Financial Review Debate — Ministry of Health

For the benefit of those who are tuning in to this debate, I will explain that we are looking at the financial performance of the Ministry of Health. This debate gives Parliament an opportunity to review the performance of not only the Government but also the ministry in the last 12 months.

Over the last few weeks in Parliament, the National Party has demonstrated some of the incredible pressures being borne by the public health system in New Zealand and that despite $4 billion of extra money, the services in our hospitals are still wanting. We have demonstrated, through answers to written questions, that fewer New Zealanders are receiving elective surgery today than there were 5 years ago, and that fewer New Zealanders are receiving surgery, full stop, than there were 5 years ago. This country should not be proud of that state of affairs. After 6 years of the stewardship of Annette King as the Minister of Health, $4 billion of extra public funding, and huge pay increases for people who deserve them, what do we have?

After 6 years of Annette King as the Minister of Health and an extra $4 billion in funding, what does her colleague the current Minister, the Hon Pete Hodgson, say about her performance as Minister of Health, with a mark out of 10? Five-and-a-half. What did Annette King say to Pete Hodgson, when he rated her performance in the health portfolio as being five-and-a half out of 10? I have seen the Minister’s face every time—

💬 Hon Maurice Williamson: What was the raw mark before scaling?

That is a very good question. What do New Zealanders receive from that $4 billion of extra money? Fewer elective surgeries, and fewer surgeries altogether.

We will also hear today from other members of the National Party health team what the district health boards are saying about that. I will be interested in the comments of the Minister in the chair, Pete Hodgson, about the sort of reception he receives in the boardrooms of district health boards in New Zealand, because I can tell him about what we hear as we go around the district health boards. District health board after district health board is saying that a person has to be more sick today than he or she had to be 5 years ago in order to get an operation. District health board after district health board is saying that despite $4 billion of extra money, in order for people to get an operation today they have to be more sick than they had to be 5 years ago.

I would like the Minister in the chair to take a call and explain how it can be that after all that money, fewer elective procedures and fewer surgeries are being carried out. Fewer individuals are receiving surgery overall than received it 5 years ago. We will get a line about out-patient operations, and all that stuff. I think the Minister will be surprised to hear how few of those he can add to the total when the figures come along in July 2006.

We will also hear from the National Party health team about how the Government has been underfunding the investment in pharmaceuticals in this country in the last 4 or 5 years.

💬 Hon Annette King: That’s a laugh.

Annette King says that is a laugh. Well, Pete Hodgson has rated pharmaceutical policy under that Minister at 5½ out of 10—that is what he said. That is how highly the Minister in the chair rates Annette King’s performance as former Minister of Health. We will hear from Dr Jackie Blue. She will talk about the fact that per head of population, the funding spent on pharmaceuticals in this country, after inflation, has dropped in every one of the last 4 years. That is why Annette King receives a 5½ from Pete Hodgson on that issue.

We will hear from Jonathan Coleman, who humiliated Mr Hodgson in the House over the cardiac waiting list at Auckland City Hospital. Mr Hodgson got up and said people were actually getting angioplasties done by Waitematā District Health Board. Then, the next day, he came back and said angioplasties were not done by Waitematā District Health Board.

We will hear from Jo Goodhew about the parlous state of workforce training in this country, and about the fact that there simply are not enough doctors and nurses. She will talk about the fact that this Government is wasting taxpayers’ money by sending staff from 10 district health boards to London.

On behalf of New Zealand First I rise to speak to the 2004-05 financial reviews, and in particular the Ministry of Health financial review.

The area of health that New Zealand First wants to see progressed is children’s health. We know that health outcomes are a defining feature of our First World status and that any decline affects our quality of life. New Zealand First believes in, and will actively work towards, the objective of having free health-care for all under-6-year-olds. In 1997 this initiative was implemented, but with escalating costs the initiative was gradually whittled away, basically to the detriment of our children. Today’s primary health organisations have a policy of part charges for medical visits and prescriptions for children, but sometimes even these charges are too high for parents.

It is absolutely essential that we provide our very youngest citizens with certainty about health care, and ensure timely access to all health-care services. We believe that an emphasis on preventive measures at an early age ensures that later problems, like hearing problems and sight problems, that eventuate and reduce educational achievement do not go undetected, and of course an increased amount of investment is required at this later stage. I recently read a report that states that a 1 percent increase in overall literacy results in a 1.8 percent increase in GDP. When we relate this to educational achievement—and health is usually a factor in this—we see that these figures cannot be ignored. We say that investment in this area will definitely produce very worthwhile results for New Zealand.

Last year Minister King spoke of many advances that were to be made in the area of oral health for primary school children. Indications were given in this House that a number of positive issues relating to oral health-care were to be worked on and fixed. This was repeated again prior to the election. To date, unfortunately, I have heard of very little action, and the questions remain around oral health-care. I have heard of some advances, to be fair, but there is still quite a lot that needs to be done in this area.

The facilities and services review was carried out on school dental services, and the final report commenting on this is not easy to find on the Ministry of Health website—if it is even there. We all know that dental decay is on the increase, and although each district health board has its own oral health service—which was repeated in a written answer I received from the Minister—we know that adequate resourcing for this essential service is absolutely paramount. The possibility of having local super-clinics and the increasing reliance on mobile clinics appears to be the best way of managing this scarce resource that is absolutely essential for the well-being of our nation’s children. Perhaps sharing resources between district health boards in order to provide an effective service and ensure that children can actually be seen within a specified time frame is one of the changes that must be managed in order for this service to survive and flourish—because we do want to see it flourish. Good oral health is absolutely essential for the well-being and overall health of every child.

The final area of health care in which we are looking for action is the Government’s intentions regarding the changes to maternity services. The latest addition to the voices calling for change is the Health and Disability Commissioner, who has reported on another avoidable death. The public has a right to know as soon as possible exactly what the Minister intends to do to improve the current system. The proposed alternative that we have heard about—the setting up of a database of maternal and prenatal deaths—provides nothing in the way of reassurance for pregnant women or even for those contemplating pregnancy. I say to the Minister in the chair, the Hon Pete Hodgson, that it is obvious to all New Zealanders that changes are necessary to ensure that women have access to the best possible medical care while they are pregnant, and when giving birth.

We hear that people are becoming sicker, kids are becoming fatter, diabetes is on the rise, and obesity is at epidemic levels. We also hear the Minister in the chair, the Hon Pete Hodgson, has given his ministry a rating of 5½ out of 10, and we hear that $4 billion more than previously has been spent on health over the term of the Labour Government. I want the Minister to get up and take a call to answer one question: where has all the money gone? What has the $4 billion been spent on? What do we have to show for it? I can say now there is nothing to show for it. We are becoming sicker as a country, and it is becoming harder to get an operation than previously. The health service is absolutely decaying.

There is one place where we can say the health money is going. It is going into bureaucracy. There are 12,000 hospital beds in New Zealand, and there are 12,000 bureaucrats to fill them. That is just outrageous, but it is absolutely true. I was stunned when I heard that statistic. When I came into this Parliament, I had heard that Mr Hodgson was a competent Minister. I had heard that he would do good things in health. Then I picked up my copy of New Zealand Doctor and I saw that he rates himself as being only 5½ out of 10. He says he does not feel confident in the health portfolio, and he does not even feel that he can get to grips with the ministry. Frankly, if that is how the Minister feels about health in this country and about the health service, what do the public think?

I want the Minister in the chair to take a call to admit that, and to explain why, despite the lies that Labour tells the people of New Zealand, we do not have a health service in this country that is free at the point of delivery. The Minister has to get up and admit to that. People are falling through the cracks of the health service. The fact is that people in this country need to have private health insurance. We have heard that time and time again. If someone goes to a hospital anywhere in New Zealand to have a cataract fixed, a joint replaced, or an ear, nose, or throat operation, he or she will not get it. I was talking to an orthopaedic surgeon on Friday. He said North Shore Hospital does not have waiting lists. Why is that? It is because the hospital will not let anybody on to them. That is the actual truth.

We have heard time and time again that if people do get on to a waiting list, they have to be sicker than ever before. All the district health boards, including Capital and Coast District Health Board, are saying that. We had the board’s surgical services manager, poor lady, in front of us at the Health Committee last week. She went through a range of specialties, under questioning, in which one has to be sicker than ever before in order to get an operation—ear, nose, and throat surgery, orthopaedics, gynaecology, and eye operations. I asked her whether one had to be sicker than ever before in order to get an operation in New Zealand, and she said yes, one does. That was a confession that the health service is failing New Zealanders.

I ask the Minister, Pete Hodgson, what he will do about that. Frankly, we see no evidence that under Labour the health system is providing the services people need. Would any member want to be a heart surgery patient in Auckland? Four years ago there were 800 heart operations done in Auckland; this year there will be 400. Frankly, the message is that one has to be sicker than ever before in order to be operated on. The Minister has to tell us where all the money has gone. The Minister owes the people an explanation of that.

People come to my constituency office every day and talk about the operations they cannot have done under the Labour Government.

💬 Hon Tony Ryall: Tell us about them.

Look, the situation is just appalling. I had a letter the other day from a World War II veteran who had served his country. He needs to have a cataract operation and cannot get it. That man has paid taxes all his life, and people are having a whip-round at the RSA so that he can have his operation. Frankly, I think that is disgusting. Another constituent, a lady, has a broken thumb. The Accident Compensation Corporation will not cover her surgery costs, and North Shore Hospital will not even see her, so that lady can no longer use her hand. She is left in limbo because she cannot afford to have private insurance cover. That lady used to be a Labour voter, and she tells me she will never vote for Labour again. That is the case with a growing number of people out there. Labour has sold its voters the big lie that the health service is free at the point of delivery. We know that that is not the case. The Minister knows it as well, and Labour members know it.

The Labour MPs must be ashamed at what they have done to the health service. They must be ashamed that people in this country cannot get operations. Under this Government, operations that people need will not be done. That is a failure.

It is the responsibility of Governments to strive to provide the best health care for their citizens. Sadly, I say that this Labour Government is failing its citizens. I add, too, how disappointed and stunned I am at the poor performance of the Minister, Pete Hodgson. But my sadness is balanced by the fact that I am part of a wonderful health team: the marvellous Hon Tony Ryall—what a great leader—Dr Jonathan Coleman, and Jo Goodhew. What a great team I am with!

The House has heard from some of my colleagues already, and will hear from Jo Goodhew, about the deficiencies in the health system. But the real scandal is in pharmaceuticals, and in the 5½ out of 10 performance of Pharmac. That is really bad. Pharmaceuticals and prescription medicines play a vital role in the prevention, amelioration, and treatment of disease and disability, and are an essential tool for improving health outcomes for New Zealanders. With Vote Health now at almost a massive $10 billion, one would expect that the spend on pharmaceuticals would have increased proportionately over the last 3 to 4 years. My colleagues will be aghast—absolutely shocked—when I say that that has not been the case.

💬 Hon Maurice Williamson: No! What’s happened?

I will tell the member. Rather than the per capita pharmaceutical spend increasing, it has flatlined. I ask my colleagues to look at the graph I am holding up. Spending has flatlined. The graph is like an ECG of a cardiac arrest; spending is as dead as a dodo after 1, 2, 3, 4 years—dreadful. Even Pharmac admitted during a recent Health Committee hearing that population funding for pharmaceuticals has not kept pace with inflation. At the same committee hearing Pharmac said that New Zealanders had access to more drugs than Australians. That claim was repeated—parroted—by Mr Hodgson in the House, but it did not make sense to me because, as members have just seen from the flatlining graph, spending has—

💬 Hon Maurice Williamson: Show it again.

I will show the member. Spending has flatlined. It is as dead as a dodo—nothing has happened there over the last 4 years.

So what was Pharmac’s claim all about? It took the research medicines industry to expose the truth. It found that Pharmac’s data contained numerous omissions and errors and, astonishingly, included items that were not medicines. My colleagues will be interested to know that Pharmac counted items such as condoms and bandages as medicines. But that outrageous lie was exposed.

Australians have more access to medicines. For example, they have extra medicines for the treatment of Alzheimer’s disease. They have five new medicines to treat HIV, four new biological medicines, five new cancer treatments, and new medicines for heart failure treatment. Organ transplant recipients have new medicines, and new medicines are available for the treatment of atopic dermatitis. New Zealanders are being short-changed not just by the number of medicines available but also by the fact that what is available is more restricted.

But there is more. Proud of its lack of spending over the years on pharmaceuticals, Pharmac went even further and underspent its budget by $25 million in the financial year ending 2002, by $3 million in 2003, and by $8 million in 2004. Clearly embarrassed by its legacy of underspending, it underspent by only half a million dollars in the year ending 2005. Pharmac has its priorities all wrong. Access to medicines will improve the health of New Zealanders. Pharmac’s miserly attitude does a huge disservice to all New Zealanders.

Before I conclude I want to ask the Minister of Health two questions, and I hope he takes a call and answers them. The first concerns Herceptin funding. Will the Minister ensure that district health boards have enough money in their cancer budgets to agree to fund Herceptin when they are asked to do so? The second question concerns women who have to start Herceptin now and cannot wait until later in the year when it might be approved, and who are prepared to look at paying for the drug—they are struggling, raising mortgages, and fund-raising; $70,000 is a lot of money but some are getting there. Will the Minister allow them to have the drug administered in a public hospital, which will save them up to almost $50,000? The basic cost of Herceptin is $70,000, and for women to have the drug administered and to be monitored in a private hospital can cost anything up to $30,000 or $40,000.

What exactly is the state of the health system? We have heard that it got 5½ out of 10. What is the level of confidence in the new Minister?

💬 Lindsay Tisch: Good question. What’s the answer?

Well, I can tell the member. As a former health professional I have been talking to other health professionals, and they are very, very concerned. They have diminishing confidence in the new Minister of Health. They have described what is going on as “shifting the deckchairs on the Titanic”. Why is that? I have posed a question to a number of groups in my electorate when talking about health. I have asked them whether, knowing we had spent $6 billion on health some 6 years ago and $10 billion on health more recently, they would say we were any better off. Resoundingly they shake their heads in disbelief. They cannot believe we have spent an extra $4 billion when they can see no benefit. People are outraged. They say that they are, in fact, worse off.

When I thought about my opportunity to speak here this afternoon, I thought about what is happening in health. I looked at press releases such as “Pathology services at risk”, “Canterbury DHB failing to meet demand”, “Wellingtonians have to be sicker to get operations”, “Financial crisis at Capital and Coast DHB”, “Hodgson needs to wake up”—we are looking forward to that—and “Dramatic decline in heart surgery in Auckland”. Another release reads: “Labour cannot ignore call to review maternity services”—and boy, have we seen the headlines about that one. Others read: “Labour’s head in sand on GP crisis”, and I wish to speak a bit more about that in a moment; “Pharmac advice leaves Health Minister red-faced”, as we have heard; “Labour irresponsible over BreastScreen”; “Patients counted, but no surgery”, what another scandal that one was; and “Smaller DHBs”—and I am in the area of one of them—“struggle for viability under population-based funding”. I thought to myself that if those statements appeared over 6 months, then that would be fine; the Opposition would be exposing them. But it was not over 6 months; those are just 2 weeks’ worth. It is absolutely horrifying.

I wish to comment on the two further areas of aged care and general practitioners. First, I will deal with aged care. Last year Sherrill Dackers, on behalf of rural women of New Zealand and 18,000 others, petitioned Parliament to take urgent action to guarantee the provision of home-based care services for rural communities by paying travel costs and travel time for home-care workers who are required to travel more than 15 kilometres return to care for their clients. Those petitioners have exposed a problem that has been building over the years. The problem means those who are home-care workers in rural areas are doing it for the love of it. I understand some home-care workers are being paid no more than $1.52 an hour. That is absolutely criminal.

Some of the first letters I wrote as an MP were to the Minister of Health. They were about home-care workers who were having problems making ends meet. I got a very reassuring answer that it was intended that the home-based support services price increase in 2005-06 be targeted to address travel costs for workers. Has that happened? No, it has not happened. I still receive phone calls about the problem and I am still making representations on the part of those same people. Aged-care services are grossly underfunded. We are undervaluing these very important members of our society.

The next thing I want to touch on is general practitioners. The crisis there has not arrived overnight. Over the past years we have heard only rhetoric about this growing problem that is now described as a crisis. General practitioners are overworked, underpaid, and ageing. That sounds pretty grotty, does it not? Hundreds are planning to quit, yet the Minister of Health says that general practitioners’ profits are soaring and their training courses over subscribed. That does not sound like a very comforting thought, does it? Yet general practitioner discontent appears to be reaching fever pitch. Last year we heard that about a third of general practitioners were planning to leave, and their average age is 48 years.

I would like to thank Barbara Stewart for her contribution. I freely acknowledge that in its confidence and supply agreement New Zealand First states its interest in both ends of life, in terms of the availability and affordability of health care, and it hopes this would be free for children under 6. I acknowledge the member’s ongoing attention to the health of older people, to the roll-out of the positive-ageing strategy, and to what we need to do to improve home-based support services, and so on. I thank her for her interest in those matters. Embraced in that is her interest in maternity services, and the Government enjoys her support as it seeks to improve linkages between midwives and primary health organisations, and as it seeks to improve data sets still further and introduce a mentoring system for new midwives, and so on.

I give a quick little reminder to the member that my predecessor, the Hon Annette King, indicated in the election campaign a bunch of moves we will be making in the area of child health, and she will have some familiarity with those. They include a newborn hearing screening programme to be rolled out in the course of this term of Government; improved child and adolescent oral health-care, especially a bunch of capital investments to be made there; improved child and adolescent mental health services, where often there is a shortage of adequate health workers; the preschool wellness check, and so on. I enjoyed the contribution from the member and thank her for her support.

All of the other speakers came from the National Party, and it was a bit strange. Mr Ryall, who is the nominal health spokesperson, began, more as a sort of master of ceremonies than delivering a speech. He talked about what would follow, about what this person would say, what another colleague would say, and that verily they would have yet another colleague who would get up and make his or her contribution. Mr Ryall gave us an idea of what we would hear in the future, then sat down, having said only one other thing, and I took significant exception to what that was. It was his assertion that fewer New Zealanders are receiving surgery and elective surgery. Such assertions are wrong. They are simply at variance with the facts. I enjoin the member to try to pay attention to his own credibility and to his own reputation by making sure that he sticks to the facts, at least on occasion, because from time to time, facts ought to get in the way of a good story. It is not OK to say that fewer New Zealanders overall are receiving surgery than was the case 5 years ago. That simply is not true.

The rest of it seemed like a sort of sixth-form cabaret, actually. It was a sort of sing-songy roll-out of some pre-arranged positioning that had been carefully rehearsed in the lobby, complete with graphs that could not be seen on radio, and complete with what were clearly some well-worked-out lines about the “5½ out of 10” theme. “We’ll play that one at the Minister!”, they said to themselves excitedly and breathlessly before they came into the Chamber. I say to members of the National Party health team that they should put in some more practice during their lunchtime, because it was not an auspicious beginning. They need to try harder. Let us hear what my view is of Annette King, because one of those cabaret players asked me to say what it was. [Interruption]

The CHAIRPERSON (Ann Hartley): The member cannot do that; he knows he cannot barrage like that.

I would say, uncomplicatedly, that Annette King was a hugely successful Minister of Health. She held the health portfolio for 6 years. I do not know of another person who has held that portfolio for 6 years in my adult life; it certainly did not happen in the 1990s. The National Government managed to get through five Ministers of Health in that time. A quarter of its caucus was at one time the Minister of Health and another third of its members were Associate Ministers of Health. We had Ministers Upton, Shipley, Creech, Birch, and English, and Associate Ministers of Health all over the place, since when members opposite have quickened their pace. They have had more health spokespeople in 6 years in Opposition than I can name. They have about five now.

That is what the National Party is like on health. Its members keep passing the parcel because they cannot get a grip on it, and the reason they cannot get a grip on it is that they do not think as strongly as we do on public health. They do not think of the importance of primary health care. They did not mention the following areas. In all of the time they took, did we hear anything about mental health? Not a word! Did we hear anything about Māori health? Not a word! Did we hear anything about the Pacific Island communities? Did we hear anything about the determinants of health? We heard nothing. All we got was niggle and scratch about pharmaceutical numbers versus Australia. As if it matters! What matters about that debate is that the Australians spend twice as much as us per head, so even if they are doing a little more than us, or a little less—Pharmac versus the Researched Medicines Industry Association debate—they are paying twice the amount. We did not hear about that from the National Party. There was an awful lot we did not hear.

One thing came from Dr Coleman that I would strongly endorse, and I thank him for it. He said that obesity is an epidemic, and I say to that gentleman: “Right on!”. For the 20 or 30 minutes members opposite had to put their finger on something that matters in health, only one of their members did so. That was a rare moment. The next time we have a financial review, those members should practise more during the lunch hour.

Report noted.

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

Ministry of Transport