Financial Review Debate — Ministry of Health

Our health system is in a state of crisis. We could say that it is ailing because, despite an increase in funding, more funding is required for patient care. Health is a critical investment in the people of New Zealand, and it is not really a balance sheet item. New Zealand First, and I would say every New Zealander, wants a properly funded and resourced health system. We need to move towards matching France’s expenditure of 10 percent of gross domestic product on the health of its citizens if we want to have a First World health system, and this is achievable. It is essential to provide people with certainty about their health care and to ensure timely access to quality services.

The health system in New Zealand has reached a crisis point with waiting lists longer than ever, and an increasing number of cancer patients being referred overseas for treatment rather than being treated in New Zealand. We have patients’ qualifications being tested by a pain-ranking system, and we have general practitioners fleeing for a variety of reasons.

In 1999 the Labour Government promised voters to cut waiting lists, yet every day we hear about patients who are waiting years for operations or are waiting months for a specialist appointment. Just recently it was reported that patients waiting for gallstone surgery had to suffer at least four severe attacks of pain and vomiting before they would be considered for surgery. This new type of pain-ranking system is outrageous, and obviously a last resort attempt by the health boards, with inadequate resources, to cope with the number of patients coming through. The bottom line is that patients need treatment, not the run-around.

As well as this we have recent reports stating that general practitioners are unhappy with their working conditions and that fewer than 30 percent think they will be practising in the next 4 years. This follows an increasing number of health professionals—nurses, and pharmacists—who are now leaving our shores. It is absolutely appalling. Our patients need treatment; they do not need the run-around. The district health board moves to reduce the waiting lists for all patients by referring them back to their general practitioners are an insult to the intelligence of New Zealanders who are increasingly being subjected to such tricks. Waiting lists need to be shortened as a result of patients being given operations and treatment rather than just being sent back to their general practitioners.

We do know that health boards are attempting to assist general practitioners by having personnel visit to discuss their patients. But we really must question as to whether it is more expensive to cull patients from the waiting lists in this way rather than treat the original problem. We were always taught that a stitch in time saves nine, and perhaps that is exactly the case with the health system. The bottom line is that we need a clinical, rather than a clerical, removal of patients from the waiting lists.

One of the areas that I also want to touch on is dental care for adolescents. It was very evident that one of the key concerns expressed by adolescents at the Children’s Rights Symposium in Wellington recently, and I know it will be a matter of concern to the Minister of Health too, was that many adolescents are no longer receiving any free dental care, despite the fact that it is available to teenagers. Parents who can afford to pay for dental care for their children do so, but an increasing number of teenagers miss out totally.

Sitting suspended from 6 p.m. to 7.30 p.m.

New Zealanders are concerned about their health care. They want certainty, and they want timely access to all services.

I would like to talk about two issues in the health report: nursing, and effects on children’s health of foods high in sugar and fat, which the committee addressed itself to. Of course, that is highly relevant because only today the Hawke’s Bay study by paediatricians was released. It was a study of 9,000 young New Zealanders in the Hawke’s Bay, and it confirmed that the number of children in New Zealand who are obese has trebled over the last 11 years. We almost have to say that quickly because it is hard to believe. All the experts say: “What does that mean? That means that we will have an epidemic of a whole lot of chronic dietary-related diseases, and an epidemic of diabetes.”

People have described the situation as a health time-bomb, and so on and so forth. So given the enormous obesity epidemic and the way that it is increasing in New Zealand, what is the Government doing about it? Well, the Government has issued a strategy, a Healthy Eating - Healthy Action strategy. But while the strategy is very good on words, it is very short on action. In fact, we have strategies and studies coming out of our ears, but to date we have had almost no action.

When we look at the issue of schools, just as an example, surely we should not be selling or promoting unhealthy food in our schools. But what the report, unfortunately, had to acknowledge was that we have nothing even as simple as nutrition guidelines in place in our schools. We do not have any nationwide guidelines for all schools on promoting healthy food. We do not even have guidelines on, for example, the use of vending machines in schools. We know that vending machines that sell high-sugar drinks are basically normalising unhealthy food and encouraging our children to consume unhealthy fizzy drinks in our schools. Why on earth would we allow that? Why would our Government not take decisive leadership and action on this important issue and issue guidelines that all schools are required to follow, saying that schools may not have vending machines that sell fizzy high-sugar drinks? That is a very, very simple thing.

Another simple thing is the fact that most children’s nutrition education occurs while they are watching advertisements on television for unhealthy junk food. It is a very simple matter. The Government in 1999 said that it was going to look at eliminating the advertising of unhealthy foods during children’s programmes. What has it done? The Minister said today that the Government has no intention now of honouring that pledge it made in 1999 to eliminate the advertising of unhealthy food during children’s television. The fact of the matter is that there is no point in issuing strategies like Healthy Eating - Healthy Action if we are not going to do the most obvious, common-sense things to try to reduce the obesity epidemic, such as by improving the food our children eat and by encouraging them to understand what healthy food is.

In England there is the Food Standards Agency, which by contrast has issued far-reaching proposals on this issue. It is, for example, developing guidelines for the entire food industry, and is calling on the industry to reduce the amounts of fat, salt, and sugar in food products aimed at children. It is going to publish for consumers the results on any foods that do not meet its guidelines, so that people know immediately, from what is on the label, that a food is one that people should not be buying for their children.

Why are we not doing that? Where is the leadership on this issue? Why is the Government not meeting with manufacturers? Why is the Government not calling on manufacturers to do their bit—all of us have to do our bit, but that includes the manufacturers—to reduce the salt, sugar, and fat levels in food that they relentlessly target at children?

I thank the two members who have contributed to this evening’s debate on health. I think health is possibly the largest expenditure we have in Government. Currently, for 2003-04, it stands at $9.4 billion, up from something like $6.5 billion when National was last in power. There has been a huge increase in Vote Health under this Government. One would have thought that a vote as important as this would command one speech from the National Party. One would have thought that there would be one member of the National Party who would stand up tonight and put forward policy, argument, and debate on one of the big issues that any Government faces. There will be no debate from the National Party on health tonight. Why not? Because National members decided today to use all their speeches in what I think was a smokescreen to cover up for the fact that Don Brash was not going to take part in the debate in the Parliament today.

So having put all their speakers up to debate the Prime Minister’s department, they ensured that there were no members left to debate health, education, social welfare, or housing—the great issues of New Zealand. They were interested only in protecting their leader, who would not participate in the House of Representatives, where people who are elected to come and debate are paid to do that. He would prefer to be on the Holmes show, and grandstand on television, than allow one member, just one member, of his caucus to debate health. I say to Sue Kedgley and Barbara Stewart: “Thank you for your contribution.”

I will begin mine with the points raised by Sue Kedgley. I know Sue Kedgley’s commitment to issues of nutrition and diet, and her long-term interest in them. I share her interest. I do not share her approach to this issue. I believe that the only way we change behaviour is to work with communities and individuals to ensure we educate them. It is no good saying: “Thou shalt not eat French fries! Thou shalt not have sweets in thy pocket!” That approach does not work. What we have to do is ensure that parents are given the tools to be able to make those decisions.

I believe that what we are doing in New Zealand, and what we have to continue to do, is providing those tools to parents for them to make those decisions. After all, a poor old schoolteacher sitting in a classroom cannot have influence over everything a child eats. That starts in the home. What parents need in the home is the education, the tools, the information to be able to know what to put in the sandwiches and what to feed their children. They do not need to be judged or criticised; they need the tools to be able to do that.

So the first thing we need to do is to ensure that we have a proper strategic approach, and that is Healthy Eating - Healthy Action. We are one of the few countries in the world that has now got a strategy, and what is the World Health Organization saying? It is saying that every country needs to develop a strategic approach to healthy eating and healthy action. In fact, this topic is the topic of discussion at the World Health Assembly in Geneva this year. New Zealand will be able to go along and say that we have made huge progress in terms of identifying it as an issue, putting forward a strategic approach, but more than that, an implementation plan to help make sure we can improve the nutrition and eating habits and the action, the physical activity, of New Zealanders. The member Sue Kedgley praised the guidelines from the UK. What do guidelines do other than give guidance? They do not change anything, unless action is taken by the people we want to take action.

I now move to the comments made by Barbara Stewart. She recognised that there had been a huge increase in the vote and she said we needed to spend about 10 percent of gross domestic product (GDP) to have enough expenditure for a good health system. It is not the amount of money that is spent, it is how it is spent, and I shall give a very good example. The United States of America has the highest expenditure of GDP of any country we know of. It spends over 14 percent of its GDP on health. The recent Commonwealth Fund survey of comparative health systems in the United States, Canada, Britain, Australia, and New Zealand showed that the country with the best system, that came out as No. 1, as judged by the patients and not by the politicians or providers, was New Zealand. The country that came out last was the United States of America.

So it is not necessarily how much money is spent, but how that money is spent. New Zealand spends about 8.9 percent of GDP on health. Out of that we do remarkably well; we do extremely well.

I am particularly proud of the expenditure that has gone into mental health funding in New Zealand. For years the area of mental health did not receive the amount of funding it needed, nor the emphasis. I would like to share with the Parliament that in the 1997-98 financial year we spent $523.4 million on mental health. In 2003-04 we will spend $914 million. That is a huge increase of almost 100 percent in that short period of time. But still we need more. Still we need to do better in mental health. However, that shows the commitment to try to improve a very important part of health for New Zealanders.

One of the big changes has been in waiting times. Barbara Stewart raised the issue of people on waiting lists. She may not be aware, but in 1996-97, 86,620 New Zealanders were sitting on waiting lists. Many of them had been on them for years. They had never been reassessed. Many of them had already had operations, shifted to Australia, died, or no longer needed an operation. However, they were sitting on a waiting list with nothing happening to them. This Government said—as the previous Government had said—that people had to be assessed to see whether they needed operations, and then given certainty that they would have an operation. People needed certainty. They needed to be told that they would be booked for an operation and if they were not booked at that point they would have ongoing health management of their condition.

Before, no one cared what happened to those people; they were just on a list. I have had some very sad letters from people who said they were on a waiting list for 8 years, and never took a holiday, because they were worried that the letter might come to tell them that they would have an operation.

The member is correct. People want certainty. They want to know they will have an operation and that they will have it in a timely fashion. There was no list for first assessment until Labour brought one in. There was no waiting list for first assessment. It was the hidden list. Thousands of New Zealanders had never been assessed, but they were not put on a list. Now we do have a list for first assessment, and people are told they need to be seen within 6 months. That has taken a huge amount of work by clinicians and nurses, and a commitment by district health boards. It is not working properly yet, but it is so much better. I am committed to ensuring that we get it as best we can.

The member also mentioned dental care, and she is right. I am extremely interested in that. One of the problems we have had for many years is to ensure that adolescents do access free dental care. I know from my own experience over many years that when young people leave primary school they are very reluctant to sign up to ongoing dental care. The best way to address that is to put services where the kids are. If members want to see where there has been a big increase in enrolment, it is with services like Mighty Mouth, mobile health services and dental services that go into secondary schools and provide services where the adolescents are. We will see more of that, following the Ministry of Health’s review on the way dental services are provided. Also, we now have a new contract with dentists—one that pays them in a different way from the old service where they were considerably underfunded for many years.

It is wonderful to follow the Minister on her feet, and “on our feet” is the slogan that we need when we look at the issues of obesity, diabetes, and co-morbidity. The issue is not just about the food that people eat. It is about activity, and New Zealanders have become passive. But this Government is not passive. We are very proud to say that now 2.5 million New Zealanders—that is, over half of New Zealanders—are involved in primary health organisations. What does that mean? It means that those people are getting health care and access to their doctor, to the practice nurse, or to someone working in the practice who gives them sound health advice upfront, and they are getting it at a very low cost. In fact, we have even rolled forward by 1 year the access to primary health services for the over-65s. We thought we would be rolling that programme out until 2010. However, we brought it forward by 1 year, and we now have over half of New Zealand enrolled in getting cheaper access to doctors’ visits, which is absolutely fantastic. From July of last year under-18-year-olds could get cheap access to general practitioners, and because of that we will solve some of the problems early, rather than meeting the high end-cost of hospital care.

I have just returned from a visit to Australia, where we looked at the health systems there. I have to say that we beat ourselves up over the waiting times for surgery, over sending patients to Australia for oncology care, and over workforce shortages. We ain’t in half as much of a mess as Australia is with its Medicare process, which was slam dunked in the House in Australia last week. It was said that Medicare was not providing the systemic solutions it needed to improve the health-care status of the people of Australia. Australia has federal funding of doctors and nurses in the primary-care sector, and State funding of hospitals. No incentives are lined up to keep people healthy and well, and out of the high-cost hospital end. Australia talked about oncology services. As long as we fund families to go with cancer patients, it is a good thing that we are using the capacity of Australia and sending cancer patients there to get their care when they need it within the guidelines, rather than having them languish in wait for radiation and oncology services in New Zealand. We have to stop beating ourselves up about the access to oncology services.

Australia mentioned also that it has problems with its health workforce. It has huge problems over there, and asked us how we were managing to get more general practitioners into New Zealand and how we manage our workforce issues here. We are managing them because, after the failed market model, we now have a workforce strategy for developing new people to come into the workforce. We have more doctors training in medical schools. We are training more radiation oncologists; we have doubled that number from 16 to 38. We have 40 more medical students in place. That was all targeted when we came into Government in 1999, because for 9 years nothing had been done. It had been believed the market would look after the workforce. Well, the market did not look after it, and we inherited a deficit there. I am simply amazed that the Opposition is not here in the Chamber to speak to this issue today, as one of its supposedly key platform planks. The National Party is simply amazing!

Another thing that Australia asked was how we had put an accident compensation system in place in New Zealand. Australia has to manage indemnity insurance, with obstetricians having insurance policies and paying over $100,000 a year just to manage medical risk.

The Australians asked how we had ever set up an accident compensation service in New Zealand. They wished they had one. They were really interested in the work Ruth Dyson was doing, with medical misadventure and medical injury being covered by accident compensation now. Why do we beat up on accident compensation all the time here? We are too narrow thinking. We have now a system in place.

Sue Kedgley asked what we are doing about obesity. I will tell members what we are doing. We did a review of the Auckland District Health Board. It is saying that now it is not debt ridden and debt burdened, it is starting to get on with tackling the health status of our Auckland community. That is most exciting. Initiatives are going on there with Sport and Recreation New Zealand, with general practitioners, with practice nurses, and with the school curriculum. That is how we will solve the obesity issue.

Report noted.

Ministry of Agriculture and Forestry