Crown Entities Reform Bill

As we on this side of the Chamber indicated during the debate on Part 1, Part 2 is a different matter and we, unfortunately, cannot be as supportive as we were of Part 1. I guess that reflects the fact that, as I think was stated during the second reading debate, the amalgamation of public services for the sake of it is not necessarily a good thing. What matters is what the outcome is from that amalgamation, and although we can see merit in the amalgamation of the Alcohol Advisory Council and the Health Sponsorship Council, we cannot support the amalgamation of the Mental Health Commission—or essentially the absorbing, really, of the Mental Health Commission—into the Office of the Health and Disability Commissioner, and the creation of a deputy commissioner within the Office of the Health and Disability Commissioner who is responsible for mental health. If the Government had listened closely to what the submitters said at the Government Administration Committee, it would have come to the same conclusion.

The Mental Health Commission was originally established in response to the recommendations of the 1996 ministerial inquiry into mental health services, most popularly known as the Mason inquiry. It was established, really, because there was a recognition that mental health services not only were underfunded and under - provided for but also did not get the recognition and the attention that they needed, and that that was having a detrimental effect on our communities—that the people who suffered mental illness were not receiving the services that they ought.

Although things have certainly improved in the years since then—we have seen the establishment of the mental health blueprint, we have seen mental health funding ring-fenced, and we saw on a number of occasions the length of time for which the Mental Health Commission would remain established extended through, ultimately, to 2015 was the last extension it received—it is fair to say that the job is far from done. In fact, the replacement for the blueprint, Blueprint II, I would imagine is now in its pretty final drafting stages, and the expectation is that that will be published soon. That seems to be the least appropriate time to disestablish the Mental Health Commission—given that one of the last things it will do is to publish the second blueprint, it would be appropriate, really, for the Mental Health Commission to then see out its time through to 2015 and to use those first few years to get the second blueprint under way. If the people and the organisations that submitted on that drafting process are actually listened to, there will be some not insignificant changes to the way we approach mental health services and to the way, I suppose, mental health services are shifted from a focus on secondary care to a focus on primary care, and also an understanding that we need to focus on a much wider proportion of the population than what was mandated for in the first blueprint.

That amount of change and shift in focus really needs a dedicated organisation to navigate the sector through that period of change, and it seems extremely short-sighted to bring forward the disestablishment date for the Mental Health Commission from 31 August 2015 to 30 June 2012 and then leave it up to the Office of the Health and Disability Commissioner, which has not had that focus on mental health, and to a person who becomes a deputy commissioner, subordinate to somebody else, to be in charge of the navigation through that period of change. Given that, if you talk to both consumers of mental health services and people practising in the area of mental health, one of their principal concerns and beliefs—and, I think, quite reasonable beliefs—is that mental health services remain a Cinderella component, which is the word that has been used, of the health system, I think it absolutely sends the wrong signal to be disestablishing the one organisation that was focused on mental health, and to be folding that into another organisation and reducing that focus.

I notice that in its comments to the select committee the Ministry of Health noted the fact that the Mental Health Commission’s longevity, or existence, has been tenuous. The fact that it has lasted as long as it has been the result of Governments successively extending its lifespan. The comment was made that shifting the monitoring and advocacy functions of the Mental Health Commission into the Office of the Health and Disability Commissioner secured those functions into the future. I accept that that is probably true, but it is not necessary. We do not have to shift the functions of the Mental Health Commission into the Office of the Health and Disability Commissioner to give it that security. Parliament—the Government—is quite capable of giving the Mental Health Commission that level of security and still retaining it as a stand-alone organisation. So although it is true that the shifting of those responsibilities into another organisation does potentially create some security, it is not a necessary change in order to secure those functions.

There are, no doubt, some efficiencies to be gained in terms of transferring and reducing back-office functions, but, of course, what we have seen across the State sector is that when back-office functions have been somehow rationalised or made, to use the Government’s terms, more efficient, what ultimately ends up happening is that the people who are supposed to be delivering the front-line services end up having to pick up those back-office services. Therefore, front-line services actually suffer. We on this side of the Chamber are very, very sceptical of any arguments made that by reducing back-office functions, that somehow will allow the shift of resources to the front line. Whether you look at the police force, the Defence Force, or all across the State sector, we have seen that what ultimately happens is a reduction in front-line services. I think that is something that we have to be acutely aware of as well.

A number of submitters said that shifting the Mental Health Commission into the Office of the Health and Disability Commissioner would make the organisation more reactive. I think that is true: the Office of the Health and Disability Commissioner is a very reactive organisation. It reacts, essentially, when things go wrong in the health system, whereas the Mental Health Commission is a much more proactive organisation involved in the promotion of activities to promote and secure mental well-being. Again it is a shift in the focus, a shift in the nature of the organisation. That really is a retrograde step as far as securing and supporting mental health services in New Zealand are concerned.

So although superficially Part 1 and Part 2 may appear similar in that they are about the amalgamation of organisations, the outcomes of those amalgamations are quite different. On this side of the Committee we cannot support the dissolving of the Mental Health Commission and the reduction of focus on services supporting those people with mental illness in our community.

It is my pleasure to take a call on Part 2 of the Crown Entities Reform Bill. Part 2 of the bill relates to the expiry of the Mental Health Commission Act 1998 and the appointment of the Mental Health Commissioner under the Health and Disability Commissioner Act 1994. The Act will now expire on 30 June 2012, rather than on 31 August 2015. The bill will provide for the appointment of a Mental Health Commissioner under the Health and Disability Commissioner Act 1994 and the appointment of the chairperson of the Mental Health Commission as the first Mental Health Commissioner. I support this part of the bill.

I am going to start where Iain Lees-Galloway left off. I think it is fair to say that I agree with everything Iain Lees-Galloway said, which has happened before on several other measures. In the debate on Part 1 of the Crown Entities Reform Bill I talked about the dodgy rationale for Part 1 that had been advanced by Chris Auchinvole, and I said that combining functions did not necessarily produce the kind of efficiency gains that those promoting the combination expected. That has definitely been our experience in the health sector. So in the case of Part 2 I wonder what on earth can possibly be the rationale for the change that is proposed, because here is definitely a case where a topic, mental health, which has achieved a significant focus through the Mental Health Commission, will clearly be receiving less focus if the commission is folded into the Health and Disability Commissioner’s office, as is proposed, without any benefit in terms of efficiency. There is no upside and some significant downside already in the loss of focus.

But it goes further than that, because on Part 1 the Green Party supported what the Government intended to do. The functions of those various agencies that are being combined into the Health Promotion Agency are at least congruent. By combining them into a single agency, a significant gain in terms of integrating their functions is achieved. In the case of these two agencies, the Mental Health Commission and the Health and Disability Commissioner’s office, the functions are not congruent at all. The Health and Disability Commissioner has done over the years a fantastic job, but the way that that office works is not by taking the big helicopter view but rather by focusing on individual cases—the individual who complains about a particular aspect of the service that they have received. The complaint is investigated in considerable depth, and then the commissioner uses that opportunity to provide justice and some measure of closure for the person who has received services that they believe to have been inadequate or to have breached their rights in some other way, and also to try to draw from that single incident some learning that may be useful for similar services or for other parts of the health services. On both of those things—actually providing a justice process for individuals and learning from individual cases—the Health and Disability Commissioner has contributed a considerable amount to the New Zealand health sector. It is really important that that office continues to focus in exactly that same way.

But just as the Health Quality and Safety Commission, a new entity that replaced the Quality Improvement Committee, which replaced the EpiQual committee, which was in the original Act, was not set up as a subdivision of the Health and Disability Commissioner’s office because, actually, the function is a totally different one, requiring a different set of skills and an entirely different focus, so it is with the Mental Health Commission. The Mental Health Commission absolutely must take that helicopter view that considers the entirety of mental health services and plans out for the entire sector for not only the short term but also the long term, and it must monitor against that plan. Those are also incredibly important functions, but they are entirely incongruent with those that the Health and Disability Commissioner is providing for. As Iain Lees-Galloway has said, certainly the intent was that there would be a finite term for the Mental Health Commission, but the job is not done. Therefore, that job needs to be extended out into the future.

As Iain Lees-Galloway has pointed out, the origins of the commission were indeed with the Mason inquiry. That inquiry focused on a particular part of mental health services and noted a woeful inadequacy around mental health services. The initial focus for the Mental Health Commission was on remedying that part of health services. Those were services at what we would call the serious end of mental illness, because that is the end where the most severe harm is caused to particular individuals, and the end that the Mason inquiry demonstrated was incredibly underfunded and poorly focused on by health services at the time.

The Mental Health Commission established its blueprint, which achieved very considerable support and endorsement from right across the health sector—appropriately so. Successive Governments have looked to properly resource that blueprint with ring-fenced funding, and mental health services have moved from being what I have described as Cinderella services within the New Zealand health sector to being services that are seen as an integral part of at least the secondary health services. Within hospitals, at the serious end of mental illness, and in specialist-provided services, mental health has made considerable progress towards that blueprint. It is not there by any means. There is still a distance to go, even in that area. When we look at the performance of district health boards against the indicative volumes of services that the mental health blueprint sets out, the vast majority of district health boards are still failing to produce even those serious secondary mental health services at the volumes the Mental Health Commission has indicated are appropriate. There is a growing problem with ring-fenced mental health funding leaking out of mental health and being used in other areas. Those are still areas of particular importance for the Mental Health Commission to focus on.

But there is a whole other area that was not a focus in Blueprint I, and that is the area of community-based services. There is an interaction between in-patient services provided within hospitals and community-based services. What we see are acute units in our hospitals still struggling to provide space for people with acute illness—serious illness—who require in-patient care. They are struggling because our acute services are still blocked up with people who largely have non-acute needs. They have ongoing mental health needs that need to be dealt with in community settings, but those community services are not yet at that level. So we have a problem with meeting the need for secondary services, because community-based services are not yet adequate. The Mental Health Commission needs to focus on that area as well as on the primary mental health services that are required by people with mild to moderate mental illness.

There is an awfully long way to go when we see the World Health Organization predicting depression to be the most serious chronic illness faced by the world’s population. Actually, what that is saying to us is that our health services need to focus very strongly on the primary care required in mental health services. Currently, there is a bit of work going on there. It needs to be a major focus of Blueprint II, and we need, as a country, our Mental Health Commission to be focused on that area. We need an organisation with the capabilities that the Mental Health Commission has to do that work, not the capabilities that the Office of the Health and Disability Commissioner has. Both organisations play really important roles, but they are separate roles that are not congruent. This is the wrong thing to do.

Thank you, Mr Chair, for the opportunity to speak to Part 2 of the Crown Entities Reform Bill. As I forewarned in my contribution to Part 1, this is where Labour’s relationship with National on this bill in terms of our support has to come to an end.

💬 Louise Upston: You’re not leaving us are you?

Yes, we are. We are parting company. We are not going to hold hands any more on this bill, because, as Iain Lees-Galloway said and as Kevin Hague reinforced, this is not a merger within this bill that we support. As I mentioned on Part 1, there were two agencies working in a fragmented way. We know there is sense, and there are efficiencies, in bringing those two—the Alcohol Advisory Council and the Health Sponsorship Council—together, but in Part 2 the effective merging of the Mental Health Commission into the Office of the Health and Disability Commissioner we believe is not the right move. As Kevin Hague said, this is not congruent. These two agencies do not meet the same purpose, and we believe that there should be a real focus from the Mental Health Commissioner to stay focused on mental health issues. As a number of submitters to the Government Administration Committee said, there was some concern that the Mental Health Commission is seen as proactive, whereas the Health and Disability Commissioner is seen as reactive, and therefore that the Health and Disability Commissioner’s office was not the appropriate agency to take on the new mental health and addiction monitoring and advocacy functions. That was one of the strong submissions that was made on Part 2 of the bill when it went before the select committee.

As a number of speakers have already mentioned, the Mental Health Commission started its life in response to the Mason inquiry back in 1996. It was set up in 1998 under the Mental Health Commission Act and it did have a sunset clause, which was subsequently extended in the years of 2000, 2004, and again in 2007. The date that it was meant to expire under the current legislation was 31 August 2015. That has now been brought forward to 30 June 2012. The departmental report said that by transferring the Mental Health Commission’s monitoring and advocacy functions to the Health and Disability Commissioner, the bill would secure for them a permanent home in a resilient, well-established Crown entity. We do not think that that necessarily is the best home for the functions of the Mental Health Commission. We believe that this agency should stay intact where it is at the moment. We believe that there is still work to be done in terms of what its functions are and what it sets out to do in terms of the short-and mid-term plans around mental health. So we do not believe that the Mental Health Commission’s best place is within the Health and Disability Commissioner’s office.

The fact that the Mental Health Commission has been rolled into the Health and Disability Commissioner’s office has raised questions about the future long-term plans of this Government in terms of dealing with mental health issues. I guess that is another point borne out by the fact that this commission’s role is being rolled into the Health and Disability Commissioner’s functions, which look at a very wide number of issues in terms of health issues that we have in New Zealand. So we do not support this measure in Part 2 to roll the commission’s functions into the Health and Disability Commissioner’s office.

As I have said earlier in this contribution, there is some sense in Part 1, and to the rolling of the functions into the new agency there. But in terms of this disestablishment of the Mental Health Commission in Part 2, we cannot support it. As Iain Lees-Galloway said, we will need to have a positive outcome if we are going to take the action that is within this bill, and we do not believe that there will be a positive outcome in terms of the delivery of mental health services for New Zealand and making sure we take a proactive role to support those people in our community with mental health issues. We do not believe that there will be efficiencies or positive outcomes in the mental health area in Part 2.

Mr Chair, I am sure you will call other Labour members as well in the near future. I was not quite aware of that other member seeking the call.

Part 2 of the Crown Entities Reform Bill, as my colleague Kris Faafoi was just saying, represents a part that the Labour Party cannot support. One of the things I just want to talk about is the Mental Health Commission and its role—and I am sure other colleagues will want to talk about this as well—and the question of independence and independent leadership within the health sector and particularly within mental health. As has been discussed by other speakers, mental health issues in New Zealand are dealt with at a number of levels in the health system and in a number of ways. What the Mental Health Commission has been able to do is provide an independent voice, provide independent leadership, and provide the monitoring of mental health activities, which I believe is at risk with this proposal from the Government.

The proposal from the Government to locate a Mental Health Commissioner within the Health and Disability Commissioner’s office is going to provide the commissioner with some positive links with other parts of the quality and regulatory monitoring part of the health system. But the trade-off with doing that is a trade-off away from the independence of the Mental Health Commission, away from the focus—

💬 Hon Dr Jonathan Coleman: Rubbish!

The Minister of State Services says “Rubbish!”. Well, the Minister could get up to take a call and tell us how he will be ensuring that the Mental Health Commission’s independent leadership is now going to continue on within this structure. Because that is the fear that many in the sector have—that the independent leadership will have gone.

The Mental Health Commission has over the years challenged institutions within the health system as to whether they are performing their role properly, and whether they are actually implementing the blueprint. Is that going to be able to carry on with someone now within the Health and Disability Commissioner’s office, with somebody who is now a deputy commissioner within that office? People who came and submitted to the Government Administration Committee made it clear that that was their concern. They could live with this change, but asked whether the Mental Health Commission’s independent role would be able to be carried on under this change. I do not believe that, at this point in time, we have had anything from the Government to indicate that that would be the case.

Blueprint II is being worked on, and that is good, and it is positive. We always felt that the Mental Health Commission would have the role of getting that going. But what we now have is a situation where many in the sector believe that the focus on the implementation and monitoring of Blueprint II is at risk with this proposal. This is a vital transition point in the way that mental health funding and mental health support is provided in New Zealand. At that very point, the question is whether the Minister is saying to this House: “We can get that implemented. We can ensure that the monitoring is going to occur. We can ensure that the linkages between the provision of services and mental health policy are going to be able to carry on.” I do not believe, in the bill’s current form, that that is going to happen. I do not want to overdramatise this. I think it is clear that the Government has tried to come up with a way of continuing on with mental health monitoring and the provision of policy advice and services around mental health. But I do think this is the wrong way to go about getting the outcomes that we want for the new blueprint for mental health.

Some of the other ideas, which the Minister may choose to comment on, that were raised in the select committee include the role of mental health service consumers in being able to have some input into the future provision of monitoring and services around mental health issues. Overall in New Zealand over the last 4 years we have seen a number of district health boards decide where they are going to go to find the funding cuts that have been forced on them by this Government, and that is in the area of mental health. Certainly, in my own area that is what the Capital and Coast District Health Board has done.

The providers of mental health services in the community have had their budgets cut. Wellink, one of the providers of services to mental health consumers in the Capital and Coast District Health Board region, has had its funding cut by over a third. It is continuing to deliver the services. The Government is very lucky that many of the service providers in the mental health sector are so dedicated that they will keep delivering services. But the question that has to be asked is this: what will it mean, in an environment where district health boards, forced by the underfunding of this Government, have made a decision to take cuts in mental health, with the Mental Health Commission going out of existence? Will the Mental Health Commission’s successor, this person who is now the deputy commissioner, be able to actually provide a challenge to what is going on in our district health boards around New Zealand right now? Will they be standing up to the institutions that manage and control mental health, and will they actually provide the advocacy for, and the promotion of, mental health and the linkages between policy and services? We do not know that. We have not had a convincing answer from this Government. It does give people in the sector the impression that once again mental health is being pushed to the side.

Once again, mental health is the poor cousin in the health sector. The Government could have carried on the Mental Health Commission, carried on its mandate, ensured that Blueprint II got fully up and running, and then made its decision about whether or not it wanted to carry on with the commission. Instead, it brings the date forward, and puts into play risk and a lack of confidence within the sector. So I am going to end my contribution there—

💬 Hon Dr Jonathan Coleman: Great!

Well, I hope the Minister takes a call. I hope the Minister will take a call and answer the concerns of New Zealanders as to whether or not his Government is really committed to mental health. The question he needs to answer, beyond the ones about the structure, is whether this Government is prepared to fund mental health in a way that gives it the prominence that it deserves in our community and our society, because it has not done so up to now.

There was only one fact that came out of that speech on Part 2 of the Crown Entities Reform Bill by the heir to the Labour Party leadership. That is the fact that Grant Robertson is going to be running around the mental health sector, wringing his hands, and telling people how bad it is going to be. That is the one bit of truth in that speech. All the rest was complete fiction. That was a speech designed to scare people out there. I want to put the record straight. Grant Robertson is in the Chamber talking about funding. Well, the fact is that this Government has put more funding into mental health than any Government in New Zealand’s history—$40 million over 4 years, in the last Budget. Grant Robertson gets up here and talks about mental health cuts. That is completely untrue. He knows that his local district health board has had more funding under National than it ever got under Labour, and that that money has gone up every single year. He is not even going to get up and take a call, I reckon, to refute that fact. But that is the fact.

Look, this Government has not focused on bureaucracy and strategies like the last Government did. We focused on access to services. What was happening under that last Government in mental health, under the Labour Government? It is a fact: Pacific Islanders were not getting access to mental health services, Māori access was way less than it should have been—

💬 Grant Robertson: You’re making it up.

—I am not; I tell you what, this is the absolute truth—and access for older people and the very young was not what it should have been. I can tell you, if Labour thought that mental health was such a priority, why did it never allocate it as a ministerial portfolio? It never did.

💬 Grant Robertson: What about a target for mental health?

See? Here he goes. His answer to everything is a target and more money. Yet when debating Part 1 of this bill Labour members were saying Tony Ryall should not be focusing on targets, so they cannot be right both ways. They are absolutely confused. Grant Robertson went on about the independence of the deputy commissioner within the Office of the Health and Disability Commissioner, who will now take over those functions of advocacy and monitoring. He is essentially questioning the independence of the Health and Disability Commissioner. Grant Robertson knows that he is being completely mischievous, because he knows that the Health and Disability Commissioner reports regularly to Parliament. If there is one body in health, I can tell you, that is monitoring what is going on in the health system, it is the Office of the Health and Disability Commissioner.

He is also trying to make out that somehow the blueprint work will not be done. Well, Blueprint II is going to be completed by the Mental Health Commissioner. But the point will be that the implementation will then be carried on through this new position within the Office of the Health and Disability Commissioner, and most crucially we have a whole Ministry of Health—you know, hundreds and hundreds of very good public servants, many of whom are working in mental health—who will be responsible through the district health boards for implementing this blueprint. So for the Labour Party to say that there is less spending in mental health is a complete fiction.

I want to tell you that this Government has put a premium on mental health. We have focused on the services. Kevin Hague was talking about people not getting services in the community. Well, we have put a major emphasis in the Primary Health Care Strategy of making mental health services more available. I do not believe that it is actually true that there are people in our mental health system who are in hospital beds when they should be being cared for in the community. There has been an emphasis for many years—the Labour Government actually did that, as well—on getting people cared for in the community.

💬 Grant Robertson: I didn’t think we did anything.

Grant is right—Labour did not do much in mental health. He is owning up to that. He said: “I didn’t think we did anything.”, and he is correct in that in some sense. But I want to give them some credit; they got the philosophy right. We have continued on with that philosophy. The best place for people with chronic illness to be cared for is in the community. I just want to assure people that the advocacy functions of the Mental Health Commission are going to continue. Mental health has a very high profile now in New Zealand society, and I want to acknowledge the work of mental heath services consumers, people who have suffered with chronic illness, for the profile they have brought to this. I want to acknowledge the work of people like John Kirwan, who have gone outside their comfort zone to break down stereotypes around mental health. That has been very positive. It is now a very acceptable thing to people to say to their mates: “Look, I’m having a few issues.”, and people by and large are very supportive, in a way that they would not have been a decade or two ago.

But I want to get back to the central point. This is a sensible change that will preserve the functions of the Mental Health Commission, and mental health is a very high priority for this Government.

I will make a short contribution on the Crown Entities Reform Bill in terms of the debate. What I really want to focus on is rationale, and what the rationale was for establishing the Mental Health Commission in the first place. When I was asked to speak on this bill today, I thought: “Right. Well, let’s have a look.” The commission was actually established after a 1995 inquiry, because there were concerns in our society regarding the adequacy of mental health services following a programme of deinstitutionalisation and relocation to community living of people who have been in mental institutions. It was also established to consider the role of alcohol and drug services in relation to mental health. That was a need that society had at the time. We went through a process. There was an inquiry, and, as we know, the Mental Health Commission, which is actually an entity, was created to improve and lift the priority around mental health in New Zealand. I actually think that is the question. What will change from having a specific entity—the Mental Health Commission—versus having an individual, a person, who is going to carry the responsibility to ensure that mental health continues to be a priority area in New Zealand?

When I looked at some of the work of the Mental Health Commission, it is very interesting, because we know that one in five adults in New Zealand experiences mental health or addiction problems. This has a huge impact on our families and our communities. One of the other interesting pieces of research was done by the University of Auckland. We know that at secondary school level, for example, 10 percent of our girls self-harm and 5 percent of our boys self-harm. We have research that says that mental health is a big issue here in New Zealand. Obviously, our youth suicide statistics, and may I say our suicide statistics generally, are pretty appalling. We would all acknowledge that as a country there is something seriously wrong when our kids are so hopeless that the only way out of the predicament that they see themselves in is to take their own lives.

So the value of having an entity that focuses on mental health is that it ensures that there is a body that can collate that evidence, that can drive that evidence, and that can actually ensure that that evidence informs how the Ministry of Health does its work, and how different aspects of social development funding provide the services that are critically needed in our community to address these needs. That is actually the difference. That is why we will not be supporting this part of the bill. We think that having a commission and having an entity with a capacity is much better than having an individual who will be in the Health and Disability Commissioner’s office, and who has to be the champion of mental health. We think that is too big a burden to carry.

Some of the other interesting research that the Mental Health Commission has produced about New Zealanders’ well-being relates to issues—for example, we know that middle-aged people, Māori, Pacific people, and people from the most deprived neighbourhoods have mental health concerns. We know there is a link between mental health and poverty. We know that there has been no change in the proportion of people aged 15 years and over who have hazardous drinking patterns—so between 1996 and 2006 we have not been able to address those issues. We also know that 6.6 percent of people over 15 years of age have a high, or very high, probability of an anxiety or depressive disorder. So there is a lot of need in New Zealand society.

I look at the decision that has been made by this current Government and at the rationale for this bill. When the Government Administration Committee had its initial briefing on 15 February, the purpose of this bill was to realign Government functions either by grouping complementary functions, skills, and objectives or placing functions in larger or more resilient agencies that had more capacity and capability. Obviously, the overriding objective was about saving money, pretty much. So I hope at the end of the day the decision to get rid of a commission, and to replace a commission with a commissioner, is not going to see an increase in some of the mental health indicators that we currently enjoy. As long as this Government is happy that this is not going to affect the ability of us as a nation to meet the needs of those who have mental health issues, then that is fine. Kia ora.