Estimates Debate — Health Sector (continued)

When we were last progressing the estimates debate, we were debating the vote in the health sector—volume B.5, volume 6—Vote Health.

It is not that long ago that we were in the middle of a health crisis in New Zealand. It seems hard to believe now, but people listening at home will remember a time when you would turn up to North Shore Hospital—where the people of the Northcote electorate go to—and you would be greeted by a queue of ambulances in the car park, lined up, trying to get the patients into the emergency department. And then, if you got through the car park, past those ambulances, you would go into the waiting room and you would find people waiting on trollies, under harsh fluorescent lights, who had been there for up to 24 hours.

Meanwhile, you would come into the Chamber here—I can remember it well. We were in Opposition. You would hear health Ministers blustering about the success of the Labour Government. But, in actual fact, the rhetoric just did not match what was happening out on the ground. While Annette King and Pete Hodgson were in here boasting of false achievements—achievements that never really happened, that just did not take place—the public out there in New Zealand knew the reality, because they were going to the airports and getting on the jet planes to fly to Australia for basic cancer treatment.

There were 30,000 people out there who were kicked off surgical waiting lists under the reign of Pete Hodgson and Annette King. That was the fact of it. People could not get the care they needed. There were so many people waiting on those surgical wait lists over 6 months that, in the end, Labour just canned the wait lists and told everybody to go home.

Well, help was on the way. In the 2008 election it arrived. Since then, this National Government has had a consistent history of putting more money into the budget each year. There has been a record increase—a $15.9 billion vote, and $4.1 billion has gone in over the last 7 years. But the most important thing has been the solid stewardship and the results that that has delivered.

Labour was pouring money in but getting worse and worse results. Labour doubled the health budget, but it delivered 5,000 fewer appointments and 2,000 fewer operations. It got so bad that in September 2005, as Mrs King’s reign was drawing to a close, the Dominion Post wrote an editorial asking how you could pour so much money into a health system, yet it still got worse. No one could understand it. It was just incompetent management.

Since then, what have we seen? Under National there are 5,000 extra doctors and nurses in the system, 50,000 more appointments, and 45,000 more elective operations. No one is going to Australia for basic cancer care. We have set very clear targets and we are delivering on them. Under Labour, they were not even counting which kids got immunised. Now we have started—off a percentage base in the mid-70s—to have nearly 95 percent of 8-month-olds fully immunised. Ninety-five percent of people are in and out of emergency departments within 6 hours. We have achieved the first cancer care target. We have now moved on to a new one: the gold standard 62-day pathway. We are determined we will make progress with that. We are recording smoking rates and cardiovascular data. It has all improved under National. We have actually delivered what the public really cares about.

Just with this Budget, there have been some great initiatives, like another $98 million going into surgery over the next few years, and $76 million into palliative care. A lot of that money is going into the community—so delivering nurse specialists; delivering care close to the home. These are the things that New Zealanders are telling us are important. But do you know what the ultimate prize has been? It has been the free health-care for under-13s—a policy that Labour could only ever talk about, but it never delivered. So we have now got 750,000 children in New Zealand under the age of 13 who are getting free GP visits. We know that is going to make a real difference to the health of those children, so that is a signal achievement. This Government will put in $120 million over the next 4 years to deliver that.

In the meantime, all that Labour can do is to try to make up statistics and look for leaked papers. We have had no policy work from the Labour Party in health. We know that Labour is not ready for Government because we have not seen any work. Labour members do not go around the sector. What they do is go around trying to corrupt officials and steal papers, and then make up figures.

The CHAIRPERSON (Hon Trevor Mallard): Order! The member will resume his seat. I think the member knows that accusing people of acquiring things, or asking people to steal them, is not parliamentary. The member will withdraw.

I withdraw. But the essential point is that Labour poured in more and more money, but it did not run the system properly.

💬 Grant Robertson: Blow your cigar smoke all over people, Jonathan.

And you can see what a raw nerve this is, because Grant Robertson is losing it. Grant has completely lost it. National has won on health; Labour lost—Labour did.

💬 Grant Robertson: What a disgrace you are.

You can hear Grant Robertson yelling and raving here. He knows he has lost the debate.

I serve on the Health Committee, and we were fortunate to hear at the estimates hearings a few weeks ago from that very competent Minister of Health, Dr Coleman, who, of course, brings to the portfolio not only his very good and capable administrative and political skills but also a track record of real medical professionalism, having served with distinction as a GP himself. When we heard evidence from him at the select committee in the Vote Health estimates hearing, I was delighted to hear that Vote Health is the second-largest vote in Budget 2015. It accounts for 17.8 percent of the total 2015-16 appropriations. That is a measure of the commitment of this Government to ensuring that New Zealanders have access—and easy access—to health services and provision for health services when and as they are needed.

As the Minister just reminded the Committee, it was during the last Labour administration that things were so woefully bad in health that people were literally being kept in hospital corridors, under bright fluorescent lights, at North Shore Hospital for days on end, because there was no capacity to provide a service for them. Not only that, but New Zealanders were being shipped—

The CHAIRPERSON (Hon Trevor Mallard): Order! I am going to interrupt the member. I gave the Minister of Health some leniency in the debate to refer to periods outside this estimates period because I understand that he was responding to comments made by Annette King. That has now finished, and the member will talk about the estimates, thank you.

Thank you, Mr Chair. The simple matter is that in terms of what this Government has done in the health sector, it is a remarkably good story. If ever there was an example of a plan that is working and working well, it is in health, and that became immediately obvious and apparent when the Minister presented evidence to the select committee during the estimates hearings.

I represent the beautiful and much-admired environmental electorate of Coromandel. Coromandel is a seat that has not only a wonderful environment and natural aspect but also a population that is of a senior demographic. We are, in terms of the demographic breakdown, the second-most mature electorate in the country in that regard. So we have got an awful lot of people who are in the 65-plus age group.

One of the areas that I was pleased to see the Minister speak about at the select committee was the improved funding and support that would go to people of senior years and those who have chronic diseases. One of the things that became very apparent when the Minister gave evidence to us was that, as we all know, New Zealand’s population is growing but it is also ageing, and the proportion of New Zealanders aged 65 and over is predicted to increase from 14 percent in 2013 to 22 percent by 2033.

So, in electorates like mine, that means that there will need to be greater levels of support and service for, for instance, palliative care, and the Minister was able to assure the select committee that the investment of an extra $13 million a year from 1 July 2015 to help hospices expand their community palliative care services would be of great help and assistance to electorates like mine in the Coromandel. That means that services will be able to be provided to people who need support and care if they are terminally ill, and much of that support and service can be provided at home, in situ, in an environment where the person who is receiving that care and support feels most comfortable. All the evidence shows that where that sort of service can be provided in a home situation, then that is a good and excellent outcome not only for the patient concerned but, of course, for family members as well. As New Zealand’s population ages and grows, the demand for palliative care is also going to grow. Hospices make a huge difference to the lives of people who are confronting a terminal illness at end of life.

The Health Committee is currently about to embark on a fulsome inquiry into end-of-life choices. As a member of that committee, I am looking forward to it.

Tēnā tātou e te Komiti, ko Te Wiki o Te Reo Māori tēnei, nō reira, kia kaha tātou. Ki te kaupapa i tēnei wā.

[Greetings to us the Committee, this is Māori Language Week so we need to be energetic. And so to the matter at hand.]

I want to address, in the estimates debate on the health sector, the issue of mental health. I note that the Minister of Health, when he spoke before, was very animated and, in fact, got a little desperate and started making some desperate accusations. But I want to address—again, today it seems to be a day for this—an issue that is very close to my heart.

The Minister announced just a few days ago a formal inspection of the mental health services at the Waikato District Health Board. I want to seek an assurance from the Minister that that formal inspection will be done in the context of a health system that we now know has $1.7 billion less funding than it should have had in order to keep up with the demands, both the population increases and the inflation demands on the health budget. Even the Minister himself in question time yesterday accepted that the health budget has not kept up with inflation under this National Government. So I want to ensure that when this formal inspection of the mental health services happens at Waikato District Health Board, if it is discovered that resources and funding are, in fact, one of the reasons why we have had problem after problem after problem in the mental health services there, the Government will ensure that those issues are fixed and it will not use this as a whitewashing exercise.

I listened very carefully to what the Minister said when he announced the formal inspection and he said it was necessary because people needed to be reassured about the mental health services, and that sounds like the language of a whitewash to me. What I am interested in is knowing that the service is a quality service and that the most vulnerable people in our community are not put in harm’s way because of the underfunding of the mental health services, and the health service in total, that has happened under the estimates for the 2015-16 year.

The thing that seemed to trigger this formal inspection was the discovery of a fraudulent psychiatrist being employed by the district health board, but that is just the tip of the iceberg. I am now quoting from a letter that has been written by Dave Macpherson, who is a local councillor in our area. He happens to be the father of a young man who lost his life when he was under the authority of the mental health services in Waikato. He has written to John Crawshaw, who is going to do this formal inspection, to ensure that he knows the full history.

So not only have we had the fraudulent psychiatrist discovered in just recent days, but in 2014 Mr Paul Fox was employed as a psychiatrist at the Henry Rongomau Bennett Centre. It was discovered that he had to hand back his licensing registration when he had worked in America because of an inappropriate sexual relationship between him and a patient. We have had Manilall Maharajh, a psychiatrist employed by Waikato and Bay of Plenty district health boards, who was found guilty of professional misconduct by the Health Practitioners Disciplinary Tribunal in 2013 after having sexual relations with a patient and paying her not to inform authorities about this. We have had Jason Luty, a psychiatrist employed by the Waikato District Health Board in 2012 after leaving Essex in the UK under a public cloud after the publication of offensive pictures of his own children—and the list goes on.

What I am suggesting here is that the Minister needs to make sure that this is a very thorough investigation, because there is a range of issues that happened over a period of time. This, though, is the district health board, after all, that announced the formal appointment of the current chief executive officer just days before—in fact, I think it might have even been only 24 hours before—a very damning report was published about that same person and the hospitals that he had been managing in Canada. So I can only ask that when the Government is doing this formal inspection of mental health services, the inspection be more broad, because the issue about employing people under dubious circumstances I think is more broad than the mental health services themselves. I want to implore the formal inspection to take seriously the issues that have been raised by Dave Macpherson.

It is a pleasure to be taking a call this afternoon. I am really proud to be part of the Health Committee and it is really pleasing to note the record $15.9 million budget. You know, the key thing about this is that National believes that all New Zealanders and their families should have access to timely, quality health-care no matter where they live. A really key feature of the estimates going forward is actually putting things into medical services that are much closer to home. It is important for people to be close to home. If we think back a few years ago we were having women with breast cancer going to Australia. That is a most stressful time for a woman and it is so important that now they are able to have that service in their country and in their community.

I am really proud of some of the things that are happening to take the services closer to home. Even in the last few days we have seen some announcements that have come out around the estimates, so not only are they estimates but they are actually falling into action. One that I am really pleased to be part of is the mobile surgical services contract, which has been extended. That is a great bus that has gone around, and to date approximately 20,000 New Zealanders have been treated on this bus and received over 45,000 hours of education. So not only is it actually treating the patients but it is going around and actually educating health professionals on the road. What it has done is it has reduced the waiting times for patients and improved the access to health for those people in rural and remote communities.

It was really interesting because in renewing that contract there was a review prior to renewing it, and the professional development training provided to health professionals has been described as relevant and engaging. The interactive digital video equipment enables collaboration with health professionals in other parts of the country and overseas. Not only are we training people on the spot but we are actually collaborating between various areas of the country, and we have links overseas where people can share information and understand how to do it better. So I am really pleased that 24 rural towns are actually receiving this service and will continue, under the proposed health estimates, to receive this service in a 5-week cycle, where more people can have access.

It is also really important that an extra $846,000 is now going into funding 20 more nurse practitioner trainees. Currently there are 145 nurse practitioners in the country. I know that we were doing some work looking at some legislation last week where we spoke about changing some of the legislation so that we could give wider roles to some of these nurse practitioners, because up until now it has been the prerogative of the doctors to be able to do things that highly qualified nurse practitioners are able to do.

There, again, we are working on this whole theme of it being closer to home, having more people out in the community. It means that people do not actually have to always travel to the bigger hospitals and it also means that some of those people in the community can upskill themselves to become nurse practitioners, which means that they do not necessarily always have to travel to certain points in big hospitals either.

One of the future things for health is actually creating it closer to home for people, and I think that is a really important thing. It is also about working on elective surgery. So far there is 37 percent more elective surgery. That means 44,000 people up until now, and we are going to continue to work on this in the future. It just means that those people do not have to sit around and wait for these operations. I am really pleased with that.

The Minister of Health mentioned that we have under-13s being able to get to the doctor for free. That means that they will go sooner and they will get diagnosed sooner, which means the chance of them being hospitalised when they do go is less. That actually means that they will end up being closer to home as well and will have more time with their parents.

Also, up until now, in the tracking of full immunisation of children, 94 percent of 8-month-olds are fully immunised. That means that we are on track for 95 percent, and the Government is really, really proud of that—very proud.

Tēnā koe te Māngai o te Komiti, ngā mihi ki a koutou katoa, te kaupapa te hauora o tō tātou iwi o Aotearoa.

[Thank you, Mr Chairperson, and greetings to you all. The health of our New Zealand tribes is the matter at hand.]

I am a proud member of the Health Committee, and as a member of that select committee it is my responsibility, with my colleague the Hon Annette King, to hold the Government to account. In holding the Government to account, what we have done is we have commissioned an Infometrics report that has revealed a $485 million funding shortfall in the health sector. That shortfall is, actually, not only incredibly relevant to the 40,000 staff within the health and care sector but it has huge implications in respect of service cuts. I want to focus my contribution on what those service cuts may be.

One of the worries or concerns I have is that school-based health services will be cut. The latest evaluation of those school-based health services has actually highlighted the benefits to the year 9 assessments, and particularly to our young boys. Part of that assessment not only looks at their home life, education issues, what sort of activities they are engaged in, drug and alcohol issues, and sexuality issues but also focuses quite clearly on suicide and depression. As we know, as a country, suicide is a big issue, particularly for our young people and particularly for young boys, so I have a huge issue if part of the Government’s shortfall of $485 million is going to mean a reduction in school-based health services. I do want to contribute that the Minister of Health reassured us that there would be no cuts in this area, but it is something that I am particularly interested in and will be keenly watching.

The other area that I want to highlight is the provision of maternity services. Unfortunately, in Aotearoa New Zealand we have over 660 children who die every year of perinatal mortality. These are babies who die before 28 days of age. In the Counties Manukau District Health Board area, where I am from, what that represents is 27 deaths that were avoidable—27 deaths of children. This is particularly relevant in my electorate, where there are high concentrations of Māori, high concentrations of Pacific people, and high concentrations of Indian members of our community. Of particular relevance is that 34 percent of the babies who died had mothers who smoked. That is a really significant statistic, as we know that smoking is also a cause of perinatal mortality. One of the other areas that I will be focusing on is whether or not the Government plans to cut—like it did in 2010—any smoking cessation programmes. What we know is that in 2010 there was a $12 million reduction in smoking cessation programmes, and I hope that that was not a factor in terms of the fact that there were 126 babies in New Zealand who could have been saved from avoidable deaths.

I also want to focus my contribution on hospice funding. The Government has been really, really interesting because it has been crowing about this investment in hospice funding. Again, I want to highlight one of the commitments that the Minister of Health made at the select committee. He committed to 70 percent of hospice funding coming from the Government. That is the social contract—I want to call it that—that the Government has with hospice providers, and there are 29 hospice providers round Aotearoa.

In the South Auckland area we have two hospice providers: we have Totara Hospice South Auckland and we have Franklin Hospice. Both of those hospice providers, I believe, are doing a fantastic job. Again, it is my responsibility to hold this Government to account for the 70:30 funding split. One of the things that I know in engaging with my hospice providers is, in fact, that, currently, Totara Hospice receives only 49 percent funding from the Government. So the community of South Auckland is having to find 51 percent of its $8.4 million budget from a community that has high Māori, high Pacific, and high Indian populations, and that has, actually, got socio-economic challenges. Our community is expected to provide 51 percent of the funding, whereas, in fact, the Government says that that is not the case.

I will be holding the Government accountable to that funding formula and to that social contract, because it is something that it has committed to me in written questions. It is something that it has committed to me and my colleagues on the Health Committee in our select committee hearings. So if that is not going to be one of the commitments that this Government holds to, then I am sure that I and my colleagues on the Health Committee will make this Government accountable to that issue as well.

As a member of the Health Committee I too want to reiterate that some of the issues that we have been dealing with have actually been driven by the community. We saw some women come to us this week whose children, through their birth circumstances, have had to be tube-fed. One of the issues that we have in New Zealand is that we have a cohort of children who, through no fault of their own—premature births—have been fed by tubes, some for up to a year. When they leave hospital, believe it or not, there is no further intervention and engagement with not only the child but the parents. So we have children who are dependent on being fed by tubes, with no specific support.

In New Zealand we know that there are over 330 children in this circumstance, and there is no response from the Government to meeting the needs of these parents and children. So children may leave at 1 year of age, and one of the scenarios that was presented to us was children at 3½ or 4½ years of age still being—well, not tube-fed, but having—what did they call it, Barbara?

💬 Barbara Kuriger: The Mic-Key button. The Mic-Key tube.

The Mic-Key tube. So this Mic-Key tube essentially means that these children are being tube-fed because they have had dependency. Because of the circumstances of their birth, they are unable to eat and they are gagging, and obviously there are communication issues, there are psychological issues, and there are behavioural issues. These children are dependent on being fed by a tube, and what do we do to support these children and families? We do nothing. I think New Zealanders would be horrified to think that we just leave parents to their own devices.

So what we are seeing more and more of within the Health Committee, because we have got such an unresponsive system, is communities, mothers, and people who are affected by a lack of support and a lack of care coming to the Health Committee and saying: “Please help us. Please hold the Ministry of Health accountable.” Unless they can get our support, and unless we as a select committee hold the Ministry of Health to account, it is actually not meeting the needs of our New Zealand citizens. I think, as I have said, we are seeing a growing number of our constituents and our citizens using the petition process to highlight deficiencies in the health system.

I actually think it is a sad indictment on the health system, because we should have a more responsive health system. We should not have to rely on citizens having to go through a democratic process. But, in saying that, I am incredibly grateful that I live in a democracy where citizens can directly engage and citizens can stand up and advocate. And in the instance of those three women, it was not just for their children; it was for other New Zealand children who are yet to be born or who are living in the circumstances that they are living in. I think, collectively, we as a Health Committee were incredibly proud—or I was—of their advocacy, their professionalism, and the fact that they cared so much, that they were so passionate, and that they were prepared to make sure that our health system is responsive to the needs not only of their children today but of our children in the future.

So I hope that we as a select committee are going to do all that we can to make sure that our best practice is about ensuring that children who have a premature birth and who are tube-fed actually then have the ability to fully participate in life. At the moment those children are not able to fully participate in life. Their parents are not able to fully participate in life. It is going to affect their education. It is going to affect a whole lot of things unless we get it right. And what I see at the moment is that we have got a system that actually just wants to tick all the boxes, so we have, you know, the Better Public Services targets, and we have—

Tēnā koe, Mr Chair. I am pleased to take this short call on behalf of New Zealand First. I specifically want to actually talk today about palliative care in the Vote Health estimates. It is easy for the Government to turn round and say “We’ve put $76.1 million into palliative health care services.” and yet, in the same breath, it says it would spread this out over a 4-year period.

So what we are really dealing with here is the fact that we have 29 hospices from around New Zealand for palliative health care services and they receive only $19 million per year. We know from Hospice New Zealand that in 2014 it dealt with 16,000 patients. It visited over 114,000 homes of patients who actually have life-limiting conditions. This is actually for them an emotional roller-coaster time of their lives. It is generally in their last stages—about 10 days—when they can expect to live comfortably.

So what I can see is that what that works out at is that we are dealing with $1,187 per hospice patient. That is not enough. This is the most sensitive time. It is emotional for families, it is gut-wrenching, and it is really quite a traumatic time for families to go through. Any death in a family is not wanted by anybody, but when you have a loved one who is dying of a terminal condition, every emotion is wrenched and it is elongated. So what our palliative care specialists could provide and could be funded for is not just $1,187 dollars per patient; it is now going to be spread out among our whānau members and within the means of our community.

But, of course, we are not just dealing with the $1,187 being the total cost of looking after our loved ones in a hospice or in palliative care, because now, as the previous speaker, Louisa Wall, mentioned, we are looking at a 70:30 hospice-funding split. That represents 70 percent of the cost of looking after patients provided by the State, but the hospices then have to go out past their district health board and reach into the goodwill of their community to help them fund-raise. We have seen this annually through bucket collections on street corners and through groups like Rotary supporting hospices by funding, by holding annual events, and by giving support by sitting at the bedside of patients in hospices, as I know they do in Invercargill. I have also seen fund-raising occur outside the Warehouse with sausage sizzles. I have seen it outside Harvey Norman in order for the community to try to make up the shortfall of the 30 percent of funding that they need.

Hospices, along with community groups, have hundreds of volunteers who have to help raise money for what is a vital part of our public health service, at a time when the public health sector and our people need to know that these services will be met. This Government expects the community and many volunteers to cover the shortfall in funding, and in 2014 it was to the sweet tune of $42 million. That $42 million of shortfall meant that communities had extra pressure, along with hospices, to go out there and find some money. In 2014 it cost $99 million to provide these essential health services for palliative care in hospices. I am grateful, when I see the figures, to speak about them and to understand that our volunteers contributed a million hours as part of their commitment to help with hospice funding.

I look at the Mary Potter Hospice here in Wellington, which does an amazing job for the citizens of Wellington. It is run by very special people. So I do not begrudge the fact that we probably feel that with a growing ageing population perhaps the Government is being a little bit mean. Of course, this is not necessarily the fault of the Government, but it is the fault of the Government’s leadership, because some district health boards—and as we know from the estimates for Vote Health, South Auckland’s Totara Hospice is named as one of those that is receiving 50 percent less than what it needs from the responsible district health board.

Vote Health agreed to.

Justice Sector