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

I do look forward to the member’s contribution, and I apologise for interrupting him. This bill is an important bill for ensuring that the people of Waikato can continue to expect high-quality health services delivered in their region. They have a high-quality health service in the Waikato, but their district health board (DHB) has faced a number of challenges over recent years, well-documented in the media: some challenges with seemingly fraudulent behaviour, with some dysfunction at the chief executive level. Also, I’m aware of conflicts that have had to be managed. Another example would be that they’ve never really been able to achieve, under the previous Government’s watch, their emergency target—getting people through and into the hospital in a timely fashion.

Now, I don’t want to detract at all from the care that’s provided there, because, again, I want to be really clear upfront that the clinicians that serve there, the nurses, the doctors, the allied health workers provide a very fine service to the people of the Waikato. What has been the problem that this bill tries to solve is that there has been a level of performance at the board level that I have been dissatisfied with. I have not been happy with the leadership there. I have received worrying reports from many quarters about the inability of that board to plan effectively for the future and to make difficult decisions that involve changing the nature of care provided to bring things into a modern way of doing things. All of this is necessary at a DHB. Those boards—and I thank board members across New Zealand for their public service—have the responsibility of making sure that the moneys they receive from Government, taxpayer money, is spent best in the interests of their local populations. That’s no easy task, because it’s a public role. There are difficult decisions to make, but you also need a highly functional board that is minded to the future in order to make those decisions effectively. My concern there lay with a situation where there were some clinical risks being brought to my attention, and also a financial situation which was deteriorating.

I do want to thank members across the Chamber for their support for this change, which, effectively, postpones elections at the DHB until the next round of local body and DHB elections—skipping over the one that will happen later this year. That was deemed necessary because seven months—at the time of making this decision—ran until the elections would take place, and that’s simply not enough time for a commissioner and a team of commissioners to come in, to assess the situation, and to turn a DHB around. I want to thank Dr Karen Poutasi, who has stepped up as the commissioner—a former Director-General of Health in Wellington, who has taken over the role of commissioner—and acknowledge her team, who will be working very hard on the clinical aspects, as well as the financial aspects of good performance.

I also want to acknowledge the incoming chief executive, Kevin Snee, who will take up the appointment as he moves across from Hawke’s Bay DHB, and acknowledge the challenge that sits ahead of him. I’m told that he is enthusiastic for the task and ready to go.

So I’m mindful of the time—this is an opening statement. I want to acknowledge the task of this bill, which is to make sure that we have a period where those commissioners can lead the DHB, can make the challenging decisions that are needed to put it on a sustainable footing into the future to continue to provide those high-quality services that the doctors, nurses, and allied health workers provide in the Waikato region.

I want to also acknowledge the local MPs for their support for this change. They have been adamant that they put the interests of their local populations ahead of politics on this matter, and I want to acknowledge that. I think this is a thing where the House can do a good thing across the different parties; I want to acknowledge that. I also want to acknowledge the local mayor and others who’ve been all very welcoming of change that supports the needs of their local populations. Thank you, Madam Chair.

Madam Chair, could I begin by thanking Minister Clark for his kind comments. Could I also join in with others in congratulating you, Madam Chair, on your accession to the role of Assistant Speaker. It is a role that I’m sure you will perform very well. As another former senior Government whip in the House, I have no doubt that you’ve left that particular office with a degree of enthusiasm but reflecting on an experience that was worth having—but probably one you’re happy to move on from.

I’d like to pick up on one of the final comments that the Minister has just made and to say that I was in Hastings yesterday and had the opportunity to meet Dr Kevin Snee. I was very pleased to be able to do that. As the Minister has just said, he is, of course, the current chief executive of the Hawke’s Bay District Health Board (DHB). I can assure the Minister that, yes, Dr Snee did indeed say that he is very much looking forward to the challenge, and a considerable challenge it is that he is undertaking. Naturally, I and, in fact, I would say, everyone in my Waikato region wishes him very well in that challenge. I look forward to welcoming him to Hamilton next month when he arrives to take up his position. I also join the Minister in thanking Dr Karen Poutasi, who is widely respected and extremely experienced, for the role that she is undertaking currently as the commissioner, while we’re without a board.

But I would just like to put a few questions to the Minister, if I may. It’ll be a short call, but given that it was his decision to replace the board with a commissioner, I know that my constituents are looking for a pretty clear indication of how we will get back to normal with a well-functioning board. I appreciate that he’s just made the comment that he was not satisfied overall with the performance of the board, but I’ve got some specific questions I’d like to ask, the first of which is: what exactly was the process that he undertook in reaching that decision? I do want to acknowledge that he paid me the compliment of ringing me shortly before he made his decision, and I appreciated that, but I’d like to know who else he consulted with so that we can all be clear about the process. In particular, what were the specific factors that led him to conclude that it was necessary to take the significant step of dismissing our board—and I do emphasise “our board”—and installing a commissioner, because I am left wondering whether other DHBs around New Zealand should consider themselves to be on notice that they too may face that fate, particularly if budgetary and service delivery shortcomings were the main factors behind his decision?

Apart from the well-publicised and inexcusable actions of the previous chief executive—and the Minister’s just alluded to that—that led to that person’s abrupt resignation, what were the problems our Waikato DHB faced that made their performance markedly different from other DHBs that are also currently struggling with growing deficits and declining outcomes such as lower elective surgery rates, longer waiting times for cancer patients, falling vaccination rates, and so on that we’re seeing under this current Government?

The final question I’d like to put to him is that while the National Party has cautiously supported this bill to this point—and we continue to do so in our shared desire with the Government to restore sound governance and performance to the Waikato District Health Board—I do remind the Minister that we did so on condition that local democracy will be restored as soon as possible, and in the expectation that Waikato citizens will again have the right to elect their DHB representatives at the 2022 local body elections.

So my final question to the Minister in the chair is: will he reassure the House, and my constituents today, that that remains his firm intention, and, in the unlikely event that his Government remains in office this time in three years, what benchmarks will he be putting in place to measure that the improvements that he’s seeking have been achieved, and that that restoration of local democracy can be guaranteed? So I’d just like to finish by echoing the compliments that’ve been paid to Derek Wright, who has done a magnificent job as the interim chief executive, and all his team for holding the fort through very difficult circumstances, and, again, I wish Dr Karen Poutasi and Dr Kevin Snee all the very best in the important work that they are undertaking for our region.

Madam Chair, thank you for the opportunity to take a call on the New Zealand Public Health and Disability (Waikato DHB) Elections Bill. Madam Chair, can I also congratulate you on your appointment—I know you’ll do an absolutely fantastic job.

The reasons for the commissioner being instated in the Waikato District Health Board (DHB) have been fairly well-canvassed, as the Minister in the chair said in the media. I’d just like to make a few comments on that—that the leadership shown by the Minister, in terms of appointing a commissioner, has certainly been very well received in the Waikato region. As a local MP, I’m constantly talking with people, and they highlight the fact that an aspect of stability has been brought to the DHB, and I’d like to ask the Minister: was that one of the key drivers—around the instability—and bringing a sense of stability to the situation?

I’d also like to highlight the fact that the staff at the hospital do an absolutely fantastic job, and this decision by the Minister, as I understand it, was certainly no reflection on the absolutely fantastic work they do. Actually, two of my tamariki were born at the Waikato Hospital, and so I’ve obviously got a very close connection with that institution.

Tim van de Molen: Likewise.

Likewise from another member opposite, there. Actually, recently my son had a fishbone stuck in his throat and we had to go to the A & E department and the service we received was absolutely fantastic. We no longer let our son debone the fish; we have a bit more oversight over that now.

Just a couple of questions for the Minister in the chair. The first one was: the decision was made to cancel one election, meaning that there will be an election taking place in 2022—I’d just like the Minister to elaborate on the reason for limiting it to one election. I assume he has an aspect of confidence that the challenges that had been experienced will be able to be fixed within a short period of time, and I’d just like him to elaborate on where that confidence lies—the key reasons for that. The previous CEO, Derek Wright, did an absolutely fantastic job in challenging situations. I personally met with him a number of times. The staff certainly found him very warm to deal with, and really appreciate the leadership that he showed, and it’s important that we do acknowledge the work that he did there. This appointment, as we’ve heard, was a reflection of some of the challenges the board had.

I’ve got another question for the Minister, which is around the board’s view of the commission. I believe that he canvassed the board leading up to this decision, and received some responses from board members around what they felt needed to happen. My understanding is that the board were fairly close to unanimous in terms of expressing to the Minister that a commissioner was required, and I’d be interested in the Minister’s discussions there and the process that led to the appointment of a commissioner.

The aspect of funding of our health system is one that is continually under discussion, whichever Government is in power, and it’s something that affects all of our lives—our DHBs. So I’d like to ask the Minister to elaborate a little bit on the funding aspect around this decision, and how much of that played a role in his decision making. As I understand it, the Waikato’s financial performance continued to deteriorate over a period of time; 2017-18, they reported a deficit of $37.2 million, and they’re forecasting a $56.1 million deficit for the 2018-19 period, with increasing deficits forecast in future years. Now, these figures are quite sobering. They certainly highlight some of the challenges that the DHB has had in terms of their finances, and I’d be certainly very interested in the Minister’s view around how much that financial aspect played a role in this decision that he has made.

I’d also be interested if he could highlight the fact of—under the previous regime, we certainly heard from a number of people who worked in the health industry around, in a way, at times, a lack of support. I was just wondering how the Minister would compare the previous regime and what he is currently doing as Minister of Health and how he sees the way forward to fix some of these deficits—the current deficit and the projected deficit. We’ve had large population growth in the Waikato region, which has put a lot of strain on our health system, put a lot of strain on our education system, and it is a challenging environment, and I’d be interested in how the Minister plans to address some of these financial challenges, and how having a commissioner in place will support that.

I think that probably highlights the key questions that I’ve had there. So the first one was around the period of the election—2022—the views of the board around the commissioner, the engagement he had with the board there, and the aspect of funding, and how he plans to address some of the challenges there. So I look forward to the answers from the Minister. Thank you.

I suspect there are going to be more questions to answer as we go through, and I’ll look forward to the contributions of other members, but I think it’s timely to address a few of the issues that have been raised to date. The Hon Tim Macindoe asks, really, questions around the consultation that took place leading up to the decision—

💬 Hon Tim Macindoe: And process.

—how the process ran, and I think it’s helpful just to explain some of that.

The concerns had been raised with me over a long period of time. The prior board chair Sally Webb performed incredibly professionally, in my view, in raising her concerns whilst continuing to try to ensure that the board functioned as well as it might to address the challenges that they were facing. You know, I think—without sounding too political here—they’ve been in a very constrained funding environment, and I’ve been certainly critical of the previous Government’s funding of our health system. That coupled with fraud, and other difficulties in their senior team, really left the district health board (DHB) in a very difficult position, and I think we need to acknowledge that.

My dissatisfaction with the board is well known, but it would be churlish not to acknowledge that they inherited a very challenging situation, and that was the situation they were dealing with. I also had concerns expressed to me from senior clinicians at the hospital about the governance and their lack of confidence that the decisions could be made that needed to be made into the future. Of course, as Minister, I had appointed a Crown monitor into the DHB to give me a direct sight into how their financial planning was going and what their future projections were for financial performance.

Whilst the health system has been, in my view, underfunded quite significantly—an independent economic agency estimated a $2.4 billion funding shortfall under the previous Government, and that, certainly, has put a lot of stress and strain on the health workforce—this particular board seemed to be in a position where it was unable to wrestle with that stretched and strained environment in a way that they could project a confident future. Part of the solution certainly lies in ensuring that we are funding the health boards better. In this Budget, we’ve put $2.8 billion in as a Government—a record $2.8 billion—to ensure that health boards are better funded, but, of course, re-funding and developing workforces will take time. Nobody pretends that one or two Budgets will address all of the problems created by a decade of underfunding in our health system.

So those concerns have been raised with me. There was then a consultation process, as is set down under the Health Act, whereby I consulted with the board members themselves on my intention to dissolve the board. Those board members came back to me, nearly universally, offering their resignations, deeming that this was indeed the right step to take, to appoint commissioners to come in to wrestle with these challenges. Two board members chose not to offer their resignations, but they did choose to then send a very similar letter outlining similar concerns and also recognising some of the contributions that had been made during their time on the board, as did the board members who tendered their resignations. So there was a fairly widespread acceptance that this change needed to happen.

The member Jamie Strange raised the issue around whether this is limited to one election. Indeed, it is. By postponing this coming election, that is all we’re doing. We’re taking one election cycle out, and then, thereafter, the situation returns to normal, as it does with the other DHBs every election cycle. There is a law which dictates they must go through an election process. That law kicks in as usual again in 2022 and democracy is restored to the DHB appointment process—of course, albeit that under the current situation, the Minister himself or herself is able to appoint several members to the board to provide leadership on that board as well.

The engagement that was had with those board members revealed to me also—and this goes to a point raised by the member Jamie Strange—their concern that they had not been able to recruit a chief executive. I’m very pleased that the new commissioner has been able to quickly recruit a chief executive, because stability at the senior leadership level is incredibly important in situations where things become a little fragile to give the assurance to the staff that the situation is managed, to compile a plan, to ensure that we are planning into the future for that DHB, that the clinical care is delivered there now, that the high quality of clinical care is delivered into the future, and that necessary change is made over time as new models of care are deemed important to introduce, as new equipment comes in, that the changes in models of care are updated, that those leadership decisions are taken, and that the financial situation is managed.

💬 DHBs: we have put a record investment in as a Government this time around, $2.8 billion into the DHBs in this Budget, and we are putting record amounts into capital—we’ve put $2.45 billion in in our first two Budgets. To give that some context, for capital works into our public health system, that $2.45 billion in our first two Budgets for capital is more than twice as much as the prior Government put in over nine years. It’s more than twice as much as they put in over nine years. We’re serious about fixing up our public health system and making sure we have high-quality buildings for our clinicians to operate in, for our patients to get the care they need in modern healthcare environments. So we’re getting on with that work.

That inability to attract the leadership needed, as that change happens, as new buildings inevitably will come, or changes or improvements on to the Waikato campus—I mean, the mental health facility there is one that’s been there for a long time and does in the future need to be upgraded. I visited it myself. I can see that like many of our mental health units around the country, we need to update them. We need to make sure that they are places where people are going to get well, and I was delighted to be able to announce in Tai Rāwhiti recently that we’re going to do something there.

Now, to come back, though, to the engagement with the board, their indication to me was that they needed that stability at the governance level to recruit the CE. I do also want to put on record—as the members the Hon Tim Macindoe and Jamie Strange have both done—my congratulations to Derek Wright for the work that he did as the interim chief executive, really coming into a very difficult situation and providing confidence to the clinical leaders through that situation, and really giving of himself to ensure that that leadership was sustained there. So I do want to put on record my thanks to him.

Following on from that was, of course, the consultation with the members themselves. They provided the feedback to me and then I finalised my decision, as is dictated under the terms of the Act. In appointing the commissioner, Karen Poutasi, I was delighted that a person of her calibre was willing to take that role on. As a former director-general, she has the mana in the sector and the experience to lead that important work, and she has subsequently herself appointed three deputy commissioners: Dr Andrew Connolly, a surgeon out of Auckland, out of Counties Manukau, very esteemed and well known across the sector for his contributions at a governance level, and a former chair of the Medical Council of New Zealand; Chad Paraone, a data expert, also with Māori and cultural expertise, who will bring his skills to some of the challenges in terms of how models of care are developed and how we measure success over time; and Professor Margaret Wilson, herself with a strong legal background, and, of course, a former parliamentarian from this House and a former Speaker of this House—again, somebody well respected in the Waikato region as a local, who can bring that local representation as well as expertise in health and legal areas, with some experience, too, on the board previously.

So I’m confident that we’re taking the right step here, but no one underestimates the challenge that lies ahead for this group of commissioners. The financial situation and the clinical situation and the challenges they’re facing are worth highlighting. The challenge in working with primary health organisations and primary care arrangements that have been unsatisfactory to many over a long period of time—there are relationships that need to be built. There are clinical models that will need to change over time, but I’m very confident that the actual people providing the care there are incredibly proficient, professional, and will continue to do a professional job, and they can now have the confidence that there’s a structure that sits there to support them to do the job they get up every day to do, to go along and care for the people that come through the emergency door or come in for operations, be they elective, planned care of different types, or be they emergency.

Our acute operations this year are up quite significantly across the public health system. We know more care is being provided in the community as well, and the DHB, of course, has the oversight of all of those interactions—into primary care as well—to ensure that our health system is providing the right care at the right time to the right people. So it’s important we don’t just think of the hospital but we also think of the wider healthcare system: those primary care networks, how they interact with the hospitals, how we make sure that the money is being spent on the taxpayers’ behalf for the best possible outcomes, for the best future for the people of Waikato, who need and deserve as high a quality of care as anyone else in this country.

Tēnā koe, and thank you very much, Madam Chair. I’d just like to begin my contribution this afternoon, following on from other members, to congratulate you on your new role, and very much looking forward to seeing you in the Chair very often indeed. So thank you for your contribution here in the House.

I’d like to speak on behalf of New Zealand First on this, the committee stage of the New Zealand Public Health and Disability (Waikato DHB) Elections Bill. It’s a very unusual thing to have an entire district health board (DHB) shown the door, which is what happened earlier this year, so just acknowledging that there was a long run of administrative problems and, of course, that disastrous tenure by the head, now disgraced. There has been much media coverage. Much of the mana of the Waikato District Health Board has been trampled, and so for all of those people who work inside the health sector in the Waikato region, really, I would like to begin by acknowledging the fabulous work that those on the ground do. I think it’s worthy to note their contribution to our health and wellbeing, under a cloud that has been cast over them.

I do have some questions for the Minister, and I’d like to start off with, firstly, the new commissioner that has been put in place, Dr Karen Poutasi. She has a fantastic pedigree, is definitely a top public servant, and has a significant background in health administration. She has said that she will be attempting to cut the deficit that the DHB has been running and also, at the same time, will be improving services. So my question to the Minister is: what level of confidence does he have that this appointment of Dr Poutasi will mean that the DHB will live within its means but, at the same time, will be able to improve services for the people of the Waikato?

Basically, because of all that bad publicity that the board had, they did have trouble in finding the new CEO, as has been mentioned already, and I’d like to acknowledge the DHB’s new chief executive, Kevin Snee, saying he was actually attracted to the chance to address the inequities in health while working with public organisations. So to the Minister: does he share the confidence that this is the right chief executive? If he could make further comment on that, I would like to hear that too.

You know, it would be wrong of us just to think that the Waikato DHB is a dysfunctional unit. One thing that we do regularly hear about is what the focus of our DHBs should be. Should it just be a fiscal focus, or is it actually about the people—is it the people that need to come for their healthcare, is it the people who need surgery, and is it the people who have an emergency situation that needs to come and be attended to? So are we just looking at this through a fiscal lens? What can the Minister tell us in terms of the outcomes for the people through this entire process?

My final question is around democracy. I’d just like to make note of my colleague the Hon Ron Mark, who spoke at the second reading about concerns that were raised. During the select committee process there was a concern, and we did have three submissions about whether this removed a democratic process, so I’d just like to hear the Minister’s comments on that.

So, really, those are just a couple of questions to the Minister, and I’m hoping too that when we do have this new board in place in 2022, the changes will have been made, the ship will be turning around, and the focus will be on providing services to the Waikato region that we can all be proud of. Thank you.

Just to respond to some points the member Jenny Marcroft has raised there. The first, really, was a question around the level of confidence in the ability of the commissioner, Karen Poutasi, to cut deficits and improve services. I am confident that that task can be achieved over time, but I don’t underestimate the scale of the task. I acknowledge the member’s comments around Dr Poutasi’s proud track record as a leader in the public sector and, indeed, as a former Director-General of Health. She is indeed supremely well-qualified for this task, but I know that in the early stages of her work, she’s uncovering quite the extent of the challenges, and I expect we’ll learn more about that as she goes through her task. I do note that there was recently an independent report released that had been commissioned under the previous leadership which does indeed paint a very challenging picture of both the financial and clinical challenges ahead. I think we will learn more through reading and examining that report of just the scale of this task.

So it won’t be an overnight turn-around. I don’t think anybody expects that. This is not about simply slashing budgets, and this is not a Government that wants to do that. We want to make sure that they’re supported. If they need to invest to make change to put them on a sustainable footing, then that is something that I, as Minister, will certainly be looking at. I accept that sometimes you do need to invest to make change and to make sure things are sustainable in the longer term, and, in fact, the concern has been around the failure of the board in the past to make the necessary difficult investment decisions to put the district health board (DHB) on a stable long-term footing.

In terms of the choice of chief executive, certainly, Dr Snee has achieved good results in the Hawke’s Bay. It’s, obviously, the job of the commissioner to appoint the chief executive and not the job of the Minister to comment too much on operational matters, but I know that they are very pleased to have him. As someone very familiar with the health system and someone who is really looking forward to the challenge that will come with the Waikato job, it is a big job. It is a big DHB, serving a big and important population. There are lots of challenges in terms of how that all gets sorted out.

I’ve touched on some of the relationship challenges across primary care, and so on. Of course, there’s also the challenges with interacting with the regional hospitals, like all the three T’s—the three small hospitals in the region—and how those resources are used most effectively to make sure that we are making the most of all the facilities that we have in our health system and the relationships between clinicians are good, and to make sure that we’re serving the public by making services available locally for them in the locations that are convenient for them but are also of the highest quality.

So I have confidence that that team of Dr Poutasi, Dr Andrew Connelly, Chad Paraone, and Professor Margaret Wilson will turn that DHB around, but I don’t pretend that that will happen overnight. These are significant challenges. The step of putting in a commissioner is one that’s not taken lightly by a Minister of Health. It is taken when there are serious challenges to be tackled that will likely take a number of years to address. But my expectation is that we will indeed return to democracy in 2022 and that the public will then, again, be able to take the ownership in that direct way that you get through democracy, through board appointments locally, and that we will have a high-functioning DHB meeting the needs of its community, as it does now. We just need to be sure that it’s got the plan to deliver that into the future. I thank the member.

Thank you, Madam Chair. I want to take just a very brief call on this part of the debate. There was clearly agreement across the House for what this bill fundamentally does: the disestablishment of the Waikato District Health Board (DHB), the suspension of elections until 2020, and the appointment of a commissioner. I’m already on the public record saying that I support the appointment of the commissioner. Having known and worked with her through a number of roles, I think it’s a good choice. I think she’ll do a good job.

The Minister of Health has highlighted the challenges and the difficulty that the previous board had which brought us to this conclusion, and I just wanted to highlight, indeed, in the past 24 hours, there’s been further information. In fact, the Minister commented on the independent report that Derek Wright and the previous board commissioned in, I believe, April, which came into the public domain yesterday. It does indeed talk about some of the challenges the board has had and the $37 million deficit, and it actually goes on to say that a large part of that responsibility lies with the board. But I’d also point out the document that came out yesterday from the Association of Salaried Medical Specialists, which talks about the significant shortage of specialists at Waikato DHB and how that’s been a problem for them, too. Their headline article was “Waikato DHB survey indicative of national crisis; health minister guilty of dereliction of duty”, so, clearly, they’re putting some responsibility—which I do, as well—with the Minister of Health to make this work.

Certainly, in the community, we’ve heard from MP Tim Macindoe and other Hamilton MPs that they have every will and intention to make this work. That’s why, across the House, we’ll be supporting this bill. But, yes, it’s quite a hardy track to get Waikato DHB back on board, and we wish the Minister every success with that. Thank you.

Thank you, Madam Chair. Let’s be clear: we’re fixing a mess that has been left by a previous Government. Nevertheless, let us continue on. This is a really simple bill. It does what it says on the cover—New Zealand Public Health and Disability (Waikato DHB) Elections Bill. It has two parts: “Preliminary provisions” and “Cancellation of election”. Essentially, it’s very simple: it’s fixing a mess that has been going on for far too long, and we’ve known that for a long time. Finally we’ve got a Minister who has been prepared to take action, and he has done it in a respectful manner, in a manner according to the appropriate standards. He has worked really carefully and absolutely respectfully with the outgoing board, many of whom resigned. I’d just like to say that, as a select committee, we were all in agreement that something needed to happen and, of course, we did not want to have an election that would have only given this new commissioner a mere number of months. It’s going to take a lot longer to fix the mess that’s been going on for such a long time.

So, look, it’s a very simple bill. It just rolls back the opportunity to have elections in 2022. We had three submissions. It was not highly controversial. We heard from two of those people, and it was really useful. Essentially, the question that I have for the Minister is in relation to the departmental disclosure statement. I’m asking this generally—because I understand Dr Karen Poutasi has resolved this issue—but one of the matters that was raised was whether, in fact, Māori representation was appropriately considered in terms of changing what was happening. I ask this on the basis that, as we understand, Māori and Pacific Islanders—but particularly under the Treaty obligations, Māori—have the worst health outcomes. They have terrible health outcomes, and we need to do something about that. We are working towards those changes, and there is an inquiry in another select committee in regards to that. However, the departmental disclosure statement, basically, looked at whether or not the district health board (DHB) was exempt and would cause a difficulty with Māori representation.

Now, my understanding is that Dr Karen Poutasi has resolved this matter very satisfactorily in not only being able to continue to work with the subcommittees but also in her selection of the membership. So I’d like the Minister, who, I’m very certain, has considered that at the time, to perhaps explore that a little bit further to ensure that, under Te Tiriti o Waitangi, the obligations to ensure that Māori are in partnership with the DHB are in place and how that is operated. But, as I say, the report: four pages; the bill: two clauses—very simple, very practical, but actually fixing a problem that we’ve inherited, that we’re getting on and doing. Essentially, I would like to say to the Minister that he has acted in an appropriate manner, in a respectful manner, and is actually serving the community of Waikato very well by putting in place this commission. Thank you.

CHAIRPERSON (Adrian Rurawhe): I call the Hon Paul Goldsmith.

Tim van de Molen: Michael Woodhouse!

CHAIRPERSON (Adrian Rurawhe): Oh, Michael Woodhouse. I knew I was going to get it wrong one day.

That’s all right, Mr Chair. We’re practically twins! I want to add to the questions that the member Angie Warren-Clark has just asked, particularly in the context of the fact that she believes that the Minister is fixing the mess that he inherited. Well, I would just like to point out to the committee, prior to the asking of my questions, that the last full year the National Government was in office, the Waikato District Health Board (DHB) ended that year in surplus, and it took this Minister less than two years to turn that stable financial position and high outputs, according to national health targets, into the complete mess we have now—

💬 Hon Gerry Brownlee: Angie didn’t get the memo!

—clearly didn’t get the memo—where he’s now presided over a DHB that is heading for a financial deficit of somewhere in the region of $56 million. So my question to the Minister is: if this is his idea of fixing the previous mess, might he want to reconsider making the same mess the previous Government made, because it was a heck of a lot better than the one he’s presiding over?

The second question is this: if this is the threshold for implementing a commissioner framework and firing the board, when will he act on the other messes that he’s been presiding over since becoming a Minister—the fact that the Canterbury District Health Board, challenged though they have been, on his watch have doubled their deficits from around $50 million to $103 million and counting. Counties Manukau—actually what previously was an exemplar of good financial performance—is now heading towards $45 million in deficit. Even the smaller DHBs—Taranaki, $16 million; Bay of Plenty, $12 million; Tairāwhiti, $13 million—have very, very significant challenges, all on his watch. So my question to the Minister is this: if he is inheriting such a mess, why have things got so much worse on his watch, and when will he be appointing commissioners to those DHBs?

I do want to address a couple of those spurious inaccuracies raised by the previous member, the Hon Michael Woodhouse. It is somewhat laughable that he raises the issue of governance and performance at Waikato and suggests that the big problems have emerged in the 20 months that this Government has been here. I think that he would do well to recall that, during the previous Government’s tenure, Dr Nigel Murray was the chief executive there, who was subsequently interviewed and pursued by the Serious Fraud Office. His tenure was from, I am told, July 2014 until October 2017—very much the responsibility of the previous Government and very much, I think history will show, responsible for some inopportune and unwise investments in technology, for some flagrantly inappropriate spending, and for a culture at the district health board (DHB) at senior management level which was distinctly unhappy around that time and following his departure. And, of course, on top of that, the $2.4 billion that that previous Government stripped out of the health system has had a deleterious effect across the whole health system.

In that, I will agree with the member: that, indeed, across the system there are challenges, and that results from that decade of underfunding under the previous Government’s watch. It has meant that our health providers, our doctors, our nurses, and our allied health workers have been stretched and strained for far too long. I want to salute them. I want to thank them for their service under the previous Government’s watch, even though every day they had to turn up to an underfunded, stressed health system to provide care, often by going the extra mile themselves outside of their regular hours. So I do want to put on record my thanks to them.

The member asks around intervention at other DHBs. Certainly, this is a Government not afraid to intervene where there is poor performance. We have put in place Crown monitors, first and foremost, in Counties Manukau and also in the Waikato, and then that led on to the commissioner appointment in the Waikato that we are discussing today. We have also put in place recently a Crown monitor in Canterbury to seek some clarity around their worsening financial position. They certainly have provided excellent clinical care, I want to acknowledge, in response to the terror attacks and also in response to the prior earthquakes. But we do need to get clarity around their situation—how much of it results from those situations and how much is from other matters—so that we have a clear picture into the future.

DHBs under this Government have returned—some of them have returned balanced budgets. We can see that DHBs can return small surpluses, small deficits. I, certainly, as Minister, don’t accept that big deficits are a necessity for operating DHBs, especially when we are funding them this time around in record amounts. We are expecting improved performance from our DHBs, and we will continue to invest. We make no apologies for addressing that decade of underfunding under the previous Government, but nobody believes and nobody expects that we can address a decade of underfunding in one or two Budgets. It’s simply problematic to very quickly address the workforce issues that have been created.

Dr Reti raised the issue of the Association of Salaried Medical Specialists talking about the crisis of senior medical health staff at Waikato. Well, I can assure Dr Reti—and I know that the Hon Michael Woodhouse also knows that senior surgeons are not trained in 20 months, and can’t be trained in the 20 months that I’ve been health Minister; they take more than a decade to train. If there’s anybody who’s responsible for the lack of senior clinical staff in our hospitals, it is the previous Government. So they wear that criticism fair and square—an issue they raised and one that they need to look at themselves in the mirror and come to peace with, because we are certainly a Government committed to investing more.

We will invest more. We are addressing the crisis in mental health. We will continue to invest in our DHBs, because we believe in the public provision of health services on this side of the House. We won’t see our system continue to run down like it did under nine long years of National.

Part 1 agreed to.

Part 2 Cancellation of election