Annual Review Debate — Health Sector (continued)

To resume from where we were 2 weeks ago—look, if you look at the wider picture in health, over the last 7 years this Government has put an extra $4 billion into the health sector. We have been very much focused on delivering increased access to services at the same time that, globally, most other Governments in the Western World have actually been decreasing their public service spending, and their health services have been massively under pressure. So if you look at the achievements of this Government in health, not only have we kept spending at about 6 percent of GDP, which is higher than that in Australia, but we have also been very focused on delivering those services that really matter to the people of New Zealand. If you look at first specialist assessments, they have increased by 26 percent over that time. They have gone up from 430,000 to 540,000 per year. At the same time we are delivering an extra 50,000 surgeries per year. When we came into Government there were 118,000 elective surgeries performed each year; we are now doing 168,000 per year. At the election we pledged that we would continue to raise that by an average of 4,000 per year, and, actually, we have exceeded that target.

Very recently we announced the first ever results of what happens to a referral when it goes from a general practitioner through to the hospital. There has been a lot of debate around this area over time, and no Government has ever traced that path. The only evidence we have was back in 2006 when Pete Hodgson, the Minister of Health, estimated that about 25 percent of patients were returned to their GP, and at that time that would have been 65,000. We have looked at the figures, and the first lot of preliminary data released last week shows that 87 percent of patients who have been referred by their GP to hospital services are getting an appointment. There are about 5 percent who do not meet the threshold, and there are 8 percent who have to be held for further information to be sought. If you look at this area of unmet need, no Government has ever been able to deliver every operation and every appointment that every person in New Zealand could benefit from, but the only answer in the end is to do more and more. That is exactly what we have done. In the area of doctors and nurses, we have now got 5,500 more doctors and nurses working in the New Zealand health system than 8 years ago. That is a considerable uplift in the number of personnel.

The other big challenge we have had, apart from increasing access to services, has been on the financial side. When we came into Government, district health boards were spending about $150 million more than they received in revenue each year. So they were in massive deficit, and the whole place was sliding out of control. Through a progressive approach we have brought those deficits back to about $50 million, and we are determined to continue to reduce those. If you take Southern District Health Board—where we have a commissioner in place—out of the equation, those deficits are even lower. So the fiscal discipline does really matter, and the point I would make is that if you look at that whole picture of access to services and the change in the financial picture, it has been only a National Government that has been able to increase access to services as well as manage the finances. That is very important because we are never going to have an unending pool of finance for the health system. No one is ever going to say: “Stop sending dollars.” It just will not happen. But what we do need to do is make the very best use of the finance that we do have in the health system.

We have taken a very focused approach, as well. For the last 7 years we have had health targets for the sector, and that has given very clear direction to the system. If you look at the approach in emergency departments, when we came into Government there were ambulances queuing in the carpark at my local hospital, North Shore Hospital. That does not happen any more, because we set this target of 95 percent being in and out of the emergency department within 6 hours. We have actually been very successful in reaching that target. We are no longer, also, sending people to Australia for cancer care. When we came into Government, 700 people had been sent to Australia for cancer care. We are also providing the elective surgery that people in this country need. The other thing we have done is, for the first time, we have launched a comprehensive New Zealand health strategy that lays out the plan for the health system for the next 5 to 10 years and beyond.

Actually, what we need in terms of the health system is a change in approach whereby we are focusing more on the community. We are focusing on prevention and earlier intervention because, actually, it does not really help the patients if the only point of intervention is once they get to hospital. We want to deal with things much, much earlier. We want to keep people well and in the community and we want to deliver care closer to home, and all that has to be enabled with the best use of technology in the long term.

If you look at the investment approach in justice, which my colleague Amy Adams was talking about earlier today, this Government is very conscious that what we do in these different social sector portfolios is all linked. In health, if we want to keep kids out of hospital we have got to have well-insulated homes. That is 270,000 homes that have been insulated under the course of this Government. If children are getting their immunisations, if they are staying out of hospital and staying well, they are actually going to do much better in the education system. If they come through the education system successfully with the skills that you need to actually function in a modern economy, they are actually going to have far better long-term social outcomes. If you look at the statistics for people who end up in the justice system, they have fallen off the wagon at some point along the way.

So all these things are interlinked, and what we do know from the political point of view is that the health system is one of those things that the public really does care about. This Government has been very committed to making sure that health has been the largest beneficiary of new money at each Budget, and I am sure that will continue to be what happens into the future, because in the end we know that well beyond the political arena, health is one of those things—in fact, it is the most important thing—that counts for New Zealanders, and we are determined to deliver on that.

I must agree with the Minister of Health that the public does care about health. Members of the public do care about their health, their family’s health, and the health system. But, Minister, I do not know where you have been, because there are a lot of New Zealanders who are very worried about their health, very worried about their access to health services, and very worried about the health system. Part of the problem is that a Minister must actually be accurate with the information that he provides.

I have listened day after day as the Minister tells New Zealanders that under his Government 50,000 more elective surgeries have been done. He then quotes the 2007-08 figure as the base point. Who had the Budget of 2008-09? It was the Labour Government; it was not the National Government. In fact, there were 12,000 additional procedures done in that year that he counts as National’s. I am just pointing out that honesty and truthfulness in figures is very important, and that is one of the ones that is not being presented in the correct way. Saying that one Government did something when it did not is not being straight with the public.

The second issue I want to raise is that Minister Coleman constantly says that former Minister of Health Pete Hodgson said that about 25 percent of patients were being sent back to the doctor. Pete Hodgson never said any such thing. I have asked the Minister—in fact, I did an Official Information Act request; several of them—to provide the evidence. There was no evidence that Pete Hodgson said that, and I could read out the exact quote that has been interpreted by this Minister for political purposes. So I have to say to the Minister that if he is going to bring up these issues, he should at least tell the story as it is.

Let us take the issue of cancer treatment in New Zealand. Yes, we are no longer sending 700 patients to Australia, but I ask the Minister, when were they sent, Minister? They were sent between 2000 and 2002. Why, Minister? The answer is in the very report that the Minister would not release when he had it. It was a 1998-99 report into cancer services in New Zealand, which I received as the Minister of Health, that said our cancer services in New Zealand were in a dire position, that we did not have enough linear accelerators, that we did not have enough radiation therapists, and that our health cancer services were likely to crumble. That was the truth—not the truth that the Minister will tell the people of New Zealand, but that was the truth. Then the Minister said we needed to do more.

Well, I have got the figures, Minister, on what has happened since 2011 to 2015 to those old people who were waiting for their hip and knee operations around New Zealand. In that time eight district health boards did 2,181 fewer operations, not more operations. So, then, let us look at the evidence. The evidence that came out of Otago University said that there is explicit rationing of joint operations in Otago, and it is worsening—it is worsening. The research paper went on to say that “we have noticed an increase in the severity of disease of those patients who do qualify for surgery.” That is the evidence, Minister. It is not the nice rosy picture the Minister would like to paint to New Zealanders, but what the public are actually seeing and what our professionals and our researchers are finding.

I have to say that I am very disappointed in the Minister’s approach to the health budget. Unless this Minister is able to show New Zealanders that he has sufficient in his budget in this 2016-17 Budget, he will be a failure. And he will continue to have New Zealand Doctor magazine—this comes from doctors—writing things like this about him: “Who is Dr Coleman? What does he look like? Try Labour.” That is what they say in New Zealand Doctor magazine, and that is because he has been missing in action when it comes to supporting New Zealanders in terms of the health budget.

I will be looking to see how much money goes into Pharmac, because Pharmac says there are 20 drugs that need to be funded before a drug like Keytruda. So there needs to be a sizable increase in that budget. There needs to be a sizable increase in order to do more elective surgery. I would like to see more money going into public health, because what we have had is a lot of fancy words about obesity. [Bell rung]

The CHAIRPERSON (Hon Chester Borrows): The Hon Annette King.

No, Mr Chairman, I will sit down and let the Associate Minister of Health have a go.

It is a privilege to speak in this debate. We have heard the member opposite, Annette King, ask for facts, and then she proceeded to slander the Minister of Health, who is doing a fine job, I may add, compared with the former Minister. I think that that may be the problem here—that it is the former Minister having a go at a Minister who is doing a fine job. Now here are the facts: in Labour’s last Budget, it was $11.8 billion—she knows that; she was part of that Government—and that has gone up to $15.9 billion.

💬 Scott Simpson: Eh?

$15.9 billion, Mr Simpson. So that is over $4 billion more in the health budget under this National Government—under this National Government—and those are the facts that she should appreciate. But it is not just the amount of spending that matters in Government; it is the quality of the spending—it is the quality of spending, and it is New Zealanders accessing those services that are demanded by them. And the Minister of Health has already pointed out that under National an average of 6.5 percent has been spent as a percentage of GDP. So the actual amount spent by National as a percentage of our gross domestic product is 6.5 percent. Under Labour, under Miss King and her mates—5.7 percent. So it has gone up by about 1 percent, on average.

But it is not about that; it is actually about front-line services. We campaigned in 2008 that we would be putting more police on the front line, that we would be putting more teachers on the front line, that we would be putting on more nurses and GPs and doctors to serve New Zealanders, in terms of the quality services that they expect. Dr Coleman has already outlined 5,500 more doctors and nurses. And what does it mean?

💬 Hon Annette King: And what are they saying about the health system?

Well, what they have said is that there are 50,000 more elective surgeries, which she seems to try to debunk, but those are the facts—110,000 more first specialist appointments. Do you know that? Miss King knows that. What I can say in terms of the Pacific health portfolio, you know, we have spent millions in terms of getting more Pacific people to that front line. In terms of the Aniva Scholarships, over $1.19 million, in terms of getting more Pacific people on the front line—and that includes 58 doctors in the last year, 27 nurses, and four oral health and dentistry specialists. It is also about the nursing graduates.

A couple of weeks ago I attended a scholarship presentation evening where Pacific people were being trained. They were being trained to become nurses, physios, doctors—and, you know, that is a beautiful thing. Miss King supports that but she will not acknowledge the—

💬 Hon Annette King: Oh yes, I do.

—fine work that we are doing. Oh, she does acknowledge it. Well, thank you, I am glad you do.

I am glad that we also support health sciences academies, because it is not just about doctors and nurses; it is also about getting the kids at an early stage in their lives and to promote health sciences and to promote medicine and science in our schools. One of them—my local high school, Onehunga High School—has got a health sciences academy, which is a collaboration between the local district health boards and the Ministry of Health. When I talk to the students in those classes, what it is doing is promoting a subject that they would not otherwise be exposed to. It is allowing them to project their dreams and their aspirations to be in the health sector. These are young boys and girls, but they will be the men and women who will deliver health services into the future.

We also know, in terms of facts—you wanted facts; we are going to give more facts—our immunisation rates under National are mid-90 percent. What were they under Labour? Mr Simpson, do you know?

💬 Scott Simpson: Very low.

Mid-70 percent—they were in the 70s. So we have lifted immunisation rates right across the board, from the mid-70 percent under the Labour Government to mid-90 percentages.

💬 Hon Annette King: Do you know when it started? With meningitis B. That’s when it started—when we started to train all the immunisers.

Oh, here she goes—here she goes. She is denying it again, but those are the facts. We can look at all the health statistics you like; the National Government has done a great job to deliver these types of services.

One of the other statistics that I am particularly proud of is the reduction in rheumatic fever rates. Again, in investment, we put millions up front—

💬 Hon Annette King: Bronchiectasis.

—in terms of the investment, and Ms King agrees with this. I have heard testimonies from Māori and Pacific kids and their parents who have said that without that investment, without their exposure to the type of treatment to reduce these rheumatic fever rates, they would be suffering right now. So these things are important, these are the facts, and this is why—

I want to talk about one particular area in health, and that is the area of mental health, which is one that, historically, has been poorly dealt with by Governments right around the world, including ours. Perhaps it is because of our fear of mental illness—that we may be affected by it—that we have chosen instead to put people in the bin, and to put them out of sight in those big psychiatric institutions. I am thinking of Kingseat Hospital, Seacliff Lunatic Asylum, Seaview Asylum, Carrington/Oakley Hospital—successors of Bedlam. They were nasty places to be.

In the 1980s and 1990s in this country we had two forces that were changing that: one was the process of deinstitutionalisation, and the other was several reports led by Judge Ken Mason. The Mason reports led to a very substantial increase in funding for mental health services, and led to the creation of the Mental Health Commission. The commission itself did an extraordinary amount of good work. It developed the Blueprint for Mental Health Services in New Zealand: How Things Need to Be, it developed a ring-fence for mental health funding to ensure money that was intended for mental health services could not be spent elsewhere, and it ensured there was ongoing oversight of the implementation of the blueprint. Under the watch of the Mental Health Commission we saw steady improvement. We saw more services, we saw greater capacity, and we saw a pretty substantial increase in people’s health.

The commission moved on to primary mental health with Blueprint II, but now things are going backwards. They are going backwards because the ring-fence does not really exist any longer, and so district health boards, which are under substantial financial pressure, are choosing instead to use dollars that were intended for mental health services for other services. Things are going backwards because there is no longer a top-line target for mental health services. The point of targets is to increase focus and effort on those particular areas, with the consequence that those areas that are not targeted will have less focus, less resource, and less effort, and, sadly, mental health is one of those. We have seen the Mental Health Commission disbanded and replaced with a single Mental Health Commissioner, whose focus is on individual complaints and not on the kind of systemic oversight and improvement that we actually need.

The Ministry of Health recently conducted a review of the Waikato District Health Board’s mental health services after a series of tragic events under that district health board. It found that staff working in mental health had very low morale, it found that the planning and funding department was paying a price below the national price for mental health services, it found that staffing ratios meant that clinical staff in mental health were having to try to care for more people than was appropriate, and it found that vacancies in mental health staffing were being held open to enable the district health board to save money. Those shortcomings are echoed amongst other district health boards: Northland, Capital and Coast, Southern, Canterbury. They are the signs of a sector that is under severe financial pressure—severe financial pressure that is stretching our mental health services not only to breaking point but beyond breaking point.

People like Nicky Stevens have paid the price for that underfunding, for having that eye off the ball, with their lives. It is now time for an urgent, nationwide inquiry into the state of this country’s mental health services.

I am pleased to rise to take a call on behalf of New Zealand First on the annual review of the health sector. The Minister of Health continues to tell us, on every opportunity that he can, that the health system is in good shape and that we are heading in the right direction. We are hearing the increasingly loud voices of the people out there who are telling us that this is definitely not the case. We, and they too, hold grave concerns for the future of our health system because the ambulance at the bottom of the cliff is ailing, which is a very unfortunate situation.

The chronic underfunding is basically putting a huge strain on our health services and putting our system at risk. Many district health boards are not able to fund a safe level of staffing in our hospitals or even keep annual leave at a manageable level, and we have read this many times in the newspapers. The medical staff are saying that their workloads are unsustainable and that they are being forced to do more and more with less. It is not a safe situation and patients are, basically, being put at risk.

I had a very fortunate meeting with somebody on a plane going back to Hamilton—

💬 Scott Simpson: I bet.

—yes—who said that, in his opinion, the nurses and the doctors go beyond the call of duty to look after the patients. Despite the fact that they are stretched, they do far more than they actually should. In high-dependency units and intensive care units we know that staff go beyond the call of duty. The gentleman I spoke to said that the care his son received was absolutely outstanding and could not be faulted. He also praised the hospital air service that flies from New Plymouth to Hamilton, and, again, the care in there was outstanding. So we have got our staff working to the best of their ability despite the lack of funding.

We know too that district health boards are unable to cope with the demand for elective surgery. Although the number of surgeries has increased, and the Minister tells us that every day, it is simply not enough to keep up with demand. We have got an ageing population, we have got a sharp increase in chronic illnesses, and all of this is putting pressure on the health system. And what have we seen? We have seen the district health boards having to raise the threshold to ensure that people have to jump through higher hoops to actually qualify for surgery. The result is that more and more people are becoming more and more disabled, and more are left in chronic pain to try to cope until they can have surgery.

Performing operations when they are needed makes sounds economic sense and, of course, it saves money. I had one instance recently of a gentleman coming to visit me in my Hamilton office. He said that he needed a heart operation, but the hospital had told him that it did not have the money to actually carry this out. This does not sound like the health system that we have had in the past.

Pharmac too is severely underfunded, meaning that more and more New Zealanders are missing out on vital medicines. Those who can afford to pay for them privately or through private health insurance definitely receive them, but for the rest of the people it is just about impossible. They are left to manage as best they can. We have never ever had a two-tier health system here in New Zealand where those who can afford treatment get it and those who cannot basically go without.

When we look at cancer, we see that we are lagging behind Australia in this area too. Up in the Waitematā District Health Board the bowel cancer screening programme is absolutely outstanding, saving many people every year. Why has this programme not been extended to other district health boards? It is actually saving lives. I am hoping that the Minister is going to announce this in the Budget this year. An election promise is too late. We will lose another 1,200 people to this disease.

When we have a look at obesity, the number of cases is reaching chronic levels.

It was a pleasure to wait for the other Barbara, and I have to say that if anyone is in Inglewood next Monday morning there will be two Barbaras speaking in support of breast cancer as well. This National Government is making each health dollar go further. There are 5,500 more doctors and nurses with 1,000 fewer managers and administrators. What that means for me is there are more people in our community shifting primary health care out to where the people live.

An example that I just want to give to you around this today is that the half a million dollars that was put into rural mental health has been widely used in terms of training people to pick up problems and help with cases early, before people get to the stage where they need to be in hospital. So it is about more identification and more knowledge around that.

I agreed with Kevin Hague when he talked before about the things that we used to do to people with mental health issues in years gone by, and I am pleased that we are past that. When I see 480 people coming out in Hāwera to listen to John Kirwan speak on mental health, I do believe that the stigma is lifting. So I am really pleased that the community is totally aware of it.

Other things are happening in terms of shifting health care out into our communities. This week all of you here in Parliament will have the opportunity to visit on the forecourt the mobile health care units. They are visiting Parliament. I am really pleased to have them here. There will be a lot more than there used to be. We are going to be looking at the mobile breast-screening unit, the mobile dental unit, and the mobile lithotripsi—and for those of us who do not have medical backgrounds and who are lay people, that is about blasting your kidney stones. The mobile surgical unit will be there. I have been lucky enough to watch an operation in that surgical unit, and it is an absolutely brilliant concept.

But what is actually even more exciting is that there are more technologies in the making. The diagnostic technologies that we are going to be looking at, which are traditionally in the realms of hospitals, are more and more being brought into our communities. These are things like prostate function; respiratory function; mole-mapping; endoscopy, which is about your digestive tract; and skin lesions—those sorts of things. It is going to be a real pleasure to be associated with those surgical buses and health care units that are coming to Parliament.

The other thing that is happening this week is that I am opening the Rural Nurses Meeting on Thursday night. It is a real pleasure to be doing that. The Rural Health Alliance Aotearoa New Zealand is coming to Parliament—and to Wellington as well—and will be talking to us tomorrow. So there is a whole lot going on in our communities that is taking primary health care closer to where people live. You would have heard the Minister of Health talking before about integrated data and people’s health. You know, if someone is not doing well, is it a health issue, is it a learning disability, or is it a hearing issue? There is a whole range of things that we can pick up with integrated data.

I was very impressed last week when I joined the Prime Minister and the Māori Party in Te Kūiti. We had the Taumarunui Community Kokiri Trust in Te Kūiti demonstrating all the services that it offers, but the best service that it actually offers is that when people go in its door, they end up with a one-stop service. So this is the beginning of some of those integrated community services. Whether it is a health issue, a social support issue, or a housing issue, people come in very confused about where they need to go. That business has a source of navigators, who are totally there to help people work on whichever issue they need to and connect them to the right place so their health and social well-being is taken care of. They also have these wonderful groups of people who go out in their blue T-shirts. They do dancing in the community, they are fit, they are active, and they are working a whole lot on prevention as well as cure.

So I am really heartened with what is happening in health and with what I see in my communities. I am very pleased to be standing here in support of the National Government today and I look forward to all the things that are happening. Thank you.

Report noted.

Justice Sector