Crown Entities Reform Bill

It is a pleasure to stand again and speak on the Crown Entities Reform Bill, which is an omnibus bill that seeks to responsibly resolve a number of inefficiencies and missed opportunities within the State sector. The bill is a responsible reply to the very real concern of too much government doing too little for the people. I think we said in the second reading yesterday that this is a case of not so much reducing the Public Service but, in fact, increasing the service to the public from Government departments.

Government is at its best when it can move effectively and efficiently. There are some things that only government can sensibly do, but not when its body is struggling to stand from carrying the weight of duplicated overheads, small, siloed organisations, and that sort of thing. So the structural changes planned in this bill will result in better services. The changes have not been made lightly. The benefits of this reduction of State sector fragmentation have been proven through the consultation process. I think we will find very quickly that—like other agencies that have had amalgamations and been brought together—a synergy develops that enhances the agencies’ activity and enthuses their staff and executives.

The Crown Entities Reform Bill was referred to the Government Administration Committee on 4 October last year under the previous Government. The committee received and considered 43 submissions, as well as receiving advice from the State Services Commission, the Ministry of Health, and the Department of Internal Affairs. Throughout the process the focus was on ensuring the future viability of the services and creating a better State sector. I think this is the important aspect of this particular bill. This bill, I think, accomplishes these goals.

I acknowledge there are differences of opinion on the timing of one section of the bill, but that is on the timing. From my understanding, through the select committee work, the concern was not a matter of resistance to that section but just a matter of timing. I am sure we can debate our way through that and come to a sensible sort of arrangement.

The creation of a new Health Promotion Agency to enhance the functions of the Alcohol Advisory Council of New Zealand (ALAC), the Health Sponsorship Council, and related functions of the Ministry of Health is a much-needed development. It will be applauded by the sector. It will strengthen the focus on health promotion activity by transferring existing health promotion activity in the Ministry of Health to a focused health promotion entity. That will create more opportunities for innovative and targeted approaches to those people and communities with multiple health issues. This is not a faceless organisation; it is one with true focus.

The bill will bring forward the disestablishment of the Mental Health Commission, which was structured only for a certain time.

💬 Grant Robertson: That is in Part 2. Are you in Part 1?

Would you like me to restrict my comments to Part 1?

The CHAIRPERSON (H V Ross Robertson): I certainly would, Mr Auchinvole. That is what the debate is about.

I am very happy to do that, because that gives us more opportunity to give emphasis to the aspects of this bill that are so important to us. The Health Promotion Agency, for instance, will be looking after the activities of the Alcohol Advisory Council. One of the concerns about that was that the money that is currently collected for the advisory council would be distributed over a wider front. In fact, that is not the case. It is ringed, it is fenced, and it will be dedicated to alcohol educational work.

💬 Grant Robertson: Ring-fenced, or ring and fenced?

Pardon me? It’s a what? What did I say?

💬 Grant Robertson: Is it ring-fenced, or ring and fence?

💬 Hon Member: That sounds like torture to me.

No, no. The change on the part of the Government’s programme is to ensure that the State sector delivers the front-line services that New Zealanders expect in the context of a challenging economic climate.

Do you know, I am always somewhat surprised to come and hear the debates, following the work in the select committee, because in reality—and I think it is important that the public of New Zealand knows this—there is a lot of harmony in select committees in terms of seeking the best from the bill, and that was certainly the case with this one. It certainly received a lot of support from the people who made submissions.

While we are dealing with Part 1, let us just look at the key points associated with the changes. Part 1 will reduce the current back-office governance duplication incurred by separate entities. ALAC’s independent, evidence-based advisory function is retained—

It is my pleasure to relieve Mr Auchinvole from that arduous task of trying to address Part 1 of the Crown Entities Reform Bill. I would like to speak to Part 1. This is the part that the Labour Opposition is most supportive of, and in fact I anticipate that we will support this part of the bill. We cannot say the same for other parts, but we will support this part of the bill. It is the part that establishes the Health Promotion Agency by amalgamating the Alcohol Advisory Council (ALAC) with the Health Sponsorship Council. Although a number of submitters to the Government Administration Committee established some reservations about that—especially folding ALAC into another organisation at a time when Parliament and New Zealand are acutely focused on the issue of alcohol harm and what we can do to reduce our alcohol-related harm—most submitters were supportive of the establishment of the new Health Promotion Agency. It is a single agency that will focus on public health initiatives and the promotion of health and well-being. I note that one of the amendments that the select committee made to the bill was to add the words “and wellbeing” after the word “health”. I think that was a wise amendment by the select committee. In fact, a Health Promotion Agency should be about maintaining, encouraging, and fostering the conditions for healthy lifestyles for good overall well-being in a population.

I notice that a lot of the rhetoric that goes with this piece of legislation is that it is New Zealand’s first attempt, I suppose, to implement the Ottawa Charter. Kevin Hague spoke about this a little last night. It is an aspect of the Ottawa Charter, but I think it is a very limited one. It certainly does not, by any stretch of the imagination, implement the entire Ottawa Charter. This is the health promotion part of the Ottawa Charter, but the Ottawa Charter also talks about the environment, the community, the public health policy settings, and the fact that that goes beyond the health system and it goes beyond what we do in hospitals and doctors’ surgeries—indeed, what we will do in the Health Promotion Agency. It goes into all the other policies and decisions that Governments make, such as whether we should have more pokies in our community, such as whether we should get rid of programmes like Healthy Eating - Healthy Action, which support good nutrition and physical activity amongst our young people. In that respect, I think that some of the Government’s changes that it has made over the last 4 years are somewhat counter-intuitive. Although we absolutely support any intention to implement the Ottawa Charter—and this is part of it—in so many other ways the Government has actually run in a completely contrary direction to what the Ottawa Charter actually suggests. I do not think the Government can congratulate itself all that much on its efforts to implement, or even adhere to, the principles of the Ottawa Charter. That is really what a lot of the submissions on Part 1 were about.

People were concerned that the amalgamation of these organisations might take the focus off the efforts to reduce alcohol-related harm, and of course a lot of the efforts to reduce alcohol-related harm are to do with the environment in which alcohol is available and the environment in which alcohol is consumed. In that respect, Parliament is regarding the Alcohol Reform Bill, which many of the submitters to this piece of legislation argued was not as strong, as robust, or as forthright as it could be. That is a debate that we will have on another day. The Cancer Society submitted that part of the Health Promotion Agency’s core business should be addressing the issue of alcohol sponsorship, in the same way as the Health Sponsorship Council was originally established to address tobacco sponsorship. That is certainly an issue that I would like to see the Health Promotion Agency consider in the future. That issue is how do we look at adjusting the environment in which alcohol is, I suppose, perceived, not just by young people but by all people in New Zealand, and the way that alcohol is so closely related to the sponsorship of sports and other community organisations? I think particularly of students associations, and the close relationship between the alcohol companies and the students associations.

💬 Grant Robertson: Very close.

Very, very close; you are right, Mr Robertson. I think that that should certainly be part of the Health Promotion Agency’s core functions, which of course are established here in Part 1.

The other aspect that I would like to touch on briefly in Part 1 is the question of the ALAC levy, which of course will continue, more or less in its current form, except that the levy will now go to the Health Promotion Agency. But this legislation sets out the parameters under which that levy can be spent, and it will be hypothecated directly into alcohol-related activities and alcohol harm reduction activities that the Health Promotion Agency will be carrying out. A number of submitters, particularly the Smokefree Coalition, submitted to the select committee that there was an opportunity to go down the same pathway for tobacco, and to have a hypothecated tobacco levy that could be used for health promotion activities that reduce the harm related to tobacco. I know that the select committee considered this, and ultimately rejected that proposal, and certainly it is something that requires far more consideration than would be available if a member was to put up a Supplementary Order Paper in this debate. It is certainly not something that I propose, but I think it is an idea that has merit and ought to be considered. Perhaps the Health Promotion Agency could consider and report back to the Minister and to Parliament about the possibility of introducing a tobacco levy that is analogous to the alcohol levy, specifically to be used for health promotion activities.

We know that there is already a considerable excise tax, and we have heard in the media that the Government is considering increasing that again tomorrow, when it announces the next Budget. However, although that is considerably larger than the amount of money that is already spent on health promotion activity, the costs associated with tobacco use are not solely to do with health promotion activities. Of course, most of the costs related to tobacco use come from the cost of the disease, the cost of lost productivity, and the cost of hospitalisations and care for people who end up getting smoking-related diseases and suffering from smoking-related diseases. That cost is significant, and many people would argue that it actually outweighs the excise tax amount that is taken. So that is an option. It is not in this bill, and I am not proposing it as a Supplementary Order Paper, but I do recognise that the committee gave some consideration to this, and I hope that it is something that Parliament can come back to at some point in the future.

As I said, overall, with some reservations, the Labour Opposition is supportive of Part 1. We look forward to seeing the Health Promotion Agency engaging in a range of health promotion activities, to reduce not only the economic costs associated with the burden of disease but also the social costs, particularly those diseases which are utterly preventable: the diseases associated with alcohol, the diseases associated with tobacco, and the diseases associated with poor nutrition and poor physical activity. Those are the diseases that will be the greatest burden on the health system in the years to come, and those are the diseases that we have an opportunity to step in and do more about now. The Health Promotion Agency is just a small part of that. This needs to be something that the Government considers across all its policies. I reiterate our concern on this side of the Chamber that many of the policies that have been introduced by this Government over the last 4 years run absolutely counter to the concept of maintaining healthy lifestyles, and maintaining well-being across the population of New Zealand. If the Government is not prepared to do more in that policy sphere, then we are going to burden the health system with unnecessary costs, we are going to burden society with unnecessary disease, and that, I think, is a very short-sighted and unfortunate approach.

It is a pleasure to speak on this part of the Crown Entities Reform Bill. As I indicated in the second reading debate, Part 1 is the one part of this bill that the Green Party will vote for and support, but for different reasons from those advanced by Mr Auchinvole on behalf of the Government. Mr Auchinvole spoke about the efficiencies of combining back offices, and I invite the Committee to reflect on the history of structural change in the health sector and the extent to which that has actually delivered efficiencies in the back office. In fact, history tells us that the reverse is generally the case, and that the structural changes that we have tended to make in the health sector, no doubt for well-meaning reasons, have tended to reduce efficiency. They have cost momentum in structures in the sector, to our overall cost. So I make the argument to the Committee that that is not a good reason for making this particular change.

What is a good reason for making the change, though, is the creation of this new entity, because combining the functions of currently separate organisations better reflects the health promotion task that they have. It moves from the fragmentation that we currently have towards the possibility of integrated health promotion action, and that is something definitely worth supporting.

I indicated in the second reading that I congratulated the Government on its bravery in bringing to the House a bill that had the intent of implementing the Ottawa Charter, and I invited the Minister of State Services, and I invite him again, to take a call to indicate that the Government will make that an explicit purpose in the bill, because I think the bill would be enhanced by that. It would remove any confusion that might exist.

I spoke yesterday about some of the origins of the health promotion model, and the fact that it is a socio-environmental model of health. It actually says that the health status of populations depends largely on their level of empowerment and control over their life circumstances and the environment that surrounds them, not only the physical environment but also the social environment. If we want to improve the health status of populations, those are the things we need to tackle.

The Ottawa Charter sets out a five-piece formula for doing so. It says we need to promote healthy public policy, we need to create supportive environments, we need to strengthen community action, we need to develop personal skills, and we need to reorientate health services. If we were to walk into any district health board public health unit around the country we would see a poster on the wall indicating those five action guidelines, because they have become ingrained in health promotion practice in New Zealand. The interesting thing about those guidelines is that none of them is specific to the health sector. Sorry, the reorientation of health services is, of course, but those other four action guidelines are more generic, reflecting, as Iain Lees-Galloway has just been speaking about, the fact that many of the factors—probably most of the factors—that influence a person’s health status and a community’s health status lie outside of the health sector. This new agency, the Health Promotion Agency, will succeed only if the Government’s intention that it implement the Ottawa Charter is reflected in its power to influence policy outside of the health sector itself. That will be a crucial element in the success of the organisation.

The second point I want to make about that is that none of those action guidelines is specific to a particular illness or a particular cause of ill health. Indeed, one of the accepted parts of our understanding of health promotion is that if we take that formula, if we empower communities and create supportive environments around them, the consequence of that will be the improvement of the health status of that community not only in a particular health indicator or disease state but across the board. What that says is that when we go about improving the health status of a community, we will improve not just one particular thing.

I used to work, as many in the House will know, for the New Zealand AIDS Foundation. The formula that we eventually found to be successful was the health promotion formula. Although our concern was improving HIV infection rates amongst gay and bisexual men, the health promotion formula of improving the empowerment of that community and improving the social, legal, and physical environment that surrounded that community actually produces health gain in all indicators, not only that one indicator of HIV status. That is why it is such an advance to bring together agencies that are currently working apart from each other, in a fragmented way, on particular health issues or disease state issues into a single agency. What that agency will now be able to do is to concentrate and focus on the factors that are leading to disease and poor health status across all indicators, not just single indicators.

I certainly encourage the new agency to work in that way—to take the opportunity that is provided for it and to integrate health promotion practice. It is going to be critical to success, and for it to be able to do that it is also going to need Government support to work in that integrated way. It will not be able to succeed to the extent that is possible if it has a Government that is focused not so much on the health of communities but on preventing a particular disease. So that understanding is going to be crucial not only to the agency itself but to the Government masters of that agency. I invite the Minister to take a call to express his Government’s commitment around that crucial element.

I think it is also important to say, and this is another particular advantage of this approach, that in addition to improving health status across all of those indicators, a health promotion approach such as the Ottawa Charter sets out and which this new agency will be empowered to implement will also produce gains in other sectors as well. The very same factors that drive poor health status and so see disease clustered in particular communities across our country, those very same factors of disempowerment, marginalisation, and poor physical and social environments around those communities, also drive poor educational outcomes. They also drive poor outcomes across any sector we care to name. Implementing the Ottawa Charter approach will produce not only great health outcomes but better educational, social welfare, justice, and every other sector outcomes. That is something that we need to celebrate.

The Green Party will be voting to support this bill. We believe that the bill would be strengthened if the Government were to add to it a specific commitment to the Ottawa Charter rather than having the community and the agency itself relying on the expressions of support in this debate for its mandate on those grounds. We look forward to a Government that gives the agency sufficient rein and licence to be able to do that work properly. We expect that that agency not only will be able to influence outcomes in the health sector and right across the sectors that are managed by the Government but also will gradually take on the function of funding health promotion work that is currently undertaken by the ministry. That is yet another way that health promotion practice in this country can become better integrated, and that is precisely the outcome that we seek.

It seems a little unusual to stand up and join in the love fest that we have here on Part 1 of the Crown Entities Reform Bill, because it seems that most parties in Parliament will support it. It is an unusual feeling for me to be able to stand up and affirm something that the Government is doing here, but, do not worry, I will get to some problems in a minute.

The first thing I want to do is to pick up where Kevin Hague left off in his excellent speech that he has just given and to indicate that there is something in this bill that shows that the Government gets the idea of what public health might be and what the Ottawa Charter means, and that is the inclusion by the Government Administration Committee—and presumably with the agreement of the Government members, if they were awake during this bit of the select committee—of the phrase “and wellbeing” within the functions, duties, and powers of the Health Promotion Agency under new section 58 in clause 6. The inclusion of well-being indicates that we are now moving beyond the notion that this is somehow a medical matter to the fact that this is a wider issue of public health and a wider issue of the well-being of our communities.

Kevin Hague spoke earlier about what the core elements of the Ottawa Charter are and the fact that it does move beyond health and well-being to the question of the empowerment of communities and to the question of the environments in which communities live. These are the core elements of what public health means today in New Zealand. I do credit the committee and, indeed, the Government for putting in the notion of well-being.

But my cynicism, and where I would like the Minister to take a call, rises in response to how the Government has looked after public health over the last 3 years. When I say “looked after” I mean cut. That is what I mean when I say “looked after”. That is what this Government has done with public health. It has certainly lowered it in priority beside other parts of the health system, particularly in terms of secondary services, and particularly when we look at something like the Healthy Eating - Healthy Action programme, which was brought in under the last Labour Government.

💬 Hon Anne Tolley: Oh God, you’re joking.

Anne Tolley says that I am joking. The system was not perfect. The Healthy Eating - Healthy Action programme was not perfect, so therefore we get rid of it completely! That is Anne Tolley’s solution to public health—if it is not perfect, get rid of it completely. That is what this Government has done. That is why on this side of the Chamber we are somewhat cynical as to whether the Government will actually provide the resources that are needed to ensure that this works.

We support the notion of the integration of these services. We support the notion that we will actually have an agency that will look at public health in its widest context. But it will achieve its goal only if this Government is prepared to give it the resources that it needs, to put resources into prevention, and to stop treating health over and over again as a political football so that Tony Ryall can hold up charts in this Chamber for targets that he has invented, rather than what is actually going to help the long-term health outcomes of New Zealand, which is investment in prevention and investment in public health programmes.

I welcome the structure here, but what I do not think we have seen from the Government is a true commitment to public health, a true commitment to what it means to actually support the principles of the Ottawa Charter. I know that many of the agencies that submitted on the bill said that they supported this, because they are looking for that better integration, they are looking for a more responsive Public Service when it comes to public health matters. But they will get that only if the resources follow.

The second question I have for the Minister is actually around what he can tell us about the current responsibilities of the Ministry of Health’s public health directorate and how that fits within this new structure. As Kevin Hague has just talked about, the integration of policy, practice, and monitoring is vitally important. We can see that the bill focuses on bringing together the Alcohol Advisory Council (ALAC) and the Health Sponsorship Council and their responsibilities, and that is good and useful, but what do we know about the actual work of the Ministry of Health? What do we know about ongoing monitoring, what do we know about how policy will work alongside in practice? I just want some assurances from the Minister that the responsibilities of the Ministry of Health in the public health area will actually be explicitly put in front of those who will be doing the work of this agency.

My colleague Iain Lees-Galloway has already mentioned that some concerns were raised about the fact that ALAC is disappearing at the very time that New Zealand is confronting what to do about the issues around alcohol in our community. I do note that the bill, under new section 58 in clause 6, does give the alcohol-specific functions to the new Health Promotion Agency. That is, at least, something. But, once again, we need to know from the Minister that those responsibilities will go on into the wider issues of alcohol, its impact on the community, and what damage it does in the wider environments in which people live. Those kinds of considerations are vitally important if we are going to get a functioning organisation under this part of the bill.

I am not going to take up much more time of the Committee on this. Labour does support Part 1 of this bill. We do believe that this structure provides an opportunity to actually see real implementation of the principles of the Ottawa Charter and real implementation of public health policy, but we sound the warning that the Government needs to assure New Zealanders that this will be resourced and funded to enable it to do its job properly, that it will be given the kind of priority that it should be given, and that it will continue to provide linkages between policy, practice, monitoring, and promotion of public health.

I recognise the member Kris Faafoi.

Thank you for recognising me, Mr Chair. It is an honour to speak on Part 1 of the Crown Entities Reform Bill. As my colleague, whom I recognise as Iain Lees-Galloway, mentioned earlier in this debate, we will be supporting Part 1, with some reservations.

Part 1 of this bill establishes the Health Promotion Agency by, essentially, disestablishing and merging the functions of the Alcohol Advisory Council (ALAC) and the Health Sponsorship Council. As I think Kevin Hague—I recognise Kevin Hague over there—mentioned earlier in this discussion, Part 1 takes two agencies that have been working in similar areas and working in a fragmented way, and brings them together. I do agree with him that this is an opportunity for the new Health Promotion Agency to have some focus, to have some clarity as to what its new function is going to be, and to work in a much more focused manner on addressing some of the issues and responsibilities that it will now have under this bill.

I would also at this stage note that we are going to be disestablishing ALAC, so I think we should pay tribute to the work that ALAC has done—and to the chair, Rea Wikaira, and the chief executive, Gerard Vaughan—for many, many years now in terms of pushing that responsible drinking message. It has already been noted in this debate that we are going to have ALAC disappearing at a time when this Parliament, our communities, and this nation look thoroughly at alcohol law reform. Iain Lees-Galloway, in his contribution to this debate, noted that there were a number of submitters who were concerned about the fact that ALAC was being disestablished at this time, and also that there were some concerns that the Alcohol Reform Bill does not go far enough, but that is a debate for another time.

The functions of the Health Promotion Agency are legislated in section 58, in clause 6, which states that it “must lead and support activities for the following purposes: (a) promoting health and wellbeing …” of our communities. As Grant Robertson mentioned earlier, that change—to insert “wellbeing”—was made by the Government Administration Committee, and I think that is a positive move. It is going to ensure that some of the proactive things that are happening with the Health Sponsorship Council and other agencies at the moment continue, and that the health and well-being of our communities is pushed in a proactive way.

Other functions of the new agency are: “(b) preventing disease, illness, and injury:” and “(c) enabling environments that support health and wellbeing …”—again, “wellbeing” has been added by the select committee. A good thing, which I think is going to stay within the functions of this new agency, is that it will still have the ability to give grants and give sponsorship to any individuals or agencies that are going be pushing the healthy living and healthy well-being issues out in our communities.

I can think of one instance that I think should be supported at the moment, as it is very timely, and that is the Smokefree Rockquest. It is an opportunity to engage with our younger New Zealanders in an environment that they may think is cool or is much more acceptable to them, and to push that message that it is not OK to start smoking at that young age and that we do not want them to start smoking. I think that is one example of sponsorship that has worked very, very well, and I am glad to see that within the confines of this bill the Health Promotion Agency will still be able to carry out that function of sponsoring and allowing grants to go to agencies or individuals who are going to be able to push those messages of healthy living, especially to our younger ones. As I mentioned, the Smokefree Rockquest is a good example of that.

The Government should not take for granted that just because we are supporting Part 1 we are supportive of mergers per se across the board.

💬 Jami-Lee Ross: Oh!

That is not necessarily the case, but in the case of Part 1—we can hear the moans and groans already—we do think the new agency has the ability to work, and as a number of members have mentioned before, it will have the ability to work if the Government backs it.

So we on this side of the House want to ensure that the commitment that the Government is making through the Crown Entities Reform Bill to establish the Health Promotion Agency is not just weasel words, and that it is backed up with resources and commitment to ensure that the community is at the centre of this legislation in terms of trying to push those healthy living promotion issues right around New Zealand. As we have mentioned before—I will not take up too much more time—we do support Part 1, with reservations. Parts 2 and 3 may be a different story, but we certainly support Part 1.

We have had some very informed debate on the Crown Entities Reform Bill so far. It is good to get it to the Committee stage. It is good to see such agreement across the House about public sector reform. I would like to compliment the members of the Government Administration Committee on the work they have done on this bill. I would also like to acknowledge the contribution of officials—people from a range of departments—in pushing through this very important legislation. I would also like to acknowledge my predecessor as Minister of State Services, the Hon Tony Ryall, who is the architect of this legislation and has put a lot of thought into it.

It is good to see that the Labour Party is supporting Part 1, despite the fact that it voted against the bill last night. Listening to Kris Faafoi, I do not think he is quite clear whether or not Labour will be supporting Part 2. I understand that it probably will be. And then, of course, we are going to have some rather contentious debate around Part 3.

On Part 1 and the establishment of the Health Promotion Agency, that is really going to give some focus to the work of that body. It is very important work, promoting health to New Zealand communities. It is interesting, though, that the Labour Party’s first response on this is to ask for more money. It is not about more money, although, in fact, I might add that this Government is putting more money into health than any Government in the history of New Zealand. But it is not about more money, more borrowing, or more people; it is about making sure that Crown entities are very focused on the work they have to deliver. I think that with this change, which is going to bring that greater focus to health, we are really going to see the benefits throughout our communities and populations throughout New Zealand, because health has been one of the top priorities for this Government. If you look at the very focused way that the Minister of Health has gone about his work—identifying what he wants to achieve, setting targets, and then delivering on those targets—I do not think you could say there has ever been a more successful Minister of Health. There is no question that health needed that focus.

We have heard some very vague platitudes from the Labour Party during this debate about health. But the fact is that when you look at what we have done around childhood immunisation rates, around programmes to prevent rheumatic fever, and around refocusing programmes that were failing, such as the Healthy Eating - Healthy Action strategy—refocusing that around exercise and getting some measurable results—you can say that the approach this Government has taken has been very focused, very specific, and is delivering results. Grant Robertson was asking where the Ministry of Health fits into all this. Well, what we can say is that the policy and the regulation, the oversight function, will still be preserved, but the programmes are moving into this new entity, and will be administered by the Health Promotion Agency.

I can say that it is great to see this unanimity across the Committee for what I think is an excellent initiative. It is great to see that. Maybe it is an early step in some of the Opposition parties really getting to grips with the concepts of State sector reform. But that has been a major priority for this Government—making sure that we can deliver meaningful results that actually make an impact in New Zealand communities. There have been tight financial times and a very tight fiscal environment. The answer is not borrowing more, it is not pouring more money in all the time; it is making sensible use of the resources you have got, setting some very clear targets, and delivering on those.

I would like to acknowledge the work that the Alcohol Advisory Council has performed over many, many years. It has been very important work that has had a real impact in New Zealand communities. That work is going to continue on. The Health Sponsorship Council has also done very important work. But with this new entity we are going to see that work continue on, and I believe that it is going to be enhanced, because, as has been acknowledged, there will be that new and intense focus.

I would like to acknowledge Kevin Hague’s commitment to public health and the points that he has made around the Ottawa Charter. I think, to be fair, few members of this House would have heard of the Ottawa Charter prior to the select committee process. But the point he made about bringing well-being into the broader definition of a public health outcome that we are striving for I think is one that is well made. When you look at that Ottawa Charter, whether or not you have heard of it, the principles embodied there are really common-sense principles that you would look for in any public health approach.

So I think it is great that we have got such broad support across the Committee for Part 1. This entity is fully supported by the Government. It is a reflection of what we are doing in State sector reform, but it is also going to produce some very valuable outcomes for New Zealanders.

I want to take a brief call to follow up on some of the comments that the Minister of State Services just made about State sector reform and how this bill, the Crown Entities Reform Bill, fits in with the Government’s wider agenda for State sector reform. I think this bill is quite different from a number of other aspects of the Government’s State sector reform agenda. First of all, it does not involve putting Steven Joyce in charge of something else, and I think that is quite rare. Most State sector reform under this Government generally tends to involve the Joyce empire growing while the other Ministers end up being underdeployed. This bill clearly does not do that. It puts some more functions under Tony Ryall’s little empire. Of course, as we know from reading in the paper, Tony Ryall does not play nicely with others. He likes to have everything under his control, in his little box.

The Labour Party does support sensible reform in the State sector. We support reforms in the State sector that make the State sector more responsive to the New Zealand public. We believe that the public sector can certainly be better and can certainly deliver services to the New Zealand public in a way that is more timely, more efficient, and more effective, and we would like to see the public sector more focused on outcomes. We do not agree that in large part the Government’s agenda for State sector reform is achieving that. It is, in fact, doing quite the opposite in many areas. It is not leading to greater efficiency. In fact, it is leading to greater inefficiency. The best example of that is the arbitrary cap on the number of people employed by the Public Service. What we are seeing is that that is resulting in a massive increase in spending on consultants and contractors. But that is an issue for another day, rather than for the debate on this particular bill.

I do just want to underline the fact that we in the Labour Party do believe in reform of the State sector. We will support initiatives to reform the State sector where they do lead to better outcomes for the public and the more efficient delivery of public services. That is why we are willing to support this part of this piece of legislation. We will talk more about further parts that we are less supportive of, but we support this particular part because there has been a call for greater integration amongst the agencies working in the public health area, and we believe that this bill will go some way to delivering on that.

I move to new section 58 in clause 6, the objectives of the new Health Promotion Agency. We think that those are good things for the Government to be focused on—promoting and encouraging healthy lifestyles. We do believe in preventing disease, illness, and injury. I think that we should think a little bit about how that last bit about preventing injury fits in the context of the Government’s other reforms. We have seen the Government, within ACC, actually taking the focus away from injury prevention within ACC. I think that one of the big mistakes of the National Government’s public sector reform agenda has been removing that real emphasis on injury prevention from ACC. It seems to stand in contrast to what this bill is trying to achieve.

I move back to new section 58—enabling environments that support health and healthy lifestyles, giving advice, and making recommendations on the misuse and harm of alcohol. Again, these are things that we in the Labour Party certainly support, and we think those are worthy roles for the Government. Of course, coming back to the first one, promoting health and encouraging healthy lifestyles, I remember not that long ago, maybe 3½ years ago, the then National Opposition coming to this House—I was not a member at the time, but I was a follower of Parliament—and decrying many of the public health initiatives of the last Labour Government as being nanny State. It said that the nanny State had no role in telling people how to be healthy. Those were the sorts of things that National members were promoting back then. I am pleased to see that they have seen the light, and they now believe that there is a role, a positive role, for the Government in promoting health and encouraging healthy lifestyles. That is something that we in the Labour Party have believed in for quite some time.

We have believed in the role of the Government in public health and in preventive health measures. We would far rather spend money to prevent people from getting ill and to make sure that people live full and healthy lives, rather than take the Tony Ryall approach, which is to focus on all of the measures of performance when things go wrong. So what Tony Ryall has done is focus the health sector so much on measures such as operations, elective surgeries, and so on, rather than on preventive measures and on public health measures, which is something that we in the Labour Party believe the health sector should be focused on. There should be far more focus on preventing illness, rather than the ambulance at the bottom of the cliff approach, which is what Tony Ryall has done. The way he has politicised the performance measures of the health service I think has been a real shame. There are elements of what he has done with the measures that I think have been good. However, I am really concerned that those measures, those performance targets, that he has put in place have distracted attention away from wider public health measures, wider public health programmes.

So I hope that this new Health Promotion Agency will go some way to restoring the balance there, and will have the support of the Government. Establishing an agency is all very well, but if it does not have the support of the Government in its activities, then it is not going to be very successful. I hope that the National Government, now having finally conceded that there is actually a role for the Government in promoting health and encouraging healthy lifestyles and preventing disease, illness, and injury, will adequately support this agency, because so many of its other policies—take preventing disease, illness, and injury and promoting healthy lifestyles—and changes it has made within schooling, within the education system, have gone in the opposite direction.

We have seen a reduction in funding for Healthy Eating - Healthy Action, the HEHA programme, in schools, which would seem to be in stark contrast to what this bill is trying to achieve. I visit the primary schools in my electorate all of the time. I think one of the really positive things that primary schools are doing is planting vegetable gardens within the primary schools, teaching kids about growing vegetables and about eating healthily. I think that is a really, really beneficial public health initiative, which is supported by the education sector, and it will lead to better longer-term health outcomes for all New Zealanders by teaching kids the value of eating healthily, and growing vegetables. There are other advantages, of course, of teaching kids how to grow vegetables. I am amazed at how many kids who, until the time when the schools started planting vegetable gardens, would not have had any idea where vegetables came from. So I think that is a very positive initiative.

The schools in my electorate all tell me now that they are struggling to get the funding to sustain those healthy eating, healthy action programmes like the growing of vegetable gardens in schools. We will pay the cost of that in the longer term if we have a less healthy student and child population. We will pay the cost of that in the long term.

Preventing disease, illness, and injury does involve the Government taking a proactive set of measures, a proactive set of actions, in a number of areas. If we are talking about disease and illness, we have to look closely at the link between disease, illness, and poverty and people living in unhealthy houses. I want to acknowledge that the Government has not done everything wrong here. I think that some of the stuff it has done around better home insulation has been a very positive thing, and something we in the Labour Party will certainly acknowledge is that having warmer, drier houses is good. However, we have still got a long way to go. In the State housing area, in particular, there is still a long way to go before we have all State house tenants living in warm, dry, healthy homes. If we are talking about getting serious about preventing disease and illness, that is certainly something that we would like to see a much greater focus on within the Government.

Finally, just to sum up on the issue of injury prevention, I do think that the ACC cuts that the Government has introduced, where it has reduced the funding for injury prevention programmes within ACC, have been a really bad step. It has taken us down a path that in my view is counter to what this bill is trying to achieve. So I hope, now that there has been a change of Minister for ACC—the letter writer is no longer there, and he is no longer in the way of making progress there—we might see ACC restore a bit more focus on injury prevention, rather than simply being the ambulance at the bottom of the cliff. Thank you.

I move that the matter be now put.

No. The member will need to learn the correct motion that will have me agree to what the member just asked.

I rise to take another brief call on Part 1 of the Crown Entities Reform Bill, partly to respond to some of the comments that the Minister of State Services made, and, secondly, to make a further point. The Minister talked about some of the changes that the Government had made in public health programmes, referring particularly to the Healthy Eating - Healthy Action programme. I cannot let that go unanswered, because although that was presented as if it were a positive development, it is important that the Committee knows that that change was in fact opposed by absolutely everybody working in public health, including all of the experts on public health matters. It was a hugely retrograde step, which took us a long way back. It reflected an approach from the Government that until now has not been very positive on public health matters, and I am certainly aware of very many programmes throughout the country, and in many areas of the health sector, that have lost their funding, or have lost sufficient funding that they have lost critical mass and are unable to carry out their very important functions.

To put some actual numbers to that claim that I have just made, in last year’s Budget—I am certainly mindful that there is another Budget due tomorrow—funding for Vote Health was reduced in actual dollar terms by 14 percent, and that came on top of similar reductions in previous years. To actually reduce the budget, not only in real terms but in actual dollar terms, signifies a problem with the Government’s underlying approach to public health. As I have said, I welcome the Minister’s comments about what I have had to say in this debate to date, and I hope that this bill will signify a very substantial change in the Government’s attitude towards public health and towards health promotion.

The second point that I wanted to make was, I guess, picking up on the question that Grant Robertson asked and the Minister answered about what the role would be for the Ministry of Health in public health and health promotion, going forward. The particular point that I wanted to raise was a related question, and that was what is happening with regard to section 14 of the New Zealand Public Health and Disability Act, which established the Public Health Advisory Committee. I am a person who used to chair that committee, and it is a committee that I believe has done a lot of sterling work. Its reports, for example, on factors that lead to adverse public health outcomes—looking at social factors, looking at environmental factors—have been extremely important. Its report on child health is a landmark report, and there is the work that it has done on the health of prisoners, for example—all extremely good and valuable work that has essentially stopped over the last couple of years. The National Health Committee must establish a Public Health Advisory Committee, yet that committee has essentially not existed for a couple of years. Not only have the members of the committee gone but its secretariat has gone, so it is entirely non-functional. It is a statutory requirement that the Government is not, in fact, implementing.

That function of advising the Minister and advising the National Health Committee on public health matters is an extremely important one in the sector, because, as I have already outlined, the kinds of things that we are looking at in health promotion very often—even though they are the interventions that have the biggest bang for their buck; they actually produce the most health gain for the dollar invested—may take a long time to actually realise those big gains. That is why it is important that we have a committee like the Public Health Advisory Committee that is able to take that really long-term view, and provide that really high-quality advice to the Minister and to the National Health Committee to inform public debate about public health matters. And so I invite—

Kia ora. Thank you very much for the opportunity to contribute in this, the Committee stage of the Crown Entities Reform Bill, Part 1, which we on this side of the Chamber will support. What I want to do is take an opportunity to actually acknowledge the history of both the Alcohol Advisory Council of New Zealand (ALAC) and the Health Sponsorship Council. Historically ALAC was established in 1976, following the Royal Commission of Inquiry into the Sale of Liquor. Its aim was to encourage responsible use and minimise misuse of alcohol in New Zealand. Obviously this is a big issue that this House will particularly have to debate in the coming months.

I think it is important that we emphasise what ALAC has done in terms of safeguarding alcohol consumption in New Zealand for many of our communities. ALAC had a key role in shaping the discussions and debate around alcohol use and abuse in New Zealand for 36 years, and its contribution to the sector should be acknowledged. I want to acknowledge the chief executive, Gerard Vaughan, and the chair of ALAC, Rea Wikaira. That provides a really good segue into looking at the Health Sponsorship Council, and particularly the role of its current chief executive officer, Iain Potter, who has been the chief executive officer since 1992.

The Health Sponsorship Council was established under the Smoke-free Environments Act 1990, and it was initially established to replace tobacco sponsorships. In 1999 the Health Sponsorship Council had shifted its focus to social marketing to improve health outcomes for people in New Zealand, so I think it is really important that at this time, given the merger of these two organisations into the new Health Promotion Agency, we acknowledge the contribution that the Health Sponsorship Council has made in terms of health promotion issues, with campaigns including Smokefree / Auahi Kore, the SunSmart campaign, and the Bike Wise campaign. It is these campaigns that I think we have to thank agencies like the Health Sponsorship Council for, and obviously this new Health Promotion Agency, we are hoping, will end up having these defining brands in terms of protecting and supporting the well-being of our communities.

The key message that I want to contribute about these two agencies is the significant contribution that they have made to key health issues. They were tasked with health issues that have significant social and fiscal costs for our families and communities, and their contributions have helped to change some of the risky attitudes and behaviours of New Zealanders. So we are supporting Part 1 of this bill.

Some of the most interesting, I think, comments from the Government Administration Committee report, and what I want to highlight, is that most submitters did broadly support the establishment of the Health Promotion Agency. They saw promise in the alignment and integration of its complementary functions. Some of the submitters particularly wanted the Health Promotion Agency to prioritise nutrition and physical activity, and others wanted to see a focus on health promotion issues such as tobacco. So when we look at the functions of the Health Promotion Agency, it is about promoting health and encouraging healthy lifestyles, it is about preventing disease, illness, and injury, it is about giving environments that support health and healthy lifestyles, and it is about giving advice and making recommendations on the misuse and harm of alcohol. So it is wonderful to see that those will continue to be the key priorities of the Health Promotion Agency.

I do not really want to contribute much more, other than to say that some of the rationales for the realignment of these two organisations, we can accept them, when we look at the merging of these two institutions. It is not something that we would say is a general philosophy, but in this instance we can see that the Health Promotion Agency, as it has been proposed, will be a good institution, and it will continue the good work of both the Health Sponsorship Council and ALAC. Kia ora.

The question was put that the amendment set out on Supplementary Order Paper 29 in the name of the Hon Dr Jonathan Coleman to clause 13 be agreed to.

Amendment agreed to.

Part 1 as amended agreed to.

Part 2 Mental Health Commission Act 1998