Estimates Debate — Vote Health

It is a pleasure to rise and take a call on the estimates for Vote Health. The estimates for Vote Health did not get off to a great start for the Minister of Health. The Minister’s press statement from 19 May, after the Budget came out, told us that Budget 2011 was delivering an extra $2.2 billion to public health services over the next 4 years, including an additional $585 million in initiatives in 2011-12. Well, that turned out to not be true. In this House—over a period of days, admittedly—we were able to draw out from the Minister that in actual fact the $585 million additional in this Budget was not so; it was $420 million additional and $165 million worth of money that has been cut from elsewhere in the health sector. Sadly, this is typical of this particular Minister’s approach—the smoke and mirrors and the manufactured targets. No, the reality is that $165 million of the so-called $585 million additional is, in fact, money taken from other parts of the health sector. It was a bad start for the Minister when it came to these estimates.

When the Minister arrived at the Health Committee to go through the estimates, we had to ask him to give us a little bit more information on where some of these cuts were coming from. In fact, in particular, there was the question of the $61 million of unspecified cuts to the public health budget. The Minister was asked to provide some information on that, and in the transcript from the hearing the Minister was, peculiarly, unable to tell us what those $61 million worth of cuts were. He could not actually define them. He had a bit of paper in front of him, but he really did not know what it meant. Basically, he had no idea of what he was cutting. There was $61 million going from public health, and he had no idea what he was cutting.

💬 Hon Member: He thinks it’s funny.

He thinks it is hilarious. Well, that is good, because the other thing that the Minister said in the exchange that we had with him was that he would provide us with the detail and the explanation behind each of those cuts. Well, here is a question for the Minister in the chair, the Minister of Health: why has he not provided that information? He told the select committee he would provide the information. He has not done that. The select committee was forced to write to the Minister last week to ask him to do what he said he would do at the select committee, which was to tell the committee where $61 million worth of funding cuts have been taken from in public health.

It is simply not on for a Minister of the Crown to not know where $61 million worth of funding cuts are coming from, and then compound that by refusing to tell the select committee where the cuts are coming from and not providing the information. Now the select committee has written to the Minister, and as of today we still do not have a reply. That is how little this Minister cares about the accountability in this portfolio to say where this money is coming from.

To take that much money out of public health has an impact. The Minister gets up at conferences around New Zealand and tells people that he believes in prevention and he thinks we need to take a preventive approach, and we must invest in making sure that people do not get sick. Yet his budget and these estimates take money out of public health. The Minister was at the same seminar I was at, when Sir Michael Marmot came from the UK, and we sat there all day—well, some of us stayed for the whole day. We listened to, and heard from, all the experts within New Zealand in this area and from Sir Michael himself about the importance of investing in early intervention, in prevention, and in making sure people stay healthy. But, that is not what this Government is doing.

What this Government is doing is focusing on the Minister’s manufactured targets within things like elective services. This Minister is saying—

💬 Dr Paul Hutchison: Immunisation.

The member on the other side of the Chamber says “Immunisation”. That is absolutely great. That is excellent. That is carrying on the good work that was started under the last Labour Government, and we can all be pleased about that. But district health boards focusing more and more on trying to meet the Minister’s manufactured elective services targets means that funding disappears from other areas. The Minister might say “Oh, well, these are the nanny State health promotion ideas”. Well, that is not true. Not only are they the preventive measures that keep people healthy, but also the services that are being cut on this Minister’s watch are front-line services.

I am very pleased to be taking part in this estimates debate on Vote Health, and I would like to congratulate the Minister of Health on his leadership in this portfolio. Vote Health was the biggest recipient of Budget 2011. It was one of the few areas to receive a modest funding increase, which will be paid for by making efficiencies in other Government departments. This continues the Government’s election pledge to continue the growth of funding to the public health system. Budget 2011 is delivering an extra $2.2 billion to public health services over the next 4 years, including an additional $585 million in initiatives in the coming year.

I would like to particularly focus on three areas: medicines, rheumatic fever, and maternity services. The Budget included $80 million for wider access to medicines, and it is expected that around 32,000 patients in the first year will benefit from this extra funding. Together with the extra $100 million for medicines in the last 2 years, this means that this Government has invested an additional $180 million in total.

Despite the serious economic environment, the Government has continued to invest new resources into health to meet our commitment to a strong and enduring public health service. This is in contrast to the approach taken by several Governments around the world that have slashed the funding of their public health services in response to the global financial crisis. In 2008 we made an election commitment to lift the pharmaceutical spending per head of population, and the extra $180 million will bring us up from $163 in 2008-09 to $174 per head of population in 2011-12. This means more patients are benefiting from community medicines and cancer treatments. In terms of the number of medicines funded, under this National Government we have seen the most intensive programme of medicine investment since Pharmac was created in 1993.

This Government has acted on rheumatic fever. In the 2011 Budget $12 million has been allocated towards this debilitating disease. Māori and Pacific people, most of them children, living in cold, overcrowded homes are most likely to get rheumatic fever. They are 20 times and 37 times, respectively, more likely to be admitted to hospital for the first time for acute rheumatic fever than anyone else. It is a Third World disease and we need to eradicate it from our country. It has been a health priority since 2001, but nothing has ever happened except that more children contracted this disease. This $12 million investment in the Budget this year is aimed right at rheumatic fever and will support a massive campaign across high-prevalence communities, involving school-based sore throat clinics for over 22,000 children.

It has been a long time since I practised as a general practitioner, but the Minister of Health showed us in the Health Committee the throat swabs that will be used for these programmes. I had not appreciated that they are actually on-the-spot throat swabs that are taken of children with sore throats, and they show whether they have strep throat. If they have strep throat, they have an antibiotic and that is it. If they do not have strep throat, they do not need to have an antibiotic. I had not realised that technology had advanced in the time since I left general practice. I am delighted that we have this programme, which will make a real difference to children in those communities.

Rheumatic fever is a terrible disease. It can lead to heart problems. Basically, it is a crippling, chronic illness with a terrible outcome for children, who need to have monthly, painful injections of penicillin, and they have a terrible outlook. This is a fantastic programme. It is long awaited—it has been waiting since 2001—and this Government is doing something about it.

Budget 2011 has new initiatives for maternity services and to help new mothers and babies. The Budget provides an extra $33.2 million for maternity services over 4 years to improve safety and quality. A further amount of $21.3 million will boost Well Child services, with particular focus on first-time mothers. The additional funding is expected to deliver an extra 54,000 visits to about 18,000 mothers who need this additional support. For these mothers, this will mean, on average, three additional Well Child visits up to the first 2 months of a baby’s life. The extra $33 million announced for maternity services includes $18 million to improve the safety and quality of services for mothers and babies.

To carry on from where we were, I say that front-line health services have in fact been attacked under this Government. The Minister of Health likes to stand up in this Chamber on a regular basis and tell members that it is all about moving services to the front line. Well, I ask the Minister, what could be more front-line than a mental health clinic—an addiction clinic for young people? What could be more front-line than that in addressing services? Yet that is exactly what has just closed in the Nelson-Marlborough region. That is exactly what has just closed in the Nelson-Marlborough region. It is right here for the information of the Minister, if he would like to read it. That clinic has closed because of the pressure that this Minister has put on district health board budgets.

Although the money that has gone into district health board budgets has increased slightly, the increase is nowhere near enough to keep up with inflation. The chair of the Whanganui District Health Board told us in the Wanganui Chronicle that there was no way the board could keep providing the services that it was expected to provide, with the money that was coming from the Government. It has simply not been enough to keep up with inflation, and the cuts are coming. They are coming in front-line health services, they are coming in youth health services, and they are coming in sexual health services. They are coming in all the areas where New Zealanders rightly expect that there would be front-line public health services. The pressure is now going on district health board budgets, and non-governmental organisations that are providing the services are having to cut back their services. That is all happening on the watch of a Minister who likes to pretend that more money is going into health and that more money is going into front-line health services, when the tragic reality is that it is not.

When we go around regional New Zealand, we see the impact of this. If we go to a place like Taihape, we see that the hospital is gone—closed. The hospital in Hāwera is under threat. But, no, the Minister comes in like a white knight there and says he will not cut a service if the community does not go along with that. I tell Mr Ryall to go to Rangiora. That community did not want its after-hours services to be cut, but they are gone. But, no, the Minister did not ride in like a white knight there; the after-hours services have gone. [Interruption] The Minister says that is the doctors’ fault. That is the problem with this Minister: he wants to wash his hands when the services are cut, but it is his Government’s underfunding that means that things like that happen in Rangiora.

In Hāwera the Minister said he would ride in there. But he will not do so around the rest of the country, because this Minister is underfunding the entire sector.

💬 Aaron Gilmore: If this member was the leader of the Labour Party, it wouldn’t be at 27 percent in the polls.

The member on the other side of the House could do with going to Rangiora, talking to the people there, and seeing what they feel about the cuts to after-hours services. He could do with going to the Kapiti coast, talking to Linley Williams, and seeing how she felt about paying $41 for her 2-year-old to go to an after-hours clinic. He could go and see the community services card holders in Ashburton who were charged $73 for an after-hours visit.

New Zealanders deserve to have access to affordable primary health care. New Zealanders deserve to have preventive health services that will help to keep them healthy, and they deserve some honesty from the Minister. They deserve the Minister not to get up and say he was delivering $585 million extra for health, when the truth is that that is not what has happened. Money has been recycled around, the pressure is going on key programmes, and this Minister is not being upfront with the New Zealand public about the impact that this will have on health services.

There is another thing in the estimates that the Minister may care to respond to. Why is it that when we look out to the capital budget for the next 2 or 3 years, we see that it almost disappears? The Auditor-General’s office wanted to know why that money just about disappears. Is all the building over? There is an urgent need to build hospital buildings around New Zealand in the next few years, and the money for that is simply not in these estimates.

Once again, the numbers are smoke and mirrors in these estimates. This Minister is trying to mislead the New Zealand public about the investment that is going into health. We need to have investment at the primary health care end. We need to ensure that there are quality secondary services available, and we need to ensure that health gets the investment that it deserves; not what the Minister wants to pretend to us. For a Minister to come to a select committee, to come to an estimates hearing, and not be able to tell the committee even where the cuts are coming from is disgraceful. But, what is more, a Minister who then refuses to respond to the committee when it asks to get that detail is a Minister who is not giving the New Zealand public what they deserve in the area of Vote Health. In Vote Health, New Zealanders know that there is not a bottomless pit.

It is an absolute pleasure to take a call in this estimates debate regarding Vote Health. What a shame it is that Grant Robertson has turned into a shroud waver, when in these estimates we signalled that $585 million extra will be put into health—

💬 Grant Robertson: No, there weren’t.

Dr PAUL HUTCHISON:—absolutely; $585 million extra will be available for health. This is a great credit to the Minister of Health, Tony Ryall, who since 2008 has managed to get $1.2 billion extra put into health. [Interruption] The Minister tells me it is $1.5 billion. That is an absolute indication of how the National Government is prioritising health as being very important for New Zealanders and is delivering. What we remember over the last 9 years was a total lack of productivity in health, but a total increase in bureaucracy. That is what happened under Labour. Now we are starting to get results.

It was very rich to hear Grant Robertson talk about health prevention, because under this Government there have been some outstanding achievements. One just has to go to the immunisation rate. In 2007 only 75 percent of 2-year-olds were fully immunised. Now the figure is 90 percent.

Progress to be reported presently.

House resumed.

The Chairperson reported the Misuse of Drugs Amendment Bill with amendment and progress on the Appropriation (2011/12 Estimates) Bill.

Report adopted.

The House adjourned at 9.56 p.m.