Estimates Debate — Vote Health

The National Party’s election slogan of “Better, Sooner, More Convenient” health care is turning into a Tui billboard, and a lot of people are looking at Tony Ryall’s and National’s election promises and are saying “Yeah, right!”. He said that resources would be moved to the front line of health. Time and time again, that has been shown to be completely untrue. All over the country there are now cuts to front-line health services and front-line health staff.

In Otago, as we heard in the House today, there are cuts to the number of staff of community health services for the rural elderly. Those people ensure that when elderly people who live on their own out in the country—maybe in Clutha or maybe just outside of Dunedin—are discharged from hospital, all the support is set up before they leave hospital. They make sure that those elderly people are discharged to a safe environment, but they are going to lose their jobs. When the Minister of Health was asked today how that would benefit him, he did his old washing of his hands trick—he can twitter and wash at the same time; he is a real multitasker—and said that it was nothing to do with the Minister of Health. He said that he was there to make only good positive announcements, and it was all the fault of that bad district health board. The district health boards make the bad announcements about health cuts, while the Minister washes his hands of all responsibilities and just gets on with announcing yet another new positive initiative in health.

The Whanganui District Health Board has announced that it is going to deliver the Minister’s “Better, Sooner, More Convenient” health services by closing hospital wards on the weekends. I am sure Chester Borrows is just delighted at that news! Michael Laws will be celebrating up and down the main street of Wanganui—

💬 Hon Member: Without a patch.

—without a patch—and that must be great news for the people of Wanganui. In order to provide “Better, Sooner, More Convenient” health services in their town, their hospital will close wards on weekends. The Taranaki District Health Board has announced cuts in future mental health services and cuts in the provision of health services for Māori. I have not yet heard Māori Party members raising concerns about that, but, given their representation in Parliament and their close proximity to the National Party, I look forward to one of them taking a call tonight.

This is not about moving resources to the front line or having better support for health staff; this is just about cuts to front-line services and front-line staff. When I asked the Minister of Health whether he no longer thought that doctors and nurses were front-line staff, and whether he did not think that home support workers, community services for the elderly, X-rays, mental health services, and emergency departments were front-line services, the Minister said “What an odd question.” But X-rays are being cut by 10 percent at Timaru Hospital. That fact was denied by the Minister this afternoon, proving yet again how poorly he is keeping on top of his portfolio. Hospital wards are being closed on weekends, mental health services are being cut, and the emergency department at Timaru Hospital has decided to see 5,000 fewer patients. I asked that question because I want it to be on the public record that the commitment given by Mr Ryall and the National Party prior to the election—that there would be no cuts in front-line health staff or in front-line health services—is a lie. It has been demonstrated to be a lie by the cuts that have been signed off by the Minister himself. At Timaru Hospital there will be 5,000 fewer patients at the accident and emergency department, 200 fewer operations every year, and a 10 percent cut in the number of X-rays. The Minister of Health wrote to that district health board and said he was strongly supportive of those plans to cut front-line health services and staff.

I am grateful for the opportunity to speak in this important estimates debate. The John Key - led National Government can be absolutely, justifiably proud of these estimates, in the way that this Government has regarded health as a priority and cemented in funding of $3 billion over the next 4 years. That is an absolutely clear example of how the National Government has regarded health as a priority and stuck to its election commitments.

We have just heard a rant from the Hon Ruth Dyson. There is something I will never forget prior to my coming into this Parliament, and that is the spectre of none other than a former health Minister, the Hon Annette King, saying that it was criminal to have a waiting list of 89,000 people. That was before the dismal legacy of 9 years of the previous Labour Government. She said that a waiting list of 89,000 was criminal, yet waiting lists almost doubled under Labour. The lists almost doubled, and when they got as large as that, Labour scurrilously culled them by devious methods, thinking that it could fool the people of New Zealand. However, that certainly did not happen.

The legacy of the Labour Government in health is even worse, because we all know that it spent and it squandered. It spent more, and it squandered more, and it built up a bureaucracy that enmeshed it in an ever-increasing tangle of inefficiency. The work that has been done on health productivity clearly showed that under Labour there was minimal or no growth in productivity. Labour’s legacy is dismal, and it is inappropriate for the Hon Ruth Dyson to suggest that the National Government has not committed itself to efficiency in the area of health and to prioritising health services to ordinary New Zealanders as being absolutely important.

There is a tremendous amount of good news when it comes to the health sector, and I want to speak for a moment or two about some of the areas that have not been talked about so often that were announced in these estimates. First of all, I refer to the maternity area, which is an area that in many respects was neglected under the previous Labour Government. There is $40 million extra in resources for increased birth rates, and $38.5 million for longer stays in birthing facilities. For the last 10 years women up and down the country have said to me that they were being forced out of hospital when they were not ready. There has been little choice for women who desperately want to stay in hospital, or at least to have the choice to stay in, so the National Government has committed to an extra $38.5 million in that area.

Then, in terms of support services for parents, there is $14 million for a 24/7 PlunketLine telephone advice service and for other advisory and information services to support the Well Child Framework. Who was it who stopped PlunketLine? It was none other than the previous Labour Government. It is an iconic service that New Zealanders trust, and none other than the previous Government cut its funding. So it is great that the new National Government has restored funding for PlunketLine.

There is also funding of $9.9 million for an extra visit to the general practitioner or lead maternity carer in each trimester for mothers or babies at risk. This is a classic example of putting in money where it is desperately needed to ensure that early intervention takes place. If ever there was a basic law in obstetrics, it is to ensure that early intervention is secured.

This year, 54c in every dollar of personal tax goes towards health care. The growth is scary. Two years ago, only 41c in every dollar of personal tax was required to pay for health care. In other words, in 2 years the figure has increased by 13c in the dollar of what we pay in personal tax.

Saying that the figure is 54c in every dollar of personal tax can hide what it really means. Let me explain. Someone who earns the minimum wage pays about $2,500 every year for health care. Someone who earns the average wage pays about $6,000 every year for health care. People say that health care in this country is free. It is not free. To me it seems that health care has never been more expensive. Health care is not free; it costs each of us. When health care costs a person on the average wage $6,000 every year, one would hope that it would at least deliver. Yet it does not deliver, and I want to know what the Minister intends to do about it.

Despite the enormous cost of health care, we ration it. Sick people are placed on a waiting list. While they are on the waiting list their health gets worse, and in some cases they even die. The suffering that takes place while people are on waiting lists is rationalised away, especially under a Labour Government, and by the Greens in particular, as if the goal of equality justifies denying health care to people who are in desperate need of it.

The most pernicious effect of socialised medicine in this country is the creation of a group of second-class citizens. It does that, firstly, by having a bizarre mixture of subsidies; some things are fully subsidised and others are not subsidised at all. Secondly, it allows pressure to be applied to the system in order to get treatments performed. For example, if people can appear on television—on a programme like Holmes—no doubt they will get their treatment. But if people are not in a group that can bring special pressure to bear, then they will suffer on the waiting list. The third way that we create second-class citizens is due to the fact that the wealthy can afford to pay twice via health insurance. So we have a situation in this country whereby the very people who miss out on health care are the very people whom universal health-care is supposed to help. While the poor die on the waiting list, the rich and the influential get treatment. No one would seriously say that the system treats people equally.

The solution offered to the problem by every party in this House, other than ACT, is the same. That solution is to throw more money at the problem. In 2 years we have increased the amount of money that goes into health care from 41c in every dollar we pay in personal tax to 54c in the dollar. Where will it be in another 2 years? Will it be 67c in the dollar? Is that really a system that is sustainable? Of course it is not. People say we can solve the problem by allocating more money, but that is nothing more than snake oil.

The great poet and philosopher Virgil expressed one of those universal truths that reminds us that health is a basic human right. He said “The greatest wealth is health”. For the Māori Party, that wealth will be demonstrated in our people being healthy and living longer. It will be seen in the evidence that whānau Māori have access to quality health-care within a culturally competent health sector. Progress in health will also be evident in the strength of relationships between health professionals and whānau. It is about realising whānau health needs and about enabling whānau to take control of their own health and well-being.

We come, therefore, to the estimates for Vote Health with a focus on whānau ora, one of the seven priority areas for action identified by this Government. That, in itself, is a great start. We want to commend the Government on its approach to Influenza AH1N1. The health sector responded swiftly to the threat of swine flu and that was due, in many ways, to the fact that as a nation we were already well down the track about how to respond to a pandemic as a result of the strategy developed for avian influenza. We want to make particular note on the way in which Māori health providers have responded to the challenge. I am told that Māori providers have accessed Māori resources at a higher rate than general resources, which indicates to me that those providers are out there, doing the mahi, and getting information to our whānau. We endorse the positive comments of the Health Committee on this area and would add only that it will be a great day when we see this same level of commitment and responsibility taken for other areas approaching pandemic proportions such as obesity, diabetes management, TB, or chlamydia.

The report then drills down into health sector priorities. I want to make it quite clear from the outset that we are concerned at the possible insecurity around future funding. The indication from the Minister of Health that funding may not increase in out-years is concerning, as it could cause a significant reduction in outcomes right across the health sector. Although we support the injection of new funds into areas such as hospice care, maternity care, and Healthy Homes, we want to encourage a whole-system approach in which primary health care remains of utmost importance.

It is our firm belief that high-quality, comprehensive primary care makes a significant contribution to whānau ora. We know that improving the physical well-being of an individual will be less effective if it takes place in isolation from his or her whānau. Social, cultural, economic, and spiritual wellness must have equal importance if whānau ora is the goal. Every family must be given the right support to achieve their full potential, and to restore their confidence and competence to take back responsibility for achieving whānau ora. Within this, we would expect that an integrated approach across the health sector will be the most effective in creating enduring outcomes.

I want to refer to one of the district health boards within my electorate, Capital and Coast District Health Board, to demonstrate the local evidence of the importance of an integrated strategy to improve health outcomes. The June 2009 report of Primary Health Care in C&C DHB reports that this district health board has some of the lowest avoidable admission rates in the country. The emergency department attendance trends for the primary health organisation - enrolled population, including those in most deprived areas, have continued to decline since 2005. What is obvious throughout the report is that improved access to primary health care leads directly to lower avoidable hospitalisation, reduced emergency department use, and improved health outcomes. It does not get much clearer than that. Primary health care works.

When I look at the select committee report, I have to say we share very keenly the concerns around the proposed fee increase and the likely consequence that cost will become a barrier to access. The best information we have comes from the RAND Health Insurance Experiment. The RAND study was a randomised controlled trial that compared health sector utilisation amongst different groups. It revealed some key findings—namely, that fees matter, especially at the low end. The study demonstrated that the majority of patients’ responses to user charges occur with small changes. For instance, when free health-care was introduced in Britain, access increased between 10 and 16 percent. A similar move in Montreal led to a 21.8 percent increase in utilisation. In effect, the number of doctor visits increased just over 50 percent more when care was subsidised than for those who paid for all their care. By far, the most important finding was that children and low-income earners were more responsive to price changes than adults and higher-income earners. The reduction of the cost barrier has a marked difference in improving access for Māori, Pasifika, and high-deprivation populations, and will remain a key policy principle. Fees matter, and what we know already is that even small increases in fees have a disproportionate impact in reducing access for those who need it most.

Another key area of concern for the Māori Party is around the changes to the Healthy Eating - Healthy Action programme. I want to challenge the misconception that the Fruit in Schools programmes is all about apples and pears. Of course, the fruit itself is a vital component of change, but the fundamental difference is the energy required to create an integrated healthy school environment. All the fruit in the world will rot if there is not due attention given to health promotion, to teaching knowledge and skills to support attitudinal change, to improving the social environment of the school, and to developing meaningful links throughout the community. A health-promoting school sees the school as part of the wider community. It reaches out to promote the view that being healthy and being able to learn are closely linked. Interventions to promote healthy eating and physical activity, to prevent injury, and to promote mental health are effective when adopted in the context of a whole-school approach.

I am aware of some amazing things being done by schools in my electorate to make the difference. A typical example is Te Wharekura o Arowhenua, which is part of the Fruit in Schools programme and is a health-promoting school. They run an annual auahi kore iwi challenge, which is all about iwi getting together on Waitangi Day, celebrating healthy eating, physical activity, and being Māori. Port Chalmers School has created an edible garden to promote healthy eating while also drawing in the community to focus on their environment. So we were disappointed at the decision to focus on sport and physical activity at the expense of healthy eating and health promotion.

Finally, I want to draw attention to the very positive progress, which is described in the select committee report, in the work that my colleague Tariana Turia is advancing in whānau ora. Whānau ora is best described as supporting a whānau-centred approach that focuses firmly on the aspirations and priorities as determined by that whānau. It is about being strengths-based, enabling whānau to take the lead in managing their own futures.

In many ways, what we are seeking to achieve in whānau ora responds to some of the challenges I have laid out about the decisions made around the allocation of funding priorities in the health sector. A recurrent theme in the discussion of the most effective health investment is the need to sustain support for prevention and public health. Earlier this year Dr Margaret Chan, the Director-General of the World Health Organization, warned that we must protect health funding during the period of recession, realising that in the past social sectors have often been robbed during times of economic downturn. Primary health care must remain a priority if we are serious about health outcomes. We need to protect life and well-being, to maintain safety-net programmes to reach the most needy, to boost productivity, and to remain committed to the view that people are the ultimate target of economic recovery. It makes plain good sense—“The greatest wealth is health”.

Warm Pacific greetings. I stand to say how proud I am to have been part of a Labour Government that moved to reduce disparities, particularly for Māori, Pacific, and low-income people in our country. It was responsible for a number of very positive programmes in schools, including Healthy Eating - Healthy Action and Fruit in Schools.

I will continue the theme I touched on in the general debate this afternoon, and that is care for the elderly. I quote a headline in the Southland Times: “Home support faces razor”. We all know that Tony Ryall’s razor is not blunt. That media release also pointed to the local regional manager’s response to try to meet deficits. He said that “reductions were most likely to be where the board funded domestic home help to elderly …”.

It is very important that actions follow the rhetoric. The Government said that it will move health services to the front line, yet some district health boards state they will make cuts to home-based services for the elderly. It is very clear that these cut-backs will be disastrous, particularly when so many elderly rely on these services to maintain a measure of independence in their own homes. The Minister of Health, Tony Ryall, promised to improve front-line services, but it has become increasingly clear that the current Government does not see home support services as being front-line or essential. Our senior citizens deserve to be treated with dignity and respect—not as a drain on resources, which is clearly the message being sent by these district health boards and the Minister of Health.

Financial arguments for reducing home-based support services are critically flawed. Providing support for people to stay in their own homes will always be a less expensive option than providing residential accommodation 24 hours a day, 7 days a week. Our elderly deserve to be treated with dignity and respect. Sixty thousand of them receive home-based support, and 28,000 are in residential care.

I sought the support of my Labour colleagues last month and this morning to request a Health Committee inquiry into the quality of care for older people, to ensure that older New Zealanders receive appropriate access to health services both in the community and in residential care. The inquiry would have also encouraged greater public participation by families, medical professionals, churches and faith organisations, caregivers, and the wider community. The inquiry would have also ensured that there was greater transparency, it would have taken a good look at the costs and benefits of different models, and, more important, it would have ensured that we in society can collectively address the present and future care of our elderly.

No one is immune from accountability; we are all accountable. We, like our elders, are human beings. We all want to be assured of the facts and the right information. The bottom line is that our elders are safe, are well cared for, and are supported in the community or in residential care. It is really important that we ensure we do everything possible to meet the needs of our elders. We all understand resource constraints. Our elders have contributed—and they still do—and our job is to reciprocate.

The inquiry would have ensured that Government funding, which is in excess of $700 million, targets the right services, and that our elderly receive the most appropriate health services at the right time. Why did National members of the Health Committee vote down my two motions to conduct an inquiry into the quality of health care for older people? What have they got to hide? Where is the transparency?

As I said earlier, it is the responsibility of the Government to look after the welfare and well-being of our citizens. Our elders are a major vulnerable group. It is only right that their contribution be reciprocated and that they be supported and thanked for their contribution to building our society and economy, and to defending our nation. For the Government to say it is shifting resources to the front line, only to then cut home-based services, is wrong. Our elders and senior citizens deserve better, and we as a nation are better off as a result of their contribution.

I congratulate John Key and Tony Ryall on making a real difference to people’s lives. There is much I could talk about in Vote Health. I could talk about Labour’s legacy of the health of the district health boards and their projected deficits. I could talk about elective surgery under Labour, which did not keep up with population growth. Or I could talk about the severe workforce crisis in the health sector, with critical shortages of doctors, nurses, midwives, and some specialists. I could also talk about National’s announcements in health and what we are doing in the eating disorders area. I could talk about how the Government has asked the Nursing Council to work with district health boards and the Ministry of Health to expand the training role of enrolled nurses in New Zealand, which is one way that that very important group can play a stronger role in nursing care.

Rather than that, I will focus on National’s policy to fund 12 months of Herceptin. To briefly recap, over the last term of Parliament the debate around Herceptin had a high profile. In early 2006 New Zealand was first out of the blocks, becoming the first country to provisionally register 12 months as a treatment, but then progress stalled. Although 12 months’ Herceptin treatment became the international standard of care, with well over 30 countries funding it for their women, Pharmac became focused on a Finnish trial that looked at only a very small number of women and a 9-week treatment regime. Subsequently, in early 2007 Pharmac committed to the Synergy or Long Duration trial, an international trial comparing 9 weeks with 12 months of Herceptin. Later, in July that year, 9 weeks became publicly funded. In mid-2007 eight women sought a High Court judicial review of Pharmac’s Herceptin decision, with the result that in April 2008 the High Court directed Pharmac to consult again on its decision not to fund 12 months of Herceptin. Pharmac declined to change its decision. In October 2008 National announced its policy to fund 12 months of Herceptin. The decision was not made lightly.

Progress to be reported presently.

House resumed.

The Chairperson reported the Road User Charges Amendment Bill with amendment, and progress on the Appropriation (2009/10) Estimates Bill.

Report adopted.

The House adjourned at 9.56 p.m.