Annual Review Debate — Health Sector

I will take a happy 5 minutes on this. The health sector is in excellent shape. It has been acknowledged by my colleague who has just resumed his seat, actually, Paul Foster-Bell, as he segued from Government administration into health and the strong leadership that has been shown by the Minister of Health in, importantly, leading an entire sector of people. In fact, even in recent days the whole TerraNova Homes and Care settlement is just an indication of that good work continuing. But I think it is important, obviously, as we are talking here today, that it is about the year that has gone past, and, as I say, it is in a very good shape. Can I acknowledge the other members of the committee who sat through the various hearings—I found that a very constructive process—and particularly those groups who came in and presented to us, for their openness.

Look, the health sector is huge, it is substantial; we are talking 20 district health boards (DHBs) and a whole array of ancillary organisations—everything from the likes of Pharmac to the Blood Service, and it was a very good chance to sample some of those organisations, if you will. Again, each has little niggles and challenges and some have some that are similar. In fact, I do not know how other members found it, but we actually brought four DHBs in at one point, the smaller ones, to talk to us. We did something quite unusual in the select committee, which was to bring them all up together and have a discussion with the chairs and chief executives. It was a really good way to get a bit of a sense of the synergy between them, how they are cooperating, some of the similar challenges, and, really importantly, how they have been empowered to manage those challenges, from how they are managing their finances and reducing the deficits to how they are making sure they are targeting the particular needs of their community.

I think that is quite important because from time to time we hear challenges, be they financial, in surgery, with children, smoking cessation, or in mental health. What was really important, coming through in these hearings, was actually that the DHBs are very aware of that. They are very aware of the funding they have, and in many cases they have sought extra funding and that has been provided—Canterbury is a perfectly good example of that and of how they in turn are able to respond. Look, we know that a record-breaking $16.1 billion is spent in health in New Zealand. That is a substantial increase, and it was very interesting to hear how those DHBs in particular have worked to spend that money.

We heard about the growing success of the bowel screening programme, starting up, actually, in the Minister of Health’s area in the Waitematā DHB and moving around the country. I know, both from the hearings that we had but also, importantly, I suppose, from my anecdotal engagement with various groups in the country, that that has been very well received.

We had a number of groups talk around the growing success around our online portal. A lot of New Zealanders will know that you can access your health records online now, and, as a small pitch, I encourage those who cannot, particularly when they are seeing their GPs, to have a talk to their GP at the end of the consultation and encourage them to do that.

We have heard of the success around immunisation. Rather scandalously—granted, it goes back many years now, to about 2007—only 67 percent of our young people were immunised. Actually, the great work that has been led by the Minister, the ministry, and right through to the DHBs and those on the frontline is now seeing about 95 percent of our young people having their immunisations. If I might just make one quick comment, in respect of the anti-vaccination, anti-immunisation materials that have been put out in public—a certain disappointment might be the diplomatic way to put it, and for those who are listening, basically do not believe a bar of it. There has been far too much pseudo-science out there around these things and it is basically palaver, for want of another polite word.

We have also seen and heard about the importance around the extra spend into Pharmac—an extra $125 million, I believe, was found last year to support the work of Pharmac. You have heard me saying in the House before that the whole developing pharmacological area is quite fascinating, but it is also going to make a huge, huge difference. Two of the highlights that were noted to us were, obviously, the funding of pembrolizumab—most people will know that as Keytruda, for melanoma cancers. Importantly, that has been extended further now. I think they are looking into the area of lung cancer. And—really successfully, too—funding for the hepatitis C drugs is quite a remarkable opportunity there.

So, look, 5 minutes does not quite provide enough time to go through the enormity that is the health sector, but it is in incredibly good shape, and I am confident that other members on either side of the Chamber or the Minister of Health himself will be highlighting these strongly and importantly. Oh, and I should just add—seeing as I have got 5 seconds left—the whole smoking cessation project was well articulated and is going well throughout the country.

A voice from the past. Can I just say that I have missed my weekly joust with the Minister of Health, and I fear that without them he is getting rather slack, so I thought that it was time that I came back to tell him what I thought of the health system. I have decided there is so much you could talk about, including the missing $1.7 billion out of the health budget by not meeting all the cost pressures, wage pressures, and population growth. There are many things I could talk about, but I want to concentrate, Minister, on the Ministry of Health.

Part of our annual review—and I fear that the Minister and this Parliament are being let down by the current Ministry of Health and the advice that it is providing, and I believe that this year it was one of the weakest performances that I have seen at a select committee in many years from the Ministry of Health. I want to concentrate on four issues, Minister. I am sure you have read the report from the Health Committee—and I would like to commend Simon O’Connor, the member who has just sat down, for his excellent chairing of our committee—but these were the four issues that I wanted to raise.

The Ministry of Health’s Ministry on the Move project—the Minister was misled by his own chief executive in terms of what money was going to be required, and I think that that was a very big oversight by a director-general in charge of one of the biggest ministries. The Minister was not kept informed that the ministry did not have the money that it said it had for its Ministry on the Move project, and there is much more, I believe, to come out in terms of the cost of the Wellington premises. It was very hard to get information about the lease, how long it will be, etc. We then found out at the committee that it is costing the ministry $250,000 more a year than the original estimate on the lease of this building, and now it is going to try to get some extra money in by having other agencies come in, including a health hub and maybe even a McDonald’s—who knows? It needs to have extra money to pay for it. It was poorly organised and poorly managed, and I think the Minister has every right to be very disappointed.

The second area I want to talk about is in terms of the bowel-screening programme. The bowel-screening programme, and the roll-out of it, was first announced in 2007 and then we waited and we had a pilot and we waited and we waited. Credit goes to this Minister. He is rolling out the bowel-screening programme. But, Minister, one thing you ought to be very worried about was the answer we received from the ministry about whether there would be funding for district health boards (DHBs) to do the follow-up services once they have screened the patients. What we heard from the DHBs was that they are expected to cover the increase for treatment out of their baselines.

If we are running a proper screening programme, I do not believe a Government can just say to cash-strapped DHBs “You find it to do the treatment.”, because we will have people on the never-never for treatment if there is not enough money to do it. Minister, that has to be addressed. For a successful roll-out, there needs to be not only the screening and the identification of people who need treatment but funding to help in the treatment itself.

The third issue I wanted to raise is in mental health, and mental health has emerged as the issue for 2017. I believe that it will be the issue for this election because there is huge concern around New Zealand at what is happening in mental health. I believe, Minister, that your ministry has got its head stuck in the sand. It is not listening to what is being said out there in the community about the huge need for mental health services.

Services for emergency mental health—people are turning up at emergency departments having been brought into those departments by the New Zealand Police, and they are unable to provide the services because their acute wards are already full. There desperately needs to be a review of mental health services. What is happening? Do not be afraid, Minister, to say “I want to get to the bottom of what’s happening in mental health.” It is far too important to listen to the soothing words we got from the ministry.

The final thing I wanted to raise, Minister, is funding for primary health care. There is, no doubt, a campaign this year by primary health providers to fill the hole that has emerged, they believe, in the funding they should receive to provide primary health care.

Well, I would just like to thank Mrs King, the previous speaker, for her contribution. She did an excellent job, actually, as the Labour Opposition spokesperson for health, and I think she has been cruelly treated by a very ungrateful Labour Party, which has made the mistake of getting rid of its best performer. She is now joined by Sue Moroney and, basically, all its Māori caucus as very able people who are not appreciated by their party. I must say that question time is no longer the same, but I hope she is giving some tutelage to her previous understudy, the member for Dunedin North, who is now the Labour Opposition spokesperson on health, because he could really benefit from listening to Mrs King for her wise experience, because it is quite noticeable that Labour is quite exposed in that area now. It cannot get a question on health any day of the week, apart from about question No. 12 on a Thursday, and health really has slipped down the agenda for Labour as its political management has crumbled, as we saw earlier this week.

Be that as it may, we are talking about the 2015-16 financial year, and I do have to take issue with some of the points that Mrs King has raised. Look, you know, it is not really like her to be bullying public servants in the manner we have just heard. I know those remarks are out of character, because we have excellent public servants in the Ministry of Health.

In respect of the Ministry on the Move programme: yes, things could have been done better. There was an issue around financial governance. There are new people there now. The issue has been addressed. We are very lucky to have Chai Chuah there despite Mrs King’s ongoing campaign against him. We are very lucky to have him there as Director-General of Health, and he has given very good and clear advice.

You have got to look at the big picture in these things, and the big picture is that, actually, health spending has increased to record levels under this Government. I must correct Mrs King when she says this fiction about $1.7 billion of cuts. She knows it is not true, and I know that when—

💬 Hon Annette King: Yes, it is true—absolutely true.

I see her smiling when she is saying that, because, actually, we all know that when you increase health funding from $12 billion to $16 billion, that is a $4 billion increase. It is pretty hard to argue against that. Mrs King increased the funding a lot, but, of course, she delivered fewer surgeries, and that is one thing that, you know, I hate to have to bring up again, but it is true.

Look, this Government, as in all things, is really focused on the results that count, and you cannot argue with those. I mean, we have got 6,800—6,800—extra doctors and nurses in the system. That is incredible. We are doing record numbers of first specialist appointments—an extra 150,000 first specialist appointments per year. We have record numbers of elective surgeries. People come up to me in the street and say—and my local district health board (DHB), Waitematā, on the North Shore of Auckland, was a cot case before—that things have never been better. We are building the infrastructure around hospitals, and we are providing the services. No one is having to go to Australia for care any more. It has been quite remarkable how that system has turned around in nearly 9 years of a National Government. The worst thing that could happen now would be to hand the system back for financial mismanagement by the people with the terrible track record from 1999 to 2008, because we have got the system in a really good place.

You go to these hospitals and these DHBs, and the staff are enthused. They do a great job—our doctors, our nurses, the allied health workers. They know this is a Government that backs them. They are thrilled, actually, with the successful $2 billion pay-equity deal that we delivered last week for some of the hardest-working and lowest-paid people in New Zealand. They know we are a Government that backs health workers because those people are doing the most important work in New Zealand.

Bowel screening—well, look, that is a fantastic programme. We are going to be screening 700,000 New Zealanders every 2 years. We are going to be detecting 700 cancers per year that otherwise would not have been found. That is going to make a huge difference to the health of New Zealanders. I know Mr Chair is probably going to tell me my time is up in a second, so I think—

I am sorry to interrupt the honourable Minister, but the time has come for me to leave the Chair for the dinner break.

Sitting suspended from 6 p.m. to 7.30 p.m.

Kia ora, Mr Chairman. Thank you very much for the opportunity to speak in the appropriations debate. I want to talk about a couple of issues with regard to the Canterbury District Health Board, namely, mental health, children with special needs, and elective surgeries.

Immediately after the Kaikōura earthquakes, there was a request put in by the district health board (DHB) for some support, particularly into the area of mental health. The district health board asked specifically for $12.8 million. What it was hoping to provide with that funding was support into the areas of Kaikōura, Hurunui, and Nelson-Marlborough—specifically, 30 additional community support workers, councillors, and clinical staff, and 12 months of free GP visits and medication for residents of Kaikōura. What the Government actually gave it was $3.7 million for Kaikōura, and the Government actually funded eight additional health staff and 6 months of GP visits. But what also occurred within that $3.7 million was a $2 million debt write-off for the new health centre. So in effect, the Kaikōura area actually got only $1.7 million in additional support for mental health, post-earthquake.

That comes on the back of what we in Canterbury know to be the real, long-term, sustained effects of a natural disaster on a community, which is why the district health board took the unprecedented step of requesting $12.8 million. It was a response that my colleague Hon Annette King labelled as miserly. We know that in Canterbury post-disaster it is important to get some resources and some support up front, but actually what is also important is the long-term, sustained support for people who experience trauma. It is not just the trauma of the main event; it is all the aftershocks, it is dealing with houses that have been damaged, and then it is dealing with trying to rebuild businesses, trying to find work, and trying to rebuild homes and communities.

Within Canterbury we know that there has been some pressure on our community with regard to its mental health and its mental well-being. The Government, under duress, actually provided some extra support to our community, but we know that even now, 6 years on, the number of people experiencing distress, even at this late stage after the events, is increasing—but not only that; the acuity of this is increasing as well. Also a result of this is not only children who experienced huge concerns around their behaviour but also children who are impacted by disability, living in our community, who are not well supported by this Government. Every week I am finding families coming to me saying that their children with severe autism are not well supported by mental health services because of the pressure that is placed upon these services because of the increased stress experienced by the rest of our community.

Just in my last minute I want to say that at the same time, our community is ageing. We are one of the oldest communities in terms of our ageing population. This is also putting pressure on our health system, without the relief that has been requested from our Ministry of Health. We are finding that our DHB is under pressure to provide services that are not being well supported by this Government. We would really look to substantial and significant increases to support the increasing pressures that we are feeling, not only with regard to mental health but also elective surgeries and for those children who are experiencing some real issues with regard to their special needs.

Thank you, Mr Chair. Tēnā koe. Tēnā koutou e Te Whare. Before the dinner break, the Minister of Health, in his speech, mentioned that more money was being spent than ever before, and so, obviously, there had been an increase in funding from 8 years ago, under the previous Government. Of course there has, in nominal terms, been an increase in funding, but that does not take into account the fact that the population has grown significantly, particularly in the last few years. There has been inflation, we have an ageing population, and in some areas, like mental health, the Minister himself has already acknowledged that we are feeling increased demand. We are experiencing increased demand for mental services, as are many other countries around the world. When we take into account all of these different factors, the reality is that after 8 years under the National Government, our health system is underfunded by about $1.7 billion to $1.8 billion.

I have found, in the 7 to 8 months that I have had the health spokesperson portfolio and have been out there talking to people who work in the sector, that it is a universal opinion—whether they are nurses, doctors, or specialists—that they are all experiencing understaffing at times and burnout, particularly in certain sectors. There is only so long we can ask people to do more with less before our health services really start to suffer as a consequence.

I am sure the Minister himself knows this, but the reality is that this National Government is far more concerned with political management and spin, so those members will get out here and they will say: “We are doing better than ever before. The health system is doing great. We are doing more with less.” They will continue to say that, even though the reality on the ground is that people working in the sector and people trying to access services in the sector are not being well served by this approach.

Nowhere is this more clear than in the mental health system, where it is very, very clear that we have a system that has been stretched nearly to breaking point. We require not only increased funding—and increased funding is really important to deliver those services—but we probably need a nationwide inquiry to ensure that we are able to meet the increasing demand for mental health support in the most effective way possible.

During the annual review, we heard that there was a reduction of the number of acute adult in-patient beds for mental health patients. That means that even at a time of increased demand and increased population growth, there are fewer beds available to people who are in an acute state of distress. We know also that those wards, generally, are being understaffed, so the mental health nurses are having to work additional shifts. They are tired, they are stressed out, and they are not able to deliver the services that people in acute distress need. We have also heard stories of unwell patients being discharged from mental health units so that more unwell people can get a bed. That is the reality now.

The key performance indicators in mental health and addiction services show that at district health boards around the country, very few are achieving their targets in terms of support, both pre- and post - in-patient care. There is no question that this is why we have not made any progress on our shockingly high suicide rate. Our youth suicide rate is something that we should be ashamed of, and we simply need to address it.

My grandmother used to say to me—she was from Ireland—“Julie Anne, you haven’t got anything if you haven’t got your health.” I would say that most New Zealanders would know this to be true. It is worth investing in those preventative services that are going to ensure that our people are able to recover or, in fact, do not even get to the point where they need to be admitted to hospital. If we take the approach that we are going to prioritise tax cuts, particularly for the wealthy, and we are not going to increase the funding for the health sector, even though we have increased population growth and increased demands on health services, then we are going to start to lose that great public health system that New Zealanders value so much.

The Green Party would make health a priority. It is not just the hospitals; it is actually the social determinants of health. It is housing, it is transport, it is the way our cities work, it is education, and it is poverty. Addressing all of these things is how we improve the health of our society. Improving the health of our society, we are achieving everything it is that we want out of life. Kia ora.

I am pleased to rise on behalf of New Zealand First and take this call on the healthcare sector. The Minister of Health, Jonathan Coleman, like he did previous to the dinner break, likes to get up and tell us all—inside this Chamber and also out in the public—that our healthcare system is well supported and that it is heading in the right direction. Well, we are not hearing that out there in the streets of New Zealand and right around the country. We are having people come into our offices who are actually giving us the situation that they are in or are forced to be in, and it is a situation we should not have happening within our healthcare system.

The issue with the funding, I think, over the last 4 weeks, and maybe, perhaps, even longer—the people whom I have interacted with, even nurses, have been saying to me that they are grossly underfunded, that they are finding that they are having to work longer hours with fewer resources. This puts patients’ lives at risk. Just yesterday at the New Zealand Nurses Organisation meeting we were asked, as panel members, whether we would be happy to have our father lying in a bed and not being able to be washed because of the services that the nurses cannot actually get to in their working day. That is the harsh reality for our nursing sector in this country: nurses cannot and do not have enough resources in order to look after the patients. The concern absolutely is that the risk to patients is quite high.

I have heard earlier tonight the Minister say that he is really happy that the Government has been able to increase the nursing numbers throughout New Zealand in the last financial year. I immediately thought about this issue: in the Southern District Health Board we are actually looking at a proposed restructure where we are going to see 23 jobs gone—23 jobs in a health system that is already buckling under the pressure. Doctors are actually even saying now that there are fewer doctors per capita down here in New Zealand. In fact, the GP per capita has actually received a 12 percent decrease, and that is a real concern. What we are also hearing is that Kiwis—New Zealanders—are trying to find a GP and they cannot find one because there are phenomenal waiting lists just to see a GP.

So when I hear a statement saying that our healthcare system is in a good position and that it is heading in the right direction, I would like to suggest that our healthcare system is in a right royal mess—in a mess. It is because we are finding that people are actually waiting longer. Regardless of the fact that the Minister is saying that surgery numbers have gone up, they are waiting longer to receive their treatment. Again, in Southland, at the district health board (DHB), we saw 30 patients recently actually suffer and lose their eyesight, because of the waiting lists for the ophthalmology cases. That has been an absolute concern.

Through the process of the review the committee heard about the state of the youth mental health care services around the country. What they are saying is that the waiting time, or the time for youth—people under the age of 19—to get non-urgent mental health care services is somewhere between the provision of 4 to 8 weeks. That is too long. That is too long for people to wait to get non-urgent mental health care.

I want to also bring up the concern that, due to the fact that our healthcare system is underfunded, due to the fact that our mental health care system is in a crisis, we are now finding that schools are having to pick up the slack from the DHBs because they have not got the right numbers of specialists to help with mental health care patients. I am quite concerned—and New Zealand First is concerned—that the state of the mental health care system is now spilling out into our schools where our young ones are actually having issues with trying to have access to mental health care.

What we are also concerned about is—if the healthcare system is in such a great position, as the Minister states—we are finding that more and more community services are being leaned on through mental health care services, because people cannot actually get access to their mental health team units in their DHBs. I think that if we look at the overall state of the healthcare system here in New Zealand, and if we look at the fact that if, as claimed, our healthcare system was funded adequately and it was funded correctly for our population base and our population growth, then we would not have the many hundreds of New Zealanders currently suffering right now in their homes because they cannot get access to healthcare services in this country. Thank you.

The public health system in New Zealand is one of the cornerstones of the civilised and decent society that we live in. It is something that we on this side of the Chamber feel particularly proud of. It was the Social Security Act in 1938, under the first Labour Government, that largely established our free public healthcare system in this country. Despite some of the Minister’s comments earlier on, it was the fifth Labour Government that largely established the structure in our health system that we currently have, after the devastation of market-led reforms in the 1990s. This Government has, to its credit, had the good sense to keep that structure largely in place: democratically elected district health boards, primary health organisations, and that broader structure that the fifth Labour Government brought in. But what is evident to so many of us in our work as members of Parliament and also through reading the reports that we are considering this evening is that it is a system that is under considerable strain because of the under-resourcing that has become endemic under this Government—the slow bleed of desperately needed resources.

As I read through the reports, I was reminded of a constituent of mine whom I met just a couple of months ago—a woman in her late 70s who, until recently, was spritely and happy and active in her community. She was desperately in need of a hip replacement, and she was told in November of last year that she was amongst the most urgent of patients on the books of Auckland City Hospital and to come back in March and it would be sorted out. Well, that constituent of mine came back in March only to be told that it would be at least another 6 months before she would get another appointment to proceed with that desperately needed operation. So that constituent of mine is not just a statistic; she is a person whose life has been utterly brought down from the active, engaged kind of life that she used to lead in our community, simply because, at critical points in our public health system, the resources that our people need are not there under this Government.

I know that Minister Coleman, when he got up to speak, made light of the $1.7 billion funding shortfall that we in this House draw to his attention. The fact is that over 8—nearly 9—years of Government, we have population growth and we have inflation. Those things have simply not been kept up with, in terms of the funding in our health system.

The other aspect that was very evident to me, in reading through the reports of the committee, is the desperate need in our mental health system. On page 502 of the collated reports, the Minister was quoted as saying that young people should be waiting only 3 weeks for a youth mental health appointment, yet it is reported in here that we know of cases where some young people have had to wait for as long as 8 months. The records that are kept by the district health boards measure whether people are seen within 8 weeks, and even at that measure, which is over and above what the Minister says should be happening, we know that not everyone is being seen even within that period.

On page 500, it says the number of acute mental health beds over the 2015-16 year is down from 602 to 589 across our country. When every single member of this House knows that the need is rising—given the year that is under consideration—we are providing fewer services for people who need acute mental health beds. In Canterbury, there are 62 beds that the Canterbury District Health Board provides, and it says that, on average, in 2015-16 it needed 85 beds—on average, every day, it has that shortfall for people in desperate need of mental health care.

I say, and we on this side of Chamber say, that we are letting down those people, and it does not have to be that way. We know that next month there are probably going to be tax cuts announced in the House by the Government. We have got people in Canterbury and across our country who cannot get an acute mental health bed. We say that those are the wrong priorities, and this party, when in Government, will have the right priorities for those people in real need in our communities.

On page 494, it says most district health boards are saying they are not meeting their own mental health and addiction targets. We have heard a lot today from the Government about targets. It is all very well to set targets—the Government stands here most days in question time and boasts about the targets it is setting—but targets on their own do not change people’s lives. Targets on their own do not help people. Having the right services and the right funding in place, and the right priorities, is what helps people. These reports show that, in respect of health, the Government simply is not meeting those needs.

Well, actually, I thought that last speaker, Michael Wood, was quite good. I think he is a great improvement on the current health spokesperson—not quite as good as Mrs King, whom they are missing desperately, but that was not a bad speech.

There were some real problems with it, though—some real problems with it. What I can tell him is that, actually, we have fully funded for population growth and inflation over the last 9 years, and I can show the member the facts. And if he looks back through Hansard, we have talked about that quite a lot in the House in the last few years. So to say that we have not is just incorrect. It is also incorrect to say that $1.7 billion has been cut from the health budget.

But, look, if you look at the other speeches we have had just before, the only thing I learnt from Julie Anne Genter’s speech is that she is actually the Green Party health spokesperson.

💬 Paul Foster-Bell: Really?

Yeah, I was not aware of that—

💬 Hon Christopher Finlayson: No, she’s the finance spokesperson.

Well, she said she was the health spokesperson. I do not think we have had a question from her. But, anyway, that was a useful piece of information.

The other thing is Ria Bond. She also made a number of quite outlandish statements. She was saying that Kiwis cannot find a GP. Well, what I can tell her is that if she would just like to ring up my office with the details of those people—in fact, go and see Sarah Dowie, the excellent MP for Invercargill. We will find those people a GP, because district health boards have to give GP services to the populations they serve.

And it is disappointing when you listen to the member for Mt Roskill and the person from Invercargill. They are raising these cases—I do not know if they are real cases or not; they probably are because they would not be misleading the Committee. But if there really are problems we can help with, you know, come and tell us about the lady with the hip replacement problem, because I would be quite happy to make sure that she gets the services that she needs. But it is, of course, always very important to check the facts of the case.

Just before I came down I was watching the news, and on it tonight there was an item about the American late night comedian Jimmy Kimmel, who told the story of his newborn son, who needed heart surgery just within the last month. He was making a plea for healthcare that is free at the point of delivery to be made available to all citizens in the country in which he lives. And when you look at that story and you stand back and look at the big picture of the excellent healthcare system we have in New Zealand, we are actually extremely lucky, whoever is running the system. I get a bit disappointed when members lose sight of the reality of healthcare in New Zealand, because we have an excellent system, it is accessible to all New Zealanders—

💬 Carmel Sepuloni: We just have higher expectations on this side of the Chamber, maybe.

—it is free at the point of delivery. This member should just listen, because this is actually an important point.

Labour’s health spokesperson wrote in the Critic magazine in Dunedin yesterday that access to high quality healthcare should be beyond politics and, actually, largely it is. Everyone in this House wants to see more access to more services for more New Zealanders, and I am very proud that that is what this Government has delivered. We are delivering more operations. There are more appointments, there are more doctors and nurses in the system, and there is more money to fund it all.

We have got a growing population—no question about that—and there is increasing demand, and mental health has been mentioned. Well, I can tell you that 8 years ago we were treating 96,000 people a year; last year we treated 164,000. That is a huge uptick in demand. What are the drivers of that? Well, you know, it is pretty complex. I mean, it is societal pressures, it is the age we are living in in terms of exposure to social media, and, you know, the contradiction around greater awareness is that more people are seeking services. So we have got more demand and we are seeing more people, but there is always more we can do.

But it does disappoint me a bit when members talk about fewer beds, because I do not think there would be any member in this Committee who would want to go back to the days of institutionalisation, when we were locking up patients and not quite throwing away the key, but people were spending years and years in these institutions.

💬 Hon Ruth Dyson: Like Ashley Peacock—like Ashley Peacock. You wouldn’t help him.

And look, it would be completely disingenuous for people to claim that they want to go back to those days, because the members over here who are squawking away—that member there, she believes in the recovery model. She knows that the best place for patients to be treated, as long as it is safe, is in the community.

So look, in our health system there is always more we can do, but there is a lot to celebrate, and I would love to have those members’ support.

I rise to take a call in the appropriations debate in regard to health. Yesterday I joined the debate with New Zealand First, with the Labour Party, and with the Green Party, but, sadly, there was no one there from National to represent the voice of the teachers union in debate yesterday afternoon.

💬 Pita Paraone: That’s your partner. They’re your partners.

That might be so. Thank you to the member. I want to make these points. One of the things that is, sadly, underfunded—and I think the Minister in the chair, Jonathan Coleman, will agree with this—is the area of mental health.

On New Year’s Eve this year I literally had four women messaging me on Facebook, from around the country, who could not get services. They have been barred from the emergency department (ED) of hospitals in this country, despite the fact that they could not trust themselves to get through the night and not take their lives. With one of them I managed to get somebody to go and see them, because they lived in Hawke’s Bay and we knew some people working in suicide prevention. The other lived just down the road from me, and with the two others I managed to get somebody to talk to them on Facebook.

Minister, we need to ensure that there is a complete review of the mental health services that are provided. Why does somebody take a mental health patient to the ED, when it is determined that they are fine and that they can go home, because every night they go home they are actually proving to themselves that they can get through the night? But they have taken the opportunity to go to the ED services, and they are being turned away. I literally spent 10 hours with a woman. I took her to the ED, and worked with the Crisis Assessment & Treatment Team, which turned her away. I then tucked her into bed that night, making sure before I left that she was going to be OK, thinking “I’m the last person who may get to see this person.”

If that is the state of our healthcare for women and people who are suffering from mental health issues who may be suicidal—if I am the one who has to go in there and fix it, then it is not working. It is not working. When we have the highest rates of youth suicide in this world for Māori, it is not working, and we need to do something about it.

In the very first Budget in 2015 we managed to get a little bit of putea—$2 million—to try to affect changes for rangatahi Māori, who are at the top of the world in the statistics of young people who take their lives. That is wrong;, that is not right, and we need to do something about it.

We are attempting to do something about it. We are attempting to ensure that there is funding out there to work with the grassroots programmes that are out there, working in our communities, with the specific issue of LTGBQI—did I get that right?

💬 Paul Foster-Bell: LGBT.

L—oh my gosh, plus. All right. So the letters are confusing me—far too many acronyms. But with this specific issue—because they felt their needs were not being tended to in the entire conversation about suicide prevention. So rangatahi Māori, kaupapa Māori models of practice—we managed to get a tiny bit of putea, but it is not enough. We are leading the statistics, and it is not good enough. A complete review of the mental health situation in this country is needed.

Those women who sat on Facebook that night, telling me that they were going to take their lives, were over the issues that made them depressed in the first place. They were now dealing with the issues of their medication, with not being able to get help, with going to the local GP and being turned away, and with being told that they are drug seeking. But when you take someone’s medication—you cut it off right there and then, and you do not support them to address their underlying issues about why they are there in the first place, that is not helping. And when a 9-year-old—a 9-year-old—chooses to take their life instead of living their reality, then we as a country are failing them.

This health system needs to take note, and we need to get it right. We are willing to work with this Government, and we are willing to work with whichever Government might be in place following 23 September, to ensure that our young people have faith in themselves and a resilience, that they understand emotional intelligence, that they understand emotional literacy, and that they become emotionally resilient. We need to do something about the mental health legislation, and we need to do something through Vote Health.

I move, That the Committee report progress presently and move to consider Te Ture Whenua Māori Bill.

Progress to be reported presently.