Financial Review Debate — Ministry of Health

I am delighted to be able to speak in the debate on the Appropriation (2008/09 Financial Review) Bill on the financial review of the Ministry of Health. I will mention in this debate the new language that has come to the fore when we consider what is happening in the health system. When we look at the services that people are currently receiving that are being cut, when we look at the impact of the budget restraints that the Minister of Health is personally imposing on district health boards, and when we look at the lack of support that the Minister is giving to the key sector leaders throughout the health system, we see there really is a big change.

The new language of health, which the Associate Minister Jonathon Coleman repeated today, is extraordinary. We do not have cuts in health services; we just have “changes” in health services. Well, he should tell that to the older people in Otago and Southland who are currently receiving 1 or 2 hours’ home support a week, which enables them to have quality of life and to be able to stay safely in their own homes in Dunedin or Southland. I say the Associate Minister should tell them that the letter they have just received, which says they will no longer receive that home support, is not about a cut in health service, but is just about a change. A big change for them is that if they want to have that home support any more, if they want to have help with their laundry, meal preparation, or house cleaning, they will have to pay for it themselves. That is the change for them, but from their point of view they know what the Minister and the Associate Minister have really been saying, which is that this is not a change but a cut.

In the same way, the nurses at Nelson Hospital know that the cuts in staff numbers in Nelson’s public hospital are not a change but a cut. The chief executive has been directed personally by the Minister of Health to stop filling any vacancies in nursing positions. What did the Minister promise New Zealand before the 2008 election? He promised that there would be no cuts to front-line services. We cannot get someone who is more front-line than a nurse in a public hospital. The nurses are now speaking out publicly, saying patient safety is being put at risk. Patient safety is being put at risk in Nelson Hospital because the Minister of Health has told the chief executive to leave vacancies unfilled. So we have fewer staff, but the same number of patients is in the hospital. Nurses are now calling on overworked doctors to help them out, and this is all about cutting costs and services, which puts patients’ safety at risk.

The good people of Horowhenua will be very interested to hear Jonathon Coleman, the Associate Minister, say the cut of 24 patient beds at the Horowhenua Health Centre is not a cut in health services. The centre has only 24 patient beds, and 24 beds are being cut. Taking away 24 patient beds is being called just a change.

This is the new language of health that Tony Ryall and Jonathon Coleman are trying to ram down the throats of the public of New Zealand, but they are not having a bar of it. We know, particularly as we look through the details in this financial review, that those are not changes in health. They are cuts to front-line services and are hurting hard-working New Zealanders. Frankly, the most upsetting are the cuts to the services for older people. They have given their lives in the service of our country, either in paid employment or in raising their families, often serving our country overseas and literally putting their lives on the line for the good of the country. When older people need just 1 or 2 hours a week of home support to keep them safe and living, with that little bit of support, in their own homes, they are told that they will just have to pay for it themselves. That is not good enough, and it is certainly not what the older people of New Zealand deserve. Just to cap it off, though, the older people who live in Southland, which is the Minister of Finance’s own electorate, have been told that not only is their home support being cut but also there will be a 6-month waiting list for their rest home. That is not good enough for older New Zealanders.

It is quite clear that one of the reasons the last Government was thrown out of office was that the public no longer trusted it to manage the health service. That is absolutely true. That is what happened. Over 9 years, the previous Government failed to deliver elective surgery and failed to make a difference overall to service provision for New Zealanders, and it was found out.

You know, it is very interesting; that member just got up and talked about the new language of the health sector. Well, I have a document here, published under the previous Labour Government, that talks about programmes being reprioritised during the Vote Health October 2008 reprioritisation. Of course, that was not a cut; it was a reprioritisation! So when that Government took $10 million from the interim funding pool for people with disabling chronic medical conditions, oh no, that was not a cut; that was a reprioritisation! I think that it is very, very difficult for that member there, Ruth Dyson, to speak with any credibility in this Chamber on matters of health, when she is so badly—

💬 Hon Ruth Dyson: We didn’t cut services.

She says they did not cut services. They took—

💬 Hon Steve Chadwick: And that Minister brought in changes in immigration policy—

And now this member wants to talk about immigration, and not health; it has got too hot for them. Quite frankly, I tell members, there is no credibility. Ruth Dyson brought up the matter of the old people of Invercargill. We inherited a massive problem left behind by that previous Government, but we have put a lot of new money into Otago and Southland—$28 million. The fact is that because of that previous Government’s mismanagement, we are in the situation where we have to make some real changes. This is not a new problem, because I can tell members that when Minister Hodgson was faced with this very issue back in 2006, I note that he took pretty similar action. He wrote at that time to Chester Borrows, when faced with making changes to the household management services for 304 elderly people under Whanganui District Health Board, and said “DHBs are expected to provide services within the limits of their budgets. Whanganui DHB, as well as other DHBs, must prioritise which services to fund. As a consequence, 304 people assessed as low-need will no longer receive household management services funded by Whanganui DHB.” So that is exactly what the previous Government did. Apparently it was absolutely—

💬 Hon Ruth Dyson: Every one of them had an assessment. Tell the truth for a change—tell the truth.

You see, she is saying now that I am not telling the truth. We cannot get any more truthful than this letter from Pete Hodgson. That member there, Ruth Dyson, is having to resort to unparliamentary language, because she has been completely caught out. She has had to get personal on this stuff; she has no credibility on health. Labour members had 9 years to handle it, and they failed. So if all they can do is come in here at question time or in debate and say “Oh, you guys are doing exactly what we did but now it is a cut, and when we did it, it was a reprioritisation.”, it is no wonder they lost the last election. I think, personally, that they need new people here. They need a new spokesperson on health—

💬 Hon Trevor Mallard: I raise a point of order, Mr Chairperson. It is a relatively simple point of order. This is, I understand, a narrow debate, unless there has been a reinterpretation of it to talk about things that are general political issues and not related. I think I have been in the Chamber for probably 3 minutes, but have not heard reference to a particular item under review. It seems to me that the debate seems to be certainly outside what used to be allowed in it. If we are allowed to have something very general, the Opposition would support that. But if that were the new ruling from here on in, I am not entirely sure that the Minister of Education would support it.

The CHAIRPERSON (Eric Roy): In response to that, I tell members that it is a somewhat difficult issue for me to contain everybody exactly inside the rails. But I think that by and large the debate has been pretty much on track. Although the Minister did not often refer to the financial reviews regarding health, he did spend some time responding to some comments made by the Hon Ruth Dyson. But I think the reminder is timely. I wish we could keep this debate tightly constrained, but both sides have erred somewhat—well, it is more than sides; the whole spectrum of the Committee has been involved. But it is a timely reminder.

Of course, it is an old technique that if one is losing the debate one tries to break it up. But we are used to that sort of thing. That member, Trevor Mallard, is one who should be leaving, as well. If members would like to discuss the financial review aspects—

💬 Hon Trevor Mallard: Put a cigar in your hand.

You see, he is getting personal. They are losing; these guys are losing: they are losing with the public, they are losing in the Chamber. Mr Mallard is another who definitely should be going. But we are quite happy to have him here, because the more he talks, the better it gets for us.

I tell members that $536 million of new money is going into health. There is more money going into health than ever before. There is more elective surgery being done—

💬 Hon Members: Oh, rubbish.

There is; those members cannot deny it. We have put more money into health than any other Government in the past, and we are delivering services: 12 months’ treatment with Herceptin, and more elective surgery than ever before. Quite frankly, I tell members, the public wanted a focus on the services they needed, and they are getting that. The public are happy. The big reasons for which this Government was elected were to manage the economy, to make people feel safer at home, to get the health service right, and of course to deliver on national standards in education. We have made some promises; we are firmly delivering on them. When we look at what else has happened, we can see that we have firmly tackled the workforce crisis, which is probably the biggest single aspect of the health care system that needs fixing. We are making more places available. We have introduced a voluntary bonding scheme. We are focusing on getting the money directed to the services that the public need, and that will be our overwhelming emphasis.

Kia ora, talofa lava, and warm Pacific greetings. I stand to speak on the Appropriation (2008/09 Financial Review) Bill with a heavy heart and with sadness as I reflect on this National Government, which continually uses rhetoric and nonsense over logic and common sense, and which labels cuts as changes.

Let me prepare a snapshot of some of the changes; we are talking about the impacts on our families, our communities, and our elders out there in the community. In March 2009 the Taranaki District Health Board publicly signalled that its hospital was preparing for cut-backs. In April 2009 the Southland District Health Board and the Otago District Health Board confirmed they were cutting home-based services in order to reduce costs. The boards were looking to make savings of up to $10 million by reducing home-based support for the elderly. In May 2009 their anti-obesity, oral health, and mental health targets were cut. National took $2.3 million out of cancer controls in Budget 2009. It has slashed the “Get Checked” Diabetes Aotearoa budget by $4.8 million each year. It has cut $3 million from the cardiovascular disease budget, and mental health services have also had their funding cut.

In June 2009 the Whanganui District Health Board said that it would be closing hospital wards at weekends to save money on nursing overtime. The Fruit in Schools programme, which currently provides 100,000 children with fresh fruit each day, is under threat. In July 2009 the South Canterbury District Health Board said that it would be reducing the number of patients seen in its emergency department by up to 5,000 people a year. In August 2009 there were cuts to elderly care in South Canterbury. Rest home care limits have annoyed general practitioners, and Dunstan Hospital has reduced community, physiotherapy, and disability home support. In September 2009 $2 million was cut from mental health services in Nelson’s mental health funding. In October 2009 there were home support cuts for the elderly in Canterbury. I quote from the Christchurch Press: “Man, 83, offers to clean shower with foot”.

In November 2009 a total of 12.5 nursing positions were chopped across Palmerston North Hospital’s main surgical, medical, and child health wards. In December 2009 a survey showed that spending was down on general practitioner visits, and on surgery. Research commissioned by Southern Cross Healthcare found that the number of people who visited their general practitioner when they felt unwell fell from 64 percent in 2008 to 56 percent in the following year, and senior doctors voted overwhelmingly to focus on achieving a pathway to try to better conditions. In January this year Mary Bourke, a district health board member, was candid about the accident compensation squeeze. She said “So effectively, madam chair, what we are talking about here is that ACC is trying to cut down on its costs by shoving its responsibilities on to someone else?”. More than 1,200 Canterbury elderly have had their home help hours cut or reduced since the new assessment service, and we have numerous stories in part of my electorate, the Mana electorate, where home-based support cuts are being assessed via the telephone. We have heard these stories all over the country. What is really disturbing is the anxiety and stress that is caused. For example, in my electorate of Mana 24 percent of Kapiti are over 65 years old, and people are worried. If we look in terms of the elder example we see that we are actually talking about over 28,000 people in rest home care and over 60,000 people who receive home-based care. It is cheaper and much more cost-effective to continue to give that little bit of support to enable our elders to continue to live independently and in their own homes.

At the end of the day, this particular group is very important to our society because they hit us at a personal and intimate level. They are our parents, they are our grandparents, and they have contributed to and built society. Is that the sort of reciprocity we want? At the end of the day, it is sad to see a lot of programmes that Labour embedded, and which needed more time to continually produce the achievement levels they were already showing—

Thank you for the opportunity to speak on this very important financial review. I must say that I am very proud to be able to speak of National’s record in health.

💬 Hon Steve Chadwick: Really?

We see the Labour Opposition and we look at its record. Labour members were the very ones who when in Government culled tens of thousands of patients off the waiting lists—tens of thousands of patients. That was a bad record, and that record is very well evidenced. In sharp contrast, in this financial year over 129,000 elective operations have been carried out. That is 11,800 more than in the previous year.

💬 Hon Member: How many?

It was 11,800 more than in the previous year, and many thousands more than in any of the previous 8 years under the previous Labour Government. One of the things that distinguished the Labour Government was the dismal productivity in the health sector. That was borne out very clearly by a series of papers written by Treasury. After all, Labour injected money into it but there was no evidence of an increase of output, clearly shown in the area of elective surgery and clearly shown when Labour culled—not reprioritised; it culled—tens of thousands of patients off the waiting list. So when we have this Labour Opposition talking about cuts, it just has to look back at its record, which was a particularly dismal one when it came to health.

One of the things I think is important to emphasise is that the health system that Labour had put in place was totally inappropriate in terms of the duplication, and the poor local, regional, and national planning and performance right around the country. That is one of the great achievements that occurred with the formation of the new National Health Board. It is indeed providing the leadership required to manage that $9.7 billion that funds the 21 district health boards. It is indeed extraordinarily timely.

It is important also to comment on the significant report, called “In Good Hands”, to guide district health boards in introducing greater clinical leadership into the public health system. Clinicians, doctors, and nurses throughout the country have absolutely unanimously considered that this is the very sort of thing that should happen after 9 years of being shunted out of front line services in the New Zealand health service.

One of the other very interesting things that happened recently was the publication of a simplified health target system. Under Labour we had target after target, we had strategy on strategy, and Labour members just did not know where they were going. I note in the Dominion Post just this morning that the editorial, “Public comparisons boost performance”, said “One thing is for sure in the wake of the publication of Health Ministry statistics comparing the performance of 80 primary health organisations. Total Healthcare Otara, the PHO with the poorest record of immunising two-year-olds, will be taking immediate steps to improve its performance. Public ignominy is a powerful motivating tool. So it should be. The release of the data highlights yet again the benefits of comparing the performance of organisations doing essentially the same job, whether they operate in the health sector, the education sector or any other area.”

That was one of the problems of the previous Labour Government. It was not transparent, it created huge bureaucracy, and it failed to bring evidence out into the public. Here, we are seeing before us one of our major papers saying that this is good. In education they have baulked at it, but the health fraternity is saying: “Yes, this is great.” The district health boards have lauded it and so have the primary health organisations.

Report noted.

State Services Commission