Financial Review Debate — Ministry of Health

It is a pleasure to participate in this debate. In the last couple of days the Government has told us that health and education are safe—health and education are safe. As the “slash-and-burn Budget” comes before the country in May, the Government tells us it is OK because health and education are safe: money will be redirected to the health system.

The truth is that the health system is operating in significant deficit. We know that before the last Budget, just for health expenditure to stand still, we needed to see an investment of $555 million or $600 million. That amount was needed just to stand still, but that investment did not come from this Government. This Government under-invested by $150 million. Programmes in public health and primary care were cut as the district health boards—pushed by the Minister to look at his manufactured targets and meet his slogans rather than the actual needs of the communities around them—were getting in there and making sure that those targets and league tables were met while primary care and public health were let go and under-invested in.

This year—I know I can talk only a little about current operations—we will see a hole in the health budget of around $700 million. Mr Key and Mr English have told us that there is only $600 million to $800 million for everything in health and education. Mark my words: we will be back in this Chamber debating a Budget that will show a cut in health spending. Government members will say more money is going into health, but everybody involved in the health system knows that health inflation, an ageing population, and the increasing costs of buying equipment because GST has gone up—all of those things—mean that just to stand still in the health sector it will take $600 million or $700 million. This Government will not be making that investment; this Government will be making cuts.

This Government has lost its focus on the core part of the health system. As my mother would say, prevention is better than cure. But the Minister of Health is not interested in prevention; the Minister is interested in looking good with his targets and charts that say that he managed to improve elective surgery, even though the Auditor-General’s report on elective surgery, which we await with interest, might actually be telling a different story about how people get their surgery.

I will leave that issue to one side. We have reviewed the district health boards’ performance and we have learned that they are following the money. They are following the Minister’s targets, which means public health and primary care are being cut back. Everywhere I have been in New Zealand since I have been the spokesperson on health for Labour—from Wanganui to Rotorua to Nelson—I have been told constantly that the cuts are coming in public health, primary care, and mental health. That is a problem for the future of New Zealand. Although the Minister’s priority might be to look good in the health portfolio and have a nice colourful chart, the priority for New Zealanders is affordable access to quality primary care. That is not happening at the moment.

That is not happening when it comes to after-hours care. When I was in Rotorua I was told by a doctor the story of somebody ringing his clinic just after 5.30, wanting advice about whether they should bring in their child. She said that if it was after-hours and the cost was going to be $40 or $50, then she would not bring in her child. The doctor said that she had better come in. When they came in the doctor found that the child was potentially suffering from meningococcal disease. If that mother is deciding whether to take her child to the doctor on the basis of how much it costs rather than how sick her child is, then there is something wrong in our system. The Minister needs to take some responsibility for what is wrong in our system.

People in Queenstown are paying $102 to take a baby to after-hours care. That is wrong.

💬 Hon Tony Ryall: That’s not true.

They are. That is exactly what they are doing. Someone on the Kapiti coast is being charged $41 to take a 20-month-old to get a cut lip repaired at 5.30. That amount represents 20 percent of that family’s grocery bill. Something is wrong. That person asked me whether Mr Ryall wants her to go to the emergency department at Wellington Regional Hospital. Is that what the Minister wants? It is the wrong priority to send people the signal that primary care and public health are not important.

The National-led Government continues to grow and protect the public health service in New Zealand. The Government continues to grow and protect the public health service in New Zealand as we move public money into the areas of priority. In the last 2 years, under this National Government, we have employed over 500 extra doctors and over 1,000 extra nurses in our public hospitals, and we are close to having a thousand fewer administrators. We are employing 500 extra doctors, 1,000 extra nurses, and close to a thousand fewer managers. We are also investing very heavily in the New Zealand health service. We put in an extra $750 million with our first Budget, keeping up with population change and inflation. Last year we put an extra $512 million into health, keeping up with population change and ageing, and using the benefits of reprioritisation within the health service.

We are delivering for New Zealanders. Every week 400 extra New Zealanders are getting elective surgery, compared with any week under the Labour Government.

💬 Hon Steve Chadwick: It’s all about counting.

The member says it is how we count it. Four hundred extra people are getting operations. Labour members do not like that. The more they do not like it, the louder they get. We are also treating more and more patients faster than previously in our country’s emergency departments. People will remember that on the North Shore and in many parts of the country, old people used to languish for 3 days on end on hospital trolleys under bright, fluorescent lights. North Shore Hospital was described as the weeping sore of the public health service. This Government pushed aside the Labour lackeys in Waitematā and put money into a new emergency department—$50 million that Labour said no to. We said yes, and we are speeding up the emergency department in Waitematā.

What is more, we are providing cancer radiation treatment for New Zealanders. When the party opposite was in Government it was not unusual for New Zealand women to be sent to Australia for radiation treatment, and they were waiting 12 to 13 weeks. We had women Labour Ministers of Health defending 13-week waits for treatment for breast cancer. Women Cabinet Ministers were defending that situation. In the last quarter not one patient who was ready for treatment waited more than 6 weeks. In fact, right now most are being treated within 4 weeks.

We are also investing very heavily in preventive health. We have the highest number of 2-year-olds being immunised in the history of New Zealand. Here is my favourite bit: do members remember the Labour Government’s plan about closing the gaps, which became about reducing disparities? The Labour Government never did anything about the gap between Māori and the rest of the community in immunisation. We have closed that gap under a National Government. What is more, we have invested hundreds of millions of dollars in a home insulation programme that has benefited over 80,000 New Zealanders. The programme is having a real impact on the health of a lot of low-income New Zealanders. The health ministry put $25 million—members should wait for this—a year into that home insulation programme, and Labour members described that as a cut to the health budget. We put $25 million of health money into the single most effective public health initiative in this country in the last 10 years, and Labour called that a cut to the health service.

What is more, the timid party opposite put the price of smokes up by 10 percent once in its 9 years in office. It put up the price of smokes, with a 10 percent increase, once in 9 years—once in 9 years. We have done that three times in 20 months. Doing that three times in 20 months resulted in the single-biggest increase in the price of smokes in the history of New Zealand. Those members had one 10 percent increase in their very first year in office, hoping that no one would remember it, but we have put a 30 percent increase on the price of smoking in 22 months. What is more, let us remember the Labour members saying: “We have a little smoking-cessation medicine here.” We have provided more people with more choice and with more smoking-cessation medicine than ever before.

That was a fantastic amateur dramatic performance there from the Minister in the chair, the Minister of Health. The Whakatāne amateur dramatic society has never looked so good. The Minister is failing to remember something about a couple of the issues he raised: firstly, closing the gaps. I remember National telling us that closing the gaps was a racist policy. That is what National told us, but now the Minister stands up and proudly says that his Government has done it. That is selective memory from the Minister.

It was selective memory from the Minister on smoking, too, because I know that that Minister and all, bar two, of his colleagues opposed every measure that the Labour Government tried to bring up on smoking. I ask Mr Ryall who opposed the Smoke-free Environments Act. Did Mr Ryall oppose that? Mr Ryall opposed that bill. “Old Smoky” over there, Associate Minister of Health Jonathan Coleman, opposed it as well while he was blowing cigar smoke all over people. This Government has no creditability to lecture Labour on smoking cessation, because those members opposed all the measures that our Government put up. Labour stands proud behind people like Steve Chadwick, Annette King, and Helen Clark, who brought those measures into play.

Mr Ryall seems very concerned about the notion of patients going to Australia. He seems very concerned about the notion of patients going to Australia—other than the fact that, of course, under National, cancer patients did go to Australia—but I will tell members whom Mr Ryall should actually be worried about going to Australia. He should be worried about doctors and nurses going to Australia. There has been a 300 percent increase in the number of doctors going to Australia in the last 2 years.

💬 Hon Parekura Horomia: 500 doctors?

That is what he said, that is right. That is what he said. But actually, a 300 percent increase in the number of doctors going to Australia is the move to Australia that the Minister should be worried about. It is all smoke and mirrors with this Minister. It is manufactured targets, it is being able to show off his little league table, but the reality is that for people on the ground, health care is now less affordable and less accessible than it was previously, because this Government has decided to focus on its cheerleading targets, rather than on the actual needs of people in New Zealand.

We have to remember that the cuts that have come have come to some of the most vulnerable people in our community, such as the cuts that have come in aged care. People have been called on the phone and asked “How are you feeling?” and at the end of the call they have received a cut because they have said they are feeling OK. My constituent’s father, a 92-year old war veteran, was called up and asked over the phone how he felt, and had his home care cut, and a neighbour found him on the ground several hours after he had a fall in his house—because his home care was cut by this Government. That is the kind of cut we have seen under this Government.

We have seen cuts here in my region of Wellington to programmes in sexual health and community mental health. Organisations that have worked for years in mental health and community mental health have had their funding cut by this Government. Because the Minister does not have a target for mental health, the district health boards look somewhere else. The Minister does not have a target for public health, so the district health boards look elsewhere. This Minister likes to shove the problem off to other people.

💬 Hon Annette King: Where did the 500 doctors come from?

Yes, and we would like to see evidence of the 500 doctors who were magicked up from somewhere by the Minister. But the problem for this Minister, and the problem for this National Government, is that the affordability and accessibility of health care have declined under this Government and will decline further in the future, as the amount of money needed to go into health is simply not being invested. This Minister might be able to throw his arms around in the air and tell us, in his dramatic style, about all the wonderful things that he has done, but the truth is that on the ground, faced with an increased cost of living and the inability to put a healthy meal on the table for many people—because it is now too expensive—people are making choices on the basis of how much money they have about whether they and their family can access primary care. That is not the New Zealand that I want to live in. I want to live in a New Zealand where people know that they can get quality health-care and that cost is not a barrier for them. Primary care, public health, and prevention should be the priority; sadly, from this Minister, it is manufactured targets and slogans.

There are New Zealanders out there who are saying this Government is out of touch. They are saying this Government is out of touch with what ordinary New Zealanders need and New Zealand’s health system is going backwards. The Government must be out of touch with ordinary New Zealanders, because the Minister in the chair, Tony Ryall, the Minister of Health, is completely out of touch with his own party’s stance on tobacco cessation and tobacco control in this country. He got up and said the Labour Government had been timid when it came to smoking cessation and trying to reduce the number of people in New Zealand who smoke. But it was his party, the National Party, that railed against everything that the Labour Government did when it was in office to curtail the number of people in New Zealand who were smoking.

💬 Hon Tony Ryall: Once.

It was not once; it was on the Smoke-free Environments Act, it was on the increase on tobacco excise, and it was on a whole range of measures right through the 9 years that the Labour Government was in charge. The National Party voted against every single one of those measures.

Now, because the Māori Party has managed to get one little thing out of its coalition deal with the National Government, Tony Ryall suddenly turns round and says—

💬 Hon Annette King: That he’s in favour.

—he is charge. He is in favour—

💬 Grant Robertson: Closing the gaps.

He is closing the gaps; that is right. He has had his road to Damascus moment. He has turned round and said the National Government is interested in smoking cessation. We know the truth; New Zealanders know the truth. If the Māori Party was not involved—and I have to give this to the Māori Party—National would be doing more to make sure that the tobacco companies had their way, and more people would be taking up smoking. That is the truth about this Government.

I tell members that what people are really worried about is the cost of living. As the cost of living continues to go up, as this Government adds GST to people’s food bills and lets car registration and ACC costs go up, people are becoming more and more worried about the cost of living. The reason they are so concerned about the cost of going to see the doctor is that that has gone up under this Government, as well. The cost of seeing the doctor is going up, and what is really appalling is the outrageous cost of going to see the doctor after hours. People in Auckland and Wellington are being charged up to $100 for after-hours care. In Queenstown it can be as high as $139 just to go and see the doctor. For children under 5, who are supposed to have free access to primary care in this country, the cost can be as much as $102 if they happen to live in Queenstown.

It is an outrage that the National Government has let those costs skyrocket and made it very much harder for hard-working Kiwi families to get to the doctor or to get their kids to the doctor. Sometimes, if we are adults, we can wait and we do not have to go to the doctor after hours, but when it is our children—when it is a 2-year-old, a 3-year-old, or a 4-year-old—we want to get them straight to the doctor. We want to get them dealt with straight away, because it can be a very scary time for parents when children are ill, their temperature is going up, and they are showing signs that something could be seriously wrong. If we are adults, we can handle that and deal with it. We might take an aspirin and go to see the doctor on Monday. But we never ever want to do that with our children, and that is why the Government should be doing more about the cost of primary care. It should be rolling up its sleeves and doing something for Kiwi families. It should be making sure that there are no barriers to access to primary care because of its cost, which this Government has allowed to explode.

The Minister got up and crowed about the $750 million extra that the Government provided in its first year and the $512 million extra in its second year. Well, $750 million was simply a continuation of the funding track that the Labour Government had put in place, and $512 million was actually the first cut, because the Government needed $750 million just to tread water, basically—just to maintain current services. The first cut was $512 million, and the Government is forecasting more and more cuts over the years to come. That will mean there will be more and more cuts to front-line services: the kind of cuts we have already seen to mental health, to diabetes clinics, to primary care; the cuts that we are seeing right across the country. I say to the Minister in the chair that people are feeling the effect of that, and it is real to people.

This is what ordinary Kiwis are crying out for: they want their basic services to be retained. That is not what this Government is delivering. It is all about smoke and mirrors. It is all about pretend targets that the Minister makes up, with no substance behind them whatsoever. He says there are 500 extra doctors, a thousand extra nurses, and a thousand fewer administrators. I ask where the evidence is. He will not answer the Official Information Act requests that our spokesperson has put in. He will not put it on paper.

Report noted.

Ministry for the Environment