional Hospital issued a provisional improvement notice because they were so dangerously short-staffed and had closed down three wards.

This is happening across New Zealand and continues to happen. A report stated that is was only the hard work and the dedication of their staff at Middlemore that was keeping it from experiencing more severe incidents. What we do know is that these exceptional health professionals—these heroic nurses—are doing everything they can. They’re working long hours, they’re working double shifts, but they are burnt out. They’re stressed out, they’re overworked, they’re up against it, and we know that they’re leaving. They don’t want to, but they have to, and we are not attracting enough nurses in New Zealand to cover the ones that are leaving.

They’re leaving because they’re stressed out, and they left this year, last year, and the year before because of the appalling way they were treated by this Government, despite what those members have said today. Let’s not forget the split migrant family nurses who left because they were split from their families, and it wasn’t until we kicked up a stink that they actually, only in May last year, allowed them to be reunited with their families.

The 2021 Resident Visa programme last year missed out a bunch of nurses because they were on the wrong visa type or because they were students. They left. Nurses with offshore partners were sent back to their home countries to sit there for three months—and this was happening in June this year—being sent back overseas to ridiculously spend three months with their partner before they could come back into New Zealand with that partner. That’s how his Government treated nurses and that’s why they left, and now we have the Green List debacle, where we are not able to compete with Australia.

So when we know that Middlemore was three nurses short-staffed and one ED nurse short-staffed that night, we should look into the dismal treatment of nurses by this Government who made them choose to leave and have chosen to leave over the last three years. Until we have better immigration settings, this will continue to happen. The Nurses Organisation says that it is the number one concern of their members about staff shortages.

We should be doing everything we possibly can to get more nurses fast-tracked into this country. No one agrees with a two-year work to residence for nurses—not Health New Zealand, not the Aged Care Association, not the Nurses Organisation, and not the care in the community sector. The only people that believe in this policy is the Government. No one backs them.

On the back of this damning report, what we would have expected today is immigration policy settings to immediately change to get more nurses in—that’s what we expected. But what did we hear today? What did we hear?

Dr Shane Reti: Excuses.

ERICA STANFORD: We heard excuses—that’s right, Dr Shane Reti. We heard “COVID.”, “Oh, it’s a really bad flu situation.”, “It takes time for change to bed in.”, and—the most egregious excuse we heard today from Minister Little—“Well, the likelihood is she may have died anyway.” That’s what we heard today from this Minister when we should have been hearing “What I am going to do today”, from this health Minister and the immigration Minister, “is get more nurses into New Zealand by fast-tracking them, by being competitive with Australia.” We do not need more excuses; we need solutions. That’s what the public of New Zealand expects.

What we want to see to avoid this happening again is nurses on the Green List. Now, despite what they say about the hundreds of nurses coming in, only 97 have applied in three months. That’s worse than when the borders were closed.

The Competency Assessment Programme course nurses—they still can’t bring their families when they come in. Let them do that. Why are we so hung up with a nurse having to have a job offer, for goodness’ sake? Let us compete with Australia. Let us have the same settings for nurses so that they choose to come here, or are Labour too arrogant to admit that they got these immigration settings wrong?

In the face of this tragic death, will they finally listen, will they set aside their pride, and will they make us a more attractive destination for nurses? Will they stop the excuses and, finally, give us workable solutions?

Thank you, Madam Speaker. I’d just like to start my contribution with passing on my sincere condolences to the family of the woman who’s led to the report that we’re debating today. I’d also like to acknowledge the incredible work that those working in the emergency department do: the doctors and nurses who get up every day, who turn up day after day to that make that difference in other people’s lives.

I spent a few years, back early in my career, working in emergency departments. I think it’s really important that, as health professionals, you go there, you sit down, you spend a lot of time trying to sit down and understand where they’re at and how you can provide the best care. Each patient you are speaking with or looking after is different. It’s a really important role that our doctors, nurses, and other health professionals do, and also for whānau. I spent a lot of time, when my mum had leukaemia, sitting in emergency departments, and just the care and respect that they gave with mum, and also, later, with dad when he had his stroke—it’s a wonderful career, it’s very rewarding, but it also can be incredibly demanding, particularly at very busy times of the year.

I think, when events like what we’re debating today happen within the health system, it’s important that we sit down and we undertake a review to try and understand what happened and what those circumstances were that led to this event.

I think, when I first started out in medicine, there was a real framing—and we were, as junior doctors, quite anxious, because often the framing back then was that it was an individual doctor’s fault. But then as things have progressed, there’s a much better understanding that, actually, many things that happen have got underpinning circumstances, and trying to understand the context in which these events occur. I’d like to just acknowledge those that undertook this review and the report that we’re debating today. Basically, I expect that Te Whatu Ora will be considering the findings in detail and also taking on board the lessons from the report.

I also just want to talk a little bit about that broader context, and thinking about the context in which our emergency departments have been operating over the last two years but also during the period when this event occurred. I think, having worked, again, in child health during winter peaks, every year we do see winter peaks and acute respiratory infections, and emergency departments are very busy.

But, I think, this year was particularly exceptional. We had the opening of the borders after two years of closure and very, very low rates of influenza in the community up until that point. So what we were grappling with this winter was one of the largest outbreaks of influenza and the impact that that had on our emergency departments and also on our hospitals in terms of in-patient care. But, simultaneously, we were grappling with COVID. The Omicron surge we experienced not only meant that we got extra demand—people coming into hospital—but it also meant that our health workforce, many of them, were off sick. We were dealing with staff absences at the same time as incredible peaks. I just want to acknowledge, again, the staff and the role they played. When we were doing our annual reviews in the Health Committee, a number of the district health boards (DHBs) were talking about how they realigned their teams and, basically, managed through those peak times, and I just acknowledge the efforts that went in there.

But, I think, while we’re talking about the exceptional circumstances, we’ve got to acknowledge that this situation didn’t arise overnight; it also comes on the back of many, many years, if not decades of under-investment in our health sector.

Again, just thinking through my previous role of monitoring child health, before I came into Parliament, one of the things that we used to monitor was called “ambulatory sensitive hospital admissions”—that was hospital admissions which could be prevented by better access to primary care. Every winter, we see huge winter peaks in these conditions, and I think a lot of the things about how we manage our emergency departments is not just making sure that they’re staffed well but it’s making sure that primary care, our GP services are available, because many, many of the people that are presenting to emergency departments could have been managed in primary care.

So when we first came into Government, one of the issues and one of the big barriers that we were seeing was that people couldn’t afford to go to the doctor. That’s where we put in place the low-cost visits to doctors for community service card holders. So now, instead of people having to pay $40, $60, they’re paying a low fee—back then, I think it was under $20 for a visit. I think that has meant that many more people can access primary care.

I think one of the other things, working in emergency departments—often where there are patients who need the most time from us, as health professionals, it is those presenting with mental health issues. So, again, what we’ve been doing, more recently, is putting aside things like the Access and Choice Programme in primary care. So, basically, people can turn up and see a health practitioner, a health coach, and start to grapple with some of those issues around mental health and addictions. So, again, thinking through how we can see people in primary care, make sure they get the best care they need to without having to go to the emergency department.

But, looking ahead, since coming into Government, what we have got is the largest number of nurses and doctors working in the health sector that we have had. But, basically, we think that there’s more work to be done. We’re in a situation where internationally there are huge workforce shortages but we’ve got to make sure that, as a country, we can provide the workforce that we need. I think that’s where there’s been a lot of focus more recently. So, basically, Government looking at the number of GPs and working with the Royal New Zealand College of General Practitioners to increase the number of GPs trained from 200 to 300 each year.

But also it’s quite apparent that nurse practitioners, again, in primary care, can manage a significant amount of the health demand that’s coming in the door, and so, again, basically doubling the number of trained nurse practitioners from 50 to 100 each year. So we’ve got our own workforce that’s coming through the system, but also nurses who may have left the workforce for whatever reason and thinking of those barriers for them coming back in—so, again, providing support and extra funding, up to $5,000, to nurses coming back into the system, with their registration costs.

We also are, though, competing in an international market. And I think this is where, with the health reforms, it actually potentially will make a significant difference, because, up until now, thinking through each DHB trying to recruit their own health workers, but now within Te Whatu Ora creating that one-stop shop where we can not only recruit health workforce, bring people into New Zealand, but also assist with a lot of the issues around getting registration for those who are qualified overseas.

So the competency assessment programmes and things for nurses coming in to make sure that their qualifications are recognised here, but also some of the time that’s taken when you’ve got somebody that’s got a medical qualification that then has to spend time here in New Zealand, getting that registration acknowledged. So, again, financial resource and other support so that our health workers, as we recruit them from overseas, not only can come and a find a job, be assisted with the processes of immigration, but, actually, will make sure that their qualifications apply here.

So there are a lot of things that we are doing to improve the health system, and I’m optimistic that as we move forward with the health reforms that we’ve put in place, we can be making a real difference, not only in the development of our workforce but also thinking about how we can manage so that people can, basically, get to primary care and actually receive the care that they want. Because, I think, a lot of the rationale for the health reforms was about the inequities that we were seeing, was about the fact that we had the postcode lottery. It’s about the fact that if you turn up to an emergency department or try and a get GP, it’s very, very different in one part of the country to the other. So I think what we’re doing now is grappling with many issues that have been going on for several decades, and it will take time to do that. But, as a Government, we’re absolutely committed to reducing those health inequities and to making sure that people, when they turn up, whether it be to the GP to get the care they need, whether they’re got some concerns with their mental health, they can turn up to a health improvement practitioner and have that conversation, whether it be to turn up to A & E, again, that they’ll get the care that they need.

This is an important issue, and just coming back to acknowledging the family and the woman that led to the report that we’re debating today. Our Government is committed to improving our health system, our workforce, and making sure people can access the care they need when they need it. Thank you, Madam Speaker.

The debate having concluded, the motion lapsed.