Estimates Debate — Vote Health

In Parliament’s voting of $10 billion to the Minister of Health for the administration and provision of our national health service, Parliament has to ask itself what progress this Government is making towards delivering a healthier nation and the improved welfare of our people. This is a Government that is asking Parliament to vote it over $10 billion, which is an increase of $4 billion since it came to office, but what has it got to show for it? There is all that extra money, and we have a sicker nation. There is all that extra money, but one has to be sicker today to get an operation in any public hospital than 5 years ago. There is an extra $4 billion, but there are fewer elective surgeries being performed in this country than 5 years ago. There is an extra $4 billion, but our public health initiatives are still not reaching the most at-risk groups in our community.

This Government has run out of ideas, it has run out of energy, and it has run out of commitment to provide the vision and leadership that we need in the health sector to provide this country with better health and welfare in terms of our natural beings. This is a Government that, this year, came to Parliament to ask for $10 billion, but we know that it is already planning on having $100 million worth of deficits in the accounts of the nation’s district health boards. That is how bad this Government’s management is of our public health system and the public purse, which is shown here in Vote Health. A $100 million deficit in district health board accounts is already being budgeted for in this year’s appropriation.

This is a Government that is having all its chickens coming home to roost. It has been able to cover up its poor performance in health through bluster and spin, but now the public is on to it. Everywhere one travels around the country one sees there is widespread dissatisfaction with the New Zealand public health system. Doctors in both our hospitals and our general practices are disenchanted with this Government’s management and the way in which the system is bogged down in bureaucracy.

We have fewer general practitioners in this country than we had 6 years ago. General practice has to be the cornerstone of our health service, and there are opportunities for general practice to have an even greater role in providing for the health and welfare of New Zealanders. But this Government is attacking general practice at every opportunity. There are fewer general practitioners in the country today, and there are many thousands of New Zealanders who cannot get registered with a general practitioner.

Earlier this week I was in the Horowhenua. In the Horowhenua they are flying down a general practitioner from Kerikeri 3 days a week, because of its shortage of doctors. On the Kapiti coast the person who runs the primary health organisation, a contracted provider, told me on Monday that 1,000 people on the Kapiti coast cannot get a doctor. We know that New Zealanders cannot get registered with a general practitioner in Timaru or Gisborne. That has been reported. We know that in Waimate almost 2,000 people cannot get on the books of a general practitioner. That is the state of the general practice workforce in New Zealand, which the Government continues to ignore.

The pressure on that workforce is becoming even worse as a result of this Government’s cynical plan to manipulate the nation’s public hospital waiting lists. That cynical plan is not about providing New Zealanders with treatment or care; that cynical plan is not about prioritising patients who need to get care; that cynical plan is all about chopping people off waiting lists, so that the Prime Minister can stand up in the Chamber and say that she has cleared those waiting lists. But New Zealanders are on to that. Every day hundreds of New Zealanders find out about their friends and neighbours getting a letter or a phone call from their district health board telling them they have been culled from a hospital waiting list.

There are two areas where people are being culled from their waiting list. The first concerns those people whose general practitioners say they need to see a specialist. Those people—over 120,000 at the last count about April—need to see a specialist. Their general practitioners say they need to see a specialist, but the Minister and the Government say that people who have been waiting more than 6 months, regardless of the urgency of their care, are to come off the waiting list. The cruellest cut of all, though, has come for those thousands of New Zealanders who were promised an operation. The Government never wanted to see that list revealed, but we got the information out. An estimated 10,000 New Zealanders, who were promised an operation, have been culled from hospital waiting lists—and the human cost is incredible.

New Zealanders heard about the young woman who had a breast mastectomy and was promised a breast reconstruction, but because of the severity of her disease she had to wait more than 6 months in order for things to settle down. What did this Government do? Did it honour the pledge to sufferers of breast cancer that they could have breast reconstructions? No, she was cut off the waiting list by Pete Hodgson. What about the young child who cannot smile? That child was chopped off the waiting list by the Government. What about the young woman who was turfed off a hospital waiting list and, as a consequence, was admitted to hospital as an acute patient and now has a colostomy bag? How happy are Labour members about that?

The Labour Party has just celebrated its 90th anniversary, but did Labour members really come to Parliament to dump from waiting lists old people, women who have lost their breasts, and children who cannot smile, and cut them out of the public health service? Did they really come to Parliament to provide fewer elective surgeries for New Zealanders who need them? Did they really come to Parliament to spend hundreds of millions of dollars on an extra 1,800 bureaucrats in the health system? Is that really what Labour is about?

Under this Labour Government, health dollars have gone further and further up the social strata. The Government is providing a political strategy rather than a health strategy. Its own people are the ones who are missing out. When Labour party people were celebrating in the electorate of the millionaire member from Ōtara, did they think for one moment about the tens of thousands of their supporters who have been culled from hospital waiting lists?

💬 Dr Jonathan Coleman: Too busy with the chardonnay.

Too busy with the chardonnay! Did they think what they were doing for the tens of thousands of their supporters—people who live on little more than national superannuation, a welfare benefit, or a low income? Did they think of the young woman with skin cancer eating away at her face, who has been culled from a hospital waiting list and who cannot get care? Is that the Labour vision of a public health system in New Zealand? Is it Labour’s vision that millionaires in Whakatāne pay $20 for a visit to the doctor, but beneficiaries in Tauranga pay $30? Is it Labour’s vision that for every two nurses who have been employed in the public health system in the last 5 years, there is another manager? Is that really what Labour came to office to have? Did Labour really come to office to have the aged-care workforce fade away through lack of support and training? Is that what Labour is really about?

This Budget is not honest to Labour’s roots, nor is it honest to the people of the public health system. This is a Budget that throws money everywhere but does not provide the care or attention needed to provide a decent health system in this country. Is this a Budget that says we have limits on our capacity in the public system so let us use the independent sector to provide more care in our hospitals and more care for New Zealanders?

💬 Hon Members: No.

No. Is this a Government that has decided that it wants to support the work of non-governmental organisations? No. Is this a Government that says it wants to keep pace with inflation and the cost of drugs, and put more money into Pharmac? No.

On behalf of New Zealand First, I am pleased to take a call on the Appropriation (2006/07 Estimates) Bill. This year, again, there have been some very positive developments in Vote Health. New Zealand First has long said that New Zealand needs a properly funded health system and that, as a start, we must move towards health expenditure of 10 percent of GDP, which many other countries around the world have. We believe this is totally achievable if we have an economic plan to improve our national income. So we definitely support the increased appropriation this year.

We must acknowledge too that there has been a considerable increase in health spending over the last 7 years, and that is to be commended. We now have over $10 billion, in total, for health, and that also must be commended.

The fact that the major priorities have been outlined for the 2006-07 year means there is no confusion about where the moneys will be spent, so the public of New Zealand can expect some positive outcomes in many areas—for example, the health of older people, children’s health, primary health, and obesity. All those areas need some dedicated moneys.

Unfortunately, there are no quick solutions to the many and varied challenges facing the health sector, and we are pleased to see that some of the challenges are at last being recognised and worked on. New Zealand First believes that one of the aims of the health service must be to provide New Zealanders with certainty about their health care, and to ensure timely access to quality services. This is, in part, largely successful, particularly when it comes to emergency admissions to our hospitals. The Minister has said, and the figures show, that 75 percent of all hospital admissions come in through the emergency department. It is only the remaining 25 percent of hospital admissions for elective surgery that we hear the most about. That is where the dissatisfaction comes about. The dissatisfaction comes from the mismatch of the public’s expectation and what the system can actually deliver in a timely manner. New Zealand First believes that that needs to be addressed relatively rapidly.

We applaud the announcement of the additional moneys for the oral health of New Zealand children. We know that the school dental service and the Adolescent Dental Benefits Scheme were both in dire straits—and perhaps, to some extent, still are—and that fewer than 40 percent of eligible preschoolers are enrolled in the school dental service. The Government has recognised that we no longer have the first-class service that existed in years gone by, and has moved to rectify the situation. This funding is a step in the right direction.

We will be very keen to see in action the process for allocating the funds. When we split the $40.8 million between 21 district health boards, it is fairly obvious that district health boards will not be able to make much of an impact on children’s oral health with that amount of money. We know that some district health boards have proposed projects of $10 million, and if we do the calculation we find that that is 25 percent of the total amount that one district health board wants to spend.

We have been reassured by the Minister of Health that those with business cases approved later on in the year will still have the funds available. We will be most interested to see how that will work. We know that oral health is important to a child’s health, or to a young person’s health, overall.

In the area of the elderly, we believe that the Minister of Health must honour his commitment to ensure that the money in this year’s Budget for elder care is passed on promptly and in full. The key to that is to ensure that the district health boards deal fairly with the providers in the sector. Allocating funds in the Budget will be absolutely pointless unless they get to their intended destination. We know that low pay rates and the lack of training that carers of the elderly receive is a situation that must be corrected if we are to see sustained improvements in this industry.

I start by looking at one item in our financial review of the Ministry of Health—the proposed trans-Tasman joint therapeutics agency. In this year’s estimates $1 million is allocated for setting up a joint therapeutic agency with Australia, and that is on top of $5 million that has already been spent. In our report we questioned the ministry’s mandate to proceed with this project and to spend all this money. We pointed out that it is operating under an executive mandate, not a parliamentary mandate. We also pointed out that this huge expenditure of money—we are now up to $6 million—has never come before our Parliament. There is no parliamentary mandate for this project.

The other extraordinary thing about our hearing on this particular aspect of the estimates was that we asked the Minister of State Services, Annette King, to come down and brief us in our select committee about the agency, but she refused to do so. She refused to come to the select committee to brief us about it. We know she has been meeting with her Australian counterpart. I think they have had 15 meetings and they have made a series of decisions. We asked whether we could see the minutes of those political meetings, but she refused to provide them. The Minister Annette King has also, for 3 years, refused point-blank to address my Official Information Act requests.

What the Minister did tell us was extraordinary. In our estimates hearing, a two-page briefing was sent in place of the Minister coming. I am speaking specifically about what is in the estimates, if members want to read the report. She said she expected that legislation would come before Parliament in July. At a cross-party briefing outside this House the officials said the same thing. The officials said that legislation setting up the joint agency would be introduced in July.

In the House today the Minister admitted there would not be any legislation introduced in July, for the simple reason that the Minister does not have sufficient political support in this House to introduce the legislation. She also does not have support from the majority of those in the dietary supplements industry in New Zealand. They are implacably opposed to what she is doing.

So, basically, we are calling on the Minister to call it quits, acknowledge that she does not have the numbers, acknowledge that she does not have the support of the industry in New Zealand, and, instead, get a cross-party group together to work on a simple New Zealand alternative in place of the legislation.

The Minister said, with great glee, that it is terrible that some dietary supplements have been found to cause adverse reactions. That is what she said in the House today. It is good that she has found out about some of those supplements, and there should be constant monitoring of them. But what she did not mention was the information that I eventually managed to extract from her after numerous written questions, which was that, last year, more than 20,000 New Zealanders suffered adverse reactions to pharmaceuticals, almost 17,000 New Zealanders suffered adverse reactions to a medicine in a hospital, and a further 4,000 adverse reactions were reported in the primary health care sector. However, representatives of the centre for adverse reactions monitoring said that that was probably only a tiny fraction of the number of adverse reactions that occurred, because there is no mandatory requirement to report adverse reactions to medicines. The centre therefore knows that it receives reports of only a very few of those occurrences.

So here we have 20,000, or probably 40,000 or 100,000, New Zealanders becoming ill with an adverse reaction to their medicine. What are we doing about it? We are doing nothing.

Tēnā tātou katoa. In the last month a number of ground-breaking reports have been released that add to the depressing chronicle of evidence about the state of health in Aotearoa. The Māori Party welcomes these reports; however, they become drained of any moral value if we fail to act. The estimates debate is an opportunity for the Government to dare to act in the interests of the health of the nation.

So let us set the scene. The world’s leading independent general medical journal, The Lancet, surveyed over 10,000 New Zealanders, asking them about any incidents of discrimination when they approached a health professional. The study described the health system of this country as “racist and discriminating against Maori”. It claimed that 4.5 percent of Māori experienced unfair treatment by a health professional compared with just 1.5 percent of Pākehā. It stated: “The findings of this survey show that deprivation and experiences of perceived racial discrimination contribute to inequalities in health outcomes between Maori and Europeans. Indeed, the combination of deprivation and discrimination as measured seems to account for much of the disparity in the health outcomes assessed.”

The impact of multiple factors of disadvantage in limiting health outcomes has always been well understood by tangata whenua. Ngāti Hine leader Moe Milne, for example, described te oranga o tangata whenua as being influenced by factors other than purely the absence of disease. She stated: “I was told, ‘We lose our tangata whenua status when we don’t have whenua to stand on. We lose our whenua status when we don’t have tangata to stand on it.’ ” It is in this relationship of all the intersecting parts that the greatest damage lies.

Reference is often made in this Chamber to the most vulnerable of our communities—the so-called welfare cheats, the dole bludgers, the welfare dependants, and those who are said to be ripping off the system. But I have to ask who the greatest beneficiaries are. Who feels good about the theft of Māori resources—our waterways, the land confiscations, and the foreshore and seabed—and who feels bad?

The relationship between health, wealth, and well-being is absolutely linked. The determinants of health are overlapping and multiple. Poverty, intergenerational and lifestyle factors, ethnicity, racism, and ill health are factors that are all related, yet this Government persists in treating one factor in isolation. These are systemic issues. We are always told that people must take personal responsibility—and, yes, people must do that—but who in this Chamber will take personal responsibility for the creation and support of systems and policies that will guarantee disadvantage and that will not change the lives of the most disadvantaged? This Parliament is frequently swamped with accusation, denial, and decision makers who will not take responsibility for decisions they have made to create what to many of our people is an unjust system. If we are really to eliminate health disparities, we need to address the institutionalised racism that reveals itself in the link between racism, morbidity, and mortality. We need to treat the health of the whānau as being intricately associated with the health of the individual—we need to make the associations, and we need to act.

The National Party must also stand up and take responsibility for its role in planting the seeds of racism amongst the public mind. I wonder how many members in this Chamber have had calls from Māori who are sitting in their homes listening to National members talk about Māori in terms of privilege, and I wonder how that wounds the psyche of Māori people. The focus on so-called Māori and Pacific privilege is in itself creating disadvantage. That party is allowing people to talk about us in a negative way. That party is giving people permission to be racist, and that must stop.

Last week the Public Health Advisory Committee released its report called Health is Everyone’s Business. That report urged New Zealanders to rise to the challenge of reducing health disparities, particularly between Māori and non-Māori. The committee advised the Government of the widening social and economic inequalities that are resulting in whole population groups being left behind. It described how in New Zealand ethnicity presents an independent and significant effect. The committee concluded that being Māori or Pacific further increases the risk of death or ill health across all socio-economic categories. I repeat—being Māori or Pacific further increases the risk of death or ill health across all socio-economic categories. If we were to say that being Pākehā further increased the risk of death or ill health, would that be ignored? If we were to say that being an MP further increased the risk of death or ill health, would attention be taken? So why is it that the association of being Māori or Pasifika with the risk of ill health and death is so casually described—almost taken for granted—as a universal assumption of truth?

The Public Health Advisory Committee identified that there is no easy solution to health inequalities, no quick fix, no one-size-fits-all. Collaborative effort is required to address the social and economic determinants of health. Health cannot be treated in isolation. The final report, released just a week ago, proved that although poor health can be expected to lower living standards, there was also evidence that poor living standards increase the risk of poor health. And who are the New Zealanders most at risk of poor living standards? Forty percent of Māori and 58 percent of Pacific people experience some degree of hardship, compared with 19 percent of Europeans. That is not a gap; that is an ocean.

Disparities emerge and grow from the overlapping disadvantages of racism and poor health, and impoverished living standards and deprivation. If we add to those factors the variable of being Māori or Pacific, the result will be severe and significant hardship. Yet the appropriation has allocated a measly $3 million to policy advice on reducing disparities in health status for Māori. Worse still, there is no specific funding at all for Pasifika health. I, like many others, have heard all the excuses that the priority of better health for all perhaps means reducing inequalities for Māori, Pasifika, and those on low incomes, without actually having to spell it out. Well, I am a firm believer in spelling it out, telling the truth, and facing the facts.

The reports I have spoken of today are not Māori Party documents. They are not the reports of Māori researchers, academics, or wānanga graduates. They are not the reports of the United Nations special rapporteur. They are the reports of Professor Peter Davis of the University of Auckland, of the Public Health Advisory Committee, and of Ministry of Social Development. We must act decisively, with courage and information, to make the connections explicit and to treat the whole rather than the separate parts. Within Te Ao Māori, we know we live the reality of taking into account all aspects of our spiritual, physical, social, cultural, intellectual, and psychological selves when we consider the concept of health. Kāore te taha wairua i te tū i tōna kotahi; the spiritual side does not stand by itself. We cannot divorce the water from the lake and still call it a lake. So we understand only too well the impact of multiple disadvantage—that everything is connected, that nothing can be treated in isolation. Solutions must be all-embracing and inclusive. We must all take responsibility for being a part of that solution. I ask today: who in this Chamber will address the living conditions that create poverty, misery, and the underclass? Who in this Chamber is prepared to burst the septic boil of racism and stand up to protect the well-being of all? When will we invest in raising the standards of living? Only then will the state of health in Aotearoa be something we can all be proud of. Kia ora.

The Labour Government is failing ordinary New Zealanders. It has had 7 years to prove itself, and it is failing miserably. Under Labour, New Zealanders are getting sicker—yes, sicker. This month, Judith Collins, National’s welfare spokesperson, exposed figures showing that a staggering 122,000 New Zealanders were on the sickness and invalid benefits.

💬 Lindsay Tisch: How many?

It was 122,000. That is more than the population of Hamilton City or Dunedin City. Judith Collins showed that the numbers of people drawing those benefits had increased by 47 percent and 38 percent respectively under this Labour Government. That is an astonishing figure. The population has not increased by 40 or 50 percent, so what is going on with New Zealand’s health, we can ask. Why are New Zealanders getting sicker? I will tell colleagues what is happening, and it is not good.

They are not getting the operations or drugs they desperately need. Tens of thousands of New Zealanders are being dumped from waiting lists and not getting the procedures that specialists say they need. Why are they being dumped? They are being dumped because the hospitals do not have the resources to do the operations. That is despite the millions of extra funding that has gone into a bloated health bureaucracy. Half of all the district health boards are struggling to match last year’s numbers of operations. Compared with 5 years ago, fewer patients are getting elective surgery. Patients now have to be sicker to get an elective operation and because they have to wait longer the operations are more complex, more complicated, and bigger. It does not make sense. There is no logic in it. There is not a lot of sense in Labour’s failed policies.

Recently there was some publicity about medical adverse events that cost taxpayers a massive $850 million each year. That is serious money. The figure comes from a 2002 study. We would think that the Government would sit up and take notice of that report, and implement immediate and urgent steps to reduce medical adverse events—not only to reduce the pain and suffering of New Zealanders but also to save money. But has it? No, it certainly has not.

This Government is interested in spending money and not in saving money. This Government is more interested in wasting hard-working New Zealand taxpayers’ money than in relieving New Zealanders’ pain and suffering. The irony is that although this Government is happy to spend money as if there were no tomorrow, in pharmaceuticals it is the opposite case. That is an area where the Government needs actually to be spending money, but it is doing the exact opposite.

💬 Darren Hughes: Who wrote this rubbish?

💬 Dr Jonathan Coleman: Shut up, Darren. You might learn something.

Yes, he might learn something! The per capita amount of pharmaceutical spending has been flat-lining and dropping over the last 5 years. Pharmac’s annual budget is not even keeping up with inflation or the consumer price index.

💬 Darren Hughes: All these prepared speeches. It is a debating chamber.

There has actually been a press release this afternoon from that member’s Government. It has announced an increase in Pharmac’s budget to $600 million, which is up from $582 million in last year’s budget. But when one works out the figures, one finds that that figure represents an increase of only 3 percent, which in no way will match the 11 percent predicted increase in prescription volumes. So it is pretty simple to work out that we are going backwards quite fast. This has done a disservice to New Zealanders. They are not getting the drugs they desperately need to keep them well and out of hospital.

A recent study shows that in the last 6 years Australians have had access to 58 more new emanated medicines than have New Zealanders. New Zealanders are missing out on medicines compared with their counterparts in Australia. This study also confirmed that the few drugs we have in common are more restricted and more difficult to access than in Australia. Pharmac tried to fudge the issue, and even the Minister was reported in the House for fudging it and saying that New Zealanders had access to more medicines than Australians. Government members were very, very quiet when the detail of it was worked out. It was pointed out that Pharmac included items such as condoms, peak flow metres, Janola, and calamine lotion. These are hardly lifesaving and innovative new drugs. It takes far too long to get drugs through Pharmac’s process.

We are talking about the estimates of appropriations, but, quite frankly, when it comes to health we might as well be talking about the estimates of misappropriations. This debate goes right to the heart of what is wrong with health under this Labour Government. The Government is now spending $10.5 billion a year on health. That is a 66 percent increase on what it was spending when it came to office. As everyone knows, and as the Labour members know, health is actually not improving in New Zealand. Those members have nothing to say about that. The marginal member for Otaki, Darren Hughes, was saying that this was a debate. Well, why do Labour members not get up, take a call, and actually debate some of these issues? Why do they not get up, put their money where their mouths are, and tell us what they will do?

Frankly, health has been an abysmal failure under Labour. The reality is that the more the Government spends on health, the worse it gets. For 6 years we had a Minister of Health who was a dental nurse. Now we are counting the problems in oral health. We all know that oral health is a problem in New Zealand. It has been going on for 6 years, and what is the Government doing? It is commissioning a report. It will have another committee, it will have a hui, but it will not have any answers. Goodness knows what we will have after 3 years of having a vet as Minister of Health. We may be counting the number of successful dog microchippings—it will be just as relevant to the health of New Zealanders as what we have had so far.

We can conclude that the more money Labour throws at the health problem, the worse it gets. Labour members are averting their eyes—they do not have the answer. They know that health is a minefield; it is a disgrace. The Minister of Health is a joke. He is an embarrassment to the Prime Minister, he is an embarrassment to the front bench, and he is not even here to take a call today. It will be very, very interesting to see what happens when the Associate Minister gets up and tries to justify the $10.5 billion of expenditure. We know that the system is in crisis. We know that one has to be sicker than ever to get an operation in New Zealand. One cannot fool the listeners at home. They know that that is absolutely correct. They would be absolutely appalled to know that one dollar in every five of Government expenditure is going into health, yet the kids are getting fatter, people are getting sicker, parents cannot get operations—

💬 Hon Clayton Cosgrove: What would you do?

The member for Waimakariri asks a very good question. I will tell him. The one line that should be in these estimates of misappropriations is the big line called bureaucracy. I can tell the member that under this Government we now have 12,000 bureaucrats and 12,000 hospital beds. That is one bed for every bureaucrat. We have had an increase of 2,000 bureaucrats in health alone under this Government. I say to the listeners at home that Government members are not saying anything now, because they know it is true. They know that since this Government came to power 17 football fields are now needed to accommodate all the bureaucrats in Wellington, in terms of office space.

💬 Darren Hughes: Ha, ha!

That is a joke. It is a disgrace. Darren does not have an answer to that—he knows it is true. We have fewer general practitioners, fewer people having operations—

💬 Darren Hughes: Rubbish!

It is true. We have more bureaucracy. Labour thought health was in a safe pair of hands, but it has turned out to be the nightmare portfolio. Who on that front bench would want to have that portfolio now? The answer is no one. The fact is that health under Labour is in the cart, Mr Hodgson is in palliative care, and the people of New Zealand are waiting for a change of Government so we can start to get the services that the people of New Zealand deserve. They are not getting those services under Labour.

Last week we had the roll-out of primary care. What a dismal failure that will be. Three million dollars will go to the poorest people in New Zealand and $60 million will go to people who can already afford to go to the doctor. How is that targeting need? The reality is that Labour is letting down the people who voted for it—the poorest people in New Zealand, who have the highest health needs. The message is actually getting through, because those Labour voters know that this Government does not represent their interests.

This Government is more concerned with irrelevant, fringe, social issues, rather than with strengthening health, strengthening education, and strengthening the economy. That will come back and bite it in 2008, if not earlier. Government members are not saying anything now, because they know it is true.

It is too difficult to resist having a crack at that member, who is allegedly a general practitioner. When we asked that member what his policy for health would be, all he talked about was bureaucrats. Has he forgotten the Health Funding Authority? Has he forgotten that when something went wrong in the health system before we had district health boards, we had bureaucrats? But no one would take any responsibility when things went wrong under the Health Funding Authority that Dr Jonathan Coleman’s crew in National set up, and that he, as a general practitioner, milked and got his income off. Now, at least we have district health boards with accountable people. If communities do not like what the health boards have done, they can get rid of them—they are accountable. That member, as a general practitioner, milked the system under the Health Funding Authority all right, and National created the bureaucrats in the system—a huge monolith of bureaucrats.

But here is the deal: Dr Coleman said we should get rid of the bureaucrats, but what does that mean? I will just talk about that. Here is an economic fact: the health sector requires money. Where do Governments get money from? They get money from taxation revenue. Is that not right? That member—a general practitioner—was elected on the basis of National’s policy of a $7 billion tax cut. I will explain to him what happens when revenue is reduced. The money has to be found from somewhere. When a $7 billion tax cut is given—[Interruption] The member did not do very well when he was on his feet; he is doing even less well now that he is squawking like a headless chook over there. Half of the $7 billion tax cut was to have been based on borrowing. Where would the other half have come from? The other half would have come from cuts in expenditure like that on health, or from asset sales. One could not sell enough assets to cover what National wanted to do.

I ask Dr Coleman to tell the truth. I ask him to get up again, take another call, and explain to the people he hoodwinked in the electorate he won that if he had his backside on the Government side of the Chamber, he would cut health expenditure in order to give away a $7 billion tax cut and then he would borrow the other half of the money needed for the tax cut. That does not mean getting rid of bureaucrats. If he got rid of every so-called bureaucrat and administrator in our health system, he still could not pay for the tax cuts that he wants to give people. What would Dr Coleman do? He would get rid of nurses, cut services, and put cash registers back into the hospitals, as National did in the 1990s—and that genius over there was a general practitioner in the 1990s. I ask him to go back and think about the legacy that the National Government put through. I ask him to look at the health figures that that Government left—at the cash registers in the hospitals. Under that Government, people were not bumped off a waiting list; they were bumped off permanently because they could not get into a hospital.

I challenge Dr Coleman to say whether he would get rid of the primary health organisations and the Public Health Care Strategy. There is silence. He is lost for words, and so is that other thing over there beside him. Would Dr Coleman get rid of the primary health organisation system? Would he get rid of the district health boards? We do not hear anything now. The reason is that this is not an election year. In election year, the only thing he came out with, of course, was a $7 billion bribe. I say to that member that he has no credibility. He may be a general practitioner—he may be a witch doctor, for all I know—but he has no understanding of economics. What is even worse is that he stands up in this Chamber and thinks everybody who listens to him is an idiot who does not see through that. Well, I say people are not idiots.

💬 Darren Hughes: He is arrogant.

He is arrogant—absolutely arrogant.

Would National get rid of the primary health organisations? Would it do away with the free doctors’ visits for under-sixes? No, Dr Coleman will not say what National would do away with. He will not tell us how he would fund his health proposals, because he does not have any health proposals. That member over there has shown himself for what he is. He is a political fraud—an absolute political charlatan. He is a naive new member, who is up himself to the point where he goes out and tells people whatever they want to hear. I say to Dr Coleman that if he were in Government, Rangiora Hospital would be gone by lunchtime. If he were in Parliament on the Government side of the Chamber, Canterbury District Health Board would have its budget slashed under him. Why would that happen? Because we know he could not pay for tax cuts without doing that. We know—as John Key said—that National would borrow half of the $7 billion needed in order to give a tax cut. [Interruption] The member says that is right. That is the first truthful thing he has said in this contribution. John Key said that. I wonder whether the folks who are listening to this debate—the elderly who would have been turfed out of rest homes, or the people who would not have had cheaper prescriptions—heard that.

We know that when we got into Government, many people could not access the public health system, and if some of them had been able to access their doctor and their specialist for treatment of their injuries, they would not have needed to be put on a waiting list. If they had minor injuries, those could have been stitched and fixed up, and they would have gone away, back to their normal quality of life. This Government has put a heap of money in the pot in order to clear the existing waiting lists out—and we are doing that. Also, for anyone with a minor injury or illness, surely it makes sense to do what we are doing: providing those people with the drugs they need, and getting them in a measured and cheap way to their specialists and their primary health care providers, so they can be fixed up and stitched up without needing to be put on a waiting list—because, by God, they are healthy. That is our policy.

We did not hear anything from members on the Opposition side of the Chamber, except for a lot of voodoo economics. The National members are running like mad from their tax cut bribe.

I take the opportunity to close this debate. Never before has a Government invested so much money in the health status and care of its people. It has committed $10.5 billion. I am very proud, as Associate Minister of Health and as part of a Government that has committed so much to the future health and well-being of its people. I acknowledge New Zealand First for its wisdom in contributing to this debate and to this Government. Barbara Stewart, quite rightfully, points out the priority areas in health care that we have laid out in front of the public and are absolutely committed to. Those are the health of older people, the health of children, primary health care, and dealing with public health-care issues like obesity. We have invested a huge amount in primary health care, because prevention is better than cure. We know—as the public of this country knows—that money spent up front looking after people, preventing many of the ailments and many of the long-term problems, is money well invested.

Tony Ryall made a very good point. He said that general practitioners are very, very important people. Yes, they are. They are key components in the Primary Health Care Strategy. I am not sure whether Dr Coleman is a necessary general practitioner, given his ignorance and the ignorance he showed in the House just before. But general practitioners and other primary health care providers, and nurses—all those people—are essential elements of our Primary Health Care Strategy. Another very good point raised in this debate was the fact that 75 percent of people go into our hospitals through emergency care or acute incidents. Every one of those people, almost without exception, will say that the care he or she received was exceptional. It is absolutely amazing. Every day, up and down this country, we can meet people who will say, and know, that when they need health care they will get it, and it is our public health system that will deliver it to them.

The National Opposition focuses on the 25 percent of people who go into the hospital system—and members should remember that that is just one part of the health system—for elective surgery. That is always an area of difficulty, because with increasing technology, with increasing knowledge, and with more drugs, we are able to deal with more people. That is a fact, and, because the demands on the system will never ever be entirely satisfied, we have had to make some calls. We have said we will focus on public and primary health care areas where prevention will deliver for us as a nation long term. We have said we will target areas of need. As the Māori Party quite rightly pointed out, too many of those areas of need are, unfortunately, found within the Māori and Pacific Island populations, because disparities of wealth align with disparities of health care. There is no doubt about that.

That is why we have said all the way through our health strategy, and through the primary health strategy as well, that we will focus on areas of need. That means we will focus on the disparities in health for Māori and Pacific Island peoples, and we are proud of that. It is a health system based on need, not on ability to pay.

The other reality pointed out by my learned colleague the Hon Clayton Cosgrove is that if National were to offer $7 billion worth of tax cuts, as it did, it would have to slash funding.

💬 Hon Clayton Cosgrove: Who to?

They blame, as the member pointed out, the bureaucrats, the administrators, and the managers in the health system. Well, if funding in health care is increased by 66 percent, we need to know that it is being spent in the right areas. We need to know that that money is being well managed. That is why we have had an increase in administrators. We do our very best to minimise increases in that area, but we need to know that every dollar is being well spent.

The other reality, of course, of the National Party’s alternative policy is that one would not only have to slash funding to health but actually hand responsibility over to the private sector. The National Party ideologically believes that the private system can deliver more efficiently. Well, I struggle to understand that, because we have had some models that have attempted to do that—for example, when the National Government privatised the railways, although I am not sure that that is a wonderful example of large infrastructural private management. But we do need a nationwide system of health care, and that is what we are backing. The National Government’s experiment in railways did not work, and privatisation in other areas it reformed has not worked, either. Its reform of the electricity system, based ultimately on the ideal that privatisation would deliver to us, did not work. Those two simple examples of key infrastructure reforms—of key Government services, such as health—have failed under the private sector management models.

That is why we as a Government are absolutely committed to the provision of public health services throughout this country. We will take taxpayers’ dollars, spend them, and invest them wisely in health care, because that ultimately will determine the wealth of this country. One’s health is one’s wealth. There is absolutely no doubt about that—members should ask people who face acute and immediate health problems. They know where their priorities lie. So too does this Government. That is why I am proud to say that under the Minister Annette King and now under Minister Pete Hodgson we have invested 66 percent more money into health care since 1999.

💬 Darren Hughes: That’s a pretty good record.

It is a very good record. In spite of all the harping on by the National Party we will have increasing health status for New Zealanders, not only now but into the future. Oral health care, which was raised by members in the Committee, is a classic example. The National Government, through its 9 years of management of this country, chopped investment in training dental therapists. As a result, we have seen a decline in the standard of dental health of young New Zealanders. There has been a direct decline in oral health because of worthless management and a lack of investment. We have started now to invest. We have 100 dental therapists training at the moment. We are investing $100 million over 5 years into dental care. That is the kind of investment we have had to make to offset the dumbing down, the shrinkage, and the attempt at private provision by the last National Government. It is a big job. We are committed to doing it properly. I think we have done an exceptional job and we will continue to do so for a long time into the future as a Labour-led Government, with the assistance of our wise coalition colleagues.