Financial Review Debate — Ministry of Health

In an end-of-term review of the New Zealand Government’s actions on five major health risk factors undertaken by the University of Otago department of public health, the scorecard of this Government, in its first term, is woeful. There were five top health risk factors that were assessed in the health portfolio. They go in descending order of importance, and the first one was tobacco use. The summary around progress on that one was “Some progress, but gaps remain which need to be addressed if substantive progress towards the smoke-free nation goal is to be achieved”. It says further: “there are unresolved issues around achieving the smoke-free nation 2025 goal, notably the lack of any coherent strategy or milestones for achieving this goal.”

The second risk factor that was at issue in this report was alcohol use. The report card says: “Some limited plans for legislative reforms that do not adequately utilise major interventions such as alcohol tax”. That is hardly a ringing endorsement of achievement in that area.

The third one was high blood pressure, and that received a “No progress” result: “No progress on reducing salt intake”. It further says: “This inaction is problematic given the many international studies suggesting how cost-effective interventions to reduce salt intake would be …”. So not even the cheap things have been done by this Government.

Another is high blood glucose. Well, we have just had diabetics lined up outside Parliament today, furious at the possibility that they will be required to use an inferior blood glucose meter because of Pharmac’s provisional contract with Pharmaco to be the sole supplier of these critical devices. But even when it comes to high blood glucose, what is the scorecard on the Government’s performance in health? “No progress on improving nutrition and mixed progress on supporting enhanced physical activity”. They go on to say: “Others have reported on the lack of a national strategy to address obesity and that in NZ ‘population approaches to reduce the burden of obesity have been systematically cut in the last 3 years; for example, the National Healthy Eating Health Action Strategy is no more, Mission On has disappeared [a physical activity programme], and the requirement for schools to provide healthy food has been abolished.’ ”

This Government’s record in the health portfolio is not coming up to scratch. It is not passing. The fifth area was about overweight and obesity rates, and the comments were exactly the same as the previous comments on high blood glucose. In other words, there was no progress. This is an appalling indictment on what this Government has done in the health portfolio.

But even more important than that, if we go to immediate data—the data of the last year or so that is under consideration—it is clear that New Zealand is experiencing, under this Government, increasing levels of inequality, higher rates of child poverty, worse levels of housing provision, and the consequent health risks that attend each of those factors.

Another report that came out was from Otago University’s Michael Baker. The New Zealand Child and Youth Epidemiology Service said hospital admissions of children with serious bacterial infections doubled from 210 for every 100,000 children in 1991 to 451 in the meningococcal epidemic in 2001. That fell back to 377 by 2005 after the epidemic was contained. How was the epidemic contained? It was because a Labour Government saw fit to invest in that meningococcal immunisation programme. But admissions have risen again since then, since this Government has been in power.

It is an absolute pleasure to be speaking on the financial reviews 2010-11, because under this National Government there have been some great gains in health, which unfortunately the Opposition spokesperson, the Hon Maryan Street, has just failed to notice. Of course the health targets are an absolutely classic example of where they are. Firstly, let us have a look at the list.

Immunisation, of course, has been an absolute gain of the highest order over the last 3 years. Three years ago only 70 percent of under-2-year-olds were immunised. Today 92 percent are, and we have almost got 95 percent being fully immunised. That is a huge achievement in health promotion and disease prevention.

To add to that, the National Government has instituted the rheumatic fever scheme, which again should have happened under the Labour Government. All it did was talk about it for 9 years, but the National Government has actually instituted this programme.

Three or 4 years ago the average wait in emergency departments in this country was over 6 hours. Today, 92 percent of patients get through emergency departments in under 6 hours. District health boards like Waitematā District Health Board, where under the Labour Government we heard stories of patients wallowing in the corridors for 24 to 48 hours, have just recently reported that 90 to 95 percent of them get into the wards, or get discharged, in under 6 hours. That is another tremendous achievement.

Let us go to the issue of radiation therapy. I vividly remember that under the Labour Government, only 4 years ago, cancer patients were being sent to Australia because the waits in New Zealand were 3 months, 4 months, 5 months, and 6 months. That was absolutely shocking. Today, we have the gold standard therapy whereby every radiation patient is being treated in under 4 weeks. That is another tremendous achievement under this National Government.

We can go on. Eighty-nine percent of hospitalised smokers are given help and advice to quit.

💬 Hon Maryan Street: What about helping them before they get to hospital?

That is an incredible achievement. We have Maryan Street saying that nothing has been done. This is the first Government to put in, year on year, significant increases in tobacco tax, which we know is one of the most effective ways to diminish smoking in this country. Indeed, it is working.

But let us just have a look at some of the other achievements. Now, 27,000 extra people are getting elective surgery every year since the National Government came into office 4 years ago. That is another remarkable achievement.

We do know that health systems around the world are characterised by almost infinite demand and finite resources. What we do know is that a Treasury study in 2006 showed no increase in productivity under the Labour Government in the health sector, despite it increasing the vote by billions of dollars. Last night on TV we heard that over the last few years there has been an increase in productivity in the health sector by 5 percent year on year.

💬 Hon Phil Goff: That’s right. Across 2007.

This was in anticipation of the National Government. It is great to hear that finally this is being carried on, because after all we heard in 1999, in the advice to the incoming Minister of Health, that the greatest gains in health would come from health promotion, disease prevention, and the integration of primary and secondary health. Nothing had happened under that Labour Government year on year, other than spending more money. We have established some absolutely great examples in immunisation, in the rheumatic fever programme—

Can I thank those members who have contributed to the debate thus far. Can I knowledge particularly the chair of the Health Committee and thank him for the contribution that he makes and the advice that his committee has delivered both on the report on the financial review but also more generally. The fact is, as the member rightly pointed out, the last year has seen significant additional achievement in the area of health. During the time that this Government has been in office—

💬 Hon Maryan Street: Depends what you measure. Depends what you want to measure, Peter.

—$1.5 billion extra spending has been allocated to the health sector. I heard the member—and I will come to her point shortly—say many times, by way of interjection, “What about prevention?”. I agree with her. Prevention is important, but so too is providing effective care for those who have moved beyond the stage of prevention. That is why we have seen 800 extra doctors employed in hospitals, and over 2,000 more nurses. That is why we are seeing new elective theatres being developed: to make sure that people can see real, tangible progress and that some of the more fundamental and basic health concerns that arise can be dealt with effectively.

There was an interchange during the debate about the tobacco policy. Dr Hutchison rightly pointed out that during the last year we have seen significant increases in the excise duty, which, we all know, will have a significant and profound downward impact on the level of consumption. We are also seeing now about 90 percent of hospitalised patients being given help and advice to quit smoking. My colleague the Minister of Justice reminded me, as she left the House after her estimate was being considered, that during her time as the Minister of Corrections prisons were made smoke-free and around 6,000 prison inmates who were previously smokers had to confront giving up that particular habit. So when the member says that nothing much has been done, I would say, in response, that a considerable amount has been achieved.

There are a number of other areas in health where great progress has been made. Over the last 3 years there has been a $180 million increase in funding for Pharmac. What that has seen is some of the more difficult and rare cases in the areas of some of the cancers, diseases like Crohn’s disease and Alzheimer’s disease, are now getting the medicines that are needed to be able to give people a better standard of living, a greater opportunity for the future, and also some real prospect.

All of this is being achieved against a background of two important things. The demand for health services in the Western World is insatiable. No matter what the level of provision, people rightly and understandably are going to demand more. As the march of technology increases, that is going to increase as well. We are operating against that general backdrop but also in an environment of the greatest economic crisis to hit the world since the Great Depression, where every dollar has to be managed with care, where every dollar has to be really scrutinised in terms of the value it achieves for the spend involved. I think it is great that we now see, against that backdrop, over 90 percent of patients who report to emergency departments are discharged within 6 hours. It is great to see people who require radiation therapy are getting gold standard, world-class treatment within a 4-week period. It is great to see the immunisation targets being increased and achieved. It is good to see that we are getting a reduction in a lot of the duplication and wasteful and inefficient expenditure in back-office services, and much more concentration, collaboration, and working together to achieve positive outcomes.

I am delighted—and again I come back to the prevention theme that the Labour member spoke of—that we are seeing the extension of the free care-hours for under-sixes, and that we are seeing, also, the extension of the number of children able to get the B4 School check. That is early intervention of the highest order. We are seeing more Well Child home visits for at-risk mums. Again, it is a positive benefit. There is always a long way to go in health. People demand better services all the time. But this Government, and this administration, has seen dramatic improvements in the status of the health of New Zealanders over the last 3 years. I acknowledge the role of the Minister in leading this, and I acknowledge the contribution of his colleagues in helping him achieve it. New Zealanders’ health is in good hands.

Report adopted.

Ministry of Education