Urgent Debates — District Health Board Funding—Allocation Errors

I have also received a letter from Dr David Clark seeking to debate under Standing Order 389 errors in district health board funding allocations made by the Ministry of Health. This is a particular case of recent occurrence for which there is ministerial responsibility. Last year the House held an urgent debate on financial mismanagement at the Ministry of Health in relation to a building project. The matter raised today is arguably even more serious, since it involves the incorrect allocation of funds for the delivery of health services. Dr Clark has pointed out that the Health Committee has already had its Vote Health 2017-18 hearing and that there was no disclosure of the issue at that time. The committee did not have the opportunity to question the Minister of Health on the matter. Public confidence in the health system is essential. Having carefully considered this application, I believe it does require the urgent attention of the House. I therefore call on Dr David Clark to move that the House take note of an urgent matter of public importance.

I move, That the House take note of a matter of urgent public importance. This is the story of a Minister who does not care about his sector, it is the story of a ministry that is demoralised and struggling with senior leadership issues, and it is a story about a sector that is growing incredibly frustrated as its efforts to provide healthcare to New Zealanders who deserve it are frustrated time and time and time again by a Government that cannot lead on one of New Zealand’s most important issues.

I want to set a little bit of context at the start. We know that this is a sector that has been underfunded by the Government to the tune of $2.3 billion. The health sector has been struggling in a funding-constrained environment because this Minister and his predecessors have run a policy of underfunding year in, year out. That $2.3 billion is not a number plucked from the air; that is a number put together by independent research group Infometrics, using Treasury data to ascertain how much more funding would have been needed each year under this Government to deliver the same level of services. If you cut the amount of funding for delivering existing services, they get cut, especially when you take $2.3 billion out of the sector.

In this Budget, $200 million was needed just to keep district health boards (DHBs) standing still, to deliver the same level of services as they delivered last year. And what did we find out? We found out that $650 million was needed, but that there was a shortfall in funding in this Budget of $200 million. The Government allocated only $439 million to DHBs—a shortfall of $200 million in this Budget alone.

In that situation, with a tight budget, the ministry let those people know that they would have to make do, but it let them know that only at the last minute. Normally, what happens is that the prior December, or thereabouts, the DHBs get an indication of how much money they might expect in the Budget, so that they can do planning. If they are having to make cuts, as they are under this Government, they have to work out how they set their priorities. That is only fair in a funding-constrained environment. But what we had here is a Government that sat on the figures, a Minister who had no leadership, and a ministry that was then unable to communicate with the DHBs that they would be receiving a cut.

On Budget day, those DHBs found out that their budget was going to be cut in real terms by $200 million, and with that cut they had to make do. When they sat down the next day and tried to work out how they were going to make ends meet with their effective funding cut, they then had to work out what they were going to cut and what they would continue—with short notice, because they had not had an indication in the previous year, as is best practice. So they proceeded to try to work out what they would cut and what they would proceed with. Given that the next financial year was looming closely, many of them—the more diligent DHBs—will have got on with their planning and may even have started negotiations for service deliveries and service cuts for the coming year.

When it worked out that there was something wrong, the ministry rang the DHBs and said: “If you have extra money in this Budget—we know it’s tight; if you’ve got a little bit extra in your pot, we’ll let you keep it. You’ll be able to hang on to that money. Even though the Budget documents are printed—you know, they’re printed, they’re out there—we’ll let you keep that money.” Two weeks later—2 weeks later—the Director-General of Health and his offsider rang around the DHBs again and said: “Look, we’re sorry, we’re going to have to claw that money back. We know you’re underfunded already. We know we promised you on Budget day that you’d get X funding, but, I’m sorry, we’re going to have to take some of that back because there has been a blunder. There has been a blunder at the ministry.”

The Minister had seen the figures; he signed them off. He is responsible to this Parliament for those figures, and yet there was a mistake—and it is not the first time, and the Minister knows it. It was not so long ago that the ministry tried to get $18 million extra out for a blunder in the spending around the redevelopment of the head office. This is not the first time, and the Minister knows it, so he is trying to cover it up. He is sitting over there with that fixed grimace on his face, and well he might, because the story does not end there. We know the DHBs were underfunded, we know they were told they could keep the little bit extra that they got in the Budget, and we know it was then taken off them, but the story does not finish there. When they were called into Wellington, the chairs and the chief executives of the DHBs, to meet with the ministry—and the Minister admitted today in response to questions in the House that he was not aware of this, so once again we see that he is not across his portfolio—they considered whether they would put forward a vote of no confidence in the director-general. It has happened once too often.

This is a sector that is distressing of the leadership in the Ministry of Health—that important sector that delivers the healthcare that New Zealanders need. And let us not forget that we believe, on this side of the House, in the Labour Party, that all New Zealanders should have affordable access to quality healthcare. But those people who are providing it out in the communities, those people at the coalface, are being let down by the senior leadership in the ministry and the lack of leadership—the lack of leadership—from this particular Minister.

What is going on out there in DHB land as they cut the services? Well, we know from the Government’s own figures that over 500,000 New Zealanders last year could not get to a GP for reasons of cost. That is what is happening with these cuts that happen year after year after year—the funding that gets restricted in real terms. I will come back to how that equation is done, because the Minister keeps liking to say—he would put his hand on his heart and say that every year more money has gone into the health budget. But I think everybody in this House knows that $1 more each year would be more funding in the health budget, and everybody in this House knows that GP fees go up by more than $1 a year. One dollar a year doth not a swallow, a summer, or something like that, make—I think you get the point. One dollar more really is not going to cut it when we have got an ageing population, more complex health needs, and a system that needs more money just to deliver the same services each year.

Those ongoing cuts have got a real cost, and the ministry’s failure of leadership and the Minister’s failure to secure adequate funding for healthcare in New Zealand mean that those health professionals who want to deliver those quality services have their hands tied behind their backs year in, year out.

The Minister over there is not aware that the DHBs are considering asking for the resignation of his director-general. He said to the media just the other day, “No, I haven’t received a resignation, and nor would I want one, either. He’s doing a fine job;”—says the Minister—“a fine job.” He is the only one in the health sector—that shows just how out of touch he is.

I have spoken at several conferences in the last few weeks that have made the point, up the front on political panels, that they have a wide range of political parties there in front of them, but there is one that is missing. Just yesterday, in front of an audience of a hundred people, there was one major party missing. It was the National Party. Last week at the Rotorua GP conference there was one major party missing. There were hundreds of GPs there, and they were furious, but, once again, the Minister did not front. The Minister is not fronting up to the issues in the health sector. He is hiding, he is running for cover, and that is not acceptable, because this is such a significant issue for New Zealanders. When they cannot afford to go to their GPs, when half a million Kiwis cannot afford to go to their GPs, when Kiwis cannot afford the oral care they need, when Kiwis cannot afford to pick up their scripts at the pharmacist, it is simply not good enough.

The Government’s own figures tell us another thing. They tell us that 60,000 New Zealanders last year were referred back to their GPs by a hospital, even after they had been referred to a specialist, because the hospital said they did not meet their threshold: “I’m sorry, we don’t have enough money to give you the care that your GP says you need. You can’t even visit the specialist. We’re going to send you back to your GP; come back again if your situation gets worse. If you’re so much in pain that you can’t move, when it gets to the point that you can’t work, then we’ll look at it again, if you get another letter from your GP to come back to us.” That is all part of what is going on. It is part of a bigger picture, because every year it gets harder for New Zealanders to get the healthcare services that they used to get. Every year it gets harder for people to get the cataract surgeries, knee surgeries, and hip surgeries that they need, because this Government is not funding adequately to deliver the same level of services each year as the year before.

That is what that Infometrics report points to. It says that with an ageing and growing population, if you want to deliver the same level of services to each member of the population as you did before, you would need to put in $2.3 billion over that 9-year period. But that has not gone in, and so services have dropped, and that is the story that is demoralising the health sector as it struggles to deliver excellent care. Anyone who goes and visits a hospital or a GP will generally have a positive experience, because those health professionals are doing a mighty fine job—despite the Government, rather than because of the Government—and I want to take my hat off to them for making the most of a very difficult situation under this National Government’s watch.

I should also mention that Labour has clearly pledged that it will meet the health costs in the sector going forward and will return that $2.3 billion over time. We believe in delivering affordable healthcare that is of a world-class quality to New Zealanders, even if that Government across the Chamber does not.

We have now a situation where the Director-General of Health is lacking confidence from senior sector members. We have a situation where the Minister says he has not received a resignation, but the director-general says he has given one. What has happened there? One of those people, clearly, has got the situation wrong—I do not want to say, but somebody needs to tell the truth out there as to what is going on.

We also know that that money is being clawed back—that money in the Budget was wrongly allocated. That is a major Budget blunder. That is really basic stuff, Minister. That is the kind of mistake that should never happen in this House. Those numbers are checked and double-checked; they certainly would be by a diligent Minister who cared about what was going on in the sector and who was worried about those DHBs that were missing out.

I want to go through—if I can find the little bit of paper in front of me—and just mention some of those DHBs that are going to miss out, because this is really significant and those people living in those areas should be concerned.

Counties Manukau—if you live in the Counties Manukau area, on Budget day the announcement was that you got a little bit of extra money. It was not enough to meet the current needs, because we know there is $200 million short-funded across the sector anyway, but now you are going to get $6 million less than you thought you were going to get—$6,600,000. Southern DHB, down where I live—it is going to be $5.7 million worse off than it was on Budget day. Capital and Coast DHB—it is going to be $3.7 million worse off than it was on Budget day. Midcentral DHB is going to be $5.4 million worse off than it was on Budget day. Hutt Valley DHB is going to be $3.6 million worse off than it was on Budget day. Taranaki DHB is going to be $3.4 million worse off than it was on Budget day. Canterbury DHB is going to be $2.7 million worse off than it was on Budget day—and we know the struggles that are going down in Canterbury, as they struggle with mental health and other issues and years of underfunding under this Government. Hawke’s Bay DHB—nearly $2 million worse off. Wairarapa DHB—$1.5 million worse off. South Canterbury DHB—$1.2 million worse off. West Coast DHB—$780,000 worse off. Whanganui, Bay of Plenty, and Nelson Marlborough DHBs—also many hundred thousand dollars worse off than they were going to be on Budget day.

This is a huge concern. When those basic things are not got right in the Budget, when the Minister who is responsible to this House—the Minister who is responsible to this House—for Budget spending cannot get the basics right, we have a real concern.

I have found, as I have gone around the health sector in the short time I have been the health spokesperson for the Labour Party, that everybody—everybody in the sector—will agree that Tony Ryall was interested in the sector. They say he ran the sector from his cellphone. He was on the phone. Many people did not like him, but none of them will say he did not care about the sector or that he was not in touch with the sector every day. Yet everywhere I go, people say: “Jonathan Coleman—he is arrogant, he is out of touch, and he does not care about the health sector.” That is the story I am hearing around New Zealand when he does not show up for public events, when I am opening conferences because the Minister has turned them down again and again and again.

I have never seen such a disengaged Minister, and when you get a disengaged Minister like this, mistakes are made. Those things are put in front of him; he is not even looking at them. Clearly, if he is making mistakes this basic, he is not even reading his papers, and that should be a serious concern to all New Zealanders, not just people sitting in this House. This is public money that is being spent, Minister Coleman, and you, Minister, are responsible and accountable for that public money and the muck-up that has happened here. Hang your head in shame, Minister.

There is much more to come on this one, I must say. There is plenty more to come on this, because the ministry is in a spiral and the Minister knows it. There is more to come on this, and the Minister knows it. We will come back to the House tomorrow. We will hear more on this picture, but first the Minister needs to explain how this bungle was made; who is right, the director-general or him, on the call for a resignation; why the money is going to be clawed back, and what the Minister is lacking that he could not get a decent amount of money for them in the first place; and whether he is content to watch the sector wither—a managed decline under his watch—because of underfunding year after year after year.

I have not got time to cover the Auditor-General’s report—

💬 Mr DEPUTY SPEAKER: No, you have not.

—which covers a myriad of faults in terms of DHB asset management—because DHBs are underfunded and they are stretching their assets. I just want to say that this Minister needs to be held accountable and he needs to do a much better job, pay attention to what is going on, and make sure that health services are properly funded so that New Zealanders can have access to the affordable, quality healthcare that they deserve and that the Labour Party will deliver.

Well, Mr Deputy Speaker, I would just like to begin by wishing you all the best on a very significant personal milestone that I know you have passed today, and I must that say that you are looking a picture of health and fitness as you complete your sixth decade.

But, you know, I was very disappointed by that speech from the man from north Dunedin, David Clark. That was a mix of gross exaggeration, wild allegations, very deeply hurtful personal attacks that he has made on me, and, much more seriously, actually, the bullying of an outstanding public servant, Chai Chuah.

But, look, I am very happy to be in here debating this every day until the election, because we have just tied up Andrew Little and Jacinda Ardern for 15 minutes on an issue, frankly, that, I can tell you what, no one at the rugby on Saturday night in Rotorua would have ever heard about. No one in Rotorua has ever heard of the population-based funding formula—the people who were there at that rugby game. No one there would have known about Chai Chuah, but what they do know is that at their district health board they are getting more services than ever before. I am quite happy if the Labour Party wants to continue to focus on beltway matters, on technical errors—and yes, it was an error that the Ministry of Health made—and on the minutiae, rather than the big debates.

I can tell you why Mr Clark has seized upon this. It is for two reasons. When we were in Opposition we spent months and months and months going around the sector, really talking to people, analysing the issues, and producing an 80-page discussion document, Better, Sooner, More Convenient, which was our manifesto in health and which we subsequently delivered. What have we seen from Labour? We have seen nothing during its time in Opposition. There has been no work done. It has gone nowhere. It has not visited anywhere, actually, and I defy David Clark to state one conference he claims to have opened that I have not been at. He claims he is being asked to open conferences. Well, actually, I do not believe him.

You know, Labour did have a very good health spokesperson, Mrs King, and she was an excellent member of Parliament, very cruelly treated by the callous Labour leadership. It has not helped Labour, though. It is going backwards in the polls, and it put in this man from north Dunedin, who needs schooling in the vote. I can tell you that my best advice to him is to go and spend some time with Mrs King and learn about the health portfolio, because, unfortunately, during the select committee hearing we had to spend quite a bit of time educating him on the difference between Vote Health and Crown core health. He did not know the difference. It was very disappointing.

There are a few things I need to correct there. The Labour spokesperson has talked about a cut of $2.3 billion. That is a complete fiction. The Health vote has gone up by $5 billion. Labour members’ argument is just that they say that it should have gone up by an extra $2.3 billion. Well, actually, we do not agree with them. There is plenty of money in health. There is a record allocation this year—$888 million—and, more important than that, out of the hundreds of services provided across the New Zealand health system, you will struggle to find one that is not better than it was 9 years ago. We are doing more of everything. There are 50,000 more operations per year. There are 150,000 more specialist appointments. There are 6,900—it is an incredible number—

💬 Hon David Bennett: How many?

—6,900 more doctors and nurses across the system. So while Labour is happy to focus on beltway issues that, frankly, the voters of New Zealand just do not care about, the National Government is about delivering the services that matter. There is a very important point here. The district health boards received $439 million—$1.6 billion over the next 4 years. Despite this technical spreadsheet error, that remains unchanged. So it is very disingenuous for Labour to say that there have been cuts to the amount of money that the district health boards are getting. There have been only increases. Mr Clark went through a long list of district health boards and he said that Counties Manukau District Health Board was getting $6.6 million less. Well, that is completely untrue. Do you know how much more it is getting than last year? It is $41 million more than last year. So it is completely disingenuous and a very good example of desperate politicking to try to count that as a cut.

Then, No. 2, he moved on to the Southern District Health Board. He said “Oh, you know, they’re getting $5.6 million less because of this error.” Well, that is completely disingenuous. It is actually getting $24 million more than last year. It is a huge increase. Then Mr Clark said that Capital and Coast—incidentally, Labour left us with tens of millions of dollars of deficits to try to turn around; it was really going to hell in a handcart—was getting $3.7 million less. Well, in actual fact, it is getting $21 million more.

So it is very misleading to try to paint a minor technical error as amounting to a cut, because the DHBs are all getting more than last year—collectively, $439 million more. What this minor technical error is all about is a fraction—about 0.3 of 1 percent—of the total vote. It is a fraction, which was misallocated and now has been corrected, but the crucial point is that DHBs were getting $439 million on Budget day and they are getting $439 million now.

I am very happy for Mr Clark to talk about this every day in the House, because I can tell you that televisions all over New Zealand will be being switched off and people will be saying, like the person who came up to me on Saturday: “You know what, I went to the local hospital and I got great care.” I hear that all round the country. I have visited all our district health boards, and I keep in touch with them regularly. I know what is going on in health. I was talking at the College of General Practitioners AGM in Auckland on Thursday night. I had spent that day up at Northland District Health Board. There is some excellent work going on out there.

The thing with Labour is that it does not want to debate the real results. It does not want to debate what counts to people—things that this Government has delivered, like free GP under-13 visits. Ninety-nine percent of the population—and Mrs King was actually very gracious in her acknowledgment of that. She knows good policy when she sees it. She knows when a Government is performing for the people of New Zealand, and, I tell you, she is someone we can work with on health.

💬 Hon David Bennett: Why isn’t she doing the job?

Well, Mrs King was stabbed in the back, and they put in this guy from Dunedin North who does not even know the difference between Vote Health and core Crown health. Confidentially, he does say to people—because he says it to people all round the Parliament—“Look, I don’t really understand the vote, and I’m not really on top of my work.”

💬 Dr David Clark: What a load of crap—what a load of crap.

Just on the basis of his immediate reaction, calling it a load of “c”, you know I am right. If I was not, he would just be smiling and going: “Oh yeah, whatever.” But that has hit a raw nerve, because Mr Clark—

💬 Dr David Clark: This, from the guy who’s just messed up the budget. This, from the guy who has just messed up the budget and is apologising in Parliament in an urgent debate—the irony!

—who is continually interjecting here—I have hit the nail on the head. Now, I have got to tell the man from—Mr North Dunedin, here. Remember, this is the man who wanted to ban Google from New Zealand. Remember when he said that? He said: “Oh, if they don’t front up to their tax responsibilities, we’re going to ban Google from New Zealand.”—so he is going to be exercising a lot of power and taking on the multinationals. He says he is going to so-called “restore” $2.3 billion to the Budget. Well, we have got a calculator there, adding up the spending promises. Andrew Little will be out the back saying: “Oh, well, you know, there’s that person we put in as a health spokesperson, and he’s just promised another 2.3 bil.” So we will be counting that up at Budget time; we will be holding these guys to account.

But, look, talking about Budget time, I did mention that $888 million, and what a great allocation that is. That is producing all sorts of fantastic initiatives. You know, $60 million in there, roughly, for double-crewing of ambulances. Labour complained about that for years but never did anything about it. That means that 100 percent of ambulances, over the next 4 years, across the country, will be double-crewed. I can tell you that that is what people in New Zealand notice. They do not notice the beltway internal machinations of Wellington, which the member for Dunedin North is so excited about. They notice that, actually, they are going to have two highly skilled people driving the ambulance that picks them or their relatives up, should they experience some misfortune.

They are also going to notice the $60 million that is going into Pharmac. You know, that is going to benefit 33,000 New Zealanders. We have raised the Pharmac budget to record levels over time. It has gone up well over $200 million over time. Last year 3 million of us got a funded medicine. It is just incredible the progress we have been making. We are able to fund Keytruda and life-saving, life-preserving drugs. That is what matters to the people of New Zealand.

I will tell you what else matters to them: the fact that they are now getting their operations when they need them. I was down at North Shore Hospital about 10 days ago, opening the new $10 million clinical skills and research centre. People there are very happy.

💬 Dr David Clark: When I said you were out of touch, I didn’t expect you to give examples.

I wish Mr Clark had been there, actually, because he needs to get out a bit. He needs to actually come to some of these health facilities. I would like to take him to some of these openings. I would like to show him what the staff are saying on the ground of the New Zealand health system and show him some of the fantastic facilities that we are building. I can tell you that North Shore Hospital—the hospital that my constituents go to—was a basket case when we came into Government. It is now not only the largest but one of the best-performing district health boards in the country. I can tell you, with the right leadership, you can turn these things around.

But what would be very, very dangerous for the health of New Zealanders would be if David Clark—who, by his own admission, does not understand the portfolio and constantly demonstrates an ability to focus on exactly the wrong thing—ever got his hands on the portfolio I would be writing to whoever was leading Labour and saying: “You’ve got to bring back Mrs King. This is urgent. This is dire.” We need her back there if the alternative is that guy. Of course, that is not going to happen.

Of course, one of the things, when you are dealing with sport and health, people do raise a number of issues with you around portfolio-related things. It is no secret we have brought sport back into alignment with health. We are looking to get greater alignment between the two portfolios. Actually, I was out in Johnsonville yesterday. I wish Mr Clark could have been there with me to celebrate Green Prescription. We had a whole range of people there. I spoke to three or four members of the public there who are on Green Prescription. It is a great programme. They brought along some representatives. It is a great programme that is about creating innovative solutions for people with some of these really tough issues around being overweight, and obesity and diabetes. It was universally lauded as a great programme—it came in 20 years ago under a National Government. It is just another example of a programme that really counts.

Talking about sport and health and the relationship between the two, I can tell you that if we were not doing so strongly in health and were not delivering for people, do you really think that in the TV1 poll National would be at 49 percent? Here is another point about sport and health, Mr Clark: if you want to know the difference between the British and Irish Lions and the Labour Party’s polling, it is that the Lions are getting better. So let us look forward to the test on Saturday. It is going to be a great one. I look forward to discussing this issue for hours and hours to come in the lead-up to the election, because, actually, it is not something that makes any difference to the people out there. Meanwhile, I will be out there every day, talking about the achievements of this National Government and how, if we earn the right to be the Government again, we will continue to focus on those things that matter to New Zealanders—not the beltway stuff but the operations, the doctors, and the appointments. Kia ora.

Thank you, Mr Deputy Speaker—tēnā koe. Tēnā koutou e Te Whare. I have to say, I was pretty shocked by the Minister of Health’s contribution just now, when he said that New Zealanders at the rugby in Rotorua do not care that their Minister and the Ministry of Health made a grievous error in the allocation of the Budget. I think that is quite disrespectful to New Zealanders. I think he does not give them enough credit. Of course New Zealanders themselves do not want to worry about those numbers—that is why they elected us as representatives. They expect the Minister to do that work so that they do not have to. But our Minister of Health—and sport, as he rightfully pointed out—is far more interested in attending sporting matches than actually doing the very important job of being a Minister of Health and having oversight of what is happening in the health budget, which is the single largest area of expenditure of taxpayer money. I think New Zealanders would rightfully expect that their Government would take that spending seriously. It does matter. Yes, it was an error, and errors do occur, but errors like these add up.

The disengagement of this Minister of Health is undeniable. It is certainly what I have heard, talking to people in the health sector around the country since I took on the health spokesperson portfolio 9 months ago—that this Minister is incredibly disengaged. And, hey, I feel sorry for Minister Coleman. It is no secret that he wanted to be Minister of Foreign Affairs or even Prime Minister, but, sadly for him, he did not win either of those contests. So here he is stuck being Minister of Health, and he has got very little interest in actually improving the health system for New Zealanders. He wants to kick back and attend the rugby matches and attend the sporting games and smile and shrug and say: “It’s all good—doesn’t matter.”

But the slow erosion of health services over the last 8½ years under this National Government is becoming very apparent to many New Zealanders. That is what I have heard when I have talked to people in this sector. There are some areas where this Government has focused more money, and those are ticking right along. It is no surprise that those areas where it has focused more money are the ones that benefit the people who are most likely to vote. The Government knows how to keep its voters happy. But it is not meeting the needs of all New Zealanders, and in the medium to long term that is a ticking time bomb that is going to come back to haunt us.

I know that all New Zealanders do not care for just their own health; they want to live in a society where their fellow citizens are healthy and happy for the long term, where the environment is healthy for the long term. That is what New Zealanders want, and they are starting to see through the smoke and mirrors and spin that this National Government has been so good at. It pretends to value the same things that New Zealanders value, but you have got to put action and Government spending where your words are. You have got to back it up with real action, and that has not been happening. It just is not good enough to hear yet one more excuse for why the Government made this minor mistake that actually involves tens of millions of dollars and how they are allocated to different district health boards. It just is not good enough.

Health underfunding—the Minister just claimed that there has not been underfunding in health. Yet Infometrics analysis makes it very clear that while the Government is nominally putting more money in, that has not kept up with inflation, population growth—record population growth—and increasing demand from an ageing population. All of that adds up to cuts. I am not saying that you just need to spend more money for the sake of it, but when we talk to people in the sector it is clear that they are experiencing the real impact of these cuts. There is burnout amongst specialists, general practitioners, and nurses, and no more so than in the mental health sector.

Minister Coleman allocated a slight increase in mental health funding, but has no idea what it is going to be spent on. When he came before the Health Committee, he said “Oh, we don’t need a nationwide inquiry.”, which many people in the sector have been calling for. The Green Party has supported those calls. We need an independent, nationwide inquiry to get to the bottom of our broken mental health system. The Minister claims that we do not need an inquiry because we already know what we need to do, but then, with the additional money he has allocated for mental health, he says it is for “innovation”, and we do not yet know what it is going to be spent on.

So which is it, Minister? Do we know what it is going to be spent on? Do we know what we need to do, or are we going to have an inquiry and get to the bottom of it? And make it be independent and make sure that we are hearing from everybody affected—the patients, the families of those patients, and the people working in the sector—because they are the ones who are best placed to tell us how we should best be allocating money and what levels of funding we actually need to ensure that the need out there in the community is being met, so that we can start reducing our disgracefully high suicide rate and youth suicide rate. It is just not good enough that New Zealanders with mental health difficulties are reaching out and being told that they have to wait, sometimes more than 8 weeks, to get the help they need. It is not good enough.

The National Government is also, while underfunding the health budget totally, not funding the areas where we really need to make a difference in the long term, and those are prevention and primary care. Over the last 8 years, the primary healthcare strategy that had been instituted and executed under the previous Government has, basically, fallen to the wayside. What we have seen is that the very slight increases to the nominal health budget have mainly been sucked up by hospitals, and that is really an ambulance at the bottom of the cliff. We are not putting enough money into primary care. We are putting less than a quarter, I think, of what GPs have said they actually need to meet the need out there.

This is pretty obvious, because—the Minister talked about the Opposition spokespeople not knowing what they are talking about. Well, at the select committee, he claimed not to know about a paper that was recently published in the New Zealand Medical Journal that estimates that one in four New Zealanders is not accessing primary care because of cost. The total cost of that is actually far greater than the cost of just funding the primary care in the first place.

We in the Green Party and the Labour Party have already committed, under our budget responsibility rules with our memorandum of understanding, to restore health and education funding to meet the need that is out there in the sector, and we have shown how we can pay for it. That means that the $2.3 billion hole in the health budget that has been created by this National Government will be met under a Green-Labour Government. That means that people out there in New Zealand are going to be able to access primary care.

We know that that is actually going to achieve what New Zealanders really want, which is their fellow citizens, their families, their co-workers, and themselves being able to access the healthcare and support that they need to live healthy, happy lives. That is the expectation of New Zealanders, the rightful expectation—that the Government will ensure that what they need, the Government services that they need, will be provided, and that our Ministers will actually sit down and do the sums and do the work to make sure that funding is appropriately allocated, not just shrug it off and say: “Oh, New Zealanders at the rugby don’t really care about the numbers.” They do not care about the numbers; they expect us to care about the numbers. They expect us to do the governing. That is what we are here for. Accept some responsibility.

This National Government is a disgrace. It is so good at the spin. It is so good at the spin, and it does just enough to keep it all from falling apart, but it is running out of time. It is running out of time.

The Green Party will prioritise public health. That is one thing that this National Government has completely—completely—let go. I have heard from anyone working or trying to work with the Ministry of Health that they know there is no capability or capacity in the Ministry of Health to meet our long-term health challenges.

We have heard excuses from the health Minister as to why we cannot have an effective plan to actually reduce the chronic disease related to childhood obesity, like a tax on sugary drinks that would fund health services and health promotions and reduce overconsumption. No, this National Government would rather prioritise the profits of a big multinational like Coca-Cola than the health of New Zealand children.

💬 Hon Members: Aw!

That is right. It just bends over backwards to help the Food and Grocery Council make sure that its members can keep making record profits on the back of New Zealand children being sick, which is going to cost New Zealand taxpayers in the long term.

We would institute a tax on sugary drinks and use the proceeds from that to fund health promotion. People would still have access to sugary drinks, but the tax would reduce overconsumption. We want to reduce the availability in schools. We want healthy food in schools. We want healthy food and drink choices available for New Zealanders, and particularly children, in sports clubs, in hospitals, and in all our public buildings, and we can achieve that. A Green Government will achieve long-term health benefits for all New Zealanders.

I am actually quite elated to finally get up here and have the chance to speak in an urgent debate, and I will tell you why. I have sat here in this House, as a member, for 2 years and 2 months and in that time I have seen the much-flouted Minister of Health, Minister Coleman, tussle with the Hon Annette King, and it seemed he was more focused on that tussle here in the House than actually the tussle out there on the street in our healthcare system, and that is despicable. What I have also seen, now that the Hon Annette King is not in the role of the spokesperson for health for the Labour Party, he has now got in, I guess, his sights to have a go at Dr Clark and question his numbers and question actually what the people out there in real New Zealand are telling us.

I do not know why that side of the House, that Government, is not hearing their voices. You have officers; you surely know that this is an absolute critical area for our healthcare system with New Zealanders out on the street. What I sat here and watched in the last 10 to 20 minutes was a Minister who actually spoke more about rugby than about people who are not getting on to the elective surgery lists—

💬 Hon David Bennett: Tell us about your mates who are going to bring in cannabis.

—who are actually having to be heavily medicated because the system cannot deal with the demand. That is a disgrace, Mr Bennett. Shut up and sit down and listen.

What we have also seen around this country—and I have been on the tour; in the last 2 weeks, for the last year, I have visited palliative healthcare. I have seen the failing of this Government in its health-allocated Budget spending, or lack thereof. I have also attended the GP seminars, their panels, and spoken about the fact that in real life GPs are actually massively underfunded and we do not have enough GPs for our normal citizens to actually have access to them.

💬 Hon David Bennett: What? How many?

It is a fact, Mr Bennett. The doctors are telling us themselves. Pull out your earplugs or your wax and start listening and pipe down in the front seat there.

What has also become evident is that the New Zealand Nurses Organisation has told us—it has had an open letter to the Government, and its message has been: “Please give us more funding so we can take of people in our hospitals and our residential homes, so we can take care of people who are actually the most vulnerable people within this healthcare system.” That Government crowed over it and thought it was so great in the Budget day release on 25 May that not one of you knew your Budget was wrong. The whole lot in health was wrong. Fools—fools, if you did not know that.

So, yes, I get worked up, because I get out there in New Zealand. Families come and tell me the difficulties they have, that they cannot get simple access, that we have 0- to 18-year-olds sitting there for 9 weeks waiting for mental health services to pick them up. It is not the fault of those nurses and doctors within mental health; it is the fault of this Government for having its head in the clouds, because it does not realise what its policy is doing to New Zealand. I think I have heard, from memory, a saying: “Keep ’em dumb, keep ’em stupid.”, and that is what that Government has delivered in this healthcare budget. It is a disgrace.

This is not going to go away. The Minister did not even address the issue of the fact that there has been a debacle and there has been absolute gross negligence from the Ministry of Health under that Minister. He preferred to talk about the rugby—the Lions games—and how wrong Mr Clark was in his figures. He preferred to talk about the issues of anything else but the fact that there has been no accountability put on the Director-General of Health. There has been not one thing—not one thing at all. Yes, Canterbury District Health Board (DHB) is calling for his resignation. Somebody has to be accountable, and that someone, who allocated taxpayer money to be spent, is the Minister of Health.

Although that Minister thinks that he now owns the Teflon coat, that is not going to last for ever—not in this year; not at this election. In September the people are going to vote. They have had enough of being stuck within this underfunded healthcare system that sees our children not having access to primary healthcare services; that sees our babies sick; that sees our families unable to actually see appropriate mental health care services given to them; and that we have to, as families in this country, take care of our most vulnerable, loved people when we actually cannot get them to be seen by mental health services when they say they want to kill themselves. We find, as members of our community, that we have to become the mental healthcare people to take care of them.

There are too many of our children who have been lost to suicide. We have the highest suicide rate in the OECD. That is nothing that this Government should be crowing about. That is nothing that families out there in our community are at all proud of. If anything, it breaks our community even more because of the fact that we are losing too many of our children.

Let us talk about the rural sector. Let us talk about the mental health in our rural sector. The amount of men and farmers in our rural sector committing suicide is an absolute concern on this side of the House and gets fobbed over on that side of the House. Let us talk about the fact that women in rural New Zealand cannot get access to healthcare services either. When we sit there—and I read, actually, a document from Cabinet from 2014 that said there is no recommendation to change the population-based funding formula and that it is fit for purpose. Well, I beg to differ. I beg to differ on that fact, and I absolutely can see, and question now, the question to that Government is: is a population-based funding formula fit for purpose today? Does it actually have its integrity intact over the debacle of what this Ministry of Health has actually done? Does it have the integrity to stand up now and still provide the key instrument in order to allocate funding for our healthcare services here in New Zealand? I suggest that no, it does not.

That Minister Coleman, that Ministry of Health, have actually just done the very job and made it become known to members of this House that that funding formula is not fit for purpose. The real question here that should be being asked is: when is Minister Coleman going to stand down? When is he going to stand down?

I will tell you what: I live in Southland, and I am proud that I live there with my family. My family accesses services from the Southland Hospital, and when our two areas, Otago and Southland, were merged into the Southland District Health Board, we had the biggest geographical area in this country of trying to cover all those who live within it, all those who live in that catchment. Some of the Ministers and some of the backbenchers do not seem to understand the distance in Southland there is to cover in terms of healthcare. My DHB, Southern DHB, has, as I have already said, actually lost out by $5.7 million. The concern here is that these DHBs, between 20 of those DHBs—yes, 14 were given an overspend, and, actually, six were given an underspend. These DHBs have already allocated the central spend. The Government might want to say: “Oh, it was a piece-of-paper problem.” The fact of the matter is that these DHBs built this budget into their budgets. The excuses that have come from that side of the House do not cut it. They are not going to cut it when it comes to election day, and they are not cutting it right now here in this House today.

The DHBs—and I think we have had members read out the whole list. I am not going to go down that way and read it all out again. What I am saying is that New Zealand First can hear the concern out there between DHBs. We know that they are being massively underfunded. We know that there is a problem with the population-based funding system, and we know that because of the debacle and the flunked way in which the Government had no idea, on Budget day, that its health budget was wrong. Not one figure was right—not one figure was right. The Minister might like to crow that “Oh, but the budget got $439 million extra in this Budget day.”, but we are still short $200 million in health just to keep it afloat today—just to keep health afloat today.

I think it is actually really quite worthy to say that in terms of primary health, from one of the panels that I went to—the question was put to the panel members: how much of Vote Health does primary healthcare receive? How much? I bet you Mr Bennett does not know that answer, and I can tell you it is less than 5.5 percent of total health spend. That is a disgrace. If we are trying to prevent health issues and outcomes—primary healthcare is only funded less than 5.5 percent of the total health budget. It needs at least 7 percent. When is that Government going to start listening to the country, start listening to the professionals inside of the area, and, actually, listen to what is essential to ensuring that our society and its health is put at the forefront of this Government? Thank you.

Firstly, Mr Deputy Speaker, happy birthday to you, while I get this opportunity. Look, I am absolutely delighted to take a call in this urgent debate. Echoing, in many ways, what the Minister himself said, this is a marvellous opportunity, a silver lining, if you will, on a dark cloud, but a silver lining to actually highlight what is really good in this health sector.

But let me, firstly, address the accusations, if you will, that have been put forward. We have to start by absolutely acknowledging, upfront, that there has been an error within the Ministry of Health in how it has allocated the increased spending on health, the increased spending into the district health boards (DHBs). The Opposition is making a lot that somehow this is a cut, this is a huge disaster, the DHBs will fall over—a Chicken Little moment. It actually makes very little sense at all. It is a mistake, absolutely, and I do not think any of us step away from that, but mistakes must always be put into context and given a relative proportionate element.

The first point we have to make, of course, is acknowledging that mistakes do happen. It is the nature of being human. I know that the Opposition has been crowing a lot around the figures being misunderstood. I just have to remind the Labour Party of course that, I think in recent years, it put out a “baby start”, or a “best start”, programme, which it trumpeted in the media along with its leader at the time—I cannot remember which one it was—but, of course, it got all its figures wrong. Within a couple of days it was exposed that it had not allocated that correctly. That goes through a whole lot of other things. In fact, I would be fascinated to see the costing that the Green Party has put forward around refugees today—fanciful thinking. So there is little bit of richness in some of the commentary coming forward from the Opposition that somehow mistakes do not happen.

But this mistake is around how an increase in funding has been allocated to the DHBs. So we have to start with what is a record spend in the New Zealand health sector, of around $16.8 billion—a record spend in New Zealand’s healthcare of $16.8 billion; the largest spend ever. We saw in the recent Budget an $888 million overall increase. As part of that increase, there is about $430 million, $440 million that has gone into DHBs, and that is actually quite important. The DHBs have been calling for more and more money, and that too makes perfect sense. For those of us fully engaged in the health sector, it is never a surprise—never a surprise—that more money is needed. I say it somewhat off the cuff and quickly, when I am out and about, speaking publicly, but, actually, you could double the health budget tomorrow and we would still have people who would want more money.

So DHBs always want more, and this Government is reacting as best it can. And, really importantly, too, because I am hearing it coming from the Opposition, it is the DHBs that, in turn, pass the funding on and through into their communities. So decisions around primary care, around mental health, those decisions are made by the DHBs. I think it is really important to spend.

We heard from New Zealand First a few moments ago, talking about how much the Government puts directly into primary healthcare. Very few dollars, in effect, are put directly by the Crown into “GP land” if you will, because it is done through the DHBs. So what we are seeing in this Budget is $439 million extra for our DHBs—$439 million. In all this debate today and what we have read in the media in recent days, not one cent, not one dime—granted, if we were American—not one dollar has been taken away from that $439 million increase to DHBs.

What has happened—what has happened—is that in the apportionment that the Ministry of Health was doing, it has done that incorrectly. As I said at the start, that is a mistake. It should not have happened. We do not want that to happen. In fact, no one in this Parliament would want that to happen. But it does not take away from the fact that the DHBs are still getting an increase in their funding. In fact, this error, this mistake, is less than even 0.3 percent, I think, of a DHB’s total budget. And really importantly too, while they are working on their budgets from 1 July, they have not received this apportionment yet. In other words, there is nothing that needs to be taken back. This is an accounting issue, effectively. This is something to be dealt with on paper.

What it does highlight too, though, and no member of this House so far has touched on it, is the complexity of the population-based funding model that we have. It is a funding model that has been around for almost, I think, 20 years. For those who do not fully understand it, it is the model that is used to work out exactly how much money should be allocated to each DHB. I am not going to go through all its iterations, but everything, from the demographics of a community, its geographic spread, whether or not its hospital has tertiary services—by that, I mean cardiac surgery, neurosurgery, and so forth—apportionments are made.

Importantly, a number of people do—and we hear it in the select committee all the time, that the funding model should be reviewed. There are issues within it. But really importantly, and again, we did not hear it from the Opposition today, no one has come back with a viable alternative. Time and time again, when DHB officials are in front of us they say: “Yep, in many ways we’d like to see it adjusted in different ways, but we see it as a good operating model.” But it is a complicated model. It will be interesting to hear from, perhaps, former Ministers of Health who may or may not be in the Chamber, around the complexity of that system and in some ways why we end up, sometimes, with mistakes like this. It has been a mistake, which the ministry has acknowledged. They are setting up, I believe, Deloitte to do an audit, to understand how this came about and how to stop it again.

But I come back to my initial point. Not one cent, not one dollar, is being taken away from the DHBs. This is a Budget whereby we have just had a $439 million increase to the DHBs. What has to happen now is that the DHBs and the Ministry of Health have to go back and readjust their spreadsheets, and plan from there.

We have also heard throughout this debate effectively a lot of personal attacks. I think that begins to belie the fact that this particular issue has just been a launch pad for sort of playing the man and not the ball, and I think that is completely and totally inappropriate. I think attacks on the Minister are completely unhelpful. It is not to try to give counsel to the Opposition, but if you cannot actually play the ball, then playing the man shows great weakness.

The other two are this continuing claim—and again it is why I am delighted to take a call today—that we are not increasing funding. Well, again, that is demonstrably false—demonstrably; we are not going to get into the semantics, to the Hon Scott Simpson. That is demonstrably false. The other is this constant claim from the Opposition, in trying to link this accounting mistake to some indication that the sector is being underfunded. Last week, I believe, according to the Opposition—Labour and the Greens in particular—we were underfunding by something like $1.7 billion. This week I hear it is up to $2.5 billion. Next week I am waiting for it to be at $5 billion. The fascinating thing—and I have explained it to the House before, in the health area—is we continue to increase the funding. The Opposition, understandably, has its wish list of what it believes should be funded, what it wants to be funded, and, in its utopia, what it feels is appropriate.

I have often put down the challenge—I am not sure why the Opposition stops at $2.3 billion or $2.5 billion or $1.7 billion—why not say it is $15 billion underspending, just to make things sort of fanciful. Again, it is not actually based on much fact, and I suppose that is where it all comes back to this debate today. In fact, there is not a lot of substance to the wider elements of the debate. Yes, a mistake was made, but, actually, it has no material impact on the increase of funding that has been put into the DHBs.

I thank all of those who now are clearly working in the DHBs and the Ministry of Health to tidy this up. Fundamentally, the same services that were delivered last week, that were delivered yesterday and delivered today, and will be delivered in the future, are going to be delivered and will be delivered—announced on the back of an enormous array of positive changes that the Government has brought in. I am conscious I have got only about a minute left.

We often hear claims from the Opposition around mental health and wanting inquiries. That is all very well and good to talk about. This Government is about more than talk. It has invested over $224 million into mental health. The Opposition talks about supporting the disability sector. Well, the Hon Nicky Wagner has put in a substantial amount of money, through this Budget, to support the disability sector.

We get calls from time to time to increase funding to Pharmac. We have done that, to the tune of something like $60 million, which has now been able to fund a whole range of treatments, from the likes of Keytruda or Pembrolizumab, right through, I should say, to retrovirals for HIV and hepatitis C.

This is a Government that is now double-crewing ambulances—double-crewing ambulances. This is something we heard from the rural sector in particular. We are doing that. We were told that we need to have more funding for doctors and nurses in hospitals. We are delivering on that, and we have delivered on that. There has been an enormous amount of positive work that this Government has led and is continuing to lead in the health sector. As someone who is out in that sector, day after day, I say the feedback is positive but there are also the challenges too, and the Government is happy to engage those. Thank you.

I just want to remind the House of what we are actually debating here this afternoon. What we are debating is basically an error in the appropriations documents that were presented to this House at Budget time. That is what we are debating. We are debating the responsibility of the Minister of Health to actually get his appropriations correct when he presents them to the House.

When he presented to the Health Committee, of course, none of this actually came up for discussion. We are only just finding out now, in recent days, that there was an error made and the Ministry of Health, in response to that error, said to the district health boards (DHBs): “The error that we’ve made—we won’t require you to give that appropriation back to us. We won’t require that.”

And then, a couple of weeks later, lo and behold, we got a completely different story. We got a flip-flop from this Minister. He came into the House, the Minister, in his usual arrogant and dismissive way, and said: “Well, the people of Rotorua at the rugby on Saturday, they don’t understand the population-based funding formula.” Well, they may not understand the mechanisms that we use to fund the health system but they sure as heck understand how difficult it is to get any decent health services under that arrogant, dismissive Minister. I, for one, am saying to that Minister: “You may say it makes no material impact in terms of your budget, but it certainly makes a material impact in terms of the people who receive health services.”

I want to refer to a specific set of issues, and that is what happens with mental health in Canterbury. The situation is pretty well known to everybody. We have been talking about it for some years now. It is widely discussed. It is widely known and agreed that we have a problem with mental health not only in Canterbury but across the country. But we have some specific issues in Canterbury, and we know that prior to this Budget our district health board was talking about a $45 million hole in mental health support—money that had to come from other services to bolster up the support that our community needs around its mental health.

It is not going above and beyond to say that mental health services in Canterbury are probably at crisis point. We are getting clinicians and staff telling us of the difficulty they have in supporting people around their mental health issues. But it is not only that—rural New Zealand is expressing deep concern that people are unable, because of isolation and because of lack of resources, to access support for their mental health. We are talking about particularly vulnerable people throughout Canterbury.

I just want to refer to some articles and reports that have come out over recent months. Cate Broughton reported in May that “The workload associated with high numbers of patients under care is putting significant pressure on clinical staff and compromising quality, … Every month some adult patients slept in other wards”—these are mental health patients—“as there were not enough beds to accommodate them. … Children and adolescents assessed as having less urgent cases were waiting an average of four months for a second appointment.” So children and adolescents who are experiencing mental unwellness are waiting for 4 months to get a second appointment.

💬 Hon Ruth Dyson: It’s disgraceful.

It is more than disgraceful. But there is more. The Prime Minister’s Youth Mental Health Project reports that came out in December showed that there were six areas assessed across the country but that Christchurch youth—east Christchurch youth—were at the most risk: “Youth in Christchurch’s eastern suburbs are more likely to have self-harmed and suffered anxiety, depression and low self-esteem than others in the country. … Data from three schools showed 36 per cent had high anxiety or depression, 28 per cent had self-harmed, 43 per cent suffered low self-esteem …”. More than that, they have nearly 60 percent of children under 12 years of age waiting more than 3 weeks to get the support they need—kids under the age of 12 have to wait 3 weeks to get mental health support.

This is another damning piece of information: “Last year, police callouts for attempted suicides rose 60 percent”—60 percent—“from pre-quake levels, the highest in the country. Canterbury saw a 37 percent increase in people entering mental health services … Rural mental health presentations were up 65 percent. Emergency health presentations have risen 104 percent, psychiatric emergency assessments [are up] 124 percent.” So when the Minister stands in the House and says the people of Rotorua at the rugby may not have understood what population-based funding is about—no, they may not understand the mechanisms but they sure as heck understand what it means to them as people who are trying to access health services.

I want to give you a couple of stories from my own constituency, from my own electorate. I get people coming to me to intervene on their behalf to try to access health services. I have a story about a 19-year-old constituent who, since December, has attempted suicide three times. She cannot get an appointment for an assessment for at least 2 months. She is a young woman, she has got her life ahead of her, she is actually working, and when she is in a low mood, that is when she needs support. When she is starting to feel that depression coming on, that is when she needs the support—not to wait 8 weeks for somebody to give her an appointment.

She has had to come into the MP’s office to try to get me to intervene with health services to get her an appointment. It is lucky that I have some connections with mental health services in Canterbury and have been able to effect an appointment for her within a few days, but she was canny and came and saw me and tried to get some help. What happens to all of those other young people who do not know where to go? It should not take the MP to intervene on her behalf to get an appointment—someone who has attempted suicide three times since December.

I also want to talk about another constituent of mine. His mother has come to see me on several occasions. We have been working on this for a while. In fact, this case is one that I have passed to the Minister for Disability Issues—when she can stop looking at the harbour—to actually take some initiative over. A mother who has a severely autistic child who is assessed as requiring 36 hours of support each week has only ever received in the region of 6 to 9 hours support, up until December where he has been receiving none. His mother has had to care for that boy because he has not had the support he requires. She subsequently had a stroke. What does it mean for his care if his mother is becoming so unwell that she cannot care for him because she cannot access the support she needs for him? When that Minister stands in the House and says that the people of New Zealand do not understand the population-based funding mechanism—they sure as heck understand the impact on them when they are trying to access health services.

I have had people come to me to intervene to get them back on the waiting list for knee operations—people who are contributing to the workforce and who actually need to get their knees repaired so that they can continue to work. Do we not want people to work? We do not want them accessing sickness benefits because they cannot work because of their knees. We actually want them to work. So people are coming to their MPs to get support to get on to the waiting list because this Government is saying that you do not need to throw more money at it. Actually, in some cases, you do. The issue is not that we have not got the capacity to do the work in Canterbury; we have not got the staff to do the work in Canterbury.

I have to say that this is not just an issue about funding. It is actually about a matter of trust and the worthiness of this Government to govern. In recent weeks we have had some really disturbing occurrences happen. We have had Alfred Ngaro threatening the community and voluntary sector. We have had Nicky Wagner being completely dismissive of people with disability issues and disability organisations. We have had what can only be described as a cover-up, in terms of what has happened down in Clutha-Southland. I have to say, there is one thing: the people are watching—

Order! The member’s time has expired. I think she got even further off the point at the end.

We are acknowledging that there has been an administrative error. We are acknowledging that. I want to talk about what is being delivered and what will be delivered regardless of that administrative error. I want to talk about it in several domains. I want to talk about access, I want to talk about actually doing health stuff, and then I want to talk about our workforce and how, regardless of this administrative error, we can still do what we were planning on doing. We have heard other speakers talk to it as well.

Let us look at access across the spectrum of a life. Initially it was the under-5s—they get free access to healthcare. We increased that to under-13s—they now get free access to healthcare. But what is not often talked about is from 13 onwards—the other part of a life. Now they benefit from something called Very Low Cost Access, and probably at least 50 percent of the population is enrolled in primary health organisations. They get improved access at a co-pay cap of around $17 to $18. So access to healthcare will continue to be high quality and available regardless of this administrative error.

The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! I am going to interrupt the member. I have been relatively flexible in dealing with this debate to date, but all other members have at least made an attempt within a couple of minutes to address the question that is before the House, which is the urgent matter. Just saying “misallocation” is not, I think, addressing the urgent matter for which the House has currently adjourned its normal business in order to consider. Now, I am not going to restrict the member—as I have not previous members—from discussing other matters, but he at least has to do more than wave in the direction of the matter before the House.

Thank you, Mr Assistant Speaker. This administrative error is going to have some consequence but we are reassured that it will not have a consequence that affects New Zealanders’ access to the good quality healthcare that we receive. I absolutely believe that. As we said, we put our hand up and said: “Look, we made a mistake in the modelling.” It is easy to do. I have done modelling as well, and it is easy to take an input and misinterpret it and realise at a later date that maybe it was draft input that we were looking at. By all accounts that is what we understand to be the issue here.

That aside, the administrative error will not change what we are planning to do. We have heard that from the Minister—we have the appropriations here. We know that the budgets are set as they are set. I am going to talk to the Northland budget specifically in a few moments, because, obviously, it is an area close to my heart. I was making the point that access will not change with this error. Access will not change to primary care, nor will it change to secondary care. In the Budget, we know that they will be doing more first specialist assessments. That means that access to secondary care is also going to continue to improve regardless of this administrative error.

So we have got access to health services—let us look at actually doing stuff. Is this going to change anything we are doing? Now, in primary care we know that the utilisation has gone up since we increased the cover to under-13s. We know that because the utilisation formula that was calculated for the capitation that first came out has been reviewed, and my colleagues are all telling me that they are doing an awful lot more as well. We also know that in elective surgery we are doing a lot more. That will continue to happen under this Budget as it was projected and predicted. In fact, we are doing 40 percent more than we were in 2008. So we are able to get to services better; we are able to do more.

I want to talk about the health workforce and address some of the questions that my colleague over there was talking about, again in primary care. I will start with that. Primary care does have some challenges. Health Workforce New Zealand is working very hard on that. I think that 50 percent of GPs over the age of 50 may be retiring in the next 5 years. So we know that workforce in primary care is an issue, but we have been doing things with that. If we look at the Health Practitioners (Replacement of Statutory References to Medical Practitioners) Bill, what we did there was look to give other allied health professionals an increased scope to do some of the work that doctors and others might do, more particularly the nurse practitioners. We gave them increased scope to sign sickness certificates, and do death certificates, and other things. So we are addressing that part of it. So I take some issue there.

Certainly, across the district health boards (DHBs), if we look at their workforce, again we are providing funding for that, and will continue to, regardless of this administrative error. In fact, what we know is that in the DHBs there are 2,250 more doctors and 4,640 more nurses. When I was a resident medical officer (RMO) at Northland DHB when I first started we had nine RMOs. There are now 90. The workforce is clearly increasing.

To briefly conclude, Northland receives $21 million in this Budget, and regardless of this administrative error, the core services that Northland DHB will deliver will, I believe, be unchanged and be the same quality they have always been. Thank you.

Can I begin by saying to the chair of the Health Committee that the Speaker would not have given this debate if it did not have substance. One of the remarks of Mr O’Connor was: “There is not a lot of substance to this debate.” Well, it had to be urgent, it had to have responsibility of the Minister, and it needed to be serious enough, and that is why there is a debate on this issue.

I have to say that I am astounded by the Minister of Health’s speech, because he believes that the health issues facing New Zealand are beltway issues. That shows a Government out of touch and out of favour, because if it was in touch it would know that health issues will be an election issue, because they affect families in all walks of life. People are affected by what happens in the health sector.

I have to say it is a sad day. It is a sad day that we once again have to raise the incompetence of the Ministry of Health, particularly the incompetence of the senior management of the Ministry of Health. I feel sorry for the staff who work at the Ministry of Health—not those in senior management but those who graft away every day, trying to do their best. I feel sorry for those who are working in the health sector and face the incompetence that has come out of this ministry under the leadership that it has. And it is not new. I have been raising these issues for over 4 years. I have raised them with the State Services Commissioner, I have raised them with the Minister of Health at the select committee, and I have raised them in this House, because there is a pattern here of incompetence. You only need to see what is happening to the confidence of those who work in the health sector. Their confidence is shot. Their confidence in the ability of this ministry and this Minister to lead the health portfolio is shot.

I have to say that when you see a district health board (DHB), like the Canterbury DHB, calling for the resignation of the Director-General of Health, that is unprecedented. I cannot recall a DHB ever calling for the Director-General of Health’s resignation. Now, the Minister might say “Unfair to pick on a public servant.”, but this was a mistake made by the head of a department that has a portfolio of billions of dollars, and this is a major mistake. But it is not the first. The first—well, there have been many. But let us just remind this House of the mistake made over the funding of the Ministry of Health’s building where the director-general did not inform his Minister that they did not have the money they said they had for refurbishment. That was hidden from the Minister for months. I have to say that this Minister has been given poor advice, this Minister has been misled, and it is fair to say that there have even been lies to the Minister.

We now have the lowest morale we have seen in any Government department in New Zealand because of this poor leadership. The Minister says: “Well, I don’t believe he needs to resign.” How can he say a $38 million blunder was just an administration error? It has also today been called a minor technical error, but it is not minor to the DHBs that have been on the receiving end of the $38 million blunder. Simon O’Connor called it an accounting error. Well, the director-general was an accountant. If they cannot do their figures over there, there is something seriously wrong.

So where is the accountability? Why has the Minister not asked the director-general to resign? He said he could not recall whether the director-general offered his resignation or whether he asked for it, which shows to me that this issue is not being taken seriously by the Minister at all. He needs to say “Be gone.”, because this sector is far too important for us to have such incompetence at the leadership of it.

Health, I have to say, is going to hell on this Minister’s watch. This Government does not like to hear it, but the shortfall in health is impacting in mental health, in primary care, in access to elective surgery, and in NGOs that are waiting for funding that they have not had for years. This is a serious debate. I am just so sorry that it has not been taken seriously by this Government.

Yes, we are having a debate this afternoon because there has been an error made at the Ministry of Health. It is an unacceptable error and the Director-General of Health has fixed it. He has also gone to Deloitte to have a look and determine how this error was made. It was a mistake—it was a technical error—and I am not going to say it was minor. I really feel for the health boards that have had their funding changed, but we have heard today that it is appropriation. It is not money that is currently in their budget; it is money for their budgets going forward. So it is disappointing that it has happened, but it is a technical error and investigations are going on to see how that error happened so that we can ensure that it never happens again.

Just a reminder to those on the other side of the House: despite this error, all district health boards (DHBs) did receive an increase in their funding under the 2017 Budget, and they are all finalising their annual plans at the moment to fit that Budget.

So $439 million extra has gone into health, and it is amazing, actually, to see some of the things that are being developed on the health front. If we think about things in terms of surgeries, there have been an extra 50,000 elective surgeries, but there are also a whole lot of other changes in health. We have had a bit of a discussion today about various people around mental health. Well, actually, mental health is not the responsibility of only the Ministry of Health.

When I think about children at school and when I think about those in the community, I also think of Fieldays. I have just been to Mystery Creek Fieldays, and I think one of the highlights of Mystery Creek Fieldays is that there has been, for the first time in our rural communities, a health hub where people have been able to come in. They have been able to talk about dentistry, they have been able to talk about breast cancer, prostate cancer, wellness—we are talking about a whole range of things that were in this health hub, and I have to say that the health hub was the highlight of the Fielday. If we do not look at doing things slightly differently in our rural areas—[Interruption] Maybe some of you do not have any idea how far some people in our rural electorates have to travel to get to health services.

I think it is great that we take advantage of Fieldays and every opportunity that we possibly can. At the last three Mystery Creek Fieldays we heard that there has been a total of $1.6 million going into rural mental health. So this year saw another $500,000 being promised to mental health, and I think it is really important because we had a reference before about mental health needs increasing in our rural communities. But maybe there also has not been an awareness—although I thought it should have been obvious—that we have had a dairy downturn, and we have had people under severe, severe pressure financially and in a whole range of different ways.

I am very proud of our rural support trusts and the way they use the funding and the way they have dealt with people during this whole process. So, you know, we can keep doing things in a certain way, but, actually, there is a whole range of people who can get involved in mental health and make a difference. I can tell you that the suicide rate in the rural areas—even despite the dairy downturn—has been less at the $4 payout than it was at the $8.50 payout, so I am really impressed with what some people have done.

You know, it really does highlight the facts around social investment. It is not just the Ministry of Health; it is a whole range of other people who are getting out there. We also have 6,900 more doctors and nurses in our hospitals, and 552,423 patients received a medical or first specialist assessment in 2016. So we are making progress in health.

We are here today and we are focusing on something that has been an unfortunate error. I think we have actually got to find out what did go wrong, and we need to make sure that it does not happen again. It is important that we study how it happens. We can talk about the complications of the funding model, and, yes, it is a complicated funding model, but we have to get it right. So that is no excuse, and Deloitte is going to spend its time putting effort into finding out what went wrong to make sure that it does not happen again. Thank you.

The debate having concluded, the motion lapsed.