Estimates Debate — Vote Health

I am very proud to be speaking tonight on Vote Health, especially with our Minister of Health sitting in the chair. This is the first time in New Zealand for many years that we have had a Minister leading Vote Health into a second term of Government. She is showing the sector and the communities of New Zealand that she is a Minister who is prepared to ride the hard knocks in health—and hard knocks are certainly what they are. The challenging health sector needed leadership in the second term of this long-term Government to show that we have stability and are prepared to continue to work through the challenges. Health is not just about money alone.

I want to point out some of the very positive aspects of that vote in this estimates debate. With funding of $9.6 billion, the health sector goes into a very well-financed period in this financial year. That funding is up virtually $1 billion since the previous year, and is an 11 percent increase over that year. That is not well understood around the country, but it is a very substantial chunk of all new spending in the overall Budget this year. In fact, we have 31 percent of it, with $443 million in new spending. One of the complex issues of this vote is that this is a 3-year funding package, and we are in the second year of that package. That is what has given the health sector such certainty—it knows where it is going. It has a longer-term strategic view than it has ever had before, in order to start planning, and this is a forward-thinking debate.

One of the things I want to talk about is the rhetoric we keep seeing in publications like GP New Zealand that bureaucracy is killing the health system. That is rubbish. When Labour took over health, the Ministry of Health had been run down while privatisation was occurring. We are now building up a vibrant public sector, and we are also supporting the Minister in her role.

We also hear about district health board deficits, and I want to talk about that. Newspaper articles all around the country from Dr Scott and others in Opposition claim that they handed over a health sector in the black. I remind that member that in 1998 the Minister of Health did a deficit switch. The Crown health enterprise sector had a burgeoning deficit and was driven to brutal bottom-line management. National did a very natty little deficit switch that gave us all a clean slate, which was a very artful thing to do. We inherited a run-down sector with hardly any capital spending going on at all. This year alone we have put $656 million into capital spending. That is hardly one of the things we want to trumpet, because most of our emphasis in health in this term is moving that emphasis into the primary health sector.

I personally know that the Minister opened the Nelson-Marlborough Hospital—$4.7 million worth—on Saturday. I know from many people who work in that hospital how thrilled they were that clinicians were involved in the planning of that hospital. The clinical director who planned the hospital happened to be my brother-in-law, and those people are delighted with the end result. In fact, it is one of the better hospitals. Things are much better planned when clinicians are involved. Another thing we heard in the estimates of capital spending is that the Auckland Hospital building programme is on time and to budget. To be able to deliver that is a massive undertaking and an absolute tribute to that hospital.

We are moving the emphasis of our funding much more into the primary sector, which is something that the Opposition cannot bear. I seem to be dancing along behind every general practitioner meeting in the country at which Dr Scott is saying that bureaucracy is killing the health system and primary health organisations are not targeting those in need. I go out there and get a totally different story. In fact, the back of this magazine states: “Rotorua smells sweet.” Now here is a primary health organisation covering our entire community, doing exceptionally well, and actually realising that it is not an independent practice association in drag. It is a primary health organisation that is getting practice nurses, physiotherapists, child health workers, community and women’s health workers all addressing the health needs of their community. It is a model primary health organisation, and around the country 46 others are covering 1.7 million New Zealanders with primary health access.

Extra funding is going in that area. It has jumped up from $115 million to $165 million, and that is an incredibly exciting move. It is going into keeping people well, and that is the secret, whereas the Opposition still carps on about waiting lists, which are the only things it likes to measure. Even though it claims that bureaucracy has run amok, it likes information on waiting lists, and hands out some very interesting facts about them. It tells us that we have culled 25,000 people from waiting lists. I remind the Opposition that before we got into Government the Health Funding Authority culled 28,000 people from waiting lists. Mrs Shipley did that, but the Opposition has forgotten about it.

The Opposition also talks about that magical 35-point threshold for cardiac surgery. No one ever achieved 35 points. General practitioners I used to visit had manuals about how to use the booking system and they had not even taken them out of the plastic. They did not even know how to use them. We now have people in liaison roles helping general practitioners to use the booking system manuals, helping them integrate with hospital outpatient clinics, and helping them with specialist assessments. Yes, we have waiting lists, and we will always have waiting lists. It is never going to be easy to get rid of them, but we are much more concerned about waiting times in surgery. For the first time we have people who know that they will get their surgery within 6 months.

I want to quote what Judith Collins from the Opposition, who has just walked in, said to physiotherapy students. It was a very good speech. She said: “No matter which political parties are the Government, there will never be sufficient money to meet all people’s health needs. The best that any Government can do is create and foster a vibrant, growing economy, creating an environment where primary health care is everyone’s personal and family responsibility, and that of the community; creating a health system where wastage is not accepted, where the best use is made of taxpayers’ funds, and where those in need get the help they need as quickly as possible.” That was a fantastic speech, and she is absolutely right. That is what this Government is all about. We are focusing on primary health-care. We are giving certainty about waiting times for surgery. We are managing surgery honestly and openly with the community, and taking the hard knocks.

But there are also some very exciting things going on. Our community, and every community in New Zealand that I go around, understands that it is getting cheaper access to primary health-care, so that people can see their general practitioner or practice nurse. They might not need to see their general practitioner, and they are starting to cotton on to that, too. Funding this year is going into decreasing general practitioner charges for 6 to 17-year-olds, and that is vital. We had it for the under-sixes, and now we are making it easier for 6 to 17-year-olds to have lower general practitioner charges. That will cost this Government $8.6 million, but we do not mind that, because we think it is money well spent. We are also lowering prescription charges for children, and that is very valuable for those who are enrolled in primary health organisations.

Another very interesting initiative is being developed called care-plus, which focuses on “disease state” management. That will cost us $11.2 million, and it will make a difference.

The Government spends 6.25 percent of gross domestic product (GDP) on Vote Health, and total health expenditure is 8 percent of GDP, when one takes into account public, private, and accident compensation spending.

We heard from Steve Chadwick about the superb job she thinks Labour is doing in health. I do not think that many people around the country would agree with her. If she asked the general public, they would say that there are serious problems in New Zealand’s health system. With the 21 district health boards, the Government seems to be pouring money down a black hole. We heard in the Budget speech that Michael Cullen wanted a deficit of $80 million for the 2002-03 year. I shall talk about hospital deficits, because they do matter. The deficit was about $237 million last year, and this year will it be $80 million? No, it will be nowhere near what Michael Cullen wanted. The deficit will be $180-$200 million. Once again, district health boards have failed to perform in this regard. We have 21 district health boards—in a country with a population the size of Melbourne. Why do we talk about hospitals deficits, knowing that most people switch off when we start talking about them? Because it matters, and it matters because of what happens to an area when a hospital is in deficit.

We saw Graeme Edmond resign as chief executive officer of the Auckland District Health Board. He was an exceptionally good chief executive officer. I remember talking with Graeme when he got Auckland Hospital and Health Services out of the red and into the black. He was really ecstatic about that. The whole dynamic of a hospital system changes when one is looking forward to what can be done that is positive, instead of looking at the cuts that have to be continually made. But instead of looking at the progress made under the Health Funding Authority, with its four regional offices, this Government continued to look back at 1993. Because of the Government’s ideology, it could not see what was in front of its nose—that the Health Funding Authority was doing an exceptionally good job. The funder/provider split did not just happen in New Zealand; it was implemented in many parts of the world, and there were good economic reasons for that. In 1998-99, going into 2000, the Health Funding Authority was doing an exceptionally good job, and it is such a shame that this Government could not see that.

Graeme Edmond resigned because he had had enough of this Government. He had had enough of seeing the Auckland District Health Board continually having to deal with a massive deficit, and having to look continually at making cuts to surgery and cuts to what it could deliver. The Government has done that by putting up the points one needs to get surgery. That has happened all around the country, so people have to be sicker or more disabled to get service. It has also been done in different clinical areas—in orthopaedics, in gynaecology, in ophthalmology. Cataracts, hip and knee replacements have been affected, and hernia operations have been crossed off the list altogether. That is why those deficits matter.

Also, the boards cannot afford new equipment. Do members remember the linear accelerator that women with breast cancer need so urgently, that we heard this Government rave on so much about, and how it was going to fix the problem? It has not done that at all—we still have a lot of old equipment. The district health boards cannot afford to invest in it, so women go to Australia for Australian private care and to get their radiology, because we cannot deliver. Because the studies have shown it, women in New Zealand know that if they wait more than 8 weeks for radiotherapy—post-lumpectomy or post-mastectomy—there is a marked increase in local recurrence. One would think that the Ministry of Health would know that and would be pushing very hard to get the equipment needed.

💬 Judith Collins: It is paid enough.

It is paid enough, but the ministry said that waiting 12 weeks was fine. The studies have shown that it is not, and the Government should be doing everything it can to deliver timely treatment for women with breast cancer. Sending people to Australia was a short-term solution that has now dragged on for 3 more years.

I know that up in Auckland John Childs would have liked to see a public-private partnership on the North Shore that would be able to deliver better services—where people could work in both systems, earn more money, stay within the sector, and within New Zealand. We would actually retain our staff, not lose them. But, no, this Government’s ideology is against that. Although the Minister says that public-private partnerships are all right, she then appoints board chairs who are philosophically opposed to them.

💬 Hon Annette King: Name one.

Waitemata District Health Board for a start. Waitemata cancelled the birth-care contract, said it had the capacity, and is now saying that it will have to build another 10 beds, because it cancelled that contract. That is a good example of how one builds the public sector and forgets about what one can use in the private sector. We do not have the equipment. Hospital deficits mean that one cannot invest in new procedures—like drug-alluting stents for cardiac patients whose coronary arteries are beginning to occlude. I will tell members what these drug-alluting stents are about, because they are more expensive but more effective. They are little things that are put in to open up the arteries, so they do not clog up. They save people from having heart attacks or needing coronary artery bypass grafting. But this country cannot afford that.

Then there are the drugs. We cannot afford things like Gabapentin. People blame Pharmac, but Pharmac’s budget went down from $520 million in 2001 to $516 million last year. No wonder people in this country cannot get access to new medicines! No wonder they cannot get access to the medicines they need to keep them well! Gabapentin is a medicine used to treat pain. I have used it myself for people with amputations. One tries everything else first, but it gives very good pain relief, and people cannot get it. The Otago District Health Board is about to cancel all people on Gabapentin. That is absolutely cruel, but this Government has not increased the amount of money that Pharmac gets to fund new drugs, so one cannot blame Pharmac. The Government has not even approved the budget for this year. Those are the problems with hospital deficits.

The Government says it is going to put all the money into primary health organisations. Once again, it is being driven by ideology only. Instead of building on independent practitioner associations, which most doctors in this country thought were doing a very good job, we get primary health organisations. Instead of funding on patient need and ability to pay—no matter where one lives in New Zealand, or what one’s race is—the Government decided it had to have politically correct primary health organisations, which are funded on location. It was going to force doctors into them, because if doctors did not join, they would get no access to new money. Does the public know about that? It knows nothing about enrolment. When one asks what the 10 big problems facing primary health organisations are, enrolment process is No. 2, because the public does not understand what is going on. New Zealanders shop around for their doctors. They might live in one area, but work in another. If they get sick, they go to the local accident and medical clinic. What happens is that all the money that was supposed to go to their primary location goes somewhere else.

Doctors are having a nightmare with primary health organisations. The system was never trialled. It is based on location, which has to be 50 percent Māori/Pacific Island, or highly deprived. What about the other 50 percent? Why give them cheaper visits, when only two primary health organisations have been set up in the South Island, and poor people, and people with high health needs in the South Island, are not getting anything? That is just unacceptable.

We have heard that Vote Health this year, 2003-04, is going to receive $9.61 billion—an increase. If one listens to the Government, one hears that this health system is working wonderfully well. Well, I agree with Dr Scott: when we go out and talk to people, that is not what we hear. More and more money, of course, is being thrown at the system. That is what the Government measures its success by; it is not worried about how the money is spent or where it goes.

I want to talk, in my brief time, about accountability. I have just recently asked the Minister of Health some questions. I asked her where the money is going. I asked her to tell me where the money given to Māori health providers and non-Māori health providers is going. Do members know what the Minister’s answer was? It was: “I can’t tell you. You need to ask the DHBs.” This Minister does not know what is happening in the health system. Her ministry does not know, because it has devolved everything to the district health boards.

A while back, we were able to get some information about two Māori health providers. One of them had spent $3.1 million in the previous year, and the Ngāti Whātua o Orakei health clinic has received $5.7 million since Labour came to power. We asked where this money had gone—we had a very short list with a few itemised bits and pieces—and then we asked what the health outcomes were. The Minister’s answer was this: “Health outcomes, general health outcomes, are difficult to assess.” That is code, of course, for “I don’t know.” The Minister does not know where this money is going. These Māori health providers may well be providing a wonderful service. In fact, as I go around the country and visit some of them, I see that some are providing a very good service to their communities. But there are also some that are not providing a good service. The question is, how do we know which ones are providing a good service and which ones are not? They all say they have forms to fill in and send back to the Ministry of Health; the problem is nobody bothers reading them. The providers are expected to fill them in but nobody looks at them. We have no idea what the money for health is being spent on.

It is interesting to move on to the primary health organisations and see where the money for them is going. Last year, $50 million was earmarked for the primary health-care strategy implementation. This year, it has been increased to $165 million. Taxpayer cash is being poured into the primary health organisations at the expense of the secondary sector. The hospitals are missing out and having to cut back their services. The Minister says that is not happening, either—because nothing happens without her knowledge—but, as we have just heard, the accountability is non-existent.

If we look at the funding formulas for the primary health organisations, what we see is that we have race-based funding in this country. If a person is Māori or Pacific Island, that person gets more funding than one does if one is European. If a person lives in a poorer area, he or she gets more funding, no matter what his or her health status. ACT says—and we agree with the National Party—that we need to have a health system that is funded based on need, not on race or where a person lives. Under the new funding formula the interim—[Interruption] Why does Mrs Pettis not stand and take a call, seeing that she is such an authority on health? Under the new funding formula, the interim formula, the great majority of male Pākehā superannuitants who do not have a community services card are funded at $17 a year. The amount that a Māori or Pacific Island superannuitant is funded is over three times higher—$53 a year—no matter what his or her health status or need. Why is it fair that a young, fit Māori, like Christian Cullen for example, should be funded at a higher rate than his Pākehā counterpart who is not well? What is fair about that? He has the wrong skin colour or he does not live in the right location, so he misses out. Health funding must be based on need, not on race or where people live. It must be determined on one’s need.

I move on to deficits. The National Party speaker Dr Scott was correct in saying that deficits are important. She outlined a very good case as to why that is. The deficits, of course, have been speculated about for a long time. We hear a lot about the $400 million—the magic cure for the health system.

I would like to address the estimates, which, of course, are what the debate today is about, and in particular a couple of issues in the health estimates.

The first one is an interesting little sentence in the Health Committee’s report on the estimates, under the heading “Trans-Tasman therapeutic products”. The committee notes that the legislative programme for this year includes legislation regarding therapeutic products. Then there is this extraordinary statement: “The ministry was not able to tell us whether drafting of this legislation would wait until our inquiry is concluded.” What does this mean? We have a major Health Committee inquiry going on into how best we should regulate dietary supplements in New Zealand. The overwhelming majority of submitters have suggested that the trans-Tasman model is expensive, restrictive, and so forth, so it is quite likely that we as a select committee will not recommend that model. But a sentence in the committee’s report on the estimates tells us that the Ministry of Health cannot tell us whether it would go ahead with the legislation even if our inquiry should recommend against what the legislation is proposing. What does this mean? Are we completely wasting our time? Why are we having this select committee inquiry, if in fact the ministry and the Minister have completely made up their minds and are going to ignore all our recommendations? It would be interesting if the Minister would clarify that unusual sentence.

Interestingly, I received a letter just 2 days ago from Australia, from someone who had been talking with the Therapeutic Goods Administration in Australia. On being asked whether the trans-Tasman harmonisation would be going ahead, the administration’s answer was that, yes, it would be going ahead regardless, and lots of examples were given as to what would happen to therapeutic goods in New Zealand. The person who wrote to me said: “The way I see it, you’re going to lose all products that don’t comply with the TGA. Dare I say it, New Zealand will effectively become another state of Australia under the trans-Tasman scheme.” In other words, in Australia the Therapeutic Goods Administration is busily telling people the harmonisation will go ahead regardless of the result of our select committee inquiry. Why on earth are we having it? It is completely scandalous that the Government is going to press ahead and, presumably, ignore all the recommendations of our lengthy and expensive inquiry into this matter.

The other issue is an odd sentence that points out that the Ministry of Health has still not undertaken any consultation on the National Health Index. Every year for the last 4 years, the select committee has made the point that there has not been any consultation on the National Health Index. The ministry has promised it will undertake consultations, and every year it has come back and said that it still has not done anything about consulting on this issue. The interesting thing is that the Health Information Management and Technology Plan report Working to Add Value Through E-information pointed out that it is quite extraordinary that most people are completely unaware that, under the National Health Index, they have a unique identifier. The report said it is time to get that out of the closet. It is a unique identifier. Most people do not know about it. Consumers must be informed about it and its purpose. There are privacy concerns. The Privacy Commissioner has expressed concerns about it.

I rise to speak in relation to the health estimates. First, I would like to thank one of the previous speakers, Steve Chadwick, for the very nice comments she made about a previous speech I had given in relation to the health system. I would also like to follow on from the comments of my colleague Dr Lynda Scott, and to thank her for the great contribution she has made, yet again, tonight.

The Counties Manukau District Health Board covers an area that is of particular interest to me because my electorate of Clevedon is in fact within the board’s area. It has been a real concern, when I have been working in the electorate, to see how badly off the Counties Manukau District Health Board is compared with any other district health board, or area. The last time I checked, the district health board had still not signed off its plan for the financial year that has just finished. One wonders what is going to happen with the next one—it is as bad as that. The board is severely underfunded, and continues to be so despite the fact that there is an increase in the health spend. That is because so much money is going on things that it should not be going on.

I will have a look at some of the actual statistics for the Counties Manukau District Health Board area, and compare them with those of other areas. I have been to visit the neonatal unit at Middlemore Hospital, which services the board’s area. Middlemore Hospital has the third-highest number of births in Australasia for its catchment area. In 2000 there were 6,250 births in the area, but there were only 20 neonatal beds. Compare that to Dunedin, with 1,751 births and 16 neonatal beds. That is an indication of the shortfall in the Counties-Manukau area. What is happening is that these very sick little babies and their parents, mostly the mothers, are being flown all over the country in order to have any sort of care. This is totally unacceptable. I was heartened to hear that, under the plans of the Counties Manukau District Health Board, a new neonatal ward is being built that will be bigger. However, it will not have the 40 beds that are needed; it will have only 29 beds. That number of beds will be insufficient. It is absolutely ridiculous to build a new health unit that we know already will not be big enough.

One of my sisters worked in the neonatal ward at Waikato Hospital for close on 25 years, so I have some knowledge of this area, having visited there many times and seen the work and the dedication of the staff and the doctors in these units. They are dealing with people at the most stressful time of their lives—when they have very, very sick babies. The last thing the staff need to be doing is trying to find a room somewhere to put an incubator, or sending people off in helicopters, all over the country, away from their families and support. In many cases the mother cannot even feed or express milk for her baby, because she has to be in another part of the country from her baby. It is a dreadful situation. It is Third World. I heard the speaker from the Greens talk about our becoming, effectively, a subsidiary of Australia. Well, I am sure that Australia does not treat its women and its babies like this. When National is back in power, in 2005, we will certainly stop that. We have a commitment to provide superior health-care, rather than provide politically correct funding based on race rather than need.

That brings me again to the Counties Manukau District Health Board. Two weeks ago I received some flowers from a grateful constituent who wanted to thank me because, he said, I had got him knee surgery. This man had been referred at the end of 1999 for a knee operation. He was clearly in need of it. He had it done only this year, and only after I had spent months and months nagging the Minister and nagging the Counties Manukau District Health Board to, for goodness’ sake, let this man be able to walk again. He has paid his taxes all his life, he has been a good contributor to society, yet he received nothing until his MP got on to this issue for him. Frankly, for an elderly person, who is not getting any younger, to spend 4 years waiting in pain is simply not good enough.

The Minister knows that I am not someone who makes silly comments—nor do other National Party members—that we should pour more and more funding into the health service. We all know that it can become a huge black hole, in terms of the Budget, and that, no matter what, we can never ever achieve everybody’s wants and needs. But the fact is we must do far better in the use we make of our health money.

We certainly cannot afford to have policies like the ones affecting the people of Drury, in my colleague Dr Paul Hutchison’s electorate of Port Waikato. Drury is all of a kilometre away from my own electorate. The doctors in Drury are looking at closing. They are very badly off because of the race-based funding policy. No doubt the Minister did not intend that result, but, my having said that, she has not done anything about it. She has not done anything to help those doctors, 40 percent of whose patients come from Papakura, in my electorate, and have been travelling the 1 kilometre down the road to Drury to go to the doctor of their choice. Now they are being told that if they go to a doctor in Papakura, where, it has been decided, special funding will apply, they will pay only $8 a visit. If they go down the road to their own doctor in Drury, whom they have been going to, often, for 15 years, they will pay the full rate of $48 a visit.

These people often, like many others, do not have money to throw around. They are having to leave their doctor of choice, to leave the continuity of care that they have enjoyed, to leave the comfort of knowing their doctor very well, of being able to tell him or her their problems, and of being able to discuss their family’s health with him or her. They now have to go to a different general practitioner, at a different health centre, which will not necessarily be able to cope and will not necessarily suit their needs. This is all because of preferential funding based on the position of the surgery, not on where the patient lives, and because of the race-based funding that now occurs. It does nothing for the people of Drury or for the 40 percent of those doctors’ patients who happen to live in Papakura.

It also does nothing for the people at the other end of my electorate, in Howick, who find that they are not a favoured group of people. The majority of them happen to be elderly and to be Pākehā New Zealanders. They feel that they are now left out of the funding, because they are not Pacific Islanders or Māori. They are people who have paid their taxes and been good New Zealand citizens, and they deserve to be treated as well as anyone else. I look at this from the position of being a mother of a child who has Pacific Island heritage, and a wife of a Samoan. It shocks me that our country is being divided on the basis of race. People are being asked and told—in fact it is demanded of them—that they choose what race they are, when they are, often, of many different races, because that is the nature of New Zealand today. We are a people of many races and ethnic backgrounds. It is appalling to see health funding dollars being wasted on race-based policies that have nothing to do with need, that presume that someone of a certain race therefore has a health need, or that presume that people of a certain race therefore do not have a health need. That is wrong. What about the people who happen to be Chinese, English, or whatever, and who happen to have a need? They are being left out of this equation.

What does this policy say to the people who need health care who happen to be Māori or happen to be of Pacific Island heritage? It says to them that they are needy because of their race, and that is wrong. It is insulting to people. It is absolutely wrong that people are not being credited with being able to make their own choices. If this policy continues, we will end up with a divided system and a divided country. Everything that I see happening in this area is going to contribute to that. I am sure that the Minister does not really wish to have all these ramifications, but the fact is that is what is happening.

Page 678 of the Estimates reveals that for 2003-04, $9,609.746 million will be spent on the health system in New Zealand. That is almost $10 billion—much more than the dairy exports. The question to ask the Minister of Health, in relation to these estimates, is whether that $10 billion is being spent well by this Labour Government. The answer is, emphatically, no. In almost every facet of the health system, under Labour there is failure. Much of that failure has been brought about by Labour’s totally unnecessary bureaucratic and ideologically driven structural reforms. That failure extends from the Ministry of Health itself, to the 21 indebted district health boards, to Labour’s utterly inequitable primary health restructuring, and to the fact that Plunket told us at its annual conference that under Labour it is resourced for only half the post-natal visits that mothers and babies received in the 1970s—and that is a shame.

Let us look for a moment at Dr Euphemia McGoogan’s report on the National Cervical-screening Programme, of June 2003. That report gets to the centre of the failure of the Ministry of Health, 4 years after this Government said that it would improve the situation. Dr McGoogan said: “I do not believe there is as yet a good understanding of the principles of public health screening programmes generally within the Ministry of Health, among health professionals, or by the public in New Zealand.” That is an indictment on the Minister and on the Government.

Dr McGoogan goes on to say: “I remain unconvinced that the culture that had been developing in the Health Funding Authority regarding the management of the National Cervical-screening Programme under the influence of Dr Julia Peters has been maintained.” There has been clear deterioration under this Labour Government. Furthermore, the doctor says: “I have serious concerns that there are inadequate appropriate training and development courses in New Zealand for all groups of health professionals involved in cervical screening.”

Something like 14 years after the Cartwright report and some 6 years after the tragedy at Gisborne under Dr Bottrill, once again—despite all the promises of the Labour Government and a budget of almost $9.5 billion—the very core of this Government’s organisation, the Ministry of Health, is dysfunctional, and, sadly, that is absolutely epitomised by Dr Euphemia McGoogan’s report.

Despite the $9.5 billion of spending, almost every one of the 21 district health boards remains indebted, and there have been successive resignations of chief executive officers. They are resignations in despair at Labour’s bureaucratic, muddled, and wasteful restructuring. I would like the Minister, Mrs King, to tell Parliament exactly why Mr Graeme Edmond, chief executive officer of the biggest district health board of all, has just mysteriously resigned. I ask the Minister to take a call and explain why. She will not, because she knows the truth—that the Auckland District Health Board is dysfunctional. We hear this from every level. We hear from the highly committed professional nurses and doctors working there that under the new structure this Government has put in place, there is endemic dysfunction. It is more than ironical that 14 years ago, in 1989, the then Minister of Health—one Helen Clark—actually happened to call for the resignation of the board due to its dysfunction.

I am pleased to rise to speak to the estimates and to thank the chair and members of the Health Committee for the report they have given to Parliament. A number of issues have been raised this evening. I deal, first of all, with what I think is a very important issue, which was raised in the estimates discussion by Michael Cullen when he said he had looked very closely at the programme that Don Brash talked about at the National Party conference last weekend, when he called for $3.75 billion to be carved out of spending. One would have to ask where one would find that sort of money. I say to New Zealanders that the only place the National Party would find that sort of saving is out of education, health, and social spending. New Zealanders want to listen very carefully to the weasel words they hear particularly from the National Party when it comes to health expenditure.

The member for Kaikoura lamented the fact that there were so many district health boards. Gosh, I cannot imagine why National members have such short memories! There were 23 Crown health enterprises that became 23 hospital and health services, and that was never thought to be too much bureaucracy. However, when this Government turned them into 21 district health boards, suddenly a decrease from 23 to 21 became an increase! The logic of that defies my understanding.

The member went on to talk about cancer services, and made an impassioned plea for the women of New Zealand. I do not believe a word of it, because the action could have been taken in the 9 years that National was in Government. Today I had a question from the member asking what reports I had received on cancer needs in New Zealand. I said that I had received in 2001 a report that was dated April 1999, to one Wyatt Creech, telling the Government of the day that it had a huge problem with cancer, that 50 percent of the linear accelerators’ lives had expired, that not enough radiation therapists were being trained, and that the growth in cancer, at 5 percent a year, meant we would face a crisis in 2000-01.

What happened to that report? It was buried. It was never released. I received it in January 2001. That is a scandal. It was a cover-up by the National Government, and from that time on, this Government has been dealing with the problem. Under the National Government 16 radiation therapists were trained a year. The Labour Government increased that to 38 radiation therapists a year, with the first graduate at the end of this year. It takes 3 years to train them. We have been in this job for 3½ years, and we have more than doubled the number of radiation therapists. We have bought four linear accelerators, and there will be more in the next 3 years, at $4 million each. We have increased the number of therapists in training, we have increased the amount of money in relation to cancer, and we have increased the amount of money for cancer drugs. National members have the cheek to come in here and try to tell the people of New Zealand that the problems we face in cancer have happened in the last 3½ years. It was a cover-up, and the people of New Zealand need to know it.

The next issue came from ACT and National members, who constantly tell New Zealanders that we have a race-based policy.

I ask the ACT party members and, in particular, Judith Collins, whether they were shocked when they read the recent report on the health status of New Zealanders. Was Judith Collins shocked? Was she insulted when she read that report to find that Māori in New Zealand die 10 years younger than other New Zealanders and that we have not been addressing the health issues of Māori as a population? This Government has said that we have to address the health status of Māori and Pacific people and raise their health status. No New Zealander wants to see Māori and Pacific people die earlier than other New Zealanders.

When we put in place policies to help raise that health status, members opposite say it is race-based. I say that they do not know what they are talking about. This country wants to improve the health of the population of New Zealand, and in particular the health of Māori people. It is an absolute disgrace that every effort this Government has made to improve the health of Māori and Pacific people is played as a race card by the Opposition parties ACT and National. It is disgraceful. I can only imagine that Mr Worth and “Mr what’s-his-name” from Nelson want Māori people to die earlier. I can only assume that, because they have done nothing to help promote the health status of New Zealand.

💬 Hon Dr Nick Smith: Check your record in Government, you stupid cow.

I raise a point of order, Madam Chairperson. He will stand and apologise for that.

The CHAIRPERSON (Ann Hartley): I ask the honourable member to stand, withdraw, and apologise.

💬 Hon Dr Nick Smith: I withdraw and apologise. I raise a point of order, Madam Chairperson. The Minister has been stating that members on this side of the House want Māori to die young. That is grossly offensive. The record of National in setting up a whole number of Pacific Island and Māori health programmes shows that it is grossly untrue. I ask you to bring the Minister to order and for her to withdraw and apologise for that serious slur on all Opposition members.

The CHAIRPERSON (Ann Hartley): No, that was a point of debate. There has been a robust debate on this.

💬 Hon Dr Nick Smith: I raise a point of order, Madam Speaker. Is it OK for me to say, for instance, that Labour members want Asians to die, or something of that sort— because I think that is grossly offensive? What drew my comment was that sort of reference by the Minister, which brings this House into disrepute.

If the member took offence at what I said, I withdraw and apologise. Can I continue with—

💬 Hon Brian Donnelly: I raise a point of order, Madam Speaker. Prior to that exchange, the comment was also made by, I think, the Labour whip, that New Zealand First wanted Asians to die young. I take deep offence at that and I ask that that member withdraw and apologise.

The CHAIRPERSON (Ann Hartley): I did not hear the comment. I ask the member, if he said that, to withdraw and apologise.

💬 David Benson-Pope: I did not make any comment.

💬 Dail Jones: I raise a point of order, Madam Speaker. I probably had a slightly better view of it. I believe that it was the honourable Minister, Chris Carter, who made the comment, and I ask you to ask him to withdraw and apologise, because I find it grossly offensive.

The CHAIRPERSON (Ann Hartley): I ask the member whether he made that comment.

💬 Hon Chris Carter: I did, and I apologise to New Zealand First members. I meant Mr Peters only, not the rest of his party.

The CHAIRPERSON (Ann Hartley): I ask the member to withdraw and apologise unreservedly.

💬 Hon Chris Carter: I withdraw and apologise.

One of the points made by Lynda Scott in her contribution was that primary health organisations had not been trialled in New Zealand, and that, somehow, this was a terrible thing. I wonder whether members would like to tell us whether we trialled independent practice associations when they were set up in the 1990s. Of course, the answer is that they were never trialled. They were a formation of organisations by doctors and other health professionals in the 1990s. The fact is that primary health organisations have built on independent practice associations, on Māori development organisations, and on union and community health services. They have taken vehicles that were there and have built on those to provide primary health care in a different way in New Zealand. We now have 1.7 million New Zealanders enrolled in primary health organisations, and it will be only a matter of time before most New Zealanders will be enrolled in primary health organisations.

By October this year, regardless of how a primary health organisation is funded, all under-18-year-olds will receive affordable primary health care. I know that New Zealand First will be very pleased with that announcement. It tried to achieve that when it was in coalition with National, and managed to achieve affordable primary health care for under-6s, but could not push the National Party any further. I am pleased that we have been able to get agreement to fund affordable health care in primary health organisations for all children under 18 from 1 October. From 1 January, all people who are chronically unwell or on active review will receive affordable primary health care, regardless of where they are in New Zealand and regardless of how their primary health organisations are funded.

I see that Mr Worth is taking a bit of notice. Perhaps he did not know that that was to happen. [Interruption] No, he certainly did not know. I can see that. We are now working to bring forward affordable primary health care for all New Zealanders who are over the age of 65. By the time we get to 2005, most New Zealanders will once again have affordable primary health care. Subsidised primary health care was taken away from them in the “mother of all Budgets” in 1991, when the community services card was brought in and the remaining New Zealanders were chopped out of affordable primary health care.

The cost of it is very high. At this stage, the cost is around $400 million, and to fully implement it the cost is closer to $800 million. That is the cost of bringing back something that was taken away by a Government that thought that the market would provide it but it never did.

The member for Waikato mentioned the National Cervical-screening Programme. In the time that I have been Minister, I have never played politics with that issue. Let us remember that the review of the National Cervical-screening Programme and the Gisborne inquiry was called by Wyatt Creech, because the problems arose in the mid-1990s under the National Government. I received the report 2 years ago, and a lot of progress has been made. There is more progress to make. The report came out 2 years ago. It had to be done to show the mistakes made in the 1990s. We need to do more. A lot has been done. This Government has taken responsibility for the errors of the past and we have set about improving the situation. A lot of progress has been made in health, and it makes me sick to hear people like Nick Smith rattle on over there about health when he has done little to improve the health of New Zealanders but plenty to improve his own publicity and status if he thinks there is a vote in it.

Vote Food Safety agreed to.