Annual Review Debate — Health Sector

Tēnā koe, Mr Chair. Thank you very much for the opportunity to contribute to the annual review debate of the health sector. As the chair of the Health Committee, it has been my pleasure to have overseen the review of 13 of our 27 entities, and they have comprised 10 of the 20 district health boards (DHBs) and three of the seven Crown entities.

I think it’s relevant that I outline who we did engage with so that the public are aware of the level of scrutiny that we undertook. The agencies were the Ministry of Health, Pharmac, and the Health Research Council. The DHBs that we engaged with were Southern DHB, Auckland, Bay of Plenty, Waikato, Canterbury, Taranaki, Counties Manukau, Wairarapa, Lakes, Tairāwhiti, and Northland. I particularly want to thank and pay tribute to the leaders of those particular organisations for the spirit in which they engaged with the committee. It was a very robust process. But I also want to acknowledge that through this process, we do ask for a lot of information, and so I want to acknowledge all the staff that were involved in preparing reports to our committee, and the diligence with which we as a committee chose to review the answers or responses to those questions.

I particularly want to focus on two DHBs, and the first DHB is Canterbury DHB. The reason I choose Canterbury DHB, actually, in part is because of their response after 15 March. Can I say, on behalf of all of us, how very proud we were of their response to that terrorist attack and the tragedy that unfolded. Their response was such, I think, that we owe them a great debt of gratitude. In saying that, I acknowledge the 51 people that lost their lives but the many others whose lives were saved.

Canterbury DHB particularly focused on their relationship with the Ministry of Health. For them, it had become a collaborative and positive relationship to address historical issues, and they felt they were on a good pathway forward. I want to acknowledge that one of the areas where they had increased health outcomes was in the Māori health area. The average life expectancy difference is 6.3 years, but for Canterbury DHB it’s actually 2.4, and so they told us quite explicitly that they’d actively engaged in closing the gaps—they even used that language. I also want to highlight, from their perspective, that infant immunisations had increased, and they also had a lower rate of avoidable hospitalisation admissions for children aged zero to four.

The other area that they highlighted specifically was the Mana Ake - Stronger for Tomorrow programme. This is for five- to 12-year-olds, to address the trauma and anxiety faced by young people who have lived through the trauma of repeated earthquakes. So I particularly want to acknowledge the relationship between the DHB and the Ministry of Health, the Ministry of Education, the police, NGO consumer groups, and the focus that they all had collectively on wellbeing and resilience. I think it’s important that we highlight that those initiatives are actually working.

I now want to focus on Bay of Plenty District Health Board, and I start from a quote by Sally Webb, who is chair. She said that the “response to the negative effects of the anti-vaxx campaign needs to be addressed on a national level.” I highlight that because, actually, the World Health Organization has said that we have a global threat in terms of vaccine hesitancy. So these are parents who are actively choosing not to immunise their children, and in the Bay of Plenty DHB that number had increased to over 10 percent. They actually think they’re doing really well in making sure that all children whose parents want them vaccinated are being vaccinated. As a select committee, we will hear from Nikki Turner, who heads the Immunisation Advisory Centre—

CHAIRPERSON (Adrian Rurawhe): Sorry to interrupt the member, but it’s come time for me to leave the chair for the dinner break.

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

Thank you, Madam Chair. It’s my pleasure to speak in this debate. It’s not a pleasure to talk about the issues that we have to discuss, but I want to start by acknowledging the chair of the Health Committee, Louisa Wall, and her very warm comments in support of the tremendous response by the Canterbury District Health Board (DHB) staff in relation to the terror attacks. That’s about where we end our agreement.

We saw, actually, the Canterbury District Health Board in February, and I think they’re a metaphor for the other 20 DHBs and the sea of red ink that our financial review process not revealed—it wasn’t easy to find where DHBs were at financially, and it still isn’t. I want to go into that in a little more detail. But I wasn’t actually at the committee when Canterbury came in; I was at the funeral for a friend in Dunedin and watched on Facebook—which is a great asset, I have to say; well done to the clerks—and I nearly fell off my chair when I heard David Meates say that they were then projecting the princely sum of $98 million of a deficit from one DHB—just one DHB—and I know it’s got worse. The Minister hasn’t released the information, but the combined Canterbury and West Coast deficits are likely to be in the region of $120 million, which is a quite interesting sum, because that exceeds the total financial deficits of all of the DHBs just two short years ago. Two short years ago, the combined deficits were $119 million, and the previous National Government budgeted for the same deficits in 2017-18. That deficit trajectory was well on target until November 2017. About a month into this administration and this Minister and away they went, away from budget, and they doubled—$240 million in the period of our financial review.

As members know, the financial review is a look backward and a look forward, and the look forward is a tremendously, tremendously sad one, because by the latest data, and this hasn’t been updated for a couple of months, we are now on track—this is the official number—for $344 million. Actually, I’m convinced that it’s going to be higher than that, and, indeed, sources that I have have informed me that that my estimate of $500 million of combined deficits is conservative. So as we review financial performance, it is impossible to overlook the fact that under this Government, these DHBs are sinking in a sea of red.

Now, most of us would be able to tolerate that, accept that with as much good grace as we can muster—particularly, it would have to take quite a bit of grace for this chartered accountant to say that was a good thing in the long run—if, indeed, more health outputs were accruing as a consequence of that deficit, but, actually, the opposite is happening.

💬 Hon Nathan Guy: Well, what’s happened to the health targets?

Well, who would know? Now, that’s a very good question, Mr Guy, because I’m not sure now whether the Minister knows whether his Government has targets or not. The Ministry of Health web page says that the target for elective surgery is 4,000 more than the previous year, and that would suggest that they would have to do, based on the data the ministry has, about 153,000 procedures this year. They are, by my calculations, about 8,000 behind that target and 6,500 behind the year-to-date figure just to stand still. Yet in another part of the Ministry of Health website, the targets have been removed.

Actually, I thought the Minister was being a little bit tricky with information, because we haven’t had the financials updated since January. We should be at least at March and knowing whether my prediction of half a billion dollars of fiscal deficits is correct. Now, I don’t think he’s being evasive with the information; I just don’t think he has any sense of what’s going on in his portfolio or in his ministry. It’s going to elective surgery, it’s going to cancer treatment waiting times, it’s going to immunisation rates, it’s going to things like the response to meningococcal, and everywhere we saw, of the 10 DHBs—which were very representative of all 20 of them, I have to say—uncertainty about what to do in the face of this sea of red ink, because they’re certainly not getting any support from the Minister, who dragged the chairs and the chief executives into Wellington and said, “Fix it.” He didn’t say how, didn’t say why, and didn’t say what the industrial relations landscape was going to be. All he can do is bark instructions, and this is the result. We have a sector and a ministry sinking.

Madam Chair, thank you for the call. It gives me great pleasure to rise and speak to the review and the achievements of this Government to date in terms of making sure that we are addressing the underfunding that we inherited in the health sector. We are boosting critical public services, and as a Government we’re determined to tackle the long-term problems and challenges we’ve inherited. We know that when we took Government we had kids living in cars, we had hospitals with rot and mould in the walls, and we had rivers so dirty they couldn’t be swum in. We are determined to tackle these things. We’re determined to take mental health seriously. The previous Government did nothing. They talked about the need to put some money in; they never actually appropriated money specifically for mental health.

In this Budget that we’re discussing now, we picked off three big things that needed to be dealt with. The first was addressing the ageing infrastructure. Now, we know that some of the hospitals had rot and mould in the walls—that’s been well publicised. Of course, many have seismic issues. In this Budget, we put the biggest injection into capital spending in the health sector in over a decade. We put in $750 million. For many years, the previous Government didn’t put any in. They just expected district health boards (DHBs), off their balance sheets, to try to deal with the infrastructure that they had, and it’s been getting worse year after year after year. But we believe in a public health system where every Kiwi can access healthcare, not just those who have deep wallets. So we’ve been determined to get on with the mess we’ve inherited in that regard. It’ll take many years, and we are determined to make the investment that’s needed to have a strong public health system. Budget 2018 kicked that process off.

We also, in the Budget, put money aside to make sure that people could afford to go to their GP. We know that when we came into Government, over half a million Kiwis were saying they couldn’t afford to go to the GP in any given year—over half a million Kiwis couldn’t afford to go to the GP. Now, that’s just not right. So we as a Government said we’re going to do something to tackle this, and we have put in place a scheme whereby people can go to visit the doctor for under 20 bucks—any doctor around the country that’s registered in a regular practice—if they’ve got a community services card. Now, that means it’ll be, on average, $20 to $30 cheaper for those people to go to visit the doctor. But the important thing is—

💬 Angie Warren-Clark: Say that again.

—$20 to $30 dollars cheaper—that they will actually go to the doctor, because we know that before they were choosing not to. They were getting sick and they were ending up in our hospitals, but 540,000 New Zealanders who didn’t have that access before now have access to cheaper doctors visits—under $20—thanks to Budget 2018, which we’re discussing now.

It’s also true that we extended free children’s visits to under-14s. We made it able to be free for more kids to get to the doctor. We’ve extended access and accessibility for around 600,000 Kiwis. Also in Budget 2018, we got real about a growing and ageing population. We put more money into DHBs than had been put in in a decade—$2.3 billion over the forecast period. This had been underfunded for so long. In Opposition, we had a piece of work done by an independent economics agency that told us they had been underfunded to the tune of $2.3 billion—$2.3 billion—under the last Government. That was money required just to stand still with services. That was an estimate of what it would’ve cost just to stand still under the last Government.

Of course, some of the money we’re putting in now is money to address the fact that healthcare costs a little bit more every year as we get more expensive treatments, as we have more people going through. But some of it is to address that backlog of underspending on our health system from a Government that really didn’t care about a public health system and was more focused on looking after the wealthy and making sure the private system flourished.

So this Government is concerned about addressing those long-term problems that have accumulated over many years, and, as I said, we’re taking mental health seriously. In our first hundred days, we launched the mental health and addiction inquiry, and we’ll be reporting back on that before the Budget. But in the meantime, we put $200 million in this Budget into ring-fenced funding for DHBs to support existing services. We introduced the community services card initiative I’ve just discussed, which means that people can access, through their GP, mental health services at an affordable rate and get into services. We’ve introduced nurses in schools to decile 4 schools—a proven policy. We have brought forward Piki, which gives integrated therapies across the Wellington region to 18- to 24-year-olds. That’s a pilot; we’ll see more of that. We’ve put money into addiction beds in Auckland, and also invested in Hillmorton mental health facilities. There’s plenty more to come, but we take mental health seriously. That’s another problem that we’re determined to tackle.

Thank you, Madam Chair. It’s an absolute pleasure to speak on this year’s annual review debate on health, and, as Louisa Wall mentioned, we reviewed, as a select committee, a range of different entities. So we looked at the Ministry of Health, the Health Research Council, Pharmac, and around half of our district health boards (DHBs). The theme I’d like to touch on today is a similar theme to what Mr Michael Woodhouse spoke about in terms of that sea of red, because what I want to do is actually unpack a bit about what is the health system that we’ve inherited. I think, for me, it’s thinking about those twin legacies of systematic, chronic under-investment in our health system over a period of nine years and, basically, taking a very hands-off approach to that strategic management, that planning of things like workforce, and also our infrastructure.

But before I want to go into that in more detail, I just want to touch on, again, what Michael Woodhouse mentioned about targets, because the previous Government very diligently monitored emergency department waiting times. But what they didn’t do is actually count the number of people coming into emergency departments with preventable conditions—things like housing-related preventable conditions, infectious respiratory diseases, and those that could be prevented by early access to primary care—or look at people’s access to primary care and housing, which are two big things that our Government is focusing on.

But coming back to the review of the DHBs, what was very, very stark was that pretty much all of the DHBs that we reviewed were in deficit, and while each of them talked about different reasons for that deficit, there were a number of common themes, and one of them was just systematic under-investment over the past few years. One DHB said that they’d had their budget capped for three years up to 2017-2018, and while they were happy that that cap had now been removed, they said, “We had to think about the challenge of coping with the $30 million that we didn’t receive in those previous years.” So for many of our DHBs there’s no fat in the system, so that if they get an increase in acute demand, there’s none of those buffers you could accumulate from previous years to be able to cope with that.

Others were talking about those increases in acute demand—things like people coming in for ambulatory sensitive conditions, those hospital admissions that could be prevented if you went to the GP early. So they were talking about those, increases in demand for acute surgery, and also mental health. These are things that our Government has been investing in. Last year we put in that huge extra investment so that community service card holders could get low-cost access to their GP when they needed it, and we also made sure that children up to and including age 13 went to the doctor for free.

While it’s too early to really check that in the hospital admission trends to see a reduction at the moment, because those investments are just bedding in, I think in future years we are going to see the impact, because people now don’t have to think twice before they go to the doctor if they’re on a low income and worrying about the cost. The other thing that we’ve signalled is that mental health is going to be a very big priority in this year’s Wellbeing Budget, because that’s something, as a country, we really have to address.

One of the other things, though, that some of the DHBs were talking about struggling with was the workforce, because we’ve really taken our eye off the ball in terms of that strategic planning, in terms of how many specialists, how many medical staff, how many allied health professionals, and how many nurse practitioners we need. Many DHBs were saying that they were struggling. One DHB was saying they were having to share their specialists with the neighbouring DHB, because they couldn’t recruit enough. Another was talking about the challenges of getting GPs into smaller towns. One DHB was citing some of the reasons for this deficit. It was because they were having to pay so much for locums, and outsource some services, because they just couldn’t attract regular staff—so, really, the whole legacy of that lack of strategic planning.

But another one, the third thing that really stood out, was the impact of the lack of investment in our infrastructure in our hospital buildings. I think the Ministry of Health in their report put it very politely—just reading their quote—that they had quite a “challenging and constrained operating environment”, and what that had resulted in was deferred maintenance, some buildings being too old, and seismic assessments on buildings since the Canterbury earthquakes leading to some that needed to be strengthened.

I think the actual media was much more honest in their reporting when they talked about some of the mould and the problems in the walls of Middlemore Hospital, and taking your eye off the ball in terms of investment in our assets. So I’m proud to be part of a Government that’s going to be investing back. In last year’s Budget, we put $750 million back into our infrastructure, and we’re really investing in primary care, cheaper doctors visits, our health infrastructure, and mental health. Thank you.

Tēnā koe and thank you, Madam Chair. It’s my pleasure to stand and take a call on this appropriation review debate in health. I am very pleased to be a member of the Health Committee, and I acknowledge the chair who spoke before the dinner hour and outlined all the organisations that came before the committee and engaged with the committee. I note that she mentioned the Canterbury District Health Board and the debt of gratitude to all of those who were involved on 15 March, and the work they did at the front line, taking care of all of those injured people. It was a tragedy that has reverberated across the country and around the world, and I particularly note a debt of gratitude to all those from the district health board (DHB).

I’d like to take my focus now to look at a DHB from my hometown that I grew up in—the Lakes District Health Board. Recently, last year in fact, they opened a new centre. It’s called Te Aka Mauri. Rotorua Lakes Council’s Te Kaitiaki Ahurei Māori—that’s Monty Morrison from the well-known Morrison family—was at the opening of the centre called Te Aka Mauri; te aka, meaning a vine or interconnection, and Mauri, meaning life force. Now, the name reflects a shared vision to create a facility of excellence to advance community wellbeing and understanding. So I really want to focus on the amazing work that they are doing, because I think it’s really important to look at these models and how the community is shaping a new way of looking at health services in their particular community. So I acknowledge Lakes DHB for a couple of really great initiatives that they have undertaken.

So the Rotorua Lakes Council, alongside the Lakes DHB, opened up Te Aka Mauri and, basically, they’ve created this hub where children can go. It has maternity services, paediatric outpatient clinics, a child development team, and vision and hearing screening, and it’s actually centred in a refurbished library. Now, anyone who goes to a library, particularly if you take children to a library, knows what a fun environment that is, unless, of course, you’ve got overdue books. So inside the library it’s this great environment, and they’re getting much more engagement with people coming in with their children and engaging in that health process. They’re also open in the evenings when the library’s open, and this health hub can be also opened in the weekend. So it’s been a great success, because the attendance now is so much higher than it was when it was just a medical clinic. So this is a great relationship that they have developed between the council and the DHB, and it’s very, very positive for their community.

They’re also running another programme called Tū Taua programme, and this is around methamphetamine. We know that synthetics, P, and meth are a scourge on our society, and so they’re looking at ways of dealing with methamphetamine in the Lakes District, and it’s a programme that is by Māori, for Māori, and it’s providing support. It’s also providing counselling, and helping to facilitate whānau support, and they’re having great success. But they are finding that it is a struggle. It’s difficult to get figures. Not every user actually ends up in hospital, so it’s quite difficult to actually have consistent data on P, on synthetics, but certainly this Tū Taua programme is becoming quite a successful programme.

The final thing I’d like to mention, which was a theme which came across in many of the DHBs that came to the select committee, is around immunisation. It was too for Lakes District. In their DHB there’s been, overall, a decline in parents choosing to immunise their children, and many DHBs actually said that there are actively declining numbers for this area. They suggested there could perhaps be a lot of difficulty in getting children of high mobility immunised—where they don’t seem to have permanent homes. So this is something in the area that all these DHBs are actively involved in improving.

I’d just like to finish off and make note of a great injection—$750 million has been injected into the health sector. This will be addressing this backlog of underfunding, and I’m very proud to be a part of a Government which is ensuring we have good health and wellbeing in our community.

Thank you very much, Madam Chair. I too would like to pay my respects to the Canterbury District Health Board. On March 15, I happened to be at the hospital, and I have to say it acted like a well-oiled machine. Obviously, it was a huge challenge, but they rose to that challenge, and I think we need to be very proud of them.

The health budget for 2017-18 involved $13 billion of funding for DHBs and another $3 billion for health services from DHBs and organisations that don’t directly report to Parliament. But I’m concerned that during our annual reviews, we heard that some of the essential services that our families are desperate for, despite all that money, are deteriorating rapidly. The key here is that because the health targets have been dropped—they’re gone—there’s no ongoing accountability and healthcare outcomes are sliding backwards.

So I’m particularly interested in two areas. One is the immunisation rate—and we’ve heard people talk about that this evening—and also better help for smokers to quit. Now, both of these were health targets under National. Both areas had been increasing in effectiveness and had improved health outcomes, which have now either stagnated or slipped dramatically over the past year or so. Without the health targets, the only way that we can monitor these failings is through increased numbers of people with disease or through deaths, and we’ve seen that.

So let’s start with immunisation. Back in 2008, 76 percent of two-year-olds were immunised, but because of the health targets, by 2017, 92 percent of them were immunised. There was a very high percentage for both Māori and Pasifika. Now, that was a huge step forward, because immunisation is one of the easiest and most effective ways to protect our children. When I was the Minister for Disability Issues, I used to meet with groups and individuals who lived with disabilities. I remember very well going to a meeting in Christchurch in 2017 for those who still suffer the effects of polio. It was a support group that consisted only of older New Zealanders—only of older New Zealanders—because now our children are immune to this crippling illness. But they’re only immune if we continue to immunise. We do not want another generation joining these older citizens with the effects of polio. This is only possible if we immunise and people immunise all children across the board.

But during the recent reviews of our district health boards, they consistently told us that their immunisation rates were dropping and that there were alarming trends of people actually being against vaccination. The result: recently we’ve had recorded deaths from meningococcal disease in Northland, and there’s been a large number of measles cases right across the country—and that’s totally unacceptable. People actually die of measles. We’ve forgotten that. So as we head into 2019-20, I hope that the Government will act to help address these alarming impacts that the anti-vaccination movements are having on public health. We must have more funding to support immunisation and to manage the outbreak of these diseases so that that can be prevented by immunisation. If anyone has any doubts about that, they just need to talk to the older generations who are still suffering from the effects of polio.

Another loss for health targets has been better help for smokers, and that’s been a retrograde step. Thousands of smokers die of smoke-related diseases every year. Research tells us that although most of them would like to quit, they can’t. I’d just like to put in a plug for vaping. It’s been a game changer internationally, and this Government really needs to recognise the value that vaping has for people who want to quit. They must encourage people to vape rather than smoke. The previous Government sought to pass legislation to clarify the position on vaping and to promote it as an alternative to smoking. It is 95 percent less harmful, and it’s a far better option.

Thank you, Madam Chair. It’s a pleasure to rise and give a good speech, I hope, on the Health Committee review. We’re a hardworking select committee and, generally speaking, we get on very well—we’re pretty collegial and we work well across the floor, I believe.

What we do know, though, is that this Government inherited a chronically underfunded health system. Everyone here on the Government benches has talked absolutely about a health system that was groaning—groaning under the weight of people accessing but not having the services that they needed, not having the funding, and the infrastructure failures etc. Most of us have had friends or family on waiting lists. Many of us know people who were desperate to access mental health or addiction services and just weren’t able to get them. I myself operated a women’s refuge and often we would call the police rather than the crisis assessment team (CAT) because the mental health services were so overloaded in my community.

But there is some good news—there is some good news. Our Government came in. We put $50 million immediately towards mental health and instigated, as our Minister has indicated, a mental health inquiry, with findings coming out shortly. It is important work. We cannot hurry this. We have put in early-intervention counselling for 18- to 25-year-olds experiencing mild to moderate mental distress. Prevention is better than waiting for a crisis. I applaud our Government for doing that. Piki was launched in Porirua. It’s now available in the Capital and Coast District Health Board and tertiary institutions throughout Wellington, the Hutt, and Wairarapa. We heard about Mana Ake: supporting five- to 12-year-olds in Canterbury and Kaikōura. Again, this is about prevention, and health is also about prevention.

The Hon Nicky Wagner spoke to us about smoking, and spoke to us about the fact that we’re no longer counting smoking. So let me tell you what that looked like previously. When a person attends a hospital or a health facility, they are asked if they smoke. If they say yes, the person says to them, “Would you like to speak to someone about that?” That is the intervention that occurs, and that is the intervention that is counted. So I for one am not at all upset about the fact that when we count the meaningful aspects—the giving up of smoking etc.—those targets are not really important or necessary.

I think it’s really important to say that with the $750 million set aside for capital works, we are going to have fit for purpose health facilities again in this country. There was mould—really; mould?—and operating theatres where the rain was coming in, and specialists were sitting and being paid but were unable to operate. This is what we inherited. I’m so proud of our Minister for the work that he’s done in this space.

Finally, I would also like to just mention our family violence intervention work that occurs in the health sector. So with the 10 district health boards (DHBs) that we spoke to, I had the opportunity to ask questions about the family violence interventions that occur, and a training package that works across the social services agencies in the community to help train to identify and vet for family violence. Everyone, without a doubt, spoke absolutely of the importance of that work and the continuation. So I’m absolutely proud, with our $320 million that we’ve just invested into family violence and sexual violence, that health is a big player in that.

Finally, I would also, in the last five minutes—five seconds—just like to say I think it is so very important that we are looking and have invested $12 million in rheumatic fever for our Māori and Pacific families. My daughter got rheumatic fever as a child, as a Māori child, and this will be a game-changer. Thank you, Minister.

Thank you, Madam Chair. It’s a pleasure to rise and speak to this theme and to work with other members of the Health Committee through the annual review process and Budget 2017-18 with our responsibility to hold the Government and Minister to account for public funding.

We saw half of the district health boards (DHBs) in person. The remainder we received in writing. At this point I just want to congratulate Bay of Plenty DHB, who did an excellent job in returning the annual review questions indexing and cross-indexing their questions. That’s spectacular. Auckland, thanks for turning up. But, otherwise, it was an excellent job. I want to congratulate them for that. It made it really easy to find the holes in this Government’s policies. So I want to thank them very much for that.

We had the Northland DHB appear in front of us. Their CEO, Dr Nick Chamberlain, talked to—when prompted—amongst other things, the meningitis outbreak in Northland. More will be said of that in the coming days. But I want to commend the Northland DHB for what they’ve done with the meningitis outbreak in Northland. They followed the instructions from the ministry and the Minister as best they possibly could. Well done; congratulations. I’m firmly of the view that the ministry and the Minister could have done more. I do not understand why, when the outbreak was triggered with an attack rate of 12.3 per 100,000—one of the key World Health Organization (WHO) criteria for an outbreak—for under-10-year-olds, we in fact stopped vaccinating at age four. We raised these questions with Nick Chamberlain and he couldn’t explain it either, other than as the Minister has said, “It’s what the expert groups told us.” That’s not even close to a good enough explanation, and, again, we’ll hear more from that over the coming days.

I just wanted to comment very briefly on rheumatic fever. My colleague over here who raised it, yes, also I want to congratulate. I think that is very much a good programme to be investing money into. It is not clear to me why Whangaroa Harbour and some of the other parts of Northland are excluded from that. It wasn’t many years ago when Whangaroa had the second-worst incidence of rheumatic fever outside of Soweto. We put a lot of money into that and had some improvements with the acute sore throat, rheumatic fever clinics. So it’s not clear to me why this new money is all going to South Auckland when we haven’t done so well up north either. But that’s a different story.

I think of all the questions we posed to the DHBs the one I want to focus on here very briefly is the National Oracle Solution, much of which changed over the 2017-18 period. I asked every DHB, both in writing and in person, about their progress with the National Oracle Solution. That multi-platform customer relationship management IT piece of software is also to do important things for logistics and procurement. It’s customer relationship management logistics and procurement, multi-million dollar benefits of scale, of course, in procurement and logistics. If you recall what happened there was it was struggling, so the Minister organised an independent review with Deloitte, who were actually key people, key stakeholders, in the National Oracle Solution. We raised questions and said there needed to be an inquiry. There was a huge conflict of interest, and eventually the Minister sent it to Audit New Zealand. Audit New Zealand came back saying, “Absolutely huge conflicts of interest, poorly managed, do better.”

We raised questions around National Oracle Solution with every DHB. There were four DHBs who were in the wave one: Waikato, Canterbury, Bay of Plenty, and West Coast. In about July the Minister paused the other DHBs, apart from those four in wave one. He said, “The rest of you stop. I don’t understand this. Don’t figure out what’s happening. But you four have sort of moved far enough along. Keep going and see what happens.” When you do that, you create a balance-sheet impairment because suddenly your software is no longer suiting the purpose it originally was there to suit. And so the question I was interested in, and asked every DHB, was “How much impairment against the National Oracle Solution have you put to your balance sheet?” It varied; in Bay of Plenty, for example, a smaller DHB, it was still a large sum of money—$255,000 they were recording as impairment. They’re part of the wave one so they’re still operational. But Auckland, where it was paused completely for them, their impairment, their write-off, due to the Minister’s decision to pause was $2.774 million dollars just from one policy setting, just from saying “You’re now paused, you four can continue.” They’ve had to write off that sum of money. And, of course, what’s happened here now is everyone’s been told to pause; even the wave one have been told to slow down. So we’re going to be very interested as to what sort of contingent liability, what impairment, is going to need to be recorded in the upcoming balance sheets. Furthermore, as I understand it, the software licence is due and the hardware doesn’t support it any more.

I want to respond to a few the points raised in the debate. I will begin by just speaking to the issue Dr Reti’s raised around the National Oracle Solution. I find it particularly astonishing that a member from that side of the House would be raising this issue in the Chamber for us all to see. This is—I think it’s been called before—weaponised incompetence. This is a programme started by the National Government, where they spent over $100 million before we took office. And, clearly, it’s run into all kinds of problems to do with governance, to do with being implementable, and so on. This Government had a review. Dr Reti’s fussed a wee bit about the review, how it was done, and so on. He’s asking questions about how much impairment there’s going to be as a result of that poor investment by that side of the House. I think this is genuinely a case of weaponised incompetence. But I don’t want to spend too much more time on that now. I want to cover a number of the other issues that have been raised as we’ve gone through the debate.

Dr Reti also raised the issue of meningococcal W, and spoke about how the district health board (DHB) had said they were listening to expert advice. He spoke in very disparaging terms about the DHB listening to expert advice on how to run an immunisation program. I’m quite comfortable with experts making the calls on these things. I don’t actually think it’s the job of politicians to decide what the best healthcare is. We’re here to fund it and support it. But the actual technical decisions need to be taken by those who are experts in population health.

To speak to some of the other issues raised, quickly, we had the Hon Nicky Wagner, a former Associate Minister of Health, raising questions about health targets. She was saying, for example, that nothing’s being measured any more, then going on in her speech to speak to all of the measures that are in place—obviously, a contradiction in her own rhetoric. But she spoke about the immunisation rate. I think the important thing to note that the member did not raise at all is that that immunisation target of the previous Government was never achieved—not once. They never achieved that at a national level, the immunisation target. Immunisation is incredibly important. On our side of the House we’re determined to do something about those low immunisation rates. Certainly it is of deep concern that the anti-vaxxers have been getting some traction out there. But I actually think it’s also incumbent on all of us to explain to people the importance of science and the importance of confronting the danger that’s presented by diseases like meningococcal W and like the measles.

We’re here on this side of the House to invest in health, and to make sure that people across New Zealand can access health services. In my previous contribution I covered the community services card fee cuts for visits to primary care and general practice, meaning people will be able to afford to go to the doctor when they couldn’t afford to go before, because we believe in making sure that healthcare is accessible.

But we’re also investing in our workforces. They’re around 1,300 more nurses in New Zealand in our hospital system than when we took office. That is because we’ve chosen to invest. We’ve invested in safe staffing. We’ve had a nursing accord that commits to safe staffing. We’ve also done settlements with healthcare workers, who’ve been stretched and strained for too long and who were giving up. We’re finding that there were staffing shortages across the system because people just were not prepared to put up with it anymore.

This is a Government that is investing. A record amount was invested in the Budget we’re debating—more than had been put in for a decade. I’m very much looking forward to the Wellbeing Budget that’s coming up, when we will get to invest more again in our health system. We will invest again in the capital infrastructure that’s been neglected for so long, so that our hospitals are fit for purpose, so that they’re good places for staff to work, so that they are pleasant places for patients to visit, so that they can get the care, because we on this side of the House believe we need services for people, be it education, be it healthcare, be it roads. We are going to invest for the future of all New Zealanders and fix the problems that have accumulated over so many years of neglect by the previous Government. We are determined to tackle those harder issues—the consequences of that underfunding—to make sure we’ve got a healthcare system that delivers for all New Zealanders.

E Te Māngai, tēnā koe. Tēnā koutou e Te Whare. Madam Chair, it’s a pleasure to rise and take a call on behalf of the Green Party of Aotearoa New Zealand on the appropriations debate for health. My contribution will focus primarily on the issues of mental health and addiction and actually align relatively nicely with the Government’s mental health and addiction inquiry, which has been canvassed by a number of those who have contributed to this debate so far. I also, before I start getting into the meat of this issue, want to acknowledge the Minister, the Hon David Clark, for his brilliant work and for working alongside us in good faith on a number of issues, particularly the very vexed issue of drug law reform, which I’ll note is an incredibly emotive issue and has elicited emotive responses from many in this House as we have progressed with legislation.

One of the many things that we’re proud of as the Greens, as a supporting party of this Government, is delivering the Piki programme delivering free, culturally appropriate, fit-for-purpose mental health services for those between the ages of 18 and 24 in this country. We, working in confidence and supply with the Labour Party and, obviously, they in coalition with New Zealand First, have delivered—that’s you, Mark Patterson and Jenny Marcroft—this Piki programme now throughout Greater Wellington. I was fortunate enough to join the Minister and Associate Minister Julie Anne Genter at Victoria University of Wellington a few weeks ago. Actually, what was most exciting about being at Victoria University of Wellington to announce that rollout was the fact that we got to acknowledge the incredible mahi of students, whom I had hosted in my office only a year before as they planned their campaign to try and raise awareness of the issue of mental health and indeed to try and get resourcing to make sure that none of their friends and whānau had to go through many of the dark times that they themselves had found themselves in.

I also want to speak to the mental health and addiction inquiry, which the Government is expected to respond to relatively quickly in the next few weeks in the lead-up to the Budget. I’m incredibly proud to have been involved in the Government’s response to it. The mental health and addiction inquiry supports, of course, the huge, growing amounts of contemporary research into the issues of mental health and addiction. I have found frequently that politicians like to demarcate the issues of mental health and addiction, being that one has to do with the vexed, as I just said, issue of drug substance abuse. However, I think it is important for those who are listening to this debate tonight to recognise that, as was reflected in that report, there are the same environmental drivers for people who experience mental ill health as for those who begin to pick up and engage in addictive or dependent behaviour when it comes to substances. This report also reflected the experiences that I have heard from students across the country in my touring up and down and also, actually, from services such as Te Whare Mahana in Golden Bay and Te Kauwatawata in Gisborne, who are both providing incredible, incredible services for their local communities.

I also want just briefly to touch on the costs and benefits, actually, when it comes to drug law reform, because, as has been mentioned multiple times, throughout my five-minute contribution, this is a vexed and controversial issue, but in October of 2018 the New Zealand Drug Foundation commissioned an independent report from Sense Partners, an accountancy or economist projecting firm by any other name. They focused on three key areas of drug law reform and, essentially, found out that on the first, when it comes to decriminalisation of people who use substances, New Zealand would be better off to the tune of $34 million to $83 million per year; when it comes to regulating and legalising cannabis, that New Zealand would be better off by $10 million to $53 million a year; and when it comes to providing better mental health and addiction services, it would cost us a $159 million investment but, ultimately, in terms of the social returns, we would end up $244 million better off per annum. This is reflected in the Government’s work programme when it comes to mental health and addiction, primarily in our response to the synthetics crisis—the misuse of drugs amendment—and also, of course, by the referendum to legalise and regulate cannabis.