New Zealand Public Health and Disability (Southern DHB) Elections Bill

Labour supports the New Zealand Public Health and Disability (Southern DHB) Elections Bill. We supported the bill at the first reading and we supported the bill at the select committee. We supported the bill in the second reading last week. We supported the bill because we recognised there was a problem at the Southern District Health Board that needed to be rectified. We supported it because it was a longstanding problem that went back to the time the two district health boards were amalgamated without the necessary work being done to see the financial impact on that district health board. We know that over time there had been huge pressure on that district health board—its deficits were growing, there was a lack of confidence in the board itself, and, finally, there was a lack of confidence by the Minister of Health in the board’s performance—so there needed to be some action taken.

We supported the Minister when he put in a commissioner. In fact, I had suggested that the Minister put in a commissioner some time earlier—the Minister might not remember that, but I actually did suggest it several months before you put in a commissioner. We supported delaying the 2016 election. We did it because the commissioner and deputy commissioners would have been in place since only 15 June 2015—so 11 months—and 5 months later we would be going into an election for the October triennial election. They will not have implemented their recommendations and they would not have implemented their plan. I agree that they need time to do that. We need time so that when they do present their plan, the Minister needs to be held accountable for the implementation of that plan. It comes very much back to him then—not to a board but to the Minister, because they are his commissioners.

We are concerned—and, in fact, both New Zealand First and the Greens, who have voted against this bill, have been concerned—about the loss of democracy. We had something like eight submissions to the Health Committee. The two from Māori submitters were not opposed to the delay in the election so much as about what representation they could have for Māori on the Southern District Health Board. The other submitters were opposed to the loss of democracy. I wish we did not have to delay the election, because I strongly do believe that we ought to have democracy in district health boards. In fact, I was the Minister who brought back democracy to district health boards. It had been got rid of in the 1990s, under the zealots who were in Government at that time—

💬 Hon Ruth Dyson: That was National.

—National at that time; think Ruth Richardson. National had got rid of democracy—it was getting rid of area health boards and putting in place a whole lot of things with funny names like “CHEs”, Crown health enterprises, and “RHAs”, regional health authorities, and “HFA”, the Health Funding Authority, and so on. When we became the Government, under the New Zealand Public Health and Disability Act we brought back democracy within district health boards. So we strongly support the ability for local people to have a say on their district health boards.

We are also concerned, Minister, that the track record of this Government, since it has been in power, relating to Environment Canterbury has meant that when a promise was made—and a promise was made—to have an election for Environment Canterbury, when it came to the time to have that election it was delayed, and the commissioners’ times were stretched out, and the election was delayed again until the people of Canterbury lost faith in the Government’s promise that there would be an election held for them. We have some grave fears that this will not be a delay of just one election.

So I have come to the Committee with a suggestion for the Minister. Of course the Minister would have to be a big man to take it, but it is a serious suggestion that, in fact, he replaces the word “cancellation” and puts in place “postponement” of the 2016 election of the Southern District Health Board, and that it be postponed until a date set by Order in Council. What that would mean, Minister, is that when the commissioners have presented you with the report and they have implemented the requirements that you have put upon them, it is no longer necessary to delay an election in the Southern District Health Board—that there is the ability for you by Order of Council to be able to then hold an election. It might be only a year from now. No time frame has been given to us as to when the work of the commissioners would be completed. It might be a year—it could be 18 months. But why delay it if there is an ability, having then got the recommendations, having put in place what was required, for the Minister to then be able to call an election by Order in Council?

I think that my amendment satisfies a number of issues. It gives commissioners time to do the work that the Minister wants. It does not cancel an election if one could be held earlier. There are no extra costs, because if it is cancelled the $300,000 that was the cost for the last election would be used for one when it was called by the Minister, and when the next election came round it would be straight back into the same timetable. It would also meet the demands of southern New Zealanders to have a say in the health board.

If the Minister was not prepared to accept this approach, then is he prepared to follow the lead of the previous Minister of Health, who, in December 2008, when he became the Minister, turned the commissioner at the Hawke’s Bay District Health Board, Sir John Anderson, into the chair of a board and then appointed the previously elected board members to a governance board until 2010? That was the way that he had managed a board that had been dismissed: turning the commissioner into the chair and making the former elected members into a board of governors, a governance board. Would the Minister consider this approach, if he would not consider calling an election earlier, if everything that he has asked for has been undertaken?

I do accept and support the Minister wanting to have a board that is financially strong, has the confidence of the people of the southern district, is able to provide the services that are so needed, and is able to do the rebuild of that hospital. Where I do not agree with the Minister is that the southern people have to find the money to be able to help build their hospital. Most hospitals around New Zealand have had funding from the State, but one of the requirements is that southern people show how they are going to be able to help rebuild their own hospital.

But, Minister, when they have achieved all those things that you require, why would you then delay when you could have the opportunity to say: “Right, you’ve performed what we want. You’ve done what is needed. I’m confident that what’s been put in place works. I will therefore, by Order in Council, call an election for the people there.” We will continue to support this bill, Minister, but we put up a suggestion for you, and I would like to hear your arguments as to why you would not accept an earlier election. You do not have to wait until 2019 for an election if what was required was done earlier.

I would be interested in the Minister’s response to that and also in whether the Minister will give an assurance that there is not a delay in an election for beyond 2019—that there is an absolute cast-iron guarantee from him that this is for one period only. I have to tell you that there are a lot of nervous people, and I have gone through many of the press clippings from out of the southern area, written by people within the community, from doctors, from Grey Power, from nurses, and from others who are very worried that this democracy has been removed from them and that it may be some time before they get it back.

So it is a serious issue but, having said that, I also know how serious it is to ensure that we get a board back into financial shape. It may mean, Minister, that the review that you have done on the population-based funding formula needs to take another look at the rural factor for the southern district, because it does not make sense to me that South Canterbury has a higher per head of population funding than they have in the southern district.

Thank you for the opportunity to speak at this Committee stage. I, of course, will be speaking in support of the bill—as my colleagues have done—and in support of the amendment put forward by the Hon Annette King, which does give an opportunity to the Government to step up to the plate to restore democracy earlier if there is sufficient progress made by the commissioners on those issues, which have really been concerning people in the South and across New Zealand, I think, in respect of the Southern District Health Board as a resource with ongoing financial difficulties and ongoing issues of capacity. I think it is helpful for the Committee to remember, of course, that part of the loss of capacity was due to people leaving when there was a great deal of uncertainty about Health Benefits Ltd and what it would achieve and about the centralisation of financial structures across New Zealand in what turned out to be a failed project. We know that people left Dunedin to be a part of that failed project, so the Southern District Health Board actually bled capacity. It bled planning capacity and financial capacity around that time because of a failed experiment by this Government.

We know that the Government had a Crown monitor on the board before the commissioners were put in place. We know that for 6 years it had that Crown monitor, who acted as a Government watchdog, effectively, on what was going on—a direct line, if you will, to the Minister to ensure that a board is performing its duties effectively and doing what is asked of it. Of course, the Minister also chooses the chairman in a normally run board and five of the 12 board members. So the Minister and his predecessors have to take responsibility for the situation that the Southern District Health Board found itself in. Of course, the Minister then stepped in, and we have supported this, and said: “We will appoint a commissioner. We are not happy with the progress, and of course we must own the lack of progress in the Southern District Health Board in meeting its financial targets and also in meeting the expectations of New Zealanders for delivery of health care. The buildings have become run down. We are familiar with the fact that there is a major asbestos issue in the buildings in Dunedin, and we have become aware, of course, of lower staffing levels and of various attempts to work with limited finances.”

The Hon Annette King also referred to the funding model and the review that the Minister undertook. We, on this side of the Chamber, are not convinced that that funding review was sufficiently broad and sufficiently deep to really assess whether the district health boards are being funded fairly. And there is the very example that the Hon Annette King just used of the rural adjustor and the fact that South Canterbury actually receives more funding per capita for a rural population despite having a far smaller geographic area than the Southern District Health Board, which covers a geographic area the size of Belgium. It just does not seem right. There are questions around whether the tertiary funding area is adequately compensated in terms of training, and so on, and those questions were not probed in sufficient depth in that review.

In speaking to the amendment put forward by the Hon Annette King, I want to say that if the Minister does take up that challenge, I will be impressed. I will put that on record in advance. It is a way that the Minister can show he is committed to the restoration of democracy there, which, rightly, has been raised as a concern because of the Government’s track record with Environment Canterbury and elsewhere, and because of the sense that the Government seems increasingly out of touch with middle New Zealand—the sense that it is not genuinely concerned about democracy and about what middle New Zealand thinks about issues and would like to see happening in the country. If that is going to be the case, I think we want to see a number of areas of progress before the intention of that amendment is realised through an Order-in-Council.

The kinds of things that we would like to see, of course, are things like the finances coming under control for the district health board and either that consistent deficit disappearing immediately or a clear plan as to how that is going to be diminished. We would like to see some clear and measurable signs that that structure and capacity are there to deliver the health care in Otago that all New Zealanders would, could, and should expect of their district health board. We would like to see that that capacity is there at a planning level, as we see the new hospital being planned for Dunedin, and also at a governance level—that there is, within the management structure, the ability to report to governance effectively and also some confidence about the people the Government intends to appoint for its appointments in that process.

I guess the other key indicator in that area would be a credible plan for the rebuild, because that is something that southerners have been crying out for for some time—capital on the table and a date on which construction will begin. I actually have a petition running in the South that seeks a commitment by the Government to begin construction on a hospital rebuild by 2017. The previous Minister expected, while he was still Minister, for there to be a business case to Cabinet for that rebuild. All we have seen since then is duck-shoving. The time lines have been pushed out—they have been pushed out further and further and further. It is like this Government is simply not committed to that hospital rebuild. It is like it wants to push it on to some future Government and pretend the issue is not there. Well, actually, it is incredibly important for New Zealanders, and particularly New Zealanders in the South Island who access those services, that we have money committed—that we have capital committed—to that project and, with it, a start date for that physical rebuild, because that is what really shows true commitment.

Also, we would seek from the Minister an assurance that the same tertiary level of hospital will be retained so that services will not be lost to people in the South. Health care needs will change. Ways of delivering services will change. Let us have a mature debate about this, but we seek an assurance that the same tertiary level of hospital will be maintained by the Minister, because we should not see falling levels of health care in New Zealand. In the meantime, we want to see—and it was expressed in the select committee process—a commitment to increased reporting. There have been some moves made by the commissioners since that select committee debate to have more transparency in their discussions—to invite people to some of the sessions that the commissioners are running, and have some more open discussion, more like what there was when the board was in place. Locally, I have certainly had feedback from people concerned that Labour has not just outright opposed this. We have taken a response that we believe is the right response: to support the Minister’s desire to get stuck in and make a difference here, and to have commissioners who sort out the financial difficulties, the planning difficulties, and the capacity difficulties at the hospital—commissioners who will commit to the nature of the rebuild and the time frames—and we want to see the Government committed to that.

That means the Minister has even closer responsibility than he used to. Let us acknowledge that he used to appoint the board members, he used to appoint the chair, and he had a Crown monitor on there. He now has his own commissioners reporting to him. We want to see the Minister commit to those time lines, to commit to the financial health of the district health board being restored, and to commit to funding it adequately. These are the commitments we seek from the Minister. If he does not achieve these things, he will have failed. He is directly tied to the appointment of those commissioners, he has skin in the game, and the southerners want to see this Government delivering. It is Dunedin’s turn. Dunedin Hospital is the last major metropolitan hospital in the country to have a rebuild, and it is simply unacceptable that the time frames for that rebuild continue to get pushed out, and that southerners get lesser health care than people elsewhere in the country, and less than any New Zealander should expect. Most New Zealanders are pretty reasonable. Most New Zealanders simply want an adequate level of health care. They want to know that the hospital will be there in their time of need and that the Government will be funding it adequately rather than a $1.7 billion shortfall that we have seen under this Government.

As I said at the outset, we will be supporting this bill. We do think that the Minister has the responsibility to step up, with this support, to deliver on the promises of the Government—to adequately fund health care and to drive forward the hospital rebuild and governance and management arrangements at the Southern District Health Board.

The Green Party is going to continue its opposition to the New Zealand Public Health and Disability (Southern DHB) Elections Bill this evening. We opposed it at first reading; we opposed it at second reading. In the Health Committee, we explored ways to improve some of the less satisfactory aspects of the bill, in particular around the Treaty of Waitangi and the effective suspension of the Crown’s responsibilities under the Treaty, which the commissioners being in place amounts to. Unfortunately, those improvements were ruled to be out of scope for what the committee could do.

We supported the appointment of commissioners in the first place, and we did so probably for somewhat different reasons to those that the Minister of Health had for appointing them. We supported the appointment of those commissioners because in our view, based on the evidence that we had gathered from the southern region, the board of the Southern District Health Board had lost the confidence of the people of that region. It had not stood up to the underfunding of services. It had not pursued the recovery of the debt from Southland Health when clearly it ought to have done if it were doing its duty properly. It did make the decision to bring in those awful hospital meals from Compass Group.

So the board, in our view, had lost the confidence of the people of that district and, in our view, that is its job. Its job is to represent the people of the district. It is an interesting tension—is it not—in the law, under the statute, whether a board is more accountable to the Minister of Health or to those whom it represents on the ground, the population of that district. My view has always been that in a situation where we support elected boards—or, at least, partly elected boards—there is a very clear accountability to the population being served. There is a notion of the district health board as being the purchasing agent of the population it serves, and that can work only if the board is accountable to that population. That is an important question because the hurdle for suspending democracy is an extremely high one—or we believe it ought to be an extremely high one.

The question now is, with commissioners in place, is there something that is inherent in elected board members that would be an obstacle to the commissioner achieving the goals for that commission? The Green Party’s position is that there is not an inherent problem with elected members, and, that being the case, our view is that we ought to be returning to the democratic process that enables the people of the southern district to appoint, or to elect, their representatives once again, forthwith, with no further delay.

If there is something that is inherent in elected board members getting in the way of achieving the purposes of a district health board, then why would we have elections at all? Why would we even bother with elected positions? If there is not, then the Green Party’s position is that we can have the best of both worlds, and we should. As Dr John Chambers indicated in his submission to the Health Committee, in fact the majority of the members of a district health board are appointed by the Minister. If it is so important that the people who are occupying the commissioner and deputy commissioner roles right now are able to have continuity in the work they have begun, well, why does the Minister not appoint those individuals to some of the roles that he can appoint to on that board? Why does he not make Kathy Grant the chair of the Southern District Health Board and appoint Richard Thomson? That would allow the people of the southern district to also elect their representatives.

It is possible to have both, and I would certainly be very keen to hear from the Minister in the chair, Jonathan Coleman, what objection he might possibly have to that suggestion, what objection he might have to having the best of both worlds. I am also keen to hear from the Minister in the chair as to whether, in fact, he believes elected board members are an inherent obstacle to the achievement of a district health board’s aims.

Annette King has spoken about an amendment that would provide for elections to be held sooner if certain conditions are met so this denial of democracy would become a postponement rather than a cancellation. Certainly, the Green Party will support that amendment.

One of the other issues that was raised by submitters to the select committee was the issue of democracy and transparency of process. They indicated that since the commissioners had taken up their roles there had been a loss of that transparency. David Clark, indeed, has spoken about that in his contribution this evening. We certainly welcome the statements made by the commissioners that they will do what they can to improve that transparency and to lift their game when it comes to consultation of the people of the southern district.

I want to take up with the Minister his comment in the second reading debate when he noted that increased transparency would be provided by the Southern District Health Board through the mechanism of advisory committees being open to the public to attend. Of course we welcome advisory committees being open to the public to attend; that is actually how they ought to normally operate. If they have not been doing that at the Southern District Health Board, that, I guess, indicates yet another problem in that district health board. I think that when the people of the southern district come to this Chamber and say they are concerned about a loss of transparency, they do not just mean at advisory committees; they mean at the highest level within that district health board where governance decisions are being made.

I would welcome the Minister’s contribution as to why the discussion and deliberation by the commissioner and her assistants is not also subject to that same requirement of transparency, because I am sure that is what is required, and desired, by the people of the southern district. It is what is available to all of the other citizens of New Zealand. They are able to attend the meetings of their district health boards. Certainly, some matters might be taken behind closed doors because of commercial sensitivity, for example, or because of privacy concerns. But successive Ministers have been clear that their expectation is—and the law provides that it ought to be—that district health board meetings are held primarily in public. And so it ought to be for the deliberations of the current governance arrangements at the Southern District Health Board.

I would welcome the Minister’s contribution on that matter, and in the event I am granted a further call later on, I want to talk about Treaty of Waitangi issues.

I would like to remind those people who are listening or watching tonight what the intent of this particular bill is. The purpose of this bill is “to cancel the 2016 triennial general election of the Southern DHB in order to provide, until the repeal date, for the continuation of the term of office of a commissioner for the Southern DHB.” I would also like to point out that this bill would extend the term of office of a commissioner until the day that elected members of the Southern District Health Board come into office, after the triennial general election in 2019. I want to point out that just this afternoon in question time I tabled an amendment that I and New Zealand First absolutely believe will help find a solution to the position that we are currently finding ourselves in. But I will get to that shortly.

It has been no secret that New Zealand First has not supported this bill. We have absolutely opposed this bill in the first and second readings. There were some amendments made through the select committee process that were good amendments and that we felt, out of those eight submitters, were good amendments.

I want to bring back the statement that the Ministry of Health made, which was recorded at the select committee, in March 2016. The ministry was quoted as saying: “While the impacts on local democracy are noted, we consider that this is balanced by the need to provide time for the Commissioner to drive the necessary improvements, which will benefit the district in the medium to longer term.” In other words, what this Government is saying, really, is that it is prepared to sacrifice the democratic rights of southerners under the guise of being fiscally responsible.

New Zealand First does not support this position, and we continue to not support this position. We refute the need to strip back democracy while alternative solutions exist. This is when I will come to my amendment that I tabled today. For those people who are listening and watching tonight, my amendment proposes, in clause 4, to replace the word “cancel” with the words “integrate a commissioner within the bounds of the 2016 triennial general election of the Southern DHB in order to provide, until the repeal date, for the continuation of guidance of a commissioner for the Southern DHB.”

Another change that my amendment is proposing is to clause 7, “Cancellation of 2016 election of Southern DHB”. I have proposed that we remove clause 7(1) and replace it with a new clause 7(1): “The following provisions of the 2000 Act shall apply to the Southern DHB in relation to the triennial general election of 2016, explicitly (a) Clause 16(1) of Schedule 2 (which provides for the Minister to appoint persons to hold positions on the board of that DHB that would otherwise be held by elected members); and (b) Clause 16(3) of Schedule 2 of the 2000 Act does not apply to the Southern DHB triennial general election of 2016.”

In the explanatory note that I have put with that amendment, it says that “The purpose of the SOP is to preserve democratic process in the triennial general election for the Southern DHB, while simultaneously promoting a reasonable time frame for the commissioner appointed in 2015 to continue the scope of work. This SOP recognises the need for both elected members, and an appointed commissioner to best address the complexity of issues facing the Southern DHB without stripping the right to democratic elections of [our board representatives].”

I believe that, once again, New Zealand First has come to the House offering an olive branch, a solution, given the very fact that the Minister himself supported this in his original intent when he sacked the board, and that was reported in the paper. So I am calling on the Minister and that National-led Government to stick to what the original proposal was and do not strip the people of Invercargill, Otago, or Southland of their right to vote. I see my amendment as being a win-win situation, not only for the Minister and also for the commissioner and her sub-commissioners but also for the people of Southland and Otago, who deserve their right to vote for their elected health board members in the 2016 election.

I have had many constituents come to me since the first and second readings and they were rather happy that the two elected MPs for the National Party in the Invercargill electorate and the Clutha-Southland electorate made a short call in the second reading. What I got, overall—

💬 Hon Ruth Dyson: Do you mean they knew who they were?

They did—they did. They took their time to look. The constituents in Invercargill truly believe that they do not want to see their democratic rights stripped away under this National-led Government. History tells us, unfortunately, that it is quite quick to actually get in there and fire a board and make promises, like it did with Environment Canterbury. I mean, we were told that the people of Canterbury were going to be given back their right to vote, and in the House just recently we have been told that that must be delayed again, and that was really disappointing. That is what we in Southland do not want to see.

We do not want to see that we are being given a promise and it actually turns out that it is not fulfilled by the Minister, and that is a huge concern for us not just in Southland but also in Otago. When people have come up to me in the street and said “Good on you for fighting for our right to vote.”, I do not think that we should downplay the importance of what it means to Kiwis to have their right to vote. My amendment, and I thank the Labour Party and I thank the Green Party for agreeing to support my amendment, supports the right—and we do recognise that there have been some deficit issues on the Southern District Health Board. We would be allowing everybody to win with my amendment, which is actually to the betterment of not just the Minister and not just the commissioner or the board but actually, ultimately, of our community.

We have been taught that in order to work together, we should not work alone—that we should join together as a group. I am listening to the constituents in Invercargill and I am listening to the people of Otago when they have supported me in ensuring that I would be the voice to stand up for their rights and have the guts to say: “Do not take the rights of Southlanders or Otago people away by implementing and supporting this bill. Take note of my amendment and recognise that we can actually all work together for a better outcome and make sure that we do not lose the voice of our right to vote.” I think that is something that is really important and should never be downplayed—never—in this House. Thank you.

It is a privilege to speak on the New Zealand Public Health and Disability (Southern DHB) Elections Bill in the Committee of the whole House stage. Before I start, I just want to acknowledge the Minister of Health, the Hon Dr Jonathan Coleman; the Health Committee chair, Simon O’Connor; and the commissioners, Kathy Grant, Richard Thomson, and Graham Crombie.

I do not think for one minute that we can underestimate the level of public service that these people have undertaken in their role as high commissioners and deputy commissioners, and the high level of public scrutiny they are under. I think what they have done is actually a service to Southland and to Otago. The task they have taken on board is, basically, to turn round a systemically dysfunctional $852 million organisation supporting a couple of hundred thousand people across a land mass the size of Belgium, as Mr Clark has pointed out. It is no easy task, and I want to acknowledge the support they give to us as local members of Parliament—and I suspect they provide the same level of support to Opposition MPs—and to the members of the community, who have basically vested a lot of support and hope in the ability of these three people to turn round an organisation we all rely so much on.

At the heart of this bill, it extends the term of office of those commissioners. I think by appointing those people to undertake this task, we would be doing them and our region an incredible disservice if, after about only a year or 18 months in the role, we were to say: “Right, that’s it. Time’s up. You now have to come to us with your proposals.” This is an incredibly complex area. I have participated in a number of public meetings where the commissioners, the chief executive, and members of the district health board themselves have fronted up in full force to listen to the concerns of members of the public, the concerns of professionals working in the health sector in the district, and the concerns of other stakeholders and key interest groups in order to really get a handle on what the issues are and to start forming some views around how we can improve the health care service in our area.

I just want to reiterate that I think this is clearly a long-term piece of work, with a long-term goal of financial stability and sustainability. We have got an organisation that had a $42 million deficit, which has now been revised down this financial year to $35 million, and that has been agreed to with the Ministry of Health. I do not think that we can take those figures lightly for a sector whose overall deficit is at the level of only about $60 million. If two-thirds of that value is taken up by one district health board, it really demonstrates the need to reform and to focus on how we can improve the health care service in this area.

The Opposition has said that the health sector, and particularly the Southern District Health Board, is underfunded. I would have to disagree with that. Over the last 6 years the Southern District Health Board’s funding has increased by $136 million. We have got more staff. We have got 66 more doctors and 195 more nurses compared with 2008. This is not a case of having an underfunded district health board; it is a case of systemic financial mismanagement. I think one of the things I want to acknowledge the commissioners and their team for is their level of public transparency and willingness to front up to the public on these issues.

This is a phase of recalibration and stocktaking. There is not much to tell at this point in time. These guys are going around listening to people and trying to find what the issues are and where things need to change for the better. Health care needs in our district have changed. We have got an increased ageing population, we have got increased ethnic diversity, and we have got an increase in young families in certain parts of our electorates. We have got parts of my electorate where there is a highly ageing population—Gore, Winton, Lawrence, Balclutha—and then we have got other parts of the electorate such as Queenstown, which has got an influx of young families and ethnically diverse people coming into the area. The district health board has to grapple with all those challenges, and I want to acknowledge, again, the support that the commissioners are putting into this area in this space.

For the Opposition to say there is a lack of transparency and a lack of accountability to the public—I have to disagree. Although the commissioners might be legally accountable to the Minister of Health, they are ethically, morally, and practically accountable to the public. Kathy, Richard, and Graham and their families all live and work in the Southern District Health Board catchment area. Just because their nine-to-five job as a commissioner means they focus and report to the Minister, it does not mean to say when they go out to get their groceries and when they go out to dinner or go out for a coffee with a friend, they are not accountable to members of the public all the time, every single day. I think the settings are right, with the legal accountability to be placed with the Government. It shows, from my perspective and from my constituents’ perspective, that the Government is taking a strong interest in getting some better outcomes for the Southern District Health Board.

I want to acknowledge the interest that the Minister is taking in this area. Since becoming the Minister, he has been down to the area probably four or five times and he has met with most of our hospitals down there, which shows a genuine desire to put things right and to recalibrate the health system for the better for Otago and Southland. This is not an inherent problem with the elected members—to touch on a point that Mr Hague has talked about. I do not think for one minute that we are suggesting there is an inherent issue with elected representatives on the district health boards or on any other public organisations for that matter. I think it is a case of a systemic problem with a complex institution.

I do not claim for one minute to be an expert in the health area or the health governance area. I know that Mr Hague has had experience working in that area himself. But what I can say is the views I have had from my constituents are that they are pleased with the approach the Government has taken by putting in commissioners, they are pleased with the level of public engagement, they are hungry for that engagement, and they are appreciative of the ongoing engagement they have with the commissioners and their team.

I think as a Parliament, instead of criticising the work of the commissioners and underplaying the level of complexity of the role we have asked them to undertake, we could actually get behind them and support them—support an extension of their duration in that role and get right behind them to ensure we get the best results for the people of Otago and Southland. Thank you.

There is nothing quite like issues around health to get to the public’s emotions and get the public stirred up. In this country we have an expectation of a level of health care. There is no doubt that over the last few years there have been some systemic failures within the Southern District Health Board. But they have not necessarily been the fault of the board. The board has had to deal with some pretty big, gnarly issues. The amalgamation of a couple of boards is certainly not going to be an easy task to manage, to cope with, considering we have already heard tonight that there are issues around differences in funding bases for one area, as opposed to another area. But health is at the heart of what we see as a good democracy—good access, easy access, to decent health-care. It is no wonder that there are a range of views across the Chamber about how that should be achieved.

When I sat in on some of the submissions—there were half a dozen, or a few more—there were a couple of submissions that talked about our absolute commitment to ensure that there are good outcomes for Māori. One of the submissions was made by Te Rūnanga o Ngāi Tahu. Their concern was that they did not believe that under the provisions of the Treaty of Waitangi their ability to have full access to good health-care and well-being was fully acknowledged under the role of the imposed commissioner. They were seeking some redress around this. We talked about it throughout the select committee, and even the report that came back to the House talked about the discussion we had had. It was fairly clear that that is not within the scope of the bill, but it was an important aspect that we felt needed to have some acknowledgment. This is why I raise it today.

One of the suggestions that came up in the select committee was with regard to the ability to appoint deputy commissioners, and whether it would be an opportunity to consider appointing a deputy commissioner to cover off the concerns of Ngāi Tahu around significant involvement for the rūnanga in the work of the commissioner, as they were working through these particular issues. I know that in our report back to the House we said that that is not within the scope. But it is certainly something that I think we should consider, given that there were significant concerns raised by Ngāi Tahu about our obligations under the Treaty of Waitangi.

The other concern that came through loud and clear from the submitters was about transparency. In most of the submissions what people were concerned about was their ability to not only participate and contribute to the discussion but actually to hear about the decisions and the decision-making process that were happening with the commission and the deputy commissioners. It is very clear that the people of the region are wanting a say in how the review and the work of the commissioners occurs because they are in such a serious state—because we are in the position of having to disband the board and appoint commissioners.

It has raised the level of concern within the community, and obviously it has raised the expectation of the community, that they will be able to participate fully within that environment. Rather than being dismissive of that, it would be a useful thing if the Minister could talk about opportunities to ensure that those voices are heard, and that there is a significant opportunity for the people of the Southland catchment area for the district health board to feel that they are able to take some comfort in the process.

The last point I want to make is something that my colleague Dr David Clark touched on, and that was about the ability to ensure that the considerable capital works programme goes on. There is no doubt that the hospital in Dunedin is seriously overdue for its rebuild. There has been a long period of time when maintenance has not been undertaken to the standard, and the building may not actually be fit for purpose any longer. I am hopeful, and perhaps the Minister can answer this question, that that may become part of the work that the commissioner does to ensure that that work is scoped properly, and that the considerable works programme that needs to occur is fully considered.

Just on a final note, I agree that the amendment that has been put up by the Hon Annette King actually makes a lot of sense. It does make a lot of sense to ensure that we give the appointed commissioners the time to do their work. However, when the work is done we should not be beholden to the fact that the elections have been cancelled, as opposed to postponed, to ensure that we get back to full democracy as quickly as possible. It would be an important point to consider—changing the word from “cancellation” to “postponement”. It is a simple amendment. But it makes a lot of sense in terms of the ability to ensure that timeliness, in terms of democracy, is returned to the people of Southland.

Kia ora, Mr Chair. I am very pleased to make a contribution in the Committee stage of this bill, the New Zealand Public Health and Disability (Southern DHB) Elections Bill. The Southern District Health Board is one of seven district health boards that I have in my electorate, but it is a favourite of mine because it actually does a very good job, despite the troubles that beset it at the moment, through the appointment of the commissioners.

I would just like to pick up on my colleague Poto Williams’ comments. Yes, there are concerns from Te Rūnanga o Ngāi Tahu at being denied by the Minister’s appointments to have Māori representation on a normally constituted board. Those concerns are very valid, but in the face of all of the change that has engulfed the Southern District Health Board, I am very pleased—and I have met with the individuals concerned—that there is a very strong Māori health directorate in the Southern District Health Board. It is well led by Pania Coote, a local from down there, in Bluff. It does a very good job because, in spite of all the difficulties, it has still managed to have iwi governance and the management advisory groups, and has been able to put comprehensive Māori health plans together for the southern region.

I do commend the Māori health directorate for the work that it is doing in such challenging and difficult times within the Southern District Health Board. We are talking about a geographically massive health board district. It is a very large size. People have said it is the size of Belgium; that is a reasonably sized European country. You could throw in a few more countries, for the South Island. It is a very large and diverse area. Those are the issues, I believe, in terms of the funding model.

What we are doing with this legislation—seven elected and four appointed board members have been replaced by three commissioners. Hopefully, the financial expertise that they will bring to bear will surpass the collective, normally constituted board that was governing the Southern District Health Board. We have these three commissioners, and they have to try to rectify and steady the ship. They have to try to close the gap on the shortfalls of funding. But, again, we are dealing with a very diverse area. It is very hard to get senior doctors all the way down in Invercargill and Southland. Trying to attract senior doctors is hard and it costs money. Those are the challenges that the Southern District Health Board faces.

Just yesterday I learnt that if you require a physio from the Invercargill hospital, there is no physiotherapist down there. You would have to wait a year for some physiotherapy attention down in Invercargill—maybe not that long, but it is certainly long because there is no physiotherapist actually employed down in the Invercargill hospital. This was at the health summit convened by the Hon Annette King. There was actually a very enlightening and very wise group of health sector heads there. Yes, they were very concerned—very concerned.

But returning to the bill, it is very important that we get—we want to get the fully elected district health board back in place. This bill sets 2019 as the year of the automatic transition back to the elected district health board. Let us hope that happens, because, as we have seen with the example of Environment Canterbury’s appointment of commissioners, these time frames are not necessarily fixed. Who knows? We may be back in this Chamber in a few years’ time extending this time out further if the job is not done. I just certainly hope that the commissioners who are appointed are getting on with their job and that they will be able to.

Mr Bridges mentioned that this is an exercise in recalibration for the district health board. I would venture to say that we need more than recalibration; we need a resurgence of funding to go into the Southern District Health Board to make sure that it is actually able to do its job more effectively, so that we can all—[Bell rung] I just want to carry on just a little bit further. I do want to make sure that there is a resurgence of some fair funding, taking into account the geographical size and the large population of the 300,000-plus Kiwis in that southern district—all of those factors, to make sure that we do get back to a top-performing Southern District Health Board.

Those are just the main remarks I wanted to make. I do want to give another shout-out to the Māori directorate within the Southern District Health Board, which is doing an excellent job in improving the health outcomes for Māori across that district. Kia ora tātou.

Having been given the call, I actually feel bad for Kevin Hague all of a sudden now, but anyway. I am very pleased to take what will be, I think, a relatively short call, but I might be found to be wrong on that. There are a couple of things I just want to draw the Committee’s attention to, as we take this Committee stage on the New Zealand Public Health and Disability (Southern DHB) Elections Bill.

The first point, and I raised it in the second reading debate, is that this is a very narrow bill. Its scope is incredibly narrow. Its singular purpose is to stop the elections this year for the Southern District Health Board, for the very proper and right reason that the commissioner needs to continue her work, we believe and, I think—when we were listening to the likes of Todd Barclay, an MP from down there, actually—for the good of the community through to 2019. Why I want to stress that very narrow scope is that a lot of the other stuff that has been raised, understandably, at one level, is not really all that relevant to this discussion, be it from food to the nature of the hospitals and so forth. That is not the direct element of this bill. Those are consequential aspects, and I think what is really important is that all those elements—from the state of the hospitals to how the funding is allocated, physiotherapists and the like; issues that are raised by members, list or otherwise down there—are actually being addressed by the commissioner and her team. And that, I think and assume, has been an important reason as to why the Minister of Health put her in there.

The issues around Māori representation I think people have rightly noted. The Health Committee took the right and proper step to put that into its report. As I say, it is not in the actual bill and amendments because that is out of scope. It is not the bill’s purpose in this Committee stage or otherwise to dictate how the commissioner operates; it is more to say—actually it is, primarily, if not, singularly, to say—that there will not be an election. We certainly encourage transparency, and we have heard some really good reports of late of how the commissioner is being more transparent to the public in the Southland District Health Board. But, again, this does not fit the bill as something to be amended or changed.

I do want to draw your attention to a couple of thoughts on the amendments that have been put down. Both of them I do not think we should support. Primarily, for the purpose, the simplicity of this bill is not served well by these amendments. I can understand the intentions of them, but both actually complicate. They also touch on to that whole dynamic that somehow democracy is best served by being democratic alone. I have touched on this before. Democracy is served because it brings about a particular purpose.

💬 Hon Ruth Dyson: Think of a better excuse than that.

Oh, look, I could but it would get incredibly complicated for the member. So I am going to try to keep it simple.

The whole point of democracy is not simply to vote for the sake of voting; it is to bring about good governance. And although I understand the good intentions of Ria Bond, and can I commend her for her work on the select committee, actually asking the Minister to appoint normally elected people really is just, I think, an overly complicated way of actually doing what the commissioner already does. So I do not think that is overly helpful. As an Auckland MP, I cannot speak to those on the Southern District Health Board, but I suspect that they would not see any difference. If the Minister was simply just to appoint all members of the board and say everything is tickety-boo, to use the technical term, I do not think they would quite believe in that.

I took a bit more time looking at the Hon Annette King’s very recently tabled amendment. I can understand the intention of wanting to get the district health board back in place as quickly as possible. The analogy I think of is actually Selwyn College in my electorate, around an education commissioner. Again, I think that in dynamics like this, communities are best served by a simple mechanism—in this case the board being taken out and a commissioner put in—but a dynamic that is quickly and easily understood. So in this case saying that a Minister may be able to reappoint at some time a board by Order in Council I think actually just complicates matters. I think it is simpler to say it is going to go through to 2019.

I would be interested to hear from the Minister in the chair—who I just have to note is not actually my future brother-in-law, Simon Bridges; I do believe it is Jonathan Coleman.

💬 Hon Dr Jonathan Coleman: Todd Barclay.

Oh, it was Todd Barclay. Oh, right. Well that is jolly good. I was getting all very confused about who was and was not in the Chamber. I would not mind hearing from the Minister in the chair as to the legal ramifications of this postponement. Is it actually possible, legally speaking, for these appointments to be—[Bell rung] Oh, look! That is great. Now I am warming up; I am right into things. I would be interested to hear from the Minister as to whether or not, actually, there is an opportunity, legally or otherwise, for these appointments to be made. My sense is that it is probably not possible. So I would like to hear on that.

The points made by most colleagues are quite right. This is a good bill. That is the reason that the select committee returned it to this Committee without amendment. I do note now that some members are not supporting the bill at this stage, but I do still want to acknowledge the work and the important voice that they brought to this, particularly in the area of Māori representation and transparency. I do thank Labour, in particular, for its support of this. I think it is important that we do our best to serve these local communities.

So, again, it is a simple bill. There are no amendments from the select committee because we understand that its primary, singular purpose is to push out that date to 2019. I think that is what keeps it simple. It keeps it, if you will, an elegant bill and a solution, and I look forward to the continuing excellent work of the commissioner and her team there. I thank them for all that they are doing and, if I might, to the patients and the public down there I say that I think they should know that through the work of the Minister, the commissioner, and others, the community is in good hands with this little piece of legislation.

I could certainly listen to Simon O’Connor make that speech several times over. I am pleased he made that contribution again. I would like to urge the National Party to use Simon O’Connor in the election campaign, because I think that message that democracy is not necessarily well-served by voting will be one that really resonates with the New Zealand public.

This bill is fundamentally about the suspension of rights, in this case civil and political rights. In this contribution I want to talk about another sort of rights, and that is the rights of Māori guaranteed under the Treaty of Waitangi. Section 4 of the New Zealand Public Health and Disability Act provides that district health boards must “recognise and respect the principles of the Treaty” with a view to improving Māori health outcomes, and it specifies the functions of contributing to decision making and delivery of health services. That talk of principles—there are various interpretations of what those principles are. There is the “three Ps” idea—partnership, participation, and protection—or there is Justice Somers’ construction that actually says that the principles must not only include all of what is included in the articles of the Treaty but go beyond that to the central ideas that underpin those articles as well.

But, actually, regardless of which of those we choose, the inevitable conclusion must be that the Treaty demands, under article 2, that Māori are present and contributing to joint decision-making at the top table of an entity like a district health board. That is actually what the statute says. I notice that the Minister of Health is yet to answer any of the questions that have been asked, although possibly Todd Barclay was representing him in his contribution.

In his second reading speech, the Minister indicated that the Treaty issues that had been raised—concerns about the effect of suspension of section 4 of the Act, in this case—would be met by the commissioner providing for Māori participation at advisory committee level. Like the concerns I raised in my earlier contribution about that being an inadequate mechanism for meeting the transparency requirement that the people of the southern district had expressed, representation at the advisory committee level is not an adequate way for the responsibility of the Crown through the Southern District Health Board to be met. The Crown will be failing its statutory and ethical responsibility to honour the Treaty, whether we are talking about articles or principles.

What is required here is for the Minister of Health, instead, to act. I do not believe that the Minister’s right to instruct district health boards has been in any way changed by his appointment of commissioners; he may still instruct. So whether he includes a proper Treaty provision in the bill before the Committee of the whole House right now or he commits now to using his power to instruct to require that the Southern District Health Board will, in fact, step up to the mark and incorporate iwi representation, mana whenua representation at that top level amongst that group of commissioners—either way is satisfactory, but to do neither is unsatisfactory. It fails the statutory test. I will leave it there, Mr Chair, and thank you very much for the opportunity to make another contribution.

I would like to discuss clauses 3, 4, and 7. Clause 4 sets out the purpose of the bill, including the cancellation of the 2016 triennial general election of the Southern District Health Board, in order for the continuation of the office of the commissioner. This is not a bill that we should pass in this Committee without rigorous scrutiny, because it suspends a community’s democratic rights for electoral term, therefore barring the ordinary members of the public from making decisions that affect their own lives and their own health services.

It is also notable that the usual rules around openness and transparency relating to the decisions of the Southern District Health Board, or any district health board, do not apply to a commissioner. Clause 3 provides that this bill, if passed, would be repealed on the day elected members of the Southern District Health Board take office after the triennial general election 2019, which would be on the 58th day after the polling day.

The issue of democratic rights is crucial, and it is one that is very important to the Labour Party. However, on balance, considering that the commissioner at the Southern District Health Board has had only just over a year or so to overhaul the financial mess that the Southern District Health Board has undergone, Labour supports this bill because it is important to give adequate time to the commissioner and the assistants to be able to put things in order. However, one extension of the term should be more than enough for the changes to achieve a new financial stability.

It is crucial that there are no further rollovers for the commissioner’s term, and that the democratic elections return to take place in 2019. I ask the honourable Minister of Health, the Hon Jonathan Coleman, to consider taking a transitional approach before the 2019 elections, as circumstances warrant. So I strongly support the Hon Annette King’s amendment. Clause 7 of this bill cancels the 2016 general election for the Southern District Health Board, and in relation to that triennial general election, clause 7 disapplies certain provisions of the New Zealand Public Health and Disability Act 2000 and the Local Electoral Act 2001 for the period that the bill is in force.

The Health Committee when it was hearing submissions on this bill heard a lot of comments from members of the public saying that they were concerned about the way that the commissioner and her assistants were making decisions behind closed doors. However, making directions to the commissioner in the context of this bill is not desirable, for a number of reasons. The Southern District Health Board runs a public service for the benefit of its local communities. The operations of the commissioner and her assistant commissioners must therefore be as open and as transparent as possible.

Labour has pushed to ensure that there is more transparency at the Southern District Health Board, and I am pleased to say that the commissioner has made moves in this direction. There are now more sessions that the public can attend. We have also pushed for more frequent reporting, and it is heartening to hear that this is also beginning to happen. Labour supports this bill. Thank you.

I have listened to this debate with interest, and I must say that it is great to have this outbreak of bipartisanship between Labour and National on this, so I thank the Labour Party for its support of the bill. It would have been good to have universal support across the Committee. I am not quite sure why New Zealand First is not supporting it. The Greens, through their spokesperson Kevin Hague, seem to think this bill is about the removal of democracy. Well, it is not, actually. It is about the big picture here.

The reason for this bill is actually that we have got to restore the sort of financial governance that is required in order to deliver the health services that the people of Otago and Southland absolutely deserve. So you have to keep in mind that big picture. No Minister of Health removes a district health board lightly. I see there are a couple of former Ministers of Health here, and they know exactly what I am talking about. We took this decision after all options had been tried over many, many years. There were longstanding problems around the financial governance in the Southern District Health Board. We had a Crown monitor there. We had had it under intensive monitoring. There had been many, many discussions, so it was with a great deal of reluctance that we finally took that step last June to remove the board and put a commissioner in place.

I want to pay tribute to the doctors, the nurses, the physios, all the clinical people, all the people who work right throughout the Southern District Health Board area in clinical and non-clinical roles, because they actually do a fantastic job delivering for the people of the southern region. Working in health care is never an easy job, and the primary aim in everything that we are doing in the health sector has to be to make sure that we are getting more and more access to more and more services for more and more of the public, all the time. So that is why we need this extra time for the commissioner to do her work.

I would just like to commend Kathy Grant for the fantastic job that she is doing down there. It is a very difficult role and she is ably supported by three really great commissioners: Graham Crombie, Richard Thomson, and—some people have actually forgotten that we have got a third deputy commissioner—Angela Pitchford. So you have got a very well-balanced team there. Actually, it is a non-political team, in the sense that we have picked the best people to get the job done, regardless of where their political sympathies lie, and that is what I think is the real strength of that commissioning team that we have got in there right now.

Mrs King has raised this amendment—she wants to know whether we could actually reinstate the elected board once the commissioners’ work has been done. Well, we thought very carefully about all of the options with regard to the duration of the commissioner and the deputy commissioners in these positions. In the end, the consensus is that it is going to take until 2019 to get the job done. It is a big job. You have got to turn around the financial situation, you have got to lay the foundations for the excellent clinical services that we have got to deliver down there, and, ultimately, of course—and we are totally committed to this—we have got to rebuild Dunedin Hospital.

The idea of having a change to this bill, in the form of an amendment, actually presents a legal issue, because there is no mechanism under the Local Electoral Act to hold an election outside the triennial general election without further amendment. So it would be quite a complex process. I think that goes to the chair of the Health Committee’s point. There also would actually be the loss of economies of scale, holding an election outside of the cycle, even if we were to go through that very complex process, and you would end up with two district health board elections in close proximity. So we are not going to be doing that.

Then Ria Bond had her point. She wants to reinstate, as I understand it, elected members on to the board. What she is asking for, actually—the use of clause 16(1) of Schedule 2 of the New Zealand Public Health and Disability Act—actually only applies in the situation of newly created district health boards. So it would not be legally possible under existing legislation, in this case.

So, look, in summary, it is a very necessary piece of legislation. I am really grateful that the Labour Party has seen the bigger picture. This is absolutely vital, and we will be having an election for this district health board in 2019. Thank you.

I thank Minister Jonathan Coleman for his comments in reply. The Minister of Health has said that he does not believe that the amendment that I have put forward for a postponement instead of cancellation of the 2016 election would be possible, that there is no legal ability to do that. I presume that was the advice that he was receiving from officials just a few moments ago. It would be interesting to see exactly what that advice is based on—because the suggestion was that you put in place an Order in Council—and why that would not be a mechanism that could be used. It would be interesting—I do not know whether we will have time, Minister, tonight, but you might be able to reply to me in writing.

If the Minister is not prepared to accept an amendment, is he prepared to use the “Tony Ryall mechanism”, which I outlined in my contribution? The “Tony Ryall mechanism” was used at Hawke’s Bay District Health Board, where he turned the commissioner into the chair of the board and then appointed the former elected members as a governance board. Would the Minister consider that, because if there is no legal mechanism, as the Minister said, for my amendment, there was obviously no need to have a legal mechanism for the Tony Ryall approach? It was possible for the Minister to make that decision and to appoint whomever he liked to the board in place of an elected board, and he chose to reappoint former elected members. Would the Minister consider that as another mechanism?

But before that, Minister, could you set out your expectations of the commissioners. You said it could take up to the 3 years—in fact, it is more like 3½ years—before they actually would have finished their work. There must be a work plan that the Ministry of Health and the Minister are working to—a work plan of what, exactly, your expectations are for the commissioners, and what is needed to be achieved before there would be satisfaction for there to be an election in 2019. The Minister said that he thought that it would take right up to 2019 to achieve it, so there must be a plan.

There must be expectations, and I ask the Minister—he cannot do it tonight, obviously—whether he would be prepared to provide the Health Committee, which took the New Zealand Public Health and Disability (Southern DHB) Elections Bill very seriously and listened to the advice that we received and worked very well on the bill, with his expectations and the time frame that he has put on the commissioners, so that we can actually measure that progress. I think that would give a lot of comfort to those who were worried—that actually there is a plan going forward, there are expectations, and that the Minister himself will be monitoring what these commissioners do along the way. If the Minister was able to do that, I think that would be progress indeed.

There is just one other issue that I would like to mention, and that is the issue of transparency. One of the changes we did try to get—we talked about it at the select committee; we suggested a change that wrote it into the bill—was greater transparency. Under advice, and looking at it, we decided that it probably was not possible, because already, under the New Zealand Public Health and Disability Act, the commissioners are required to establish statutory advisory committees; they have to make meetings, agendas, reports, and minutes publicly available; and they must publicly notify meetings, and the opportunity be given to the public to attend.

I think what worried the select committee was that at the time that we were hearing the submissions, the commissioners had made no attempt for that to happen, even though they were commissioners and they are required under the Act for that to happen. It did not occur until after it was raised at the select committee. On 28 April the commissioners announced that they were now going to hold these statutory committees in public. Minister, we would be keen to ensure—and I am sure that I could say the select committee would be keen to ensure—that that transparency and openness continues, because that is the way that the commissioners will build trust and faith with the people of the southern district. If there is openness and honesty, and they have the ability to see what is being done on their behalf—and I have to say there is a high level of suspicion that has built up down there—and if the Minister could keep his foot on the commissioners to be as open as possible in the sharing of information, that, I think, would be a great help in alleviating some of the concerns that were raised at the select committee.