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

Thank you, Madam Chair, for the opportunity to speak in this very important debate on the financial reviews of Crown entities, public organisations, and State enterprises. It is very important to look at these reviews in the context of some of the things that politicians like Annette King and Helen Clark said in the 1990s. At that stage of events, they went around the country saying they would cut bureaucracy and blitz the waiting lists. They said that if they taxed people a little more, they could fix health and education. They said they would deliver.

The CHAIRPERSON (Ann Hartley): I just remind the member that we are talking about the estimates.

I absolutely agree with that.

If we look at the 2003-04 financial review of the Auckland District Health Board, what do we see in terms of delivery? We see that the board has a current deficit of $44.7 million. In 2002 the Minister of Heath told the Health Committee that there would be no deficits by 2005. They would be gone—blitzed; nothing there. But what do we see in the report of the Health Committee? We see that in 2003-04 that board has a deficit of $44.7 million.

💬 Dr Wayne Mapp: How much?

It is $44.7 million, and according to our advice that is likely to increase in the 2004-05 financial year to more than $83.3 million. The Minister of Health, who is the Minister in the chair, told the select committee in 2002 that there would be no deficits in any of the health boards. She said the combined deficit would be nothing—it would be blitzed.

That is just like what she said about the waiting lists during the 1990s. What do we know about the waiting lists in the district health boards in 2004? Let us just have a little snapshot, because the Minister is keen on snapshots. The number of patients waiting longer than 6 months for their first specialist assessment is 2,602. According to the Minister of Health, that is blitzing the waiting list! What about one of her other commitments about delivering?

💬 Clayton Cosgrove: Scalpel!

Well, if only she had got the scalpel out and sorted them out! What about patients waiting without a commitment to treatment, and whose priorities are higher than the actual treatment threshold? These are patients who undoubtedly are pretty unwell, who are in pain and, often, are losing their vision. How many were there? There were 351. This is the Minister who said Labour would deliver and blitz the waiting list, and in the Auckland District Health Board in 2004, 1,261 patients were given a commitment to treatment but were not treated within 6 months.

That is the sort of clarity that Annette King gave patients when she went tearing around the country in the 1990s, saying that Labour would blitz waiting lists, cut bureaucracy, and deliver results. But in the Auckland District Health Board in the year in question there were literally thousands of patients waiting for longer than 6 months—patients who had worse situations than those required to receive treatment and who did not receive treatment, and patients who were given a commitment to treatment but were not treated within 6 months.

💬 Hon Marian Hobbs: There was a new hospital being built.

Well, there was a new hospital, and who went and opened it?

💬 Hon Annette King: Nobody yet.

We can guarantee that when someone does open it—well, there is every chance that she will not get the chance. In 2 or 3 months’ time, there will be a new Government. The Minister will blame the previous Government for any cost that might have accrued to Auckland City Hospital. It is as predictable as night following day that the Minister will once again not accept responsibility. She will blame the last National Government—after 5 years and $3.3 billion. It is probably only $3 billion, I say to Mrs King, but to her that does not mean much, because she gets nothing from it.

I am pleased to speak in this State-owned enterprises debate, because this is a Government that has incredibly strong leadership. The important issue as we go into the election is that we have financial security, and that is what New Zealanders care about. This Government is committed to Crown entities and State-owned enterprises working together with industry and with the private sector to benefit all New Zealanders. I am proud of that.

Our commitment to State-owned enterprises is not something we are going to flip-flop on or change our minds on. Our State-owned enterprises are working really well, and, before I talk about health, I would like to talk about Mighty River Power. In my own electorate it is working with industry—Norske Skog—to look at cogeneration of geothermal power. But our State-owned enterprises are also involved in social spending. Mighty River Power is involved in a “maintain New Zealand” partnership with the tertiary sector, the local college, and Norske Skog, and it is training maintenance engineers and has young kids doing apprenticeships. I think that is fantastic. Good on it!

We have looked at the Opposition’s view of these State-owned enterprises. Dr Brash says that minor changes are not quite enough. John Key, on the other hand, knows that privatisation is a really, really toxic issue. But, what is more, they do not know quite where or what to target. I say they will move into icons like Kiwibank and New Zealand Post. Just watch this spot. I wonder how many electorate MPs in the Opposition have gone out and seen the wonderful initiatives undertaken by New Zealand Post. It is working with communities on such things as New Zealand Book Week for little schoolkids—lovely, iconic brands like that.

I want to move on to which State-owned enterprises National will flick. I am deeply concerned about the health sector. I worked for 9 years under the National Government when it made its cuts. What did it cut? It cut the very things that made the difference to connecting communities together. National said that parenting courses were not part of maternity care any more. It said they were not part of core services, so it flicked them out to the private sector to see who picked them up. It is deeply worrying to me when National members talk about tax cuts that come to $1.9 billion. I have to look at health and ask what will go next. Of course, there is a very tidy package called the Working for Families package, which we really love because it targets—

The CHAIRPERSON (Ann Hartley): I am sorry to interrupt the member, but this debate is about financial reviews. The member needs to come back to the question.

I will get back to the financial reviews, although I am talking about health, Madam Chair. I heard the Opposition talk about deficits. Under this Government, deficits in our district health boards are better than they have ever been. It is all right to go out there and give a promise, but do members know what Labour has given to this sector in terms of deficit management? It has given certainty. How did the Minister give financial certainty to the district health boards? She went out with a 3-year funding package. So for the first time for years the district health boards were able to actually get their heads around long-term security of funding. Funding was based on a population-based formula, so that it did target areas of deprivation and it did target inequalities in health status. Because of this good funding in health—and it is a substantial increase in funding—we are seeing reduced mortality rates and reduced morbidity. That is important to me. I would hate to see cuts to our funding of services of the kind that the Nats did when in office for those 9 years, when they said those things were no longer seen as core funded issues. They cut bits out and just funded what they believed Vote Health should actually support.

In health, I want to talk also about this “exploding public sector” myth. In health let us just see what has gone. The Crown Company Monitoring Advisory Unit has gone, and the Health Funding Authority has gone. In health, the size of the State spend has reduced from 33.3 percent in 1999, down to 30.1 percent. So the exploding public sector is a myth. Labour members will counter those myths when we go out there in the election campaign, because we know that this sector is working well.

New Zealand First members are very pleased to have seen increased funding for health Crown entities over the last 2 years. We want to see health funding reach levels that are comparable with other European nations such as France, which spends around 10 percent of its GDP on health. Dealing with the health sector is tough. It is at the coalface of society’s ills, and it must deal not only with the physical but also with the emotional brunt of healing.

One of the most disturbing studies over the past year has been a Treasury report showing that despite increased spending on health, the sector has falling productivity—that is, fewer operations from more money. This report highlights the obsession within district health boards to balance the books no matter what, even if this does mean cutting some of the services. A clear example of this was the Nelson Marlborough District Health Board, which reduced the number of operations it was performing by 12 a week last October, when it was discovered that surgeons were performing more operations than were funded to be provided. So meeting the obligations of the balance sheets has come to mean vacancies and cutting staff, even in essential services. This is not the way to provide the First World health services that New Zealanders deserve.

We must question many of the monitoring regimes, which are expensive and seem to be yielding few results, that are in place across the district health boards. Do not get me wrong; adherence to procedures and protocols is really important, but when it becomes an end in itself, rather than a means to an end, we begin to lose sight of why they are there in the first place. When we choose to keep increasing the number of accountants and auditors at our district health boards, rather than the number of doctors and nurses, we have a real problem. Given the advances of modern technology, both in medicine and in information technology, the health sector ought to be booming. Instead, it is barely managing a fizzle, in some areas.

A second issue of major concern in the health sector is the training and retention of health practitioners across the whole range of professions. Hospitals are crying out for qualified doctors, surgeons, and other specialists. We know we have shortages of dental therapists, rural general practitioners, radiographers, and other technicians, and the list goes on.

💬 Jill Pettis: We need more immigrants.

The member on the other side of the Chamber calls out for more immigrants. We actually want qualified immigrants—people who can add to our economy.

We have to face up to two simple facts in this area. The first is that we are in a global marketplace for these skills, and we are competing with Australia, the UK, and Canada. If we wish to maintain a First World health system, people who have those skills are absolutely essential, otherwise we are consigned to sending more and more of our patients on to waiting lists or offshore for treatment, and that is something that we definitely do not want to do. We need to develop some strategies to ensure that we have sufficient graduates in the areas of need. [Interruption] The Minister is acknowledging that we will do that. Secondly, we also have to face up to the reality that we have to pay First World wages if we are to have a First World health system. This could include options such as bonding graduates for a number of years, in return for writing off their student loans. It could also include targeting increased funding in health spending, specifically for pay rises for those parts of the sector that need them to retain staff.

One of the areas where we particularly want to see some action is that of adolescent oral health. Many teenagers cannot access dentists because the subsidy paid to dentists is insufficient. Parents often come to me and say that they cannot even get their child on to the dentist’s waiting list, because the books are closed. The dentist has enough teenagers on his or her books, and cannot provide extra cheap services to any more. Another area we need to be more honest about confronting is the state of our mental health services. Dealing with those who have mental health difficulties is one of the most taxing areas covered in our health system, yet this is one aspect of health care that often has its budget cut and its staff numbers reduced, and its staff have substandard wages.

As the previous speaker referred to, an interesting debate is emerging about why, despite all the funding that has been poured into the health sector over the last couple of years, Treasury reports falling productivity. Why could this be so? There are many speculations about why this might be so, but I believe that one of the key reasons is pointed to in a report that came out quite quietly last year from the Ministry of Health, called Looking Upstream: causes of death cross-classified by risk and condition New Zealand 1977. That report, quite extraordinarily, analyses the 20 top causes of death by risk factor in New Zealand. Diet is twice the risk factor of any other single risk factor. Poor diet is the cause of an estimated 30 percent of deaths in New Zealand. Somewhere between 9,000 and 11,000 deaths are caused by poor diet. No one believes me, so I have to take this chart with me when I go out, and show it to them. Then they finally believe me.

So if that is the case, what have we done about it over the last year or so of this Government? We have published a wonderful health strategy that does appear to be addressing the issues. It states the 13 population health objectives: improve nutrition, reduce obesity, increase the level of physical activity, reduce the impact of diabetes, improve oral health, and so on. When these population goals were announced, we were absolutely delighted. Then the Government announced that it was going to bring out a world-leading report on healthy eating and healthy action, and we were delighted with that, too. The Minister of Health has trumpeted it internationally, at the World Health Organization, saying: “Isn’t this wonderful?”.

But the problem is that we have this major initiative, this Healthy Eating - Healthy Action, but when we look at the books, alas there is not any funding for this wonderful new initiative. Thirty percent of deaths are caused by poor nutrition and poor diet, and this strategy states that it is going to focus on this issue. We have these population health goals. One would think that this flagship strategy would have some new funding, but alas there is none.

Sure, some district health boards—and I have met them—in some parts of New Zealand are beginning to get their heads around the issue, and there are some positive initiatives, particularly in the Waikato and in Manukau, but basically the Government has no specific funding for it. One would think that if this were the overwhelming cause of death in New Zealand, way more than road deaths and all the other issues we tend to focus on, there would be a national strategy, a huge new programme, but alas there is none.

I have just touched on one issue of big concern. The second issue concerns Pharmac. The Green Party strongly supports Pharmac. We are concerned that a big public relations campaign is developing against Pharmac and against its single-supply contracts. We saw that earlier in the year when some public relations people visited me, and I could see it coming. Suddenly, and it does not surprise me at all, some parties in this House, like United Future, rose up and became part of this campaign to undermine Pharmac and its single-supplier contract.

We do acknowledge that there are all sorts of issues that we would like to see improved with Pharmac. There is great room for improvement, but we are concerned that there seems to be an across-the-board strategy to undermine it, and that is a real concern from a fiscal point of view, and many other points of view.

Finally, I would like to talk about how the Government is quietly working without any political mandate to hand over the control of our dietary supplements and our pharmaceuticals to a trans-Tasman therapeutic goods agency in Australia. It has no mandate for that whatsoever.

A few speakers ago we heard the member for Rotorua, Steve Chadwick, say that one of the achievements of this Labour Government was that it had given certainty. I say: “Tell that to the 25,000 patients taken off the waiting lists in 2003 by the Minister of Health, Annette King, and sent to a life of absolute uncertainty.” And I also say: “Tell that to the Auckland District Health Board.”, which, in this financial review, is recorded as having a deficit of $44.7 million, and there is a prediction that by 2004-05 it will be $83 million.

The Minister of Health came to the select committee and said that she did not believe that. She said that the Minister of Finance and she had got together and they just did not accept that there would be a $100 million deficit by the end of the year. But let us look at the letters the Minister of Finance sent to the Hon Annette King in 2003, in which he stated: “It will be important that the additional funding leads to increases in outputs and is not absorbed by cost increases. My officials will be working with the ministry to put in place appropriate accountability and monitoring measures to address this issue. … Output activity data continues to support our shared concern about productivity in the health sector. Analysis of Ministry of Health data suggests that despite significant revenue increases”—significant amounting to about $3 billion—“volumes in the sector are static, if not declining.”

So when the member for Rotorua talks about certainty, when she just happens to forget that 25,000 patients were culled from the waiting lists to spend the rest of their time in uncertainty—and then again on 1 April this year at the Counties Manukau District Health Board another 2,000 were taken off the waiting list to live a life of uncertainty—[Interruption] We hear Moana Mackey, the pretender for East Coast, and what happened at the Tairāwhiti District Health Board? It took 596 patients who had been waiting longer than 6 months for a first specialist assessment to get to square one and send them back to their general practitioners. What does the Minister say? She says they will be monitored.

When I spoke to one of the patients, Peggy Griffiths, who had been thrown off the waiting list at the Counties Manukau District Health Board, she told me that no one had said how and when she would be monitored. The Minister of Health will say that she is now back on the waiting list. It took a huge amount of effort by me to bring it to the attention of this House, and suddenly and mysteriously Peggy Griffiths is back on the waiting list—and the Minister of Health will claim credit for that! First, she cuts people off waiting lists, causes the huge disappointment and uncertainty to people of just not knowing what was going on—

💬 Gerry Brownlee: Have you got more?

Yes, there are eight or nine. I have a little file. Members can imagine that every time I bring those people up, they will suddenly and mysteriously be put back on those waiting lists!

While we are talking about the Auckland District Health Board, it will be helpful to say just what a professor of surgery had to say about this Minister’s interpretation of the waiting lists: “So now patients are culled upfront and those accepted for surgery are still required to wait, just like the old-day waiting list. A double jeopardy now exists. The elective surgical booking system has degenerated into the elective surgical blocking system. The Ministry of Health has some explaining to do itself. Blaming health boards is a patent distraction ploy.” It is one of the things this Minister of Health has become an absolute mistress of: perpetrating the patent distraction ploy. She is an absolute mistress of that particular performance.

💬 Gerry Brownlee: That’s a career option.

There is a career option. I shall talk about some of the other things that have plagued the Auckland District Health Board with its predicted deficit of $83 million when the Minister said there would be no deficit.

I should say upfront that none of this is personal about the Minister of Health. I actually quite like Annette King. I think that she is a lovely lady and is good fun, but I have to say that she is the most inept Minister of Health we have ever had. We see that from the data we now have before us in this country. While we are doing the financial reviews, I shall take members through the Treasury report. It is damning of Annette King, and I shall read from it. The report is to the Minister of Finance, Michael Cullen, and it states: “The current oversubscription reinforces the importance of not only managing the immediate pressures back but of addressing the unsustainable growth path of health spending over the longer term. Treasury advises that you”—that means Michael Cullen—“request the Minister of Health to manage within her allocation, and that you defer any consideration of the roll-out of future allocations until the sustainability work has been completed.” The concern there was that the current expenditure path is totally unsustainable, and Treasury went on to recommend that the Minister, Annette King, resubmit her budget, providing “a reprioritisation of her current proposals so that total expenditure comes within the allocation, and a demonstration of how she will manage known risks so that expenditure remains within the agreed funding track.”

Why did Treasury recommend that? Because that Minister cannot manage. That Minister has taken the expenditure on health up to $3.6 billion a year and produced worse outcomes than previously. She has actually produced worse outcomes. She has increased expenditure by 57 percent. The number of operations has increased by 1.3 percent. [Interruption] Government members do not like to hear their own numbers. The number of operations has increased by only 1.3 percent. [Interruption] They do not like it, do they? They do not like to hear their own numbers come back. We know that Steve Chadwick, the chair of the Health Committee, said in this Chamber last week that no New Zealanders on the health waiting list were in pain—that is what she thinks. We know that Annette King has totally failed. Why? She told the National Party that to have 96,000 people on the waiting list was “criminal”. How many people are on the health waiting list now? There are 180,000 people on the health waiting list. They are queued up, waiting to get on the waiting list.

Here is another thing. Annette King said to the Health Committee that she would take the district health board deficits down to zero. What happened? What is the deficit at the Auckland District Health Board?

💬 Dr Paul Hutchison: $83.4 million.

Annette King poured money in and got no result. I am afraid that as a Minister, she is a total failure. That is why $3.5 billion—

💬 Hon Annette King: Louder.

The Minister asks me to speak louder. She should actually ask her colleagues not to set up a barrage of interjections—I raise a point of order, Madam Chairperson. It is not about whether I can take it; it is about the Chair. [Interruption]

The CHAIRPERSON (Ann Hartley): Please be seated. The member knows very well there will be silence during points of order. That is the final warning.

I raise a point of order, Madam Chairperson. That is the problem. You are not applying the rules at any stage. The Government whip just called out during a point of order. Opposition members are invariably asked to leave when they do that. It is against the Standing Orders to set up a barrage. I am having to speak through six Government members, who are not actually interjecting. That would be one thing, but they are just calling out a barrage, so no one can hear me speak.

The CHAIRPERSON (Ann Hartley): I have heard your point of order.

I am not finished on my point of order.

The CHAIRPERSON (Ann Hartley): I have heard your point of order.

Well, you will hear another one.

The CHAIRPERSON (Ann Hartley): Mr Hide, I have heard your point of order. When I get to my feet, you must sit down. I accept that there was barracking and that it was too much. I ask members to refrain from barracking.

I raise a point of order, Madam Chairperson. The Government whip called out during my point of order. The rule that has been set down on that by the Speaker is very clear.

The CHAIRPERSON (Ann Hartley): Please be seated. I have dealt with that matter.

I raise a point of order, Madam Chairperson.

The CHAIRPERSON (Ann Hartley): No, please continue your speech.

I raise a point of order, Madam Chairperson.

The CHAIRPERSON (Ann Hartley): Please be seated. I have dealt with the point of order that was raised, and I have spoken to the Government whip and given a general warning. There was a lot of barracking going on from all sides. I have spoken about that. Mr Hide, I ask you to continue your speech.

I raise a point of order, Madam Chairperson. I want you to explain to me the rules. There was a lot of barracking, but not from all sides; it was only from the Government side. My point of order about the Government whip calling out is that there was no barracking while I made my point of order. There was one interjection from a Government whip. The rules that have been set down in this House are very clear. Whenever an Opposition MP calls out during a point of order, the member is immediately shot out of the Chamber. Madam Chairperson, I would like you to explain why the Government whip, who should be setting the standard and certainly should be held to the same standard as other MPs, is allowed to get away with that. What is the difference?

The CHAIRPERSON (Ann Hartley): I give you another warning about raising points of order that are not points of order. When I have dealt with a point of order, that is the end of the matter. I have dealt with that point of order. There was a lot of barracking. I have dealt with the two points of order that you raised. I give you a warning that raising points of order that are not points of order is, in itself, disorderly. I now ask you to continue your speech.

I raise a point of order, Madam Chairperson.

The CHAIRPERSON (Ann Hartley): Mr Hide, please be seated. Your point of order will be heard if it is a new point of order. You will not relitigate the two rulings that I have given.

I am not relitigating your ruling. I want to understand what you are applying here. You have not—

The CHAIRPERSON (Ann Hartley): Mr Hide, you will be seated, please. You are relitigating my rulings, and I ask you to continue with your speech. [Interruption]

Thank you. So what we see from this Labour Government—[Interruption]

The CHAIRPERSON (Ann Hartley): Order! Please continue.

So what we see from this Government—[Interruption] I raise a point of order, Madam Chairperson.

The CHAIRPERSON (Ann Hartley): Please be seated. I had asked that the barraging stop. I want Mr Hide to continue his speech in silence.

I raise a point of order, Madam Chairperson.

The CHAIRPERSON (Ann Hartley): Is it the point I have dealt with?

No, it is a new one.

The CHAIRPERSON (Ann Hartley): Point of order, Rodney Hide.

When Darren Hughes called out, he was in direct defiance of your ruling.

The CHAIRPERSON (Ann Hartley): Mr Hide, please be seated.

I have not finished my point of order.

The CHAIRPERSON (Ann Hartley): Please be seated, Mr Hide. As you know, interjections are tolerated. There was an interjection and then another one. When the second one was called out—although it was not barracking from one person—because there had been a lot previously, I said you could continue your speech in silence. I expect there to be silence. That matter has been dealt with. I warn you again not to trifle with the Chair—not to relitigate the ruling I have given. Please continue with your speech.

I raise a point of order, Madam Chairperson. My point of order is this, and you have not yet heard it. You gave a ruling, and you said there was to be no barracking. I sat down. Immediately, Darren Hughes barracked. That was not an interjection. You silenced him. I stood up to speak again. He immediately barracked. He is still in the Chamber, and I say he is the member who is defying the Chair, not me.

The CHAIRPERSON (Ann Hartley): Mr Hide, I will give you one final warning. You are relitigating what I have already ruled on. Please continue with your speech.

💬 Gerry Brownlee: I raise a point of order, Madam Chairperson. I have sat quietly and watched this interesting exchange. I think the problem we have here is that it appears that Mr Hughes has moved to another seat in order to gain advantage from the microphone being closer to you. There is no doubt that your instruction was that Mr Hide would be heard in silence. Then Mr Hughes—the very young member that he is, and with perhaps a slightly impetuous nature—barked quite loudly towards Mr Hide. I think at least some rebuke of Mr Hughes would be necessary. He may even like to resume his own seat, which is much further away from the interference zone than where he is currently sitting.

The CHAIRPERSON (Ann Hartley): I thank the member for his assistance. However, I have dealt with the matter.

What we see from this Labour Government is an inability for the Minister of Health to front up to the big issues. We have to have Trevor Mallard, Darren Hughes, and the fishmonger’s wife, Jill Pettis, stand up here.

💬 Hon Trevor Mallard: I raise a point of order, Madam Chairperson. I am sure you heard what that member said, and I am surprised you are not on your feet already to deal with it.

The CHAIRPERSON (Ann Hartley): The member knows that that is not acceptable. Members are to be called by their correct name. I ask the member to withdraw and apologise for that remark.

I withdraw and apologise.

💬 Gerry Brownlee: I raise a point of order, Madam Chairperson. The Chair cannot anticipate a speaker. From where I am sitting, I clearly took the inference that after the name “Jill Pettis” there was a full stop, and there was then the start of a new sentence, which was not allowed to progress because of the point of order raised by Trevor Mallard. I would be quite interested to know what Mr Hide has to say about the fishwife. I am sure there is a lot more to come. I am sure it is not offensive to the Committee, and I say that Mr Mallard should be asked to contain himself until he understands the circumstances in which any particular comment is made. I notice that Mrs Pettis also understood there was a full stop after her name. She certainly does not look offended, to me.

The CHAIRPERSON (Ann Hartley): I just warn the member. Please be seated. I am dealing with this point of order, which was not a point of order. Mr Brownlee, that came close to trifling with the Chair. I had dealt with the matter. The member had apologised. I ask the member to continue his speech.

💬 Clayton Cosgrove: I raise a point of order, Madam Chairperson. We may have a dilemma here. You have ruled, and I am not questioning your ruling, that the member should be heard in silence. The issue then arises that those of us who are offended against by, for instance, Mr Hide’s last reference to a particular member are then precluded from any retaliation at all. I am not challenging your ruling. I just seek your advice. When it is ruled that a member of Parliament should be heard in silence, that is fair, but if that member then decides to hurl abuse and make derogatory comments, or to use derogatory names about members on any side of the Chamber, those members have no option regarding that and cannot retaliate. I seek your advice on that point.

The CHAIRPERSON (Ann Hartley): I just make this point. The members, I believe, overdid their interjections, and that is why I asked that the member be heard in silence. That is the price to be paid. However, the point of order that was raised by Mr Mallard was dealt with.

💬 Hon Trevor Mallard: I raise a point of order, Madam Chairperson. I just ask you to clarify the rules of this debate. Is my understanding correct that this is a fixed 3-hour debate and that all these points of order have come out of the time that the Opposition has to scrutinise the Government?

The CHAIRPERSON (Ann Hartley): The member is correct. It is a fixed 3-hour timed debate. This time comes off the members’ time, so we have probably wasted the equivalent of one speech.

The fishmonger’s wife too is stuck on the waiting list. That is the trouble. We have 180,000 New Zealanders stuck on the waiting list. The fishmonger’s wife, the cobbler’s wife, and the baker’s wife are all stuck on the health waiting list, and here we have Steve Chadwick—

💬 Jill Pettis: Yes, we can change our occupations, but you will be out of here.

The CHAIRPERSON (Ann Hartley): Order, Jill Pettis! Order! The member’s time has expired.

I raise a point of order, Madam Chairperson. I stopped, and because you were talking I sat down.

The CHAIRPERSON (Ann Hartley): Your speech time had finished.

Yes, but I am interested in why you were talking over my speech while my time was still going, over the microphone.

The CHAIRPERSON (Ann Hartley): I was calling for order. Your speech time had finished, and I wanted to call the next speaker.

I raise a point of order, Madam Chairperson. Is Jill Pettis in trouble, or does she get away with that one, too?

💬 Jill Pettis: Tell him to dry up. Grow up!

The CHAIRPERSON (Ann Hartley): I am on my feet. I warn the member. Mr Hide, I have dealt with the matter.

The Greens are pleased to see in the supplementary estimates that some further money has been invested in the area of problem gambling and the enforcement of the gambling regulations, although it is not enough to curb the social and economic harm caused by the proliferation of gambling opportunities, including, particularly, pokie machines. My colleague Sue Bradford has been a strong and effective advocate for responsible gambling laws in this country that provide the greatest possible protection to our community from the harms of gambling. Sadly, this protection does not yet exist in our law.

In the health supplementary estimates there is $2.4 million for the funding of costs related to the administration of the problem gambling levy. That levy remains very small when compared with the profits derived from gambling The gambling industry has, of course, a massive vested interest in keeping the problem gambling levy as low as possible. Many of the industry’s representatives have argued that the scale of the gambling problem is exaggerated, and that the cost of dealing with it is overrated. But in 2003 gamblers in this country lost a record $2 billion—an increase of 9 percent on the year before. That is $5 million a day in this country, much of which is taken out of the homes of some of our lowest-income families. The industry continues to complain about the levy, and, clearly, wants to keep problem gambling strategies focused on treatment, rather than on the additional public health goals of health promotion and harm minimisation.

We need only recall the case a couple of years ago of the pokie-machine outlet, money-lending business, and problem gambling treatment centre all within the same building complex, and all associated with the same single director—a lucrative immoral ring of business interests. We need only recall the pokie-machine bar in the Ōtara shopping centre that contributed to the costs of a fenced children’s playground right outside the front door of that pokie bar. Or we need only recall the objection by the gambling industry to the regulations requiring pokie machines to display how long a person has played and how much money he or she has lost, to know that the industry is committed to the maximisation of its profits, and not the minimisation of social and economic harms from gambling.

Sky City recently wailed about how these regulations would lose it money—regulations that will affect all new slot machines after 1 October this year, and all machines from 2009. This company has over 2,000 gaming machines in New Zealand, with a forecast annual profit of $100 million. This complaint was despite the Government figures that show that New Zealand has 100,000 problem gamblers, who contribute $2 billion to that industry. Eighty percent of people who come in for treatment from the Problem Gambling Foundation say that they have a problem with pokie machines; for Māori women, the figure is 96 percent.

The fact that the proceeds of pokie addictions are then used for the benefit of all sorts of worthy causes should not be an excuse for any values-based group to continue to endorse this industry. The Greens would like the many community organisations that now rely on the proceeds of human misery for their continued survival to consider other funding options, and for Government and other non-gambling funders to better resource the sector, so that groups do not feel obliged to depend on the addictions and desperation of some of our poorest people for the pursuance of their good works.

Despite some of the minor improvements over the last 6 months—and we note the increase in the Vote Internal Affairs supplementary estimates of $1.17 million to enforce the new regulations in the Gambling Act—the levy and the legislation so far are not enough to deal with these harms. The Greens want to see much greater reduction in the number of pokie machines operating in this country, and a total revamp of the way the profits of those that remain are distributed.

I thank members for their contributions to the debate on the performance of Crown entities, public organisations, and State enterprises. It was interesting that both the National member and the ACT member raised the much-maligned Treasury report. Of course, if we were to believe Mr Hide, everything that Treasury wrote would be absolute gospel, although I note that he does not take much account of Treasury’s report when it comes to its views on private insurance. However, those members quoted the much-maligned Treasury report and talked of falling productivity. Of course, what that report tells us, and what Treasury says, is that at this stage it is able to measure only about 46 percent of hospital activity, and it is not able even to measure what happens in the primary health sector.

It goes on to state that 60 percent of the costs are the wages of those who work within the health sector. I make no excuse for saying that the wages in the health sector have gone up—so they should. I think it was Barbara Stewart—and she always makes a considered intervention in this House—who said how important it is for us to retain our health workforce. Well, we do not retain our health workforce in an international market if we do not increase wages and salaries. So the settlement for nurses, which is backdated to last year and going forward, is half a billion dollars. It is the biggest increase that nurses in this country have had at any time, and they have fought for it for a decade. Past Ministers of Health know exactly what the campaign has been over that time. It has been settled, and I am proud that nurses will have that increased pay—they deserve it. I also tell members that over the last 3 years doctors in the hospital system have had about a 50 percent increase in pay. We needed to do that, to retain our medical workforce. I make no apologies for spending health money on that, either.

I also make no apologies for investing in new hospitals and rebuilding old hospitals. It was absolutely crucial because, in terms of the hospital sector, we actually have to have the bricks and mortar in order to provide the health service. We have put money into that. I believe that we are now seeing a health system that has had the investment in it that it needed. In fact, if we look at investment in health throughout the 1990s we can see that, in comparison with OECD countries, we under-invested in health. We needed to catch up, and we certainly have been doing that.

Dr Hutchison talked of deficits. I remind the Committee that under the previous Government, deficits reached 5 percent of the Health vote. They are now 1 percent of the Health vote. By anyone’s measure, that is an improvement. We have seen nearly every board in New Zealand reduce its deficit, with the exception of Auckland, and Auckland remains a particular problem. Many issues impact on Auckland, not least the impact of a building project that did not realise the $80 million of saving that was promised. It did not come about. However, the board is working very carefully on the issue, and we believe that it will reduce its deficit this year, as well.

Dr Hutchison mentioned the booking system. I think Bill English will be very disappointed in Dr Hutchison’s view on this. After all, it was introduced in 1998. I think the booking system is a good system because it is honest and it is fair. It tells people whether they will get an operation—

💬 Hon Bill English: That’s not what you used to say.

It certainly is. Let me tell the member this: in 1999, 40 percent of those who were waiting for their first specialist assessment waited longer than 6 months. That figure now is 21 percent. It is getting better. I admit that when we started, we started from a low base and it had to be built up. The system, I believe, is one of the best we can have in terms of being fair about elective surgery.

Dr Hutchison mentioned bureaucracy. There has been an increase in staff of district health boards. In fact, the biggest increase has been in nurses. The next-biggest increase has been in doctors. In fact, the total increase in the number of bureaucrats in the health system has been 0.4 percent. Those are the facts. Opposition members talk about the bureaucrats, but the people they call bureaucrats are those who book the operations, answer the telephones, and help to run the system. Those members would have us get rid of people who help to make the system work. National would turn the funding for that handful of people into “funding for health”. Well, it would be lucky to get much out of that, I have to say.

I then heard Barbara Stewart talk about workforce issues. I agree with her. We have put a lot of investment into trying to improve our health workforce. To begin with, we reopened two training schools for dental therapists in 2001 and 2002. I know that it sounds amazing to the member, but all the training schools were closed in the 1990s; no dental therapy training schools were left in New Zealand. I am not quite sure how we were going to provide the service. Perhaps we were going to employ therapists until they were 99 years old; we certainly were not going to produce any more. It now takes 3 years to train a dental therapist—there is a degree course. We had our first graduates out of the Otago school last year, and we had our first graduates out of the Auckland school this year, but we need at least 40 graduates per year to provide oral health to the children and adolescents of New Zealand. We will get there, but we have to invest in training. We have to be committed to training.

We have also increased the number of medical students by 40 per year—the first increase since 1981. We actually have a much better grasp on those health workforce issues. We were training only 16 radiation therapists per year; we now train 38, and for the first time we can provide radiation treatment in New Zealand within the guidelines. It is fragile. We have to keep training and producing them for our own needs. It has taken a huge investment of money and energy to try to rebuild our health workforce.

Then we heard from the very, very sad member Rodney Hide. I actually pity that member. I have great pity for him, because he is now a very bitter, twisted, and thwarted man. He has been thwarted by his own party, actually. He had to spend the whole weekend stopping his members from getting rid of him. He has decided that he will go on a crusade on health. The unfortunate thing is that he is unable to put the facts out in a straight manner, which means that people do not believe him. He over-exaggerates and overcooks everything, and the consequence is that nobody believes him and nobody takes notice of him.

He talked about the sustainability of health expenditure. Certainly, there has been a big investment in health over these 6 years. I have already talked about the need to invest in our health workforce, infrastructure, and so on, and also in our primary health care, where we will get the results we want. But there does need to be a look at the sustainability of health funding in the long term. The Prime Minister announced at the beginning of this year that work would be done on the long-term sustainability of health funding. That work is now under way. It will be done properly, and I can assure this Committee that the Government will go through each part of that expenditure in order to get the best use of it. It will not be done with slogans and smart statements.

I conclude with reference to the Green member Sue Kedgley. She talked of the Healthy Eating - Healthy Action strategy. It is a nationwide strategy. It is not about a few people in the ministry trying to run a strategy around healthy eating and healthy action. It actually happens out in our communities, in homes, and in schools. It is about engaging all those players, in getting through the message on healthy eating and healthy action. I believe that as one of the first countries—if not the first country—in the world to put such a strategy in place, we will address those issues over time. But there is no quick fix solution to the fact that there are obese and overweight people in New Zealand. We have a growing number of them.

💬 Gerry Brownlee: Oh, where?

I say to Gerry Brownlee that I could not possibly say I see any of them in this Chamber—I know that he is asking where they are. We have a few folk who are overweight, and, unfortunately, far too many children are overweight. There is funding, and action taking place.

I conclude by saying that very rarely do I agree with Sue Kedgley in any debate, but that I totally agree with her comments about Pharmac. She said that she supports Pharmac, that it does a very good job, and that there is a campaign to get it. I support her, and I believe that she is correct.

Reports noted.

Career Services

Learning Media Ltd

New Zealand Qualifications Authority

New Zealand Teachers Council

Tertiary Education Commission