Estimates Debate — Health Sector (continued)

Kia orana, colleagues. The House is in committee for further consideration of the Appropriation (2018/19 Estimates) Bill. When we were last considering the bill, the committee was debating the health sector. The question is that Vote Health stand part of the schedules. Dr Liz Craig had the call and has four minutes and 25 seconds remaining if she so wishes.

Thank you, Madam Chairperson. So when I was interrupted I was talking about targets and about how the fact is that in the health sector they’re useful for focusing action in important areas but they can also be used to divert attention from things that we’d rather people didn’t see. And I was also talking about how this Budget starts to address some of those real underlying drivers about what’s really happening in our health system.

So I want to talk a little bit about one of the targets: emergency department waiting times. Because what we’re seeing is—you know, with the previous Government’s targets a lot of emergency departments (EDs) are working really hard to get patients through the system so they can meet the target of 95 percent admitted, discharged, and transferred within about six hours, but the problem that these targets completely miss is why our EDs are bursting at the seams in the first place. This is something that the district health boards (DHBs) were talking about in their annual reviews, with DHBs talking about this ongoing, increasing, relentless demand for acute services.

The problem we’ve got is a lot of those conditions that people are coming in with are called ambulatory sensitive. What that means is that the hospitalisation could potentially be prevented if they had early access to primary care. What the New Zealand Health Survey is saying is that about 14 percent of people in the last year put off going to the doctor because of the cost, but if you look at people living in the poorest areas, that went up to about 20 percent. So what this Government wants to do is make sure that people can afford to go to the doctor when they need one. What Budget 2018 does is invest an extra $360 million over four years to extend access to Very Low Cost Access (VLCA) GP services to community services card holders. What that means is that for those who are not on a VLCA practice already, their doctors visits will be about, on average, $20 to $30 cheaper.

We’re also going to be extending community service cards to all those on accommodation supplement or income-related rent, so even more people can access affordable primary care, and that’s really important for ensuring that people can get to the doctor rather than having to turn up at A & E and end up in hospital.

The area I was working in before coming to Parliament, though, was child health, and again, looking at targets, there was this huge focus on immunisation rates. Indeed, as we focused on that, immunisation rates did improve because DHBs got together with public health organisations and GPs and worked out how we could improve timeliness and access to immunisation. But the problem is that that’s only sort of a few hundred vaccine-preventable hospital admissions—maybe a couple of thousand. What it misses is that our whole hospital system is full of sick kids: on average, there are about over 40,000 hospital admissions every year for infectious and respiratory diseases, a lot of them related to the economic conditions that the kids are living in. The problem we’ve got is that most of those conditions aren’t actually vaccine-preventable. So when you’ve got to reduce this, what you need to be doing is looking at housing, looking at family income, reducing child poverty, and also making sure families can get to the GP when they need one.

This Budget addresses all of those areas. With the Families Package, we’re looking at family income. We’re also looking at housing, with 6,400 new houses—State or social houses—over the next four years. In the primary-care space, what we’re looking at is extending free GP services to all 13-year-olds and also extending the nurses in schools programme to all decile 4 secondary schools that are publicly funded. So what we’ve got is many more young people being able to access GP services.

The problem we’ve also got with some targets—while a lot of the ones I’ve been talking about are tangentially related to targets, there’s others where the targets have completely missed what’s going on the health sector, and that’s the state of our infrastructure, our buildings. What we’ve seen is under-investment in our hospitals, so we’ve got mouldy, leaking buildings. We’ve got buildings that are completely out of date and need repair. A lot of this stems from the fact that we haven’t got an asset management plan nationally, so that was masking the fact that a lot of DHBs, in the face of chronic underfunding, may have been delaying their asset infrastructure. So what this Budget does is it adds 750 million—

The member’s time—I’m sorry—has finished. We turned off the clocks so that the member didn’t get confused.

Thank you very much, Madam Chair. The Director-General of Health, in his annual report 2017-18, acknowledges that New Zealand has achieved important health gains over recent years. We are living longer, and we’re living longer in good health, but, of course, there’s always challenges in health, and they remain. After going through the Budget process and after looking at the Estimates, I’m not sure that this Government is up to managing those health challenges.

Now, of course, Vote Health is one of any Government’s really large expenses—or, as National believes, a social investment. Under National, the Government increased Vote Health substantially in every Budget, but during this election, Labour made the case that there was a huge deficit in health spending, that they would invest $8 billion more in health if they became the Government. I actually wonder how many people voted because of that promise, because, of course, they didn’t put an extra $8 billion in health, and at the Health Committee, the Minister of Health had to admit that in percentage terms, Labour’s increase this year was less than National’s last year—so much for election promises.

There are other issues that really bother me about this Government’s approach to health. Doing away with the health targets is a travesty, and it was interesting to hear the member Liz Craig talking about health targets and the importance of health targets, because there’s absolutely no doubt that they have driven the health gains that the director-general has noted were achieved since 2007. The key thing about targets is that they focus on the things that are important to New Zealanders, and on their health outcomes. The targets mean that everyone in the sector—everyone that works in the sector, everyone that supports the sector—knows where to put the emphasis, knows where to put their expertise, and knows where to put their energy. The targets make health organisations, health workers, and district health boards (DHBs) accountable. That’s the key issue—it makes them accountable. The regular publishing of DHB outcomes in the newspapers meant that every New Zealander knew how well the health system was working across the country but, more importantly, how their local DHB was performing. I think everyone in this House knows that monitoring and transparency of any system drives better results, and that, of course, is what we want in health.

There’s other failures in the funding that bother me as well, and again I note that the member Liz Craig was talking about cheaper GP visits—well, weren’t we promised $10-cheaper GP visits across the board? Yes? Again, another election promise that’s very easy to make—we know the reason for it—but has proved very difficult to deliver.

And what about mental health? Just as with the $8 billion promise, Labour campaigned that there was urgent need for more mental health funding and initiatives, and we agreed, but what happened? Since they’ve been in Government, the $100 million that National put up, ring-fenced for mental health and the 17 mental health initiatives that were on the table and committed to, has disappeared, and we’ve now got a mental health talkfest. Now, I’m not necessarily against having an inquiry. This is an important area, but don’t make urgent mental health programmes wait while they talk.

Then, what about the $100 million for medicines for rare diseases? Up in a puff of smoke.

Finally, as if disabled people don’t have life tough enough, this Government has just cancelled $6.5 million worth of funding for cochlear implants. Now, cochlear implants are brilliant devices that help deaf people hear, and National—[Time expired]

Thank you, Madam Chair. I want to put a few comments on record, as there have been a number of speeches made by members of the Opposition, some of them on a previous day that the committee sat, and correct a few things for the record.

The Hon Michael Woodhouse, in his opening contribution—I appreciate he hasn’t been the Opposition health spokesperson for a long time—made the claim that Labour, in Opposition, had said the health budget was $8 billion short. That’s not quite accurate. We had some research done in Opposition that suggested the health budget was $2.3 billion short just to achieve the existing level of services in the health system, that it had been short-funded, and that with a growing ageing population with more complex needs and increasing demand, the funding had not kept up with the pace. So it was actually now harder to get access to services than it used to be.

What we saw under the previous Government was a health system that was drifting and that was in decline. With the underfunding, it struggled to keep up, and New Zealanders saw that. They saw that they couldn’t get the services they used to be able to get because the funding simply wasn’t there to deliver them.

So that’s why this Government campaigned, as the previous member said, on putting $8 billion more into the health system. This Government is committed over the forecast period to putting $8 billion into the health system, which, over time, contributes that $2.3 billion that they cut out back in, and it adds new funding in as well, recognising that growing ageing population. That’s the pledge we have made, and we’ll be held to account on that over the forecast period.

But, of course, we can’t fix everything in one Budget. The levels of neglect and the nine years of neglect can’t be addressed in one Budget. Nobody pretends that it can be. Nobody pretends you can magic up a workforce when it’s been run down under the previous Government’s watch while they had just let it drift and decline.

But this Government is committed to the public delivery of health services. We have determined that we will take measures straight away. We will do things like invest in mental health in a way that the previous Government never did. They seemed content, again, to let that drift and get worse and worse, and to let the wait times get longer for mental health services. They did not take action, despite—

CHAIRPERSON (Hon Anne Tolley): I’m sorry to interrupt the Minister, but we are on the Estimates, which is about what the Government is going to do, and not necessarily—we’ve had half your five minutes now on the previous Government, so can you focus on what you’re doing.

I will come back to the reason why we’re responding. What we have committed to in the Budget, therefore, is to already put in some integrated therapies: a pilot programme for 18- to 25-year-olds—more than $10 million over the next three years—which makes counselling and therapy available for young people. We’ve invested $28 million over the next three years to better support Canterbury kids to mean that every primary school - age child in Canterbury will have access to a mental health worker, and we’ve put $17 million over the next four years into expanding school-based health services, which is the next step in rolling out the nurses in schools programme. Quite aside from that, of course, we’ve launched the mental health and addiction inquiry, which reports back in just a couple of months and will project the way forward for future Budgets and commitments that will be made to make sure that we spend the money well.

One of the other significant things that was done in the Budget which will benefit those with mental health issues is the reduction in fees for community services card holders—540,000 more New Zealanders will have access to doctors visits under $20. For many of them, that will mean a saving of $20 or $30 per visit, and, for some of them, a saving of up to $50 per visit. So they will actually be able to access a GP and, for many, that is the way into mental health services. They get the initial consultation that puts them in a position to get access to mental health services. So that’s a really important initiative on mental health.

A number of speakers have mentioned the $100 million contingency the previous Government had put forward, so I do want to address that and say that that money was never appropriated. No money was ever appropriated for programmes. They were in the realm of nice ideas. That Government had nine years to act and did not.

Thank you, Madam Chair. It’s a pleasure to speak to the Estimates for health, and I’d like to thank the Minister of Health for turning out to that session. We raised a lot of questions in the health portfolio, and I have a particular interest in the National Oracle Solution, which we raised extensively with the Minister, and there are some points I want to talk to here.

Just to set the background, the National Oracle Solution is a $90 million IT project which started in 2011. It was given a different name then—Finance, Procurement and Supply Chain—and in 2013, it became the National Oracle Solution. We asked the Minister and we probed further on conflicts of interest, which, quite clearly, we’ve been concerned about. We’ve been concerned that the Minister and his team have turned away some of the questions, saying that the National Oracle Solution didn’t exist in 2011. Well, we know that to be incorrect. We pointed that out. We have the work schedule from Deloitte—and it’s not an issue of Deloitte; it’s an issue of the appointment that we’re working with—that shows us that they were working on this in 2011. In fact, they were working quite deeply, which I’ll come to in a moment. So I think that, as an argument, just doesn’t stand.

It’s quite clear. Again, we know from released documents that at one point, Deloitte didn’t want their conflict of interest brought into the public domain—when they said, “It is our preference for this not to be made public.”, once we’d raised questions in the House—and then, later in the day, they came back and said, “Oh, OK. If you have to, you can.” That’s not a good look, and, of course, the conflict of interest document they’re talking about details all the work that they’d done on the National Oracle Solution.

It actually goes a little bit further than that, because what Deloitte does in their conflict of interest statement—the one they wanted to keep from the public—is they actually highlight where they’re materially involved. So it’s not just a passing comment but where they’re materially involved, and I would note that in a majority of their work in 2013 right through to 2017, they have been materially involved. They have had a conflict of interest.

Now, the Minister tried to distance himself from this debacle—and, again, another sort of riposte that’s been made is, “Well, I didn’t commission the review.” Well, you know, if we look to the statement in the House, the Minister said this—and we raised this in Estimates, as well—“There is no way that the public would not be interested in the reason why we commissioned an independent report”. That’s an inclusive pronoun—it was a “we”. Yes, Minister, you were involved in that appointment.

Then we talked about the quality of the review that’s been commissioned, and this is really important: $150,000 is what the taxpayer has paid Deloitte and/or its full subsidiary Asparona—and the Minister confirmed that—to complete this supposedly independent review. It’s important that I read from the transcript so you can grasp how these few sentences were exchanged with the Minister. Reti to the Minister: “[The Deloitte] review was $150,000, Minister. Can the taxpayer expect the review to assess if the solution is fit for purpose?” Clark: “Sorry, can you say that again?” Reti: “Can we expect, for $150,000, the review will assess if the solution is fit for purpose? Is that something that will be looked at?” Clark: “Whether the solution is fit for purpose?” Reti: “Correct.” Clark: “[Yes].” Now, we know that’s not possible, because, again, Official Information Act (OIA) documents have shown us Deloitte writing to us specifically saying, “We will not be assessing if the solution is fit for purpose.”

What have New Zealand taxpayers paid for? They have paid for $150,000 that the Minister, quite correctly, thinks is going to assess if the solution is fit for purpose. It’s a very reasonable expectation that the Minister should have for $150,000, and I think he answered as best as he understood his expectation. Fair enough; I agree with him. However, we have, on OIA documents, Deloitte writing back saying, “Oh, by the way, we will not be assessing if the solution is fit for purpose.” That’s unbelievable. We can’t really expect to pay $150,000 of taxpayer money for a review that’s really important, that will inform the next stages—it will inform Cabinet as to whether they put more money into the National Oracle Solution. The Minister expects it to assess if it’s fit for purpose. I expect it. I’m sure the House expects it. I’m sure taxpayers expect it, and yet in writing, Deloitte said, “Oh, by the way, our review will not assess if it’s fit for purpose.” That really needs a lot of scrutiny.

We gave it some time in committee. We received a response from the new director-general—clearly new in his portfolio. I’m sure he would give a different response today, but I think that still stands outstanding for the Minister to explain why all of our expectations, including his own, were that we would get a quality review for $150,000, and yet the reviewers are saying, “Ah, nah, we’re not going to do ‘fit for purpose’.” So I challenge the Minister to offer some further comment to that. Thank you, Madam Chair.

Kia orana, Madam Chair. I’m delighted to take a stand today and talk about the health appropriation debate, because health is genuinely the biggest spend across all of Government. We can be really proud as a Government, across the benches here, of the money that we have actually put into health. We have inherited some—well, I could start with the dad jokes, but I’m not going to do the dad jokes, but we have inherited an ailing system. We have had some massive problems, and there’s been some wishy-washy action from National in the last nine years. We’ve got critical—

💬 Hon Kris Faafoi: Stop being kind!

—I’ll stop being kind—facilities in disrepair, unaffordable primary healthcare, the average cost for seeing a GP went up 30 percent. The demand for mental health support has increased by 70 percent in the last decade—70 percent. There wasn’t a 70 percent increase in funding to support that—oh no—and we have a crisis. Funding didn’t increase by half of that, and 606—606—Kiwis took their lives last year. We have the highest suicide rate in the OECD. Our workforce has been under strain over the last nine years, and I completely support the Minister when he says that those workers deserve fair pay and safe and decent working conditions. We have all used the health system over—

CHAIRPERSON (Hon Anne Tolley): Order! Look, this is quite a focused debate. I’m looking at the report from Vote Health, and some of the points the member makes are in here, but she must reference them in her conversation.

Absolutely, Madam. Me hana, Madam Chair. So I am delighted today because we believe in adding value into our health system. So we have added $3.2 billion extra into the health services, and an extra $750 million into the capital for hospitals—$750 million to fix our ailing, leaking system that we have. No doubt, most of you have heard the saying “If we don’t have our health, what do we have?” Well, this coalition Government believes that if we don’t have a health system, what do we have?

We believe in free, universal healthcare for all and, as a consequence, we have done our very best—our very best—to direct funding to support those who are least able to pay doctors’ fees. So there will be 540,000 Kiwis on low incomes able to access cheaper GP visits. Plus, we have 56,000 more children funded who are 14 and below. So that’s 56,000 more children who are going to be able to access free doctors in the system. And if we need to go to the hospital, $750 million—or a new hospital in Dunedin—is going to be invested in. We’re adding $80 million to the air ambulances, so that we can get to our emergencies faster, with more fit-for-purpose, safer helicopters, with bigger capacity and with more crew. That’s really important in such a rurally diverse community out there. We’re also increasing funding for elective surgery, so that people won’t be on the waiting list in pain waiting for their knee replacements, etc.

I think the Minister of Health is the pain relief that we all need for our health system. I think the Minister of Health has provided a great budget—one that is going to support all of us out there, all of us Kiwis who use this system. We have a plan, we’re working on it, and, in fact, it’s going to take a while, but we’re going to get there. Thank you.

Thank you, Madam Chair. I rise to look at the health situation. I’m tempted to start with a remark about some doctors making you sick and some making you better, but, really, there is much more interesting stuff to get on with here with the Estimates.

It was very interesting for the Health Committee to confirm that Vote Health 2018 had the widest gap between the reality and the rhetoric—and it certainly did. The Minister David Clark talked about the challenges of facing a growing and ageing population with more complex needs. He was right about that one thing, but what did he actually do to deliver in this health budget for that ageing population’s needs? What did he do, for example, to look out and plan for the next 20 years, when there will be 1.3 million New Zealanders over the age of 65?

There is a very real need to front-load more money into healthcare, particularly for our older and more vulnerable New Zealanders. Minister Clark said that there are challenges. Yes, older New Zealanders are known to consume something like three to four times the amount of healthcare services, and that rises dramatically from the age of about 50. Those are the international trends. We don’t need to think too hard about it—there is certainly a need for a greater investment in that level of services. So what is he doing about it? Is he managing increased demand for elective surgery? No, he is not. What provision is he making for providing greater access for primary care? As far as many senior New Zealanders are concerned, nothing very much at all.

We have palliative care, which is, incidentally, expected to increase by about 51 percent over the next 20 years or so. Under a National Government, we delivered an extra $150 million to hospices and into funding end-of-life care, but what has this Minister done in this Budget to allow for it? Absolutely nothing. Palliative and end-of-life care is something that needs to be invested in at a more meaningful level. I think that the amount of money that is put into it at an earlier stage, given that everybody has to die, whether they’re older, younger, whatever—sometimes, unfortunately, people are taken before their time. But there needs to be more consideration given to ensuring that end-of-life care is available to people wherever and whenever they need it—so whether it comes to boosting hospice funding, for example.

Thirty-four hospices do a remarkable job in New Zealand. Last year, they made something like 145,000 calls to people’s homes. People being able to stay in their own homes is, I would suggest to the Minister, a very worthwhile investment. If that’s where people who are dying want to stay, and if that is where people who have dementia would like to stay—in their homes—for as long as possible, again, it requires a level of funding and a level of increase in that funding that will allow for caregivers, the people who are responsible for really making the homes safer.

I would urge the Minister to look at the ACC funding that the last Government put into falls prevention. More than $30 million was put in. When I search through the Estimates in Vote Health, there is nothing that is going to be able to advance a safer and more preventative measure, which has shown to be very worthwhile and saves a really difficult situation for older people, particularly, who have a fall and are then very high-needs.

We also see people in that older age group who find that they don’t have the level of resources that they need to stay in their own homes in terms of the budgets, in terms of the increasing costs of rent. These are not necessarily within the health budget, but, again, I would urge the Minister to be more of an advocate for health for older people. We’re not seeing it from the current Minister for Seniors, but perhaps the Minister of Health would like to pick up on that, because it is something that requires a decent amount of money at an early stage.

I think, when I talk to seniors—particularly those with onset dementia—they are seeing no realistic funding or any kind of support through the health dollar for the wonderful work that is done by dementia and Alzheimer’s groups around New Zealand. They need some leadership and guidance. If it isn’t coming from the Minister for Seniors, Tracey Martin, then perhaps the Minister of Health could look again at making up the shortfall, because there are vulnerable New Zealanders who need a leadership initiative from this Government. They are waiting to see it. They’ve been waiting nine months and they have received nothing, not even an indication that it’s really being taken seriously as a health concern. Dementia is, arguably, with our ageing population, one of the more significant areas of need that this country needs to make a profound investment in. Therefore, Vote Health is woefully lacking in 2018. Thank you.

Kia orana e Maine Vaa Tuatua. It is an absolute privilege to stand here and speak on this very important topic: health. It would be rude of me not to acknowledge some of the words that have been echoed from across the Chamber, in terms of the talkfest by the Hon Nicky Wagner and what Dr Shane Reti has just gone through. Again, for me, it’s a rundown of the transcript on the day, which is another talkfest, and “Some doctors make you sick”, I think, is a bit of a compliment to some of the doctors across the other side.

Anyway, let me get back to Vote Health. We’ve heard people in the committee talk about numbers, talk about underfunding and neglect for nine years, but last night I took my out-of-Parliament staff member to the accident and emergency in Wellington Hospital. There is where we see what we are talking about. The hospital was full. People were coming in. My staff member needed to go to A & E to get a blood transfusion, because she wasn’t aware how ill she was. We went into A & E and the hospital was full. Every seat was taken. When we were met, we went into a room where we were met by the nurse, followed by the doctor. They put the drip in her arm, but they then had to put her in reception because there was no room—there was no room at A & E for her to be in. The nurses, despite reception being full, were upbeat and they were really engaging with everybody.

I want to acknowledge all the staff that were at accident and emergency in Wellington Hospital last night. We walked in at 8 o’clock in the evening, and we then went up to Ward 4, North Pod A, where the nurses—Kerry junior and Kerry senior—had talked to us. And we hear about messages that were shared by the Minister on his visit to the select committee. He talked about hard-working health professionals that have been under the pump for the past nine years, providing invaluable service. The senior nurse and the junior nurse had not had their dinner—had not had their dinner—and it was 11 o’clock. Their priority was to ensure that the blood transfusion had started before they took their break. Not only that; their role also was to teach the junior, the student nurse—to take them along the journey of teaching them what to do when they’re in hospital.

So, as a person who took in someone—as a support person—I saw everything that we are talking about in this place. I saw the hard-working nurses who were not taking their breaks because the priority of the health of the patients was No. 1. I saw a young woman with a bloodied face and everything, because of family violence. They were at reception—full.

So I want to acknowledge the Minister of Health on the leadership that he has with this Budget, because this Budget is truly about leadership. It is about the leadership to fix what New Zealand has inherited after the last nine years.

I want to make a special mention. I live in South Auckland, so I want to make a special mention to acknowledge the Minister in terms of the leadership this Government has addressed with the severe buildings of high concern in Middlemore Hospital. Can I take this opportunity to acknowledge the appointment of lau afioga Fepulea’i Margie Apa by the Counties Manukau District Health Board as the Chief Executive for Counties Manukau district health. That is about leadership and insight, bringing in experienced insight to serve the public, to serve—definitely for me—Counties Manukau. I want to acknowledge the Minister on his leadership in the appointment of the Hon Vui Mark Gosche, and now the appointment of afioga Fepulea’i Margie Apa in Counties Manukau. I’m happy that that has happened.

I want to talk about—I know I’m running out of time. I want to, again, commend the efforts of the people at Wellington Hospital accident and emergency last night. They definitely earned the appreciation of New Zealand and everyone’s appreciation for the effort they had put in. Not only do they have to look after the patients but they have the responsibility to teach the future nurses, and with that sentence, meitaki maata.

Thank you very much, Madam Chair. I’d like to begin by just addressing one issue. I think the Minister of Health has tried to claim his narrative of the 17 mental health initiatives of the $100 million amount not being appropriated as if it was his argument. In fact, if he remembers quite rightly, it was my mistake when I wrongly put the word “appropriated” in my primary question at question time one day about the 17 mental health initiatives and the $100 million. So I just don’t want the Minister taking the kudos that he had come up with that defence himself, when in fact it was actually my mistake.

But it actually poses the question: if it hasn’t been appropriated, why not appropriate it? And then he tried to say, “Well, it hasn’t been to Cabinet.” By definition, if it’s in a contingency fund, it means it hasn’t been appropriated and it has been through Cabinet, but it gets put in a contingency fund that’s been approved by Cabinet, and when the details are worked up more into a business case then the funding is released. That’s the real question here, because, as we know, we’ve got a huge pipeline coming down at us through the demand of mental health services. We know that mental health demand in New Zealand has increased from 2.3 percent to 3.6 percent of the population, an increase from about 98,000 to 168,000. So, actually, there’s an agreement that there needs to be a change. If you go out and talk to the mental health sector, what’s the biggest thing they tell you?

CHAIRPERSON (Hon Anne Tolley): Not me.

It’s that there’s no point—sorry, not you, Madam Chair. The biggest thing they tell us, as politicians, is that there’s no point in continuing to pour money into the district health boards (DHBs). In fact, there have been reports out in the last few weeks where DHBs allegedly weren’t even spending their ring-fenced funding of mental health per year. What I’m saying is it’s the actual NGO sector—it’s the community sector—that’s saying they’re primed and ready to go. They can deliver high-quality services at the same cost and higher productivity. That’s why those 17 mental health initiatives were developed with the Chief Science Advisor and the mental health sector themselves, to break out of the box and think about how can we do things differently.

So the Minister can argue that, yes, it was never appropriated, but he needs to say why he has not gone with the consensus of change, to release the community sector so they can go out and deliver services at the mild to moderate end. Rather, he’s tipping more and more money into the DHB system, and, yes, to a point, they have a role to play, but, actually, the mental health sector is agreeing that actually more needs to go into the community sector. That’s what I think needs to be asked here.

The Minister did raise a couple of things as well, and one was the GP visits and how great it was that there’s more access. He forgets to say, actually, that he announced in November as the health Minister that there would be free GP visits for mental health issues, and, unfortunately, that wasn’t honoured in Budget 2018. When you look at Budget 2018, in fact, it really was a disappointment for mental health. When you look collectively across the three parties—

CHAIRPERSON (Hon Anne Tolley): I am looking.

Thank you, Madam Chair. Thank you for your attention. When you look at the policy announcements of the—

CHAIRPERSON (Hon Anne Tolley): I’m not looking at those.

—three parties in coalition—

CHAIRPERSON (Hon Anne Tolley): I’m not looking at those.

—it adds up to about 20, and what do they deliver in Budget 2018? About five, and that is the real disappointment.

As we’ve heard recently, we’ve had vital pilots. One was ready to go around putting mental health professionals with our emergency responders. There’s another pilot that’s been cut that was looking at suicide and our response to identification, support, and follow-up. There was another trial that was to go out as part of the 17 mental health initiatives, around people who had been in crisis. It was a step-up, step-down trial when they get discharged from acute into community and back up again—three out of 17 initiatives that would have made a real change now. Yes, there is an inquiry, but, in fact, we could have done both, and it would have returned a great thing for the mental health sector.

E Te Māngai, tēnā koe. Tēnā koutou e Te Whare. I rise to speak today to the health Estimates debate, and I’d like to particularly address the two issues of mental health and also drug and alcohol abuse and addiction.

I’d like to note straight off the bat that this is evidently an emotive topic, as I think it’s something which touches the lives of far too many New Zealanders. I also just wanted to address, in particular, the points made by the speaker previous to me, Matt Doocey. I don’t intend for this to be a tit-for-tat sparring session, because I think that the issue of mental health and drug abuse and addiction are things which are much bigger than politics. But when we’re talking about cost and productivity in the context of this space, I get really dubious. The reason for that is that we’re not talking about economic units here; we’re talking about people’s lives and the quality of people’s lives.

Yes, absolutely, I don’t think anybody on any side of this House would argue that we shouldn’t be talking about the efficacy of treatment, but I think that we should be careful about the language that we’re using because I think that a lot of the context that has led to this spike in mental health incidents—particularly amongst young people—is absolutely a culture of competitiveness where we are all out fighting against each other as opposed to coming together as communities. We’re incredibly individualised, so I think that that’s something which we can work to fix from the get-go and doesn’t necessarily require a change in legislation or structural funding or otherwise to begin with, but so too it would provide a space and environment for people to feel more welcome to speak about their issues and their troubles.

So to turn now to the Estimates as were heard by the Health Committee and the questions that were put forward. On the point of mental health, I actually wanted to refer to the confidence and supply agreement between the Greens and Labour. I quote from No. 16 in that agreement which reads: “Ensure [everybody] has access to timely and high quality mental health services, including free counselling for those under 25 years [old].” Allocated under this Budget for the next three years is an integrated therapy pilot for 18- to 24-year-olds. I think that this is an incredibly exciting starting point, and I will note that this is just that—it is only a starting point. It is focused explicitly on those who are currently falling through the cracks and missing out, which I think is incredibly important, because I personally know far too many people who haven’t been able to access the mental health services that they need when they need them.

It’s focused on ensuring that we end up with the recommendations as to how to make mental health services in this country more affordable and more accessible. I note it’s an interesting choice of words, but it’s referred to in the outcomes and objectives of the pilot as being more acceptable and attractive to young people. I think that’s important, because it’s about not just the services being there but people actually engaging with them—those services being fit for purpose.

I so too note that there is funding in this Budget for the Mana Ake services for rangatahi in Christchurch, who have, obviously, been affected by the trauma associated with the earthquakes, and so too $17 million for the school-based health services expansion. I also—with the final bit of time that I’ve got left—refer to the issues around alcohol and drug addiction services, which are, obviously, also referenced in our confidence and supply agreement at No. 19: “Increase funding for alcohol and drug addiction services and ensure drug use is treated as a health issue,”. Critical to that point is the $16 million which is being allocated to Auckland City Mission for the use of their beds for those with drug abuse and alcohol addiction, and abuse issues as well.

I think, as I kind of alluded to at the beginning of this speech, the point around cross-party collaboration is incredibly, incredibly critical. Mental health issues do not happen in a vacuum. They are informed by culture. They’re informed by the behaviour of the leaders in our society. I think that we in this House have every opportunity to stand up and to grasp that leadership and to show some political will to solve these problems, because it is as much important that we instigate a cultural shift as a structural one.

I want to address some of the points raised by members during this debate and make a few comments along the way about the overall health budget. This is the biggest investment a Government has made in nearly a decade into healthcare. Overall, it’s a $3.2 billion investment—represented in the documents in the Budget that we’re examining—including $750 million in capital investment, which is the most significant, certainly, in a decade. This is a big Budget for health, and it needed to be. We have significant underfunding in the health sector, and, as my colleague Anahila Kanongata’a-Suisuiki noted, when an emergency department is visited these days, they’re pretty busy places—they are very stretched.

I want to, particularly, address the issue of health targets which has been raised, and the honourable member who raised this talked about the progress made against those targets. It’s true that some of those targets have driven good progress, and I certainly have never denied that. The quicker emergency visits target is celebrated widely. The fact that faster cancer care should happen is true, although I note that the target focuses on only 25 percent of cancers. The immunisation target was largely achieved a long time ago. But some of the other targets, clearly, are not ideal. An obesity target that simply stamps referrals—so that if I referred to a practitioner and they referred back to me, that’s two stamps on the book—doesn’t actually reduce obesity. Nor too does a target on activity around tobacco control.

So this Government is concerned to put a suite of measures in place that actually looks at how we improve the overall population health—measures that are broader and that can track the progress of district health boards (DHBs), rather than focusing on specific targets that can distort behaviour in the sector, and can mean that investment isn’t necessarily going where it produces the best value for the taxpayer dollar. Of course, the pin-up for that is in the area of electives, where we know that figures have been pumped up by Avastin injections and skin lesion removals that, in many cases, were previously done in primary care. So we want the best value for taxpayer money from the available health dollar. That’s what this Government stands for, and we’re less interested in a particular, narrow set of political targets.

In response to the issue raised by Mr Reti around the Deloitte review, I’m advised that it does catalogue the failures under the previous Government’s watch. I’m surprised he wants to keep bringing it up when that’s what it’s actually a review about, but there we are. They spent $119 million and have nothing to show with it—$119 million and nothing to show with it—and that is, indeed, recorded in the Estimates document. Why he keeps bringing that up is a mystery to many, many people.

Then Maggie Barry raised the issue of the health of older people, and I want to congratulate the Hon Tracey Martin for the work that she’s doing in that area. Health, of course, has invested in this Budget in preparation work for a SuperGold card check for all people, and also, the cheaper doctors visits initiative, that will see community services card holders able to access cheaper doctors visits, will affect hundreds of thousands of seniors in this country and will mean that they get doctors visits, in many cases, $20 to $30 cheaper. This is a good Budget for older folk.

On top of that, of course, is the biggest investment into DHB funding in nearly a decade. This Budget is really significant in that respect: $549 million per annum is going to DHB budgets, as compared to the previous Government’s record, which includes, over the last period, $439 million, $400 million, $300 million, $275 million, and $250 million—low numbers—going into the DHBs. I guess that’s why they’ve been put under such strain. I do want to congratulate the health workers that continue to work in our health sector, despite the underfunding over many years that they’ve struggled with.

Mr Doocey’s point—quickly—about the initiative and his mistake. I acknowledge that, but we’ve put another $200 million into DHBs, we estimate, over the forecast period for mental health within the ring-fence. On top of that, there is $49 million in new initiatives, and we would expect more to come out of the mental health and addiction inquiry that’s under way. This is a Government determined to deliver joined-up services, and when he talks about pilot initiatives that never happened in the nine years they were in Government and says that somehow this is this Government’s failure, I want him to have a look in the mirror.

Thank you for this opportunity. This is the best Budget for health in a decade.