Estimates Debate — Vote Health

I tell members that if there is one area that best sums up the way that this Government is failing, it is health. If we look at Vote Health, we see that nothing in it will make any difference. Expenditure on health has increased from $6 billion a year to $12 billion a year under this Government, yet people still are not getting the care they need.

We heard of several great examples during question time today. At 9 o’clock this morning there were no neonatal intensive care cots available throughout the country. The Government spends $12 billion a year, yet we cannot make one cot available for the most sick, most vulnerable babies born in New Zealand today. That is absolutely disgusting.

Then, in question No. 11 today, we heard my colleague Paula Bennett ask the Minister of Health how many times the Waitakere Hospital accident and emergency department had been closed in the last year, and the Minister answering on behalf of the Minister of Health got up and said none. Paula Bennett then said to the Minister that actually it was closed 52 times. That is absolutely incredible. The Waitakere Hospital accident and emergency department, which is the department that the constituents of the Minister of Health have to go to, was closed 52 times in the last year. There is $12 billion of health expenditure a year, and the Government cannot even keep the Waitakere Hospital accident and emergency department open.

Do members know what this Government does? When that department is closed, patients are given vouchers to go down the road to a White Cross facility. Can members believe that? Despite the Government spending 12 billion bucks a year, Labour goes to the ACT party for health policy! It is absolutely disgraceful.

Let us look at what has happened in elective surgery. The Minister of Health has consistently told us he is going to provide more and more operations. Do members know what? In the area that I represent, which comes under the Waitemata District Health Board, less elective surgery was performed last year than in the first year of the district health board structure—actually fewer operations. When we consider that the population in the Waitemata District Health Board area has gone up by 14 percent over that time, we can see that people are getting even less surgery, on a per head basis, than they were getting 6 years ago. That is the legacy of the Labour Government in health.

I totally agree with the surgeon in Dunedin whom we heard about yesterday who said that the real tragedy about the health system under Labour is that working-class people cannot get access to the operations they need. If Labour members are not here to deliver a good health system for working-class people, I do not know what they are here for. All the Labour members over there are just reading their notes; they know that what I am saying is absolutely true. They are failing in providing elective surgery, and they are failing in providing neonatal intensive care.

I can tell members where else the Government is failing: it is failing absolutely dismally in mental health services. What has the Minister’s response been? It has been to launch another strategy. Last week the Minister launched his latest effort, Te Puāwaiwhero. He gave exactly the same speech that was delivered the last time Labour announced a strategy, which was 2 years ago. Under Labour, mental health provision has been nothing but strategies, plans, and frameworks. Meanwhile, ward 27 at Wellington Hospital represents another broken promise under Labour. This Government said that that ward would definitely be rebuilt and refurbished. What is happening? It is off the drawing board. What is happening? More and more people in the Wellington region are not getting the acute mental health services they need.

I have today lodged a written question for the Minister to answer: how many people have committed suicide since that plan was scrapped? I will be very interested to see the answer, because the reality is that when acute mental health services are not available, things start going off the rails. People need to be able to get into hospital in their time of need. In terms of mental health provision, there have been plans, strategies, and frameworks, but not the services that people need.

This Government cannot continue to make excuses, because, basically, the spending goes up and the care goes down. People cannot get the care they need, when they need it, under a Labour Government. I tell members that when I talk to people in my electorate, the Northcote electorate, I find that they are saying that this Government has not delivered. They may have voted for it last time, but they say that they will not make that mistake again, because, under Labour, promises are broken. The state of play of elective surgery is absolutely disgraceful. Labour promised more and more operations, and in actual fact we are getting fewer each year. The extra spending just has not worked. The people opposite have lost control of the situation. They have gone through three Ministers, and each one is more desperate than the last. Meanwhile, there is less elective surgery, more people cannot get access to mental health care, and there are no more neonatal intensive-care beds than there ever was. The situation is completely untenable. Things have got to change.

On behalf of New Zealand First, I am pleased to take a call in the estimates debate, and, in particular, on Vote Health. We are very pleased to see the continued investment that the Labour Government has made in health. We know it inherited a system that had become very run down under the National Government, to the extent that there were tills in hospitals. Most people who went to hospital were horrified to find that they could not afford to pay for their treatment. It does not fill us with a great deal of confidence when we hear Sir Roger Douglas say that when he comes back to office he will do to the health system exactly what he did to the railway system. That is not a nice thought for the people of New Zealand.

💬 Dr Jonathan Coleman: Well, he isn’t coming back with us. Is he coming back with you?

No, he is not coming back with us; he is expecting to come back under an ACT-National arrangement.

New Zealand First is very pleased to see the extra investment in health. We know that people need some certainty about their health care, and timely access to treatment. We hear from members opposite that the queues are larger than they ever were, but under the Labour Government there has been some movement towards dealing with that.

However, we were disturbed to read in the Dominion Post that Ministry of Health figures show that the number of babies born in New Zealand to non-resident mothers more than quadrupled between 2006 and 2007. The figures show an increase in births in our hospitals of 3,248 in the previous 12 months. We wonder why. If one does the figures, one sees that 76 such births a week are happening in our hospitals. That is a quite significant number. We have to ask why, and for what benefit, our hospitals are being used in this particular way. We in New Zealand First believed that the loophole had been closed and that the numbers of such births would be dramatically reduced, but for some reason they have not been. The automatic right to citizenship for babies born here stopped in 2006. Now, at least one parent must be a New Zealand citizen before any newborn is granted a Kiwi passport. We applaud the action that was taken on that front. For a long time there were maternity safaris to New Zealand under National, and at last that has stopped.

Although we are fully aware that it is up to the individual district health boards to recover costs from non-resident mothers who have used our hospitals, we know that that is very difficult and can be very challenging, because most district health boards do not have the resources to follow up on this particular area. It is not uncommon, as we read in the Dominion Post, for a woman’s maternity bill, including the cost of a baby’s delivery, to spiral above $12,000, particularly if the baby is premature and needs to stay in a neonatal unit. We know that the district health boards are funded to provide maternity services only for mothers who are New Zealand citizens or residents, or who have appropriate working visas or refugee status, or who fall under the reciprocal agreements with Australia and Britain. The women I am talking about fall outside of these parameters, and the matter needs to be followed up. We need to be sure that we can offer health services to our own citizens. I was pleased to hear Minister Chadwick say today that she will look into the situation with neonatal babies, and find out how many foreign mothers who come to New Zealand are using neonatal units. Quite honestly, we do not want New Zealanders to miss out in this particular area.

We know there are no simple solutions to the many and varied difficulties that are confronting the health system. We have to be realistic and face the realities of an ageing population. Improving technology and medicines are increasing life expectancy, and, of course, this places unique demands on the health system. We are very aware, too, of the workforce shortages that are being experienced. That is a big challenge, and the World Health Organization also pointed it out. We are also becoming overly dependent on foreign-trained medical personnel and the increasingly costly use of locums.

After looking at the mental health portion of Vote Health, I believe that the Government has to take a whole lot more seriously the signs of crisis evident in regard to psychiatric services—in some parts of the country, at least. I was not at all comforted by answers I received in the House on Tuesday from Minister Jim Anderton to questions I posed around recent events involving Auckland’s and Wellington’s acute psychiatric units.

For a start, I find it astonishing that the Capital and Coast District Health Board announced last week that it has postponed, indefinitely, plans to replace Ward 27. That is 4 years after the district health board promised in 2004 that plans for a new ward would go ahead urgently. In recent years the ward has been renowned for its overcrowding and staff retention problems and for a number of serious incidents involving patient injuries and deaths. For example, Chad Buckle died after walking out of the ward with no one apparently noticing his departure.

Most recently, there has been the tragic case of Nicole Maconaghie, who died in June, not long after being discharged from Ward 27. Her mother said, and I quote from the Herald on Sunday: “I was told $80,000 had been spent on her and ‘we can’t account for any more money; she just has to get on and live the best life she can.’ ” Her mother is further reported as saying that she tried to tell those caring for her daughter that she would not be able to look after herself, but that she “felt like she was disposable from [the doctor’s] point of view.”

I am sure that the hospital and the district health board will contend that the family’s statements are not accurate, and that their apprehension of the situation is all wrong, but whatever the exact details are in this case, I believe there is an underpinning truth to the mother’s statements that this district health board’s acute unit, like some others, is often under stress; that staff do at times—and probably quite frequently—push people out into the community when they are perceived to have stayed in the unit too long; that there is an inadequacy of care once they are out there in the community; and that there is also a reluctance to listen to, or to really hear, the voices of family members who are desperately trying to tell staff about the real situation for their loved one.

The reason that both the Minister and the Capital and Coast District Health Board give for not building a new unit, when one is so manifestly needed, appears to be that a new 10-bed house for people with mental illnesses will open in Wellington this year. Using this as an excuse for not building a replacement unit is ridiculous; both are needed.

I turn now to the Auckland District Health Board, and I believe that the crisis there is even worse. The Te Whetu Tarewa mental health unit at Auckland is chronically overcrowded, and/or has patient numbers at its maximum. A number of deaths have been associated with the unit in the past year. There is pressure on staff to discharge people who are still very unwell. There is an inability to discharge people to adequate step-down or rehabilitation accommodation and health services. Waiting lists for the one in-patient rehabilitation unit in Auckland at the Buchanan Clinic are long, and, of course, sadly, many people will never access the benefits of its care. There are allegations by staff that there is an inability within Te Whetu Tarewa to keep male and female patients sexually safe, and that there are cases of sexual abuse within the unit. There is an apparent lack of recognition of the true levels of need in the Auckland District Health Board district, and there must be more resourcing, appropriately spent, even to begin to make the systemic changes needed.

The Minister is correct that work has been done on a proposal for structural change within the Auckland District Health Board mental health services. I do not know whether the document resulting from this review is the one he referred to in the House on Tuesday as being under injunction, but from what I know of the review—if it is indeed the one to which he referred—it is very unlikely that its recommendations will in any way, shape, or form go to meet the concerns surrounding both the operational and resourcing issues with Te Whetu Tarewa.

I call on the Government to take some responsibility for what is continuing to happen in our mental health services. There is not enough resourcing. Mental health continues to be the poor cousin of physical health. The problems are systemic and they are acute. People are dying. District health boards should not be left unaccountable in any genuine way for the deficits in their approaches. People with or recovering from mental illness, their families, and the staff who care for them deserve a whole lot better than what is going on right now.

I rise in this estimates debate to speak about rural health. How interesting it is that in the appropriation for Vote Health there is $5 million for rural health. One might think that that would perhaps address some of the issues in rural health, which include the safety of rural patients being compromised by shortages of general practitioners, and long waits for people to see general practitioners. Can members imagine the situation in some parts of New Zealand—it does not sound like a New Zealand setting, but it is true—where patients wait 2 weeks to get an appointment with a general practitioner? Is that the sort of system we are happy to accept? Of course it is not. There is a very heavy reliance on locums, and rural health services have been described in a report by the New Zealand Institute of Rural Health as being in a “fragile” state.

The institute has pointed out that, despite any input by this Government—despite the doubling of Vote Health over the past 9 years—it has not resolved the most significant issues present in the rural health sector today. We may think an appropriation of $5 million might be quite useful, but guess what? There is no idea in the Ministry of Health, or on the part of the Minister, as to what that money is for. It was just a way of saying to the sector: “Go away and keep quiet for a while.” That is not what the sector asked for or what all the recent reports have suggested is required. Those people are not quite sure what to do with the money. They know that the rural health sector needs money to be invested in it, but they know also that this is not what they asked for. In fact, they have completely lost faith in this Government. They used to think the Labour Government looked after rural health, but they have most certainly changed their minds.

Let me give one example of a symptom. When the Associate Minister responsible for rural health went to a conference recently where he was to be the lead speaker on one side of the debate up against myself on the other side, he deferred to a medical student at the very last minute. What does that tell us about the Associate Minister’s confidence to address the issues in rural health today? He deferred to a medical student to be the lead speaker in that debate. That says a lot, does it not?

So what has this Government been doing for rural health? We know that three reports directly affecting the sector are still outstanding. The first is a report into the PRIME system—primary response in medical emergencies. The second is a report into the rural ranking scale, which has been buried since the rural sector commented on it; it has been buried since last October. The latest we have heard from the Minister is that it will be out in November. That is funny—the election will be over by November, so I find that rather strange. The third is a report on the after-hours service. This Government says it has prioritised the after-hours service, and that it is right up there—so much so that it still does not have a full complement of district health boards reporting on what they are going to do about it! So it is now 3 to 5 years later, in the case of each of those reports, yet we do not see progress.

But the Ministry of Health is doing something! We should not worry, because on the ministry’s website we find 54 reports listed that deal with workforce issues! We would think that something must be happening, but, no, nothing is happening.

💬 Lindsay Tisch: How many?

There are 54 reports on the website.

Let me talk about the National Travel Assistance Policy. That policy was introduced in 2006, and was intended to deliver travel assistance to the rural people of New Zealand so that they can access health care. How has that policy been described? It has been described as “complex, cumbersome and slow”. It is no wonder my constituents ask how to fill out the forms and how to access the money. Honestly, most of them just give up and go away. But that must be what this Government intends them to do.

National has some ideas, though. We have had good support for our idea of voluntary bonding—note that I said “voluntary”—in return for student loan write-offs for doctors who agree to work in hard-to-staff areas. There was some confusion, at first, about the fact that it was to be voluntary, but it was welcomed once we explained our intention that it would be voluntary. Ever since it has been shown to work internationally we have supported the immersion of medical students in rural areas for their training. It has been shown to bring extra general practitioners into rural areas.

It would be very interesting if the National Party had a constructive contribution to make in this debate. That party has no health policy, unless, of course, one refers to the supposed phone book - sized book of policy that the party’s geniuses have been dreaming up in the background but have not deigned to put into the public domain. I wonder—and I ask Opposition members to confirm—when National will give that phone book to the public. When will it trust the public with its 10 million good ideas for solving all the problems of the health system?

I was at the general practitioners’ conference in Queenstown 2 weekends ago. When Jo Goodhew was answering questions from the general practitioners, she gave the same answer to all four questions. I will tell members what she said: “Why don’t you GPs tell us what you would do? We’re looking for your ideas.” The first time it sounded humble, the second time it sounded vacuous, the third time it sounded desperate, and the fourth time it sounded tactical.

It is the same with accident compensation. The only reason the public knows National’s accident compensation policy is that one of John Key’s former workmates at Merrill Lynch—[Interruption] I raise a point of order, Madam Chairperson. There is a constant barrage of drivel coming from the other side, and the public does not need to hear that. [Interruption]

The CHAIRPERSON (Hon Marian Hobbs): Sit down, please; I think I can deal with this myself, thank you very much. There has been a barrage from both sides, actually. Members are meant to make pithy points, not repetitive ones, but it is not helpful to make a judgment about the interjections. Thank you.

💬 Lindsay Tisch: I raise a point of order, Madam Chairperson. My colleague Jo Goodhew spoke on a matter of health; the Minister has deviated from health to talk about accident compensation. The debate is on the appropriation regarding Vote Health. It has nothing to do with accident compensation. The Minister should confine his comments to health, and not talk about other subjects.

The CHAIRPERSON (Hon Marian Hobbs): I think the reference to accident compensation was a passing reference. The debate has been on health. We will continue.

Accident compensation and health are, of course, intertwined, because people require both. The point I am making is that the only reason the public has any knowledge about one National policy is that it was leaked by a company that helped to write it. That stands in contradiction with the situation regarding its health policy, because either National does not have one, or it does have one but is not telling ordinary New Zealanders about it. I do not know which is worse. Personally, I think it is worse to have one and not be frank with the democratic process, because whether one votes for Labour, votes for National, or votes for anybody else, what is important is that one makes an educated decision. The public deserves to know whether National has ideas. How about it telling the public during the estimates debate, which is forward looking and is occurring just months from the election, what its policy is? Would not that be a good idea? But, no, National members will not do that.

The reason they will not tell us their policy is that the last time they were in Government their experiment in market health services was a dismal failure. Why cannot health services work as a competitive private market? Well, firstly, because profit is not a good motive for health care, and, secondly, because patients depend upon health professionals for their services. So there is an information problem that one cannot overcome with a market price.

Our vision is for a health system that is collaborative, that is patient centred, and that is geared up through investment in each of capital development, workforce development, and service development, and that is exactly what we have done in the last 8 years. The public know that they can trust Labour with health care—they always have been able to and they always will be able to—because our record is very different from National’s record. Our record is one of consistent investment and consistent improvement.

Sixty percent of health costs are workforce costs. We have invested very strongly in the health workforce. Nurses, doctors, care workers, radiologists, Public Service Association workers—all the way through the sector—almost every workforce claim is now settled. Only one is outstanding, and that is the junior doctors’ claim. We know what that is about, and it is not about the money.

Ladies and gentlemen, the issue for the health service is where we go to from here. The public of New Zealand do not want to know just what we have done; they want to know where we are going. I will not pretend that there are no issues to be confronted, but I will say that Labour has an active and consistent plan for getting there. On the workforce front, we will build a nationwide demand-supply forecasting engine within the Ministry of Health that ensures we can predict well in advance where shortages will come. We will be working with each of the health workforce groups to ensure that we have a combination of short-term, medium-term, and long-term measures—

💬 Jo Goodhew: But you’ve had 9 years.

—actions, not reports—that will solve not only the workforce problems of today but also those of tomorrow.

A health system also runs on money. There are no two ways about it. One can have all the fine theories one likes, but if one is not funding the system properly, one cannot do anything. Eighty percent of the health budget—and $2 billion of the $3 billion extra that we announced this year—goes into the district health board system to build health services that we can trust. I tell New Zealanders to line up the National Party members, look them in the eye, and ask whether they will keep increasing the health budget as quickly as Labour has increased it. What answer would they get? “I do not know; John Key has not told us yet.” Where is the phone book - sized book of policy, and what does it say? I ask what those members’ policy is and whether they have a bright idea to save themselves. I do not think so; if they did, why would they not tell it to us?

To run a health system we need a workforce and we need money. What is the other thing we need? We need health information. We need information to be able to follow the patient through the system. Labour is investing in information systems in the health-care sector so that we can do things smarter. We have an ageing population. We have to look forward to the future. How do we balance rising public expectations, an ageing population, and limited growth potential in the health budget? We do it by working better, by working smarter, by cutting out waste, and by having clinicians spend more of their time in front of patients, and we enable that by assisting them with good business planning and good information that follows the patients through the system. Those are some of the strategic enablers that we are working on.

Of course, there is work to be done in mental health care, but let us ask who has helped out there. The Government has been investing to fund the mental health blueprint over the last 8 years. It has been consistently funding—

💬 Sue Bradford: Well, why don’t you make sure the money is spent properly?

My colleague asks whether it is all done yet. No, it is not. But when I walk around places like Waitakere Hospital and I see its brand new mental health ward, I know that consistent investment is being made, year on year. Ms Bradford asked a question about the Capital and Coast District Health Board. I look forward to the day, which I hope is not very far away, when ward 27 will be rebuilt. I know the Buckle family, I know about that tragedy, and I want to see that ward rebuilt. But I respect the governance decision of the district health board, which has to balance that demand against the cardiac waiting list, against obstetrics and gynaecology services, against maternity services, and against getting the new regional hospital up and running. Given the situation that the district health board has found itself in, I think it is building a responsible forward plan, and I know that it wants mental health services to be part of that plan, too. That is very important.

In respect of primary health care, someone said to me that National was copying all of Labour’s policies. What is the difference? The difference is whether one wants Labour or “Labour-lite”. National, for the first time that I can remember, has actually put the words “primary” and “health care” into the same sentence. But all that those members could come up with was so-called integrated health centres—giving the problem to the general practitioners and letting them solve it. National members would not know a strategy if they tripped over one. Although the general practitioner clinics are—[Interruption] If Jo Goodhew had had a good idea, it would have been a good thing to tell it to the general practitioners’ conference, instead of asking them to come up with the solutions. General practitioners are essential, but they are not the only answer; the answer is to ensure that there are good linkages between primary health care delivery, with low-cost access, and population and public health policies that are working. That is why we are investing in Healthy Eating - Healthy Action. That is why we have been reducing the incidence of smoking. That is why we have campaigns against youth alcohol abuse. We are taking down the drivers of ill health, in order to keep people well.

How many New Zealanders now find that cost is a barrier to their accessing health services? According to the latest New Zealand Health Survey, which was released just a few weeks ago, the answer is 1.7 percent. Under that lot opposite, with their market health-care system, it would have been about—goodness me—50 percent, 30 percent, or something like that. The working-class, which National has finally discovered, suffered for a decade under that lot. They suffered in employment, they suffered in welfare, they suffered in health, and they suffered in education. That is why the people of New Zealand sent us into Government, and, whatever they decide at the election, we know that we have been good to our word and good to our programme. We are honestly putting our programme before them, with plenty of detail, and then it is up to them to choose. That is how democracy works. They get to choose, and we respect their decision. But we can contrast that, I say to the ladies and gentlemen who are listening, with the position of the National Party. Either its members have no policy, which is frightening, or they have a phone book - sized book of policy that they are not telling people about.

Tēnā koe, Madam Chairperson. Kia ora tātou katoa. The first sentence of the report of the Health Committee on the 2008/09 estimates for Vote Health should have made us feel pretty good. According to the Minister, health expenditure has doubled in the past 9 years and New Zealand is beginning to see the results of this investment. Although that is great and I am all for results, the funny thing is that the word “Māori” did not come up in the Health Committee report. Why should Māori be noted distinctively in this report? Because Māori are 18 percent more likely to get cancer and twice as likely to die from it; heart disease kills nearly twice as many Māori but they are only one-third as likely to have angioplasty; avoidable death rates are almost double for Māori than other New Zealanders; and, on average, Māori die 8 to 10 years earlier than non-Māori. Tema Whero—team Labour—is constantly crowing that the Government spends 1 in 5 tax dollars on health. So why is it that Māori obtain fewer referrals, fewer diagnostic tests, and less effective treatment plans?

The Māori health statistics I quoted earlier paint a lousy picture. Where is the plan to address it? That is the question. The report of the Health Committee happily covers district health board deficits, inherited deficits, and operational deficits, but the biggest deficit of all appears to be missing—that is, the systematic deficit that we might call racism. There was perhaps one vague suggestion of this in the transcript of the discussion that took place on 25 June with the Minister and his merry men of the ministry—well, to be fair, there were a couple of women there as well. When responding to questions about the aged residential care industry, the Minister raised the issue that wage rates are so low that turnover is very high, and he concluded that there are “some very valid concerns about working conditions for the workforce, many of whom tend to be Pasifika or Māori, and that is not a situation which is either sustainable or proper.” We will give the Minister the benefit of the doubt and presume that it was the working conditions that were neither sustainable nor proper, not the fact that the workforce is dominated by Pasifika and Māori. It is, indeed, neither sustainable nor proper that such gaping inequalities and levels of deprivation and deficit characterise Māori health within our national health system.

What can be done to urgently turn the situation round? Well, first off, we have to get to grips with the reason why the Māori population is overwhelmingly dominant, not only in the low-wage sector of the health workforce but also in every negative statistic across the health system. To help, Dr Mātire Harwood, the director of Māori health for the Medical Research Institute, suggests that the basis for such inequalities is found in the fact that racism is thriving in the health system. She describes three levels of racism that must be confronted. There is the systematic racism that drives inequalities and health determinants, there is the one-on-one racism within the doctor-patient relationship, and finally there is the level of internalised racism that is observed in individuals—in this case, Māori feeling as if we do not deserve to have certain procedures.

Although the media profiled these revelations of racism, which Dr Harwood talked about just this morning on Radio Waatea, the faces of racism are not exactly unknown to the State. I am thinking back to the report some 20 years ago called Pūao-te-ata-tū—Day break, and it is fitting to refer to that ground-breaking report today on the day that Tūhoe have come to Parliament to sign an agreement with the Crown to settle their historic grievances. The group that produced Pūao-te-ata-tū was, of course, chaired by John Te Rangianiwaniwa Rangihau of Ngāi Tūhoe, who made a major contribution to the renaissance of tangata whenua through his work with Government departments, as well as through the wānanga he founded in culture and history for the people of the Tūhoe nation and wider. Pūao-te-ata-tū instructed the Government that the most destructive form of racism is institutional racism—the outcome of monocultural institutions that simply ignore or freeze out the cultures of those who do not belong to the majority. Why is it that 20 years after Parliament received this report we are still witnessing the desperate statistics that constitute the crisis in Māori health care, yet the Health Committee’s report neglects to even speak the name Māori out loud?

I take just a quick call to say that I was very tempted to take a point of order on the grounds of my taking offence at the use of the word “racism”.

This Government cares very deeply about inequalities and about reducing those inequalities, and is very passionate about the health of Māori people. Investment in Māori health runs to the tune of many billions of dollars under this Government; under the population-based funding formula Māori have significantly higher funding per capita than non-Māori. Some of these improvements are showing up in the fact that, for example, under Labour infant mortality has declined in the total population by 28 percent, yet has declined in the Māori population by 43 percent. Infant mortality for Māori has declined by 43 percent during the life of this Government—that is nearly double the rate for the general population.

Of course there is more to do, but neither the member nor the public should be in any doubt that the Government’s heart is in the space of wanting to help Māori and work with Māori. That is not about paternalism; it is about understanding that the way to reach Māori communities is through iwi, hapū, whānau, and using Māori providers—by Māori, for Māori. That is why in this year’s Budget we have brought in a much larger funding stream for Māori provider development. That funding is on top of the money that is going to Māori health through the district health board system.

So this is just a short call to say that. I do not want to disagree with the member—I think Māori health is essential. Apart from anything else—apart from the ethics and apart from the principles of the Treaty that we adhere to—there is a reality here that by 2020 one-third of all New Zealanders will be Māori or Pasifika in origin, and if we do not have all our people healthy, educated, and productive we will all go down the economic toilet together.

I raise a point of order, Madam Chairperson. I was not sure whether the Minister took a point of order.

The CHAIRPERSON (Hon Marian Hobbs): No, he did not. He called to speak, which he is entitled to do. He can take multiple calls.

I raise a point of order, Madam Chairperson. With regard to the statement made by the Minister around the word “racism”—

The CHAIRPERSON (Hon Marian Hobbs): I warn the member to be very careful. That is a debating point. Are you going to enter into debate? If so, you will have to take another call.

No, I just want to say that that reference was taken out of Dr Harwood’s report; that is all.

The CHAIRPERSON (Hon Marian Hobbs): Thank you.

I say to the Minister that National has an idea and a policy that we would be really happy for him to copy. It is to free up money so that women can get 12 months’ supply of Herceptin. We would be very happy for the Minister to take that up right now for women; they need it. This is a critically important issue for women and their families.

When I was speaking as a new MP, this issue came to the forefront and began with such hope and such excitement. The results of large international trials were coming through and they were showing that breast cancer recurrence rates—that is, coming back in the bones, the brain, or the liver—were reduced. Let us face it. When cancer comes back in those organs there is a very poor outlook, and it is not surprising that the studies were also showing that there were improved survival rates. Medsafe moved really quickly, and New Zealand was the first country in the world to register 12 months of Herceptin usage. A few months prior to that, in December, the pharmaceutical company had made an application for funding for 12 months’ supply—a decision that Pharmac turned down outright, without consultation. That was the basis of the April decision by the High Court to direct Pharmac to re-consult and to review its decision.

Since 2006 we have had to sit back and watch 33 other countries, one by one, fund 12 months’ supply of Herceptin. I go back to 2006. The issue bounced around the various Pharmac committees, but it was clear over 2006 that Pharmac had become very interested in a very small Finnish trial that gave women only 9 weeks of Herceptin. The results were interesting—yes, they were interesting—but they were not statistically significant. But Pharmac did not seem to be bothered by that at all. In fact, Pharmac seemed to become quite fixated about the idea of 9 weeks of Herceptin, so from July last year women were funded to have 9 weeks’ supply only.

I have not met one cancer specialist yet who is of the opinion that 9 weeks is the standard of care and has the evidence to back it up. Pharmac even made an application to Medsafe for the 9-week regime, but Medsafe turned it down because it lacked the clinical evidence. It also agreed with the cancer specialists, but did not have the clinical evidence backing it at all. So to give the 9-week Herceptin regime some legitimacy, Pharmac decided to give women a clinical trial whereby half the women would get 9 weeks of Herceptin and the other half would get 12 months. It proposed that women would enter the international short-or-long-duration trial. But it does not seem as though that trial is going to get off the ground. It needs 3,000 women. Pharmac started recruiting in January this year, but until May this year—

💬 Jill Pettis: Jackie, say it like it is. National cannot both give tax cuts and supply Herceptin for 9 months.

I am telling the member how it is. Only 39 women have been recruited internationally, and the preliminary result, presuming the researchers can get 3,000 women—they want 600 from New Zealand—will not be available for another 7 years. This is really important. Women with aggressive HER2 breast cancer do not have 7 years to wait for these results to come through. They do not have the luxury of waiting for 7 years to see whether the 9 weeks is a goer.

None the less, we have the situation that from 1 July women are getting only 9 weeks of treatment. It is an unproven course, there is no trial, and I do not think there will be a trial, in my opinion. Here and now, women with HER2-positive breast cancer are being advised by their specialists that 12 months is the best standard of care internationally. Specialists have told me that they feel they have a moral duty to tell women all the facts. The facts are that 9 weeks is not proven, and 12 months is the better option. We can see what is happening. Women have been told the truth, and the fortunate few who have had the resources, the community support, or the house to mortgage are doing that to raise money desperately. They want to live, and they want to see their children grow up. A fortunate few can do it, but hundreds and hundreds of others do not have the community support, do not have the house to mortgage, and do not have the resources to do it.

This is the most vulnerable time in these women’s lives. Can members imagine being diagnosed with the most aggressive form of breast cancer and being told that 12 months of treatment is the better course, but they can be given only 9 weeks? They want to live—boy, do they want to live. Make no mistake, these women who have a suboptimal treatment of Herceptin face an uncertain future. They do not know whether the 9 weeks will be a goer. There is no proof that it will be. They want the best insurance, and the best insurance is 12 months of Herceptin.

Pharmac reviewed this decision yesterday. We understand that a decision is coming out next week. Pharmac called for submissions and there have been over 300. I read the submission from the New Zealand breast cancer special interest group, which represents the majority of breast cancer specialists in New Zealand, and it overwhelmingly backed a 12 months’ supply of Herceptin.

I had not intended to take another call right now, but there were some significant factual inaccuracies in Dr Jackie Blue’s contribution. For the sake of New Zealand women, particularly those who are vulnerable and worried because they have Herceptin-positive breast cancer—

💬 Hon Dr Nick Smith: I would trust Jackie Blue any day.

The public would not trust Dr Smith; nor would the courts. I suggest he just cans it.

The facts of the matter are that the FinHer trial is statistically significant for disease reduction. That is not in contention. What is also not in contention is that the mean efficacy of the FinHer trial is very close to—actually slightly better than, I understand—the mean efficacy of a number of the 12-month trials. What this debate boils down to is a technical debate about the additional value of additional sample size. It is an extremely complex debate, and I think that is why it is very good that we have an independent technical body that is advised by clinicians and that goes through a transparent and rigorous process to answer those questions. It is not about politicians debating in the House, and saying “Oh, I think the wind is blowing that way.” It is about serious rigorous analysis, as it should be, because this is about the lives of New Zealand women.

Pharmac is consulting. I understand that Pharmac will be making an announcement next week, and the Government will have something to say at around that time.

💬 Hon Dr Nick Smith: You will have to eat some humble pie, because Jackie is right. It will be time for humble pie.

I guess Dr Smith must be a doctor of philosophy, not a doctor of medicine; otherwise he would not be making such a fool of himself.

The facts are that this is a complex debate. The facts are that we have a very robust process under way, and I understand that Pharmac has been working very, very hard on this issue for some considerable time now and has heard all sides of the story. We will all have to wait to see what the announcement will be next week. Thank you.

One of the things we have to be really careful of in the health sector—and most of us who have worked in the sector are aware of this—is not to exploit the vulnerability of a group of people who think they will get everything they want delivered to them. That member over there, Jackie Blue, who has worked in the health sector and in the area of women’s health, knows that National cannot deliver the tax cuts it is promising to New Zealand and deliver 12 months’ supply of Herceptin. I do not believe that at all—not for one single minute. National is not telling the women of New Zealand the truth, and I think that is despicable. National is telling them tattle and telling them that repeatedly. I despise it when vulnerable women are exploited for political purposes. I say to those 5-minute Tories over there—most of whom were not here in the 1990s, when the health sector was decimated by National—that they should give us a policy. I ask them to give us a policy—just one. There is none—absolutely no response at all.

I can tell the people of New Zealand who care about health issues—and a large number of New Zealanders do care about health issues—that under National the cash registers will be back in the hospitals again. There will be an increase in private insurance take-up—as there was when National was last in power because people were fearful of never getting their treatment. They were fearful they would never see it, so the health insurance take-up rate increased. Health insurance rates will increase again. National members’ mates in the insurance industry know that; they are rubbing their hands with glee, knowing that their profits will increase.

Under Labour health spending has increased to $13 billion, and we are delivering more services than National did. There are lower doctors’ fees—it costs $22 less than it did previously for most families to see a doctor now—and prescriptions are down to $3. We remember what it was like in the 1990s, when people left prescriptions sitting on the chemists’ shelves because they could not afford to pick them up. There have been 5,000 more elective surgery discharges this year alone, and those of us who actually run constituency clinics—those of us in Labour who actually see people—know that. We do not have to write letters to the hospitals, asking when Mr Brown or Mrs Smith is to receive his or her surgery. People know when they will receive their surgery, because the waiting lists are not a sham like they used to be under the former National Government, where people were just dumped on to waiting lists. People now know, once they are on the waiting list, when they will have their operation. National hid people on waiting lists; it gave them the panacea of being on a waiting list, saying “You’re going to get your operation, Mrs Brown.” Then Mrs Brown lived in totally false hope, because she did not understand that she was being manipulated and used by the former National Government.

As for cancer treatment, I remember—I am not a 5-minute MP like those 5-minute Tories over there are—that the former National Prime Minister Jenny Shipley ignored the advice of the cancer health specialists, the non-politicians, about the dramatic capital expenditure that was required on linear accelerators in order to treat the increasing number of people who required treatment against cancer. Jenny Shipley and the National Government of that time, in which Nick Smith was a Cabinet Minister, ignored that advice. When we came into Government, we found that massive capital expenditure on linear accelerators and on getting cancer treatment equipment into our key hospitals was required. The National members did nothing. They played politics. They played Russian roulette with the most vulnerable people in New Zealand.

We know what it is like to have friends and family members die from cancer. We know what that is like, and we know how vulnerable our nieces, nephews, and sister-in-law were when they lost their father and partner at the age of 41. We know what that is like. We do not play politics with vulnerable groups of New Zealanders, and I say the National members should not do that either.

Vote agreed to.

Vote Communications agreed to.

Vote Environment