Debate on Crown Entities, Public Organisations,and State Enterprises — Residual Health Management Unit

The debate tonight is about the 2002-03 financial reviews and the performance of our district health boards. During that time, the district health boards had a large deficit. That deficit has improved, but one has to ask what has happened in our district health boards, where morale has never been lower than it is today. We see time and time again that our doctors and nurses feel that cuts are being made in all areas by a Government that said there would be no cuts, and that said it would reduce the waiting lists. Well, it did that! It did it by simply dumping everybody off the waiting lists. The Health and Independence Report 2003—the Ministry of Health’s own report—showed clearly that we are doing fewer orthopaedic major joint replacements and less cataract surgery than in 1999, when National left Government.

💬 Steve Chadwick: In hospitals.

Where else is a hip replacement done, if it is not done in a hospital? Quite frankly, we will not be setting up corner stalls to do hip replacements, I say to Steve Chadwick. We will not have people who are to have cataracts removed lined up on the footpath. Yes, we do those operations in hospitals, because that is where they need to be done. But maybe that is this Government’s solution. Maybe that is what people will have to come to accept. When I went to the doctor the other day, someone bailed me up and asked me whether I knew someone actually had to be crippled and in a wheelchair, or so blind he or she could not get across the road, before that person could get a hip or cataract operation out of this Government—and that is not far from the truth.

The wife and the doctor of a 67-year-old farmer contacted me, because they were so concerned about his situation. That man, who had been a very active man, had pain in his right hip. So the doctor had an X-ray taken, and decided that the hip needed to be replaced. The man was put on the waiting list. He waited and waited, to the point where he was on morphine and his general practitioner was saying that the man was suicidal because he had not slept for months. What he needed was an operation, not continual trips to the doctor and to be put on morphine. It is no wonder that in the Budget we will see the Prime Minister dish out a bit of money for orthopaedic surgery, because there are people like that all over New Zealand. Not all of them go to their MP. That man suffered in silence until somebody said enough was enough.

We know that our hospitals’ productivity has reduced. Treasury’s own report showed immense concern that despite the fact that there has been a 6 percent increase in funding, the productivity in our hospital sector has reduced. The Government can say that it has put money into primary care, but—let us face it—those people who want operations do not want to know that less surgery is being done in our public hospitals than was being done in 1999, when National left Government. The fact is that a whole lot more private surgery was also being done in 1999, when National was in Government. The Capital and Coast District Health Board is a very good example of a board that has taken some bad decisions that have impacted both financially and on patients’ lives. It decided to pull Wakefield Hospital’s contract for cardiac surgery. The board said it could do it all in-house, in its own public hospital sector. The only problem was that the intensive care unit could not cope. Acute cases bumped elective cases off the surgery lists, and two patients who were twice cancelled for cardiac surgery died last year, one of them being the 42-year-old father of two children. If he had got his surgery, there is a very, very good chance he would be alive today. The Capital and Coast District Health Board saw it as an achievement to have brought all surgery in-house, but after careful consideration, 3 years down the track it admits that it cannot do it and is finally going to re-contract with a private hospital.

Our public hospitals do a very good job with regard to acute care, but let us hope that when this Government brings the money forward for more orthopaedic surgery—which it should have done 4 years ago—the private hospital sector will be contracted. I say that not because of ideology, but because of the fact that acute care does not take place in private hospitals, so when elective surgery is booked, it can be delivered on the day. People are not continually bumped off the surgery lists because acute cases take the surgeons, the theatre space, the intensive care space, or the bed space. That contracting of private hospitals needs to happen. The productivity of the hospitals has gone down, and it is no wonder as to why that has happened. There is nothing in the current system of 21 district health boards—

I am delighted to follow the National spokesperson on health and to come out fighting, by saying that hospitals are all that that member mentioned. We already know that this Government has created a stable and an effective health service, something that we did not have in the 9 years Labour was in Opposition. We are putting resources, staff, funding, and infrastructure in place. We are building a public health system that people can trust, and that is transparent and has community involvement in the democracy of the district health boards. That health service will be there for people, regardless of their ability to pay. We know that that member of the Opposition has already talked about what she would do if she were ever to become the Minister of Health. We should be afraid—be very, very afraid—because she says that National would discontinue the forced implementation of primary health organisations. Everything that this Government is focusing on will build a robust and healthy community based on health and wellness, which that spokesperson would scrap. She has also gone on to say that the whole primary health organisation system would go, and that we are forcing the model on communities. But it is interesting to see how communities are responding to us. That whole speech was about the morale of hospitals, productivity cuts in hospitals, and operations. This Government is focused on the community and on the primary health organisations.

But I want to look at the focus on district health boards, because—good news—in the first three-quarters of this year, they have reduced their deficits quite markedly. The deficits are 20 percent better than the boards had stated they would achieve. We have put 43 percent more funding into the health sector since 1999. We are spending more money on operations. Operations are not measured properly—the member knows that—and we are doing work to look at that. Does the member know about the innovation of the surgical bus? There are new technologies allowing surgery to be done out in the primary health sector. They are not even measured in the productivity of hospitals, let alone the outcome measures, in terms of health and wellness, that we are focusing on now. One of the most profound statements in our financial review of the Auckland district health boards came from the chair of the Waitemata District Health Board, who said, when the health boards got together: “We’re moving to survival of the patient, rather than survival of the organisation.” I was very proud to hear that statement.

When we did the financial review of the district health boards, we looked at innovation. District health boards talked about managing chronic disease outside the hospital setting, and they were looking at parish nursing ideas to manage obesity and diabetes in the church community in south Auckland. That type of innovation was never in the health sector before. District health boards are involving the non-governmental sector, and they are looking forward to managing devolution of the services for the elderly, which they have responsibility for now. Even with the difficulties, they say that they want to manage services for the elderly in their own communities. We heard all the Auckland district health boards talk about the population-based funding formula. They said we should not get rid of the formula, but that we needed to tidy it up a bit, and we should look at quaternary and tertiary services. They said that we needed to look at interdistrict flows and patient movement, but they liked the formula and said we should not change it.

One of the formulas from Dr Brash that we need to be very afraid of is a comment from him that shielding people from the consequences of their actions has costs, and sometimes substantial costs. He suggested that a Government under his leadership would not provide free kidney dialysis to those who, over many years of overeating, had substantially increased their risk of type 2 diabetes. He said he would not provide hospital care for somebody who had a road accident while driving under the influence of alcohol. Those are appalling statements. People should be very, very afraid. National would continue to make cuts, based on a market model that the Leader of the Opposition feels he knows. He can only look at pricing economic value units in health care, while we get on with the innovation.

We saw some wonderful things happening in the South Island, when we looked at the Otago District Health Board. The chair of that district health board said that the boards talked to each other.

I shall start where the National Party spokesperson on health left off and talk about productivity, which, of course, is down. When the Health Committee did the financial review of the Capital and Coast District Health Board—[Interruption]—perhaps the member would like to take a call, instead of shooting insults across the floor of the Chamber. When we did the financial review of the Capital and Coast District Health Board, I asked in detail about its mental health services. I was not trying to get at that board, because, in fact, mental health services across the country are a national disgrace. Ward 27 at Wellington Hospital has had its fair share of problems, although it does not experience those problems on its own. However, in recent times it had a patient who left the ward and climbed into the tigers’ cage at Wellington Zoo. Soon afterwards, that incident was followed by the Buckle suicide, which resulted in an inquiry. More recently, after leaving the ward a patient jumped off the sixth floor building at Wellington Hospital, and received serious head injuries.

Two weeks ago I highlighted the problems with regard to overcrowding at Wellington Hospital’s mental health unit, and I am at pains here to say that that is happening not only in Wellington but at many mental health units around the country. Overcrowding is a particular problem in Wellington, but the Minister of Health has done nothing about it. In fact, she said what a good thing it was that the extra mental health ward at Kenepuru Hospital closed in July 2002 without so much as a murmur, leaving the Wellington region to cater for a population of 250,000 patients with 30 mental health acute beds. Two weeks ago that ward was so full that it had 35 patients, and others queuing up to go in, so one patient was put to sleep for the night in the ward’s telephone booth—the room that is assigned for the telephone. The telephone was taken out, and the patient was put in. This is a Government that prides itself on reducing the stigma experienced by those with mental illness. In fact, it prides itself so much on that that it has spent just over $13 million to date on the Like Minds Like Mine campaign, with flash television advertising and various other components to it. I would like to know, and I would like the Minister in the chair, the Hon Ruth Dyson, to tell this House, how making a patient sleep in a telephone booth for the night tells that patient that he or she is a first-rate and well-respected New Zealand citizen. It does not. It tells people that mental health is the poor cousin in the New Zealand health system, and that they will be treated in that way.

Let us imagine the public outcry if a child was put to bed on a mattress on the floor of a children’s ward in any hospital in this country, or if someone with a broken leg was put, in similar circumstances, in a telephone booth for the night. There would be a public outcry about that. The relatives of the patient would go straight to the local newspaper. However, when that sort of situation happens to a mental health patient, there is not a murmur from this Government. The Minister of Health is well aware of those problems. In replying to question for written answer No. 5684 this year in relation to the Capital and Coast District Health Board, the Minister stated she had been advised that 35 patients were in the ward that night, and two beds were set up in a room usually designated for telephone use—one in the women’s lounge and one in a doctor’s interview room. Are we not treating mental health patients well in this country!

What has the Minister of Health done about the problem? She has thrown more money at it. That has not resulted in any more treatment. The Hon Ruth Dyson answered an oral question in the House last week by saying that since 1999 an extra $321 million has been allocated to mental health. This year about $800 million will be spent on mental health—almost 10 percent of the health budget. What are the mentally unwell getting for that? Three percent of the population suffers from a serious mental illness requiring treatment. How many are treated? The figure is 1.6 percent of the population, and that figure is down from 1.7 percent in the previous year. It is a disgrace that 1.4 percent of the population of this country who suffer from a serious mental illness are not receiving any treatment, at all. What is the Government doing about it? It says that it is ring fencing that money. It is a disgrace!

The Labour Party speaker said I had been concentrating only on hospitals. That was because this speech will be about primary care.

One thing we did hear from the Auckland district health boards that that member was so busy quoting was that they think it would be a really good idea if there were only one district health board for Auckland, because the cross-boundary flow issues are huge. Following patients from one side of Auckland to the other, moving money and patients around—if the patient moves, the money follows—is hugely time consuming and costly for the Auckland district health boards. I have to say that if we have one district health board for 1 million people, a quarter of New Zealand’s population—it is probably above that now; there are probably 1.3 million people in the Greater Auckland area—why have a whole lot more, 18 others, for the rest of the country? When we talked to the Otago District Health Board it also said it thought it would be a really good idea if there were one district health board for Otago and Southland. The district health boards are getting together on a lot of backroom functions. Having 21 boards causes a major increase in bureaucracy.

But let us talk about primary health organisations. The member opposite was correct: National will not force the implementation of primary health organisations. Their funding is based on race and location, and that has caused major implementation problems across New Zealand. I wonder whether Clayton Cosgrove would like to tell people in his electorate who happen to be poor and have high health needs why he backs a scheme that has people in Rotorua and Gisborne, regardless of their health need or whether they can afford to go to the doctor, paying $15, while his people are still paying $35 or $40. That is an unfair funding formula, and we do not agree with it.

I am absolutely astounded that the Minister of Health said that 3 million people are enrolled. For goodness’ sake! If you do not enrol you get no access to the new money. Does she not understand that financial incentives drive everyone?

The CHAIRPERSON (H V Ross Robertson): The member is bringing the Chair into the debate.

The Minister of Health should wake up and realise that if she puts a financial incentive there, of course people will join. Why would doctors not join, if joining meant that their patients would get access to the new money? No one disagrees with the new money being put into primary care, but it absolutely has to be based—

💬 Clayton Cosgrove: What’s the member’s position on primary health organisations?

Instead of shouting and screaming across the House, as that member is so wont to do, he might like to get up and take a call—but he will not do that.

The primary health organisations funding is based on race. Those organisations are wasting dollars. They have a bureaucracy. There are 84 of them—another Government structure. When New Zealand was told it would have 21 district health boards that would look after hospital care and primary care, we were not told that this Government would set up yet another bureaucracy; that it would set up 84 primary health organisations, all with a community governance board—yet another set of committees. This Minister of Health is the “Minister of Committees”.

We have a major problem with the implementation of the primary health organisations. We have problems that the independent practitioners association system could have solved. If the Government had let the doctors get on with doing what they know and what they are good at doing—that is, providing excellence in primary care in this country—if it had backed the doctors to do that, it would have had a much better outcome for the money it spent. Actually, it probably would not have needed to spend as much, because it has set up a whole new bureaucracy.

We heard about aged-care funding being devolved. Well, every district health board that I have spoken to is shivering in its boots about the funding of aged care, because those boards know that this Government has not put a penny into it for the 5 years it has been in Government. Why has it not done that? Because it is saving the money to fund its asset-testing promise—the asset-testing promise that it has not actually kept. So there are no new services whatsoever in aged care. We have not seen an expansion of care for Alzheimer’s patients. In fact, I have just got a letter on my desk from the Minister saying: “Sorry, we don’t have any psychogeriatric facilities in Wanganui.”

There is certainly a time in a Government’s term when it can no longer hide its failures. If ever there is an area where its failures are becoming more and more obvious, it is the district health boards and the health services they provide. One has only to go back to 1999, when Labour said on its pledge card: “We will deliver.”

💬 Dr Lynda Scott: No surgery!

It is not quite that bad, but there is certainly a hanguva lot less surgery. Back in 1999 Labour also said that it would focus on patients not on profit, and that waiting times for surgery would be cut. The system that the Government has created over its 4 years, the system of district health boards, which we are analysing tonight, is one of the most complex bureaucratic systems that New Zealand has ever seen, and probably one of the most complex, bureaucratic, and inefficient health systems in the world.

Back in 1999, when this Government was supposed to deliver on its so-called pledge card, who should come into Parliament looking somewhat arrogant but one Hon Dr Michael Cullen, who said: “We won. You lost. Eat that!”. In the next 24 months the Government proceeded to deliver this highly complex bureaucracy of 21 district health boards, and even the Government is now beginning to admit: “Gee, we’d better amalgamate all the district health boards in Auckland.” I remind the Committee once again that back in 1989 the then Minister of Health, Helen Clark—now the Prime Minister—fired her own Auckland health board, which included her own husband, because it had become so dysfunctional. Ten years later she had forgotten the mistakes of the past and set about recreating what had been a dismal failure back then. So we had Michael Cullen saying: “We won. You lost. Eat that!”, but if we look in last week’s Dominion Post we see: “More money. Less surgery. What’s wrong?”.

What is wrong is the design of the health system that this failing Labour Government set up. As my colleague pointed out just recently, the number of publicly funded surgical inpatient discharges—acute and elective—has fallen significantly in the 4 years of the Labour Government. Back in 2000 there were 160,000 of them; this year the figure is down to 157,000. When Dr Cullen was asked in this House what was wrong, he said: “Look, they mustn’t have been counting things. We’ll start counting what is happening in the outpatients clinics, in the radiation clinics, and various other aspects.” Once this Labour Government starts to count and to try to defend its actions, we will find a network of deception—the very same network of deception that it created when it said it would cut waiting lists. What did this Labour Government really do? It set up what is called an active waiting list, and literally tens of thousands of ordinary New Zealanders who had expected to get surgery under this Labour Government were simply shifted into the community to wallow, to lie in pain, to wait for their cataracts or hip surgery to be done.

I would like to give the Committee an example that I have picked up over the last year, during the period for which the Counties Manukau District Health Board is being examined. I received a letter from an 86-year-old man who has failing eyesight. He wrote: “Please note an enclosed report from Dr Singh of Tuakau Surgery detailing the condition of my failing eyes. A peculiar turn is the fact that Dr Singh received a report from Manukau eye clinic stating that Mr McPhail had been put on the list for cataract surgery, while at the same time I, Mr McPhail, received one telling me my name had been removed.” That is the sort of shambles that this totally dysfunctional, bureaucratic district health board system that the Labour Party Government created is actually creating in the community. It has caused confusion for that sort of elderly man. The district health board wrote back to me: “We can appreciate that the decision to remove Mr McPhail’s name from the rating list is upsetting and frustrating for him and must seem strange given that he had originally been on the waiting list for surgery. Clinically, Mr McPhail would benefit from cataract surgery. Unfortunately, we can’t deliver it.”

That absolutely backs up the Treasury report that we addressed in December 2003, which showed that despite this Labour Government spending more money, it was delivering less. That has been backed up absolutely clearly in the areas of both major joint replacements and cataracts, over the 4 years of this Labour Government. It is extremely serious to note that in 1999 the number of major joint replacements done was 5,250, and that in 2002-03 this Labour Government delivered only 4,481 major joint replacements. I refer now to cataracts, which affect the elderly of this nation and which my constituent Mr McPhail writes about. He writes about the failings of the district health boards under this Labour Government. What are the actual figures? Back in 1999, 7,831 cataract operations were carried out, and in 2002-03 that figure had gone down by over 400. What is the reply of the Labour Government to that? It is: “Oh, we’ll do some more analysis of what we are doing in the outpatient clinics, in the radiation clinics, and in the oncology clinics. We’ll fix some numbers that will befuddle the general public.”

It is absolutely clear what has happened under this Labour Government. It has put in more money but the number of cataract operations for the elderly has gone down over 4 years. The Government has said it will deliver—that it will cut waiting times. What has it done? It has created an active waiting-list whereby patients who have real illnesses, difficult conditions, and are in pain are put off the waiting list to await their fate. That is the effect of this Labour Government’s design of the health system for New Zealand, and it is a disgrace.

I have gone around each district health board, asking each of them two questions. One was whether there had been any shifting of resources from the secondary and tertiary areas into the primary area. That was one of the promises; that was one of the things Labour said would happen when it concentrated on primary care. Every one of them has said a resounding “No”. The other question I asked them was whether there had been any tangible improvement in health outcomes out in the community that they could measure. The answer has been a resounding “No”. This Labour Government, despite all its rhetoric, despite Labour’s pledge card, has delivered absolutely no improvement in heath outcomes out in the community.

The CHAIRPERSON (H V Ross Robertson): Honourable members, just before I put the vote, can I say that a cellphone was heard during the speech made by Dr Paul Hutchison. I remind members that it is my duty to keep the debate within the Standing Orders. After all, they are the rules that have been crafted by well over a century and a half of parliamentary practice in New Zealand, and it is my duty to ensure that they are upheld. So if members do have cellphones in the Chamber, would they please turn them off. I refer them to Speaker’s ruling 16/2.

Reports noted.

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