Estimates Debate — Vote Health

On behalf of New Zealand First I rise to speak to the Appropriation (2005/06 Estimates) Bill. There is still a lot of work to be done in the health area, and that was emphasised some time ago in the New Zealand Herald polls. We all know that health spending has increased, but the outcomes in some areas have not increased proportionately. We are referring particularly here to children’s oral health and the adolescent oral health service. There is no money set aside in the Budget specifically for that service. On the Health Committee we were told that it would come from the health capital budget. We must hope that that money has actually been ring-fenced in the estimates for that particular area. The chronic shortage of resources for that service is a real concern, and it should be of concern to the Minister and the Government, because the bottom line is that children and teenagers need oral health-care. We do not want to see a return to the 1930s, when those who could afford to have oral health care had it, while those who could not had no teeth. It is interesting that there has been no announcement or any action taken on this issue. We want to know what has happened to the action that we were told was under way. We know that two reviews have been undertaken, but we need to see action, and we need to see some money being allocated to that particular area.

It was very disturbing to see last month that there was a mass resignation of Southland dentists from a scheme providing free care for children referred from school dental clinics. That should send a message to the Government that action is urgently required in order to prevent the complete collapse of the scheme. We know that the subsidy for dentists to carry out work on children’s teeth has been inadequate for many years—we all know that in this Committee. The accident compensation fees of $67 per visit are about 75 percent of the average private fee charged in Southland, but the Government has set the dentists’ fee for schoolchildren at around $33 for a basic treatment. That is obviously way below a level that is acceptable for dentists, who are not charities. They require reasonable fees for the services that are carried out. We know in this Committee that school dental therapists do a great job, but there is a time when they do need to refer children to dentists in order to have far more complicated work carried out.

The parents of the Southland children who need dental care will now have to pay for it. If they cannot do so, then their children will be added to the waiting list at Southland Hospital for that treatment, and we all know what the waiting lists are like. They are often quite lengthy. It is difficult to tell a child who has toothache to wait for actual treatment. We know that the situation in Southland is not unique, and that the dental care system for children and teenagers throughout the whole country is at risk of collapsing under the weight of inadequate funding. The Minister has done lots of talking about the system that she would like to see established, and it is time that we saw some action before it is too late. We urgently need some action there.

We were pleased to see that honouring the nurses pay settlement will be carried out in these estimates. That is essential, because that will bring nurses’ pay up to a reasonable standard. But, of course, it does absolutely nothing to address the issue of staff retention and other areas where workforce planning is actually required for the future. Here we are talking about our medical workforce: our nurses, our doctors, our cancer therapists, our dental therapists, of course, and many others. We need to retain their services, because after all is said and done they provide the health services for our people.

We note too that the funds allocated to rest homes are only enough to maintain the status quo. It is very unlikely that any money will filter down to the caregivers for the elderly, who we all agree in this Committee are chronically underpaid. Another area that requires immediate action is the mental health services. The Ministry of Health has estimated that 3 percent of the population has a serious mental health problem, and we know that there has been some increase in funding there.

The previous speaker was quite right when she said there is much work yet to be done in health. There is indeed a lot to be done. This year, $3.5 billion more was poured into health than went in when Labour came to power in 1999—a 57 percent increase. That is a huge amount, and the Government constantly boasts about it. The problem is that it is always easy to spend somebody else’s money. This is not the Government’s money. It is the money of the people of New Zealand, the money they have given to the Government—some of which is spent on their behalf on health services. I would like to say here in this Chamber, and to New Zealanders, that this money is not being wisely spent.

Figures collated shortly before Labour came to power in September 1999 showed that 180,401 people were waiting on surgical waiting lists and waiting to see a specialist for the first time. With an extra $3.5 billion a year, and 6 years down the track, the number on those lists, as at the end of April this year, was 180,672—an extra 271 patients are waiting on the waiting lists. This is 6 years down the track, after Labour claimed that it would slash waiting lists when it came to power.

Another way of looking at how well the money is being spent on health is to look at the number of operations being performed. I asked the Minister of Health earlier this year how many operations were carried out in the 2000-01 financial year, compared with the 2003-04 financial year, because those figures were easy to retrieve. She said that the number of case-weighted discharges in 2000-01 was around 270,000. Three years later, with a population increase of 4.3 percent, that figure had reached 273,000, and I am rounding up the number slightly.

So with a population increase and from the numbers she had given me, I worked out that per head of population the number of discharges had decreased in that time, despite huge injections of cash into health. So fewer operations per head of population are being carried out, but basically the same number of people are on waiting lists, so what value is the taxpayer getting from the tax dollar? I would contend that it is very bad value.

When I presented the Minister of Health with these figures—and remember that these are her own figures; they are figures I have been given by the Ministry of Health and by the Minister of Health—she said: “But I’m very proud of the 40,000 more discharges that we now have.”, the 40,000 more operations that she says are being done.

On 9 June I put down a question for written answer, asking the Minister to give some more information on that. When she said: “I will take more responsibility for the 40,000 a year more medical and surgical discharges.”, I asked: “What is the full yearly breakdown of medical and surgical discharges upon which this is based, broken down by financial year, and what is the source of this information?”. She made that statement in answer to an oral question I asked, but the answer I received to my later question, and this is the same answer by and large that I have had to all the questions I have asked in the last 7 weeks, was: “It has not been possible to obtain the information required to enable me to respond to this question by the due date.”

Is that not staggering? She has 4 hours to get an answer to an oral question, and she was able to give us a figure in reply to that question, but 7 weeks after I asked a question for written answer, she still has not been able to get the information. Despite my phoning her office frequently she still seems unable to get this information. So she goes around the country, saying we have 40,000 more operations, but where is the proof? It is not there.

Unfortunately New Zealanders are being tricked into thinking that this Government is doing a good job in health—that it is doing more operations. Well, it is not. These figures are unsubstantiated, and they are already included in the figures the Minister has given me.

This is a disgrace. The Minister of Health keeps saying she has provided New Zealanders with transparency and that figures are readily available to the public. This is not true. The website tells only part of the story, and the figures she gives to newspapers around this country and gives to us in this Chamber deal with only part of the problem.

One of the real difficulties with waiting lists is the category of “active review”. Active review is the waiting list to get on to the waiting list, and this continues to grow, too.

I want to refer to the Health Committee’s response to the estimates and I am interested in focusing my 5 minutes on primary health organisations. Certainly, funding for the 2005-06 year included $24.9 million for increased primary health organisation enrolments. This was all about extending the subsidies to people in the 18 to 24 age group from 1 July 2005, and then funding in the out-years. In the middle of all this we also come up with the fact that Treasury has said that it is concerned about the sustainability of the current rate of growth in Vote Health. The Minister explained to us that in her view there was a need to rebuild the health system, and she included in this issues of staffing, infrastructure, and facilities. She also made us aware of the fact that a working-group made up of Ministers and officials from Treasury and the ministry has been established to look at the long-term sustainability of health funding.

In the context of where we are now, heading into the election, certainly there is evidence to say—and this is mainly anecdotal—that there is a small reduction across the board in hospital admissions. No extensive research has been done to get a clear picture of this, but when questions are asked across different district health boards and different projects, like KidzFirst Children’s Hospital in Counties Manukau, some encouraging outcomes are starting to show themselves. This seems to be linked to the primary health organisations.

That is the first thing. However, when we look at the fact that there are nearly 1.2 million adult New Zealanders across two age categories—spanning 25 to 64-year-olds—we see that both categories are encompassed. Nearly 1.2 million people are actually enrolled in interim primary health organisations. I got that information from an answer to a written question I put to the Minister. So we still have quite large numbers of people who are associated with primary health organisations but who are not yet experiencing the roll-out of the full subsidy.

National seems to be a bit unclear about what it plans to do about primary health organisations, and I have concerns. United Future members are clear. We would like to see this endeavour rolled out. We think it is heading in the right direction, and we want some questions asked. We think that the Treasury report, when it comes out, will be very interesting on whether the funding formula for primary health organisations is exactly right. We have some question marks on that. Certainly, reports in the New Zealand Herald seem to indicate that National has been giving signals that it wants to reverse plans to provide cheaper doctor visits for all New Zealanders and appears to have, despite contrary claims by Dr Brash, some interest in cuts to health spending. Whether Dr Paul Hutchison is responding to a concern about the sustainability of Vote Health or whether those cuts will be reflected in the tax cuts National is yet to announce is all very unclear. However, I do think that voters going into the next 6-week period need to look very, very closely at what the parties’ policies are in regard to reducing hospital visits.

United Future believes very strongly that the real key to a robust health system begins with the ability to access one’s local general practitioner and the ability to afford, without hesitation, a visit to one’s doctor. It certainly concerns me. I have lived through times of having sick children and having to check my bank balance to see whether I could afford to take them to the doctor, and of making judgment calls around the health of my children based on whether I could afford to go. I know the appalling feeling that can create in a family. Therefore, I think it is really important that the Government also look very closely at whether doctors and primary health organisations are delivering on these cheaper subsidised cares. Certainly, where there is no cap to their co-payment, there are some real worries there.

I shall focus my kōrero on diabetes. New Zealand has made some incredible achievements on the international stage, including, of course our Ngā Rauru and Ngāti Ruanui golf champion winning the United States Open. We will all welcome him home later this week, and that is Michael Campbell. But there is another world record that nobody is talking about. An epidemic of type 2 diabetes is occurring in New Zealand, driven mainly by demographic trends and the increasing prevalence of obesity. The epidemic most severely affects Māori and Pacific peoples. Mortality rates for Māori are six times higher than those for non-Māori, and the situation is just as bad for Pacific peoples.

Just 3 weeks ago public health experts gathered in Wellington to discuss the fact that health inequalities are still evident. The conference concluded that it was ironic that while some politicians are making political mileage out of claiming targeted interventions as race based, those same politicians are not standing up to draw attention to the race-based inequalities that created the need for the interventions in the first place. Looking particularly at race-based privilege in relation to Māori, I point out that Māori develop diabetes 10 years earlier than non-Māori do, Māori are four times more likely to develop type 2 diabetes than non-Māori are, and we are overrepresented in cases of diabetic renal failure, with rates up to 10 times that of non-Māori. What is of even more concern is that a study undertaken by Dr David Tīpene-Leach and his colleagues revealed the very high prevalence of insulin resistance among Māori from the East Coast north of Gisborne, particularly young adults below 40 years of age. Such a finding indicates that type 2 diabetes is already well established in our midst.

So what do the 2005 Estimates of Appropriations say about such a vital health issue for this nation? In the 50 pages allocated to Vote Health, the word “diabetes” was mentioned once, on page 727. This is a life-and-death issue. Diabetes causes approximately 1,200 deaths per year, and, in fact, at least 1,000 people lose their limbs. There was one mention of diabetes in 50 pages, and no specific Budget investment. We cannot afford to wait any longer. These are issues of great significance to Vote Health. Diabetes presents a significant health challenge for Aotearoa and should be a major priority for health investment. We should be seeing a comprehensive, multifaceted strategy to address this disease on all fronts. Prevention and better-quality care could reduce costly hospitalisation. Indeed, half the cases of kidney failure and dialysis, blindness, and amputation could be prevented if more money was invested. We need gold-star treatment and we need it now.

One of the most bizarre statements in this year’s estimates is the following: “The Ministry of Health is the Government’s primary advisor on health policy and issues and its contribution to improving health and independence is largely indirect.” One would have thought a policy agency would take direct responsibility for analysing the demographic trends, assessing the population demand, and forecasting appropriate interventions. The recent economic study commissioned from PricewaterhouseCoopers estimates that current services for diabetes costs the taxpayer about $247 million. If current services are kept at similar levels, the estimated cost of diabetes will be over a billion dollars each year by the year 2021, in current dollar terms. That is because of the projected increase in the numbers of people developing complications such as blindness, limb amputation, and dialysis requiring hospitalisation.

Progress reported.

Report adopted.