Estimates Debate — Health Sector

Members, we come now to the vote in the health sector volume—B.5, Volume 6. The question is that Vote Health stand part of the Schedules.

Tēnā koe, Madam Chair. It is my absolute pleasure to speak on this Estimates debate about Vote Health, as the chair of the Health Committee. I want to acknowledge the Minister who’s in the chair beside you, the Hon David Clark, for running an organisation that, actually, has been challenged, and those challenges stem from underfunding over the last nine years.

I say that because in our report we actually talk about the DHBs and their financial stability. As we know, many of the district health boards have to deal with these legacy issues and we need look no further than Counties Manukau District Health Board. I highlight that because you can’t actually deliver services if three or four of the buildings that are supposed to provide the context for us to care for New Zealanders are rotting, are leaking, had sewage, had air quality problems. That’s been highlighted by the Nurses Organisation and other health workforce organisations who are worried about their staff working in these conditions. I highlight that because the cost to ensure those facilities are sufficient and adequate for the health system to deliver to the health needs of New Zealanders has been severely compromised. The response from the Minister and from this Government was to invest an additional $850 million in the last financial year for capital investments in DHBs. This hasn’t been done randomly, because one of the other things the Minister did was develop a new infrastructure unit to support DHBs. We knew that we had to be more strategic in this area, but the reality of hearing from our DHBs is many of them had no option, under the last Government, to highlight some of these issues because they knew they would get nothing. This Government has been incredibly responsive, and increased funding in areas which we think are incredibly important.

So in addition to more capital investment money we’ve also provided another $143.448 million to ensure that our staff who are working in our health sector are remunerated. That’s a big deal for us, because in addition to the infrastructure, the other most important component of delivering a health service is having a quality health workforce who is valued and knows that they, through their efforts, are contributing to a great Government plan.

And then the third area that I want to highlight is our mental health initiatives. Many of you came into the Grand Hall tonight, and I want to thank colleagues who chose to do that. It was actually an acknowledgment of the prioritisation of mental health and addiction wellbeing that this Government did in having an inquiry that ensured that over 2,000 New Zealanders, who in 26 locations across Aotearoa New Zealand attended 400 meetings, were part of a conversation about our mental health wellbeing, and also how addiction contributes to our mental health wellbeing. So the Government have, through that process and the leadership of Professor Paterson, provided for the Government He Ara Oranga. Within that document there were 40 recommendations; the Government accepted 38 of those. So we have a commitment—a $1.384 billion commitment over four years—to ensure that we operationalise that plan. That plan isn’t our plan; that plan is actually New Zealand’s plan. One of the great things that we heard tonight was that for us to achieve the objectives of that plan, we actually have to work together.

Part of the, I guess, challenge we have—and especially in that mental health and addictions area—is that we don’t have enough staff who have the skills to meet the needs of those mental health and addiction challenges. The Minister has been incredibly transparent and has said that we need 1,600 additional staff; 25 percent will come from the existing workforce. So, I guess, this is a mihi to the people who work within our current health sector: our nurses, our occupational therapists, our social workers, and our community workers, who we think can contribute in another way. So I look forward to us working with the sector to ensure that we have the capacity to meet those mental health and addiction challenges going forward.

I haven’t got much more time, but I do have to talk about some of the petitions that came before our committee this year, and specifically those related to the availability of pharmaceuticals. I do want to acknowledge the petitioners; the Terre Maize petition, in particular, was one where we had incredible engagement from people who were most affected by a lack of access to advanced breast cancer drugs—and so I pay tribute to them. I pay tribute to them—

💬 Hon Michael Woodhouse: Pay tribute? Give them money. Give Pharmac more money.

—for putting the petition to the committee. I pay tribute to them for coming to talk to us. My colleague Michael Woodhouse is making some comments, but the reality of our Health Committee report is that we said this Parliament should not determine what drugs should be funded. We were clear about that. That’s a political process; we have a process in place, where an independent entity does that. But, in saying that, I do want to highlight that we have issues about access to these new technology, new treatment drugs, and we will address that. I want to acknowledge the Minister and the ministry and Pharmac who have committed to addressing that issue going forward. Kia ora.

Before I call the Hon Michael Woodhouse, can I just apologise to the House for not setting the timer. So the Opposition are 45 seconds ahead, but I took a minute off Jan Logie prior to dinner, so I think we’re about quits. The Hon Michael Woodhouse.

Thank you, Madam Chair. I must say I do commend the chair of the Health Committee, Louisa Wall, on her loyalty to her Government. Her rhetoric was just as far from the reality of what’s going on in our health sector as the Minister Dr David Clark’s is, and the Government’s, who pretend that they are fixing nine years of neglect. Frankly, this Budget shows more than ever that they are overseeing chaos and drift and an absolute crisis point emerging in our health sector. I want to deconstruct some of the things that the Minister told us in select committee, in Estimates review, and I will also focus very much not so much on what is in the Budget but, actually, what’s not in the Budget.

What’s not in the Budget is what the Minister said he would do in reversing what he claimed was an $8 billion underfunding under National. Now, I want to deconstruct the so-called $8 billion myth. The Government, in Opposition, put together a manifesto that had a fiscal plan that said that they would invest $7.925 billion over the next four years, and somehow the perception was that that would be $7.925 billion more than a National Government would. Well, that’s not true, that’s not accurate, and it was presumptive on National putting no more money at all into health over that four-year period. Indeed, if you take the spending increase track at 2017 of 4.1 percent and just round it down to 4 percent, there would have been $9 billion more put in by a National Government, more than this Government is.

And the evidence is plain to see in the haemorrhaging financial positions of DHBs. I said, in January, that they would get to $500 million in deficit, and the Minister pooh-poohed it. In April, when we saw that it was going to go to $390 million, I said that was too low and it was going to go to at least $500 million. It’s now being projected at $508 million, and that is conservative. So let me make a prediction about where the actual deficits are going to end up in the 2018-19 year, because this very much influences the Estimates for the next Budget year that we’re talking about: it’ll be a billion dollars. The Minister knows it’s going to be a billion dollars, because there’s another one-off hit of about $500 million to $600 million for the DHBs’ failure to comply with the Holidays Act; a Holidays Act that when I was the chief executive of a surgical hospital was being passed by the Clark Government, and I submitted in committee and I said it was going to be a complete muddle. I hate being right about these things. The reality is the union movement has spent years saying that it was errant employers, lazy employers, lazy Australian-based payroll software providers that were the cause of the problems of employees not getting their entitlements under the Holidays Act. And then what happened? The police happened to have a $33 million underspend.

Now, the Minister is going to blame me, actually, as Minister for Workplace Relations and Safety. I can tell the House that at the time I was that and Minister of Police, the committee of State sector Ministers on employment relations asked the Director-General of Health to go and explore, with the DHBs, what their situation was, because as a 24/7 operation with lots of evening and weekend allowances, the Holidays Act can be quite complicated. They came back and told that committee of Ministers that there was no problem. So we sent them away and we said, “Look harder.” It was after we got taken out of office that the real situation emerged. Now, I’m not going to blame the Minister for that. It’s actually not the Government’s fault. The Government can only act on the information that it is provided with. But I refuse to accept what Dr Clark will inevitably come out with and say: that it was the previous Government’s fault.

💬 Hon Members: It was.

It absolutely wasn’t. I will table, if the member wishes, the letter from the New Zealand Council of Trade Unions saying there was no problem with the Act, imploring the previous Minister not to change the Act. The moment that the Government gets into office, Iain Lees-Galloway is saying he’s going to have a review. It is a problem, and it’s a problem for hospitals but it is not a problem of the previous Government.

What is a problem is the fact that that Minister talked a good game in Opposition. He said, in May 2017, when the previous Government put in $459 million for DHB cost pressures, that it was far too small; it was $650 million that was needed just to keep the lights on, two years ago. Yet in this Budget, we are exploring why, two years later, he only put in $549 million. Why is it that two years later, he’s put nearly $100 million less than he said was necessary in order to just keep the lights on in 2017? And we wonder why DHBs are haemorrhaging money. It’s that reason, it’s talking a good game in Opposition but not delivering, and it’s also allowing DHBs to settle pay increases at 8 percent and 9 percent per annum, and then not giving the DHBs the money to pay for it. It’s simple arithmetic that when 75 percent of the cost base of the DHBs is people and pay goes up by 8 percent to 9 percent and then there’s a 4 percent increase in the vote, deficits will occur—and 19 of 20 DHBs are going to be in deficit, if not 20.

Now, the chair of the committee has rightly pointed out a quite significant increase in the appropriation for mental health, as part of the Wellbeing Budget, and I certainly don’t begrudge that. But what I would ask is this: how can we say that this is a wellbeing Budget when, in order to pay for those mental health appropriations, the rest of the health tin was raided? It was raided in pharmaceuticals, and Louisa Wall says, “Well, you know, we’ve heard a lot of petitions for cancer drugs, and we’re listening, and it’s not for the Government to interfere with drug-buying decisions.” Couldn’t agree more. What the Government can do is give Pharmac more money.

When the Minister came to us he was quite proud of the fact that in the 2018 Budget not a single dollar of extra money was put into Pharmac. He talked about 331,000 New Zealanders who had benefited from the drug-purchasing decisions that Pharmac had made despite getting no money. Well, that 331,000 was a result of the 2017 Budget, Minister, not the 2018 Budget, and this penny-pinching Minister who needed to pay for mental health somehow raided the tin for Pharmac and they’ve had $10 million in the last two years—0.5 percent per annum. That’s only one-fifth of the average annual increase of the previous Government. And he says we’re to blame because drugs can’t be purchased, because people have to go to Australia, because Givealittle pages have to be set up. It’s a nonsense.

But the real scandal of this Budget is the failure to address the growing crisis in maternity services. And independent midwives are leaving the sector in their droves. And I say to the Minister and I say to this committee that there will be a lot more said about this over the next 10 days as the crisis in maternity comes to fruition. The Minister had got a report in February 2018 that said that independent midwives were worth much, much more than they were getting. He buried the report and he threw them crumbs in the 2018 Budget, and in this Budget he threw them nothing—nothing but hot air and a promise.

💬 Kieran McAnulty: Well, they’re used to that.

And maternity wards—what they were used to, Mr McAnulty, was being listened to, which was why we set the mediation process up in the first place. They went to the High Court. They had that right. We listened. We waited for the report and by the time it came we were out of office. This Minister is the one with the cloth ears, I must say.

Then we’ve got the cancer plan. Where on earth is the cancer plan? This is fundamental to the Wellbeing Budget and we’re still waiting. But it’s not going to be a plan; it’s going to be an interim plan. What we got—because the National Party made very sensible and strong announcements at its national conference—was a scrambled stand-up at Wellington hospital where the Minister announced linear accelerator purchases that were already on the list. So I’d heard the Minister say, “Oh, well, they promise a lot, particularly in roading.” In fact the Government says this, but there’s no budget. I asked the Minister, “Where is the capital budget here for the linear accelerators that were announced for the Hawke’s Bay, Northland, and Taranaki?” And you know what the answer is—none. There isn’t a single dollar of capital budget for the scrambled announcement that he and the Prime Minister made just so they looked like they were doing something in health.

We know what they are doing in health. They’re doing this and they’re doing that [Covers ears and eyes] because there is a crisis emerging and their Minister doesn’t want to know about it because he doesn’t know what to do about it. Well, it’s pretty easy what he has to do. He has to set expectations for performance. Targets were removed. He has to fund things like Pharmac and midwifery and the GPs broken promise and the many other things that he said he would do but has gone silent on. And then he’s got to hold the sector to account. And he has to lead, because there’s no leadership in the sector now. All we’ve got is a sea of red ink and some very angry people. The most benign industrial relations environment in the health sector was in the years 2009 to 2017. We’ve now had more industrial action in the last 18 months than in generations and that cannot be sheeted home at anybody else but the Minister.

That is the longest, most tortured apology I have heard from that member in quite some time. Honestly, a member who talked at the beginning about the $8 billion promise that the Labour Opposition made to put $8 billion more into healthcare in the first four years. We are well on the road to delivering that as a coalition Government. We’ve already put over $6 billion in in our first two Budgets in that forecast period as relevantly measured.

That member, of course, neglected to focus too much upon the nine years of neglect, the underfunding—the long-term underfunding—that has left us in the position we’re in where the health system has been scrambling to fund services to make sure that it could deal with the level of need in our communities, because our buildings have been run down. We’ve had rot, mould, and sewage in our buildings as a consequence of their Government’s failure to invest.

In the Budget we’re talking about here, more money was put in to health capital in the most recent Budget than that previous Government put in in the whole nine years they were in office. In one Budget we’ve put more money into health capital than they put in in nine years, because we are serious about rebuilding our health system after nine years of neglect. We’re determined to tackle the long-term challenges that have been left to us that we’ve inherited, Madam Chair—Mr Chair—the person next to me keeps changing.

We have funded a number of things. We’ve funded cheaper doctors visits. We’ve made sure that it’s cheaper for 600,000 New Zealanders to go to the doctor. We have started funding the fixing of our rundown hospitals but, of course, more investment will be needed because they have been neglected for so long. We’ve funded modern radiation machines. Mr Woodhouse, I don’t know where he was when the announcement was made about those radiation machines. He was saying no capital had been put aside. That was the whole point: capital was being put aside to make sure that we funded for the next 12 replacements—modern radiation machines to make sure that New Zealanders can get cancer care closer to home.

We better funded our ambulance services. We’re paying family carers what they deserve. We’ve funded Pharmac better, and, again, Mr Woodhouse completely misunderstanding Budget 2018 where $13.5 million of new money was put into Pharmac. He keeps repeating that error. I do not know what he doesn’t understand there and, of course, we got more value for more New Zealanders because a whole lot of money at the same time was transferred across from the DHB management into the Pharmac management where we know the Pharmac model purchases more drugs. So we are getting on and providing more health services for more New Zealanders. But no one pretends that we can fix nine years of neglect in just two Budgets. It will take ongoing investment but we are doing some serious investment.

We are taking mental health seriously. We have put $1.9 billion in this Budget—$1.9 billion; the biggest-ever investment in mental health—into mental health because we think that we need to take mental health seriously. It’s something that has not been done before. It makes economic sense. It’s the right thing to do and we know that one-in-five New Zealanders in any given year could be wrestling with a mental health or addiction challenge. So we’re going to make that investment. In fact, we’ve already made good investments in that area. Nurses in schools—we’ve funded the Piki programme in the Greater Wellington and Wairarapa area—

💬 Kieran McAnulty: That’s right.

—and I want to thank the Green Party for their support and Mr McAnulty for his verbal support, especially, of that good programme in the area that he represents. Also I want to think about the investments that we’ve put into those community services card cheaper doctors visits, which, of course, are a way into mental health services for many people. Two hundred million dollars in capital we’ve put aside for building our mental health and addiction facilities for making sure that they are coming up to scratch again because many of them are no longer the ideal place to look after people who have mental health or addiction needs. And of course we’ve put significant money into the mental health ring-fence to support our specialists, additional programmes for vulnerable mothers, and money going into detox services in Auckland, and so on. The investments keep coming. We’re very focused on making sure that we support that health system after those nine years of neglect.

As a Government, we’re building a new front-line service, and I think in the closing seconds I just want to say how important that is, to make sure that people with mild to moderate mental health needs can access services in primary care. That’s one of the big investments in the Budget; nearly half a billion dollars going into that. That will take time to set up and to deliver, but we’re determined to do just that.

Thank you, Mr Chair. It’s a pleasure to speak to the Estimates, and I particularly want to speak to the Estimates figures around health information technology: the $5.2 million in the national health information systems and the $49.3 million in health sector information systems. I want to start by premising this on the major projects list which are failing, particularly those that are failing in health, those that are high risk and are likely to fail: the National Bowel Screening Programme roll-out, bowel cancer screening IT, the national infrastructure platform, and the national electronic health record. And it’s the last that I particularly want to kick off with to start—the national electronic health record.

Where is this? Where is this in the Estimates, when the Minister, this time last year, 13 June 2018, at a conference, said, “The ministry’s new digital health strategy should be published in coming months. A new identity management and integration service is being defined, which will act as building blocks towards the creation of a national electronic health record.” Not a word—not a word for a year about the national electronic health record. Maybe there’s a reason for that; maybe it’s because the Minister has done the indicative business case at an eye-watering figure—absolutely eye watering? You would never guess, or could never guess, how much the Minister and his ministry have spent just for the indicative business case of the electronic health record. Remember, that’s not the detailed business case but the indicative business case—$3.4 million just for the indicative business case of the electronic health record, which is now a project that is defined as at high risk. We also know from inside industry players that they’re very concerned that Accenture and MartinJenkins seem to have taken all that money, all that work, and we’re just not seeing any evidence of it being delivered. So I wanted to plant the electronic health record at the Minister’s feet as “Where is this? Where does it sit in the Estimates? Why is it a high-risk project?”

I then want to move to the National Oracle Solution, which the Minister spoke to in oral questions today, and which the Prime Minister spoke to last week. Just to remind everyone of the National Oracle Solution: in 2017—so the project had been under way for about five to seven years—the incoming Government, under David Clark’s hands, December 2017, there or thereabouts, decided they’d look at the National Oracle Solution and, surprise, surprise, ordered a review. They ordered a review from Deloitte—but, hang on, didn’t Deloitte design the National Oracle Solution? Oh, yes, they did. Hadn’t Deloitte, through Asparona, their subsidiary company, actually done a lot of contractual work on the National Oracle Solution? Yes, they had. How could this be an independent review when the people who were setting the exams were also the people sitting the exams? They were marking their own exam work.

So we pointed this out to the Minister, including the fact that Deloitte said they didn’t want made public their conflict of interest—thank you to the Official Information Act—and reluctantly the Minister sent it to Audit New Zealand. Audit New Zealand came back with a damning report of his handling of the National Oracle Solution and particularly the commissioning of Deloitte to do that. I won’t read that, because I want to move on to what that report showed. Then what happened was the Minister parked the National Oracle Solution around about April last year. He realised he’d got it wrong. He let the four Wave 1 DHBs continue—Waikato, Canterbury, Bay of Plenty, and West Coast—and he parked it. And he did nothing until about 10 days ago.

Now, over this whole year, those parked DHBs have written off impairments in the sums of millions of dollars, and, furthermore, the systems that were failing were the systems at Auckland, Northland, Counties Manukau, Waitematā, Taranaki, and Southern DHB. Their versions of Oracle expired, and their software and hardware was no longer compatible with the Oracle platform—over this year, while the Minister was parking the National Oracle Solution. What do you think that’s done for security, running software versions on platforms that are no longer supported? Is it a surprise that we’re seeing cyber-security issues with this Government when you have a Minister who doesn’t think forward? What happens if you park a health information technology project and the software licences run out and no longer meet the hardware requirements?

That’s a further damnation of what the Minister is doing with health information technology. And then we hear today, “Don’t worry; it’s moved to the FPIM.” The Minister needs to tell the whole story. There are 10 DHBs that the Health Finance, Procurement and Information Management System (FPIM), which is the new name for the National Oracle Solution—there are 10 DHBs that now have no procurement basis. It has been wiped by the Minister. He did not say that in oral questions today, nor did the Prime Minister last week. Let’s hear this whole story.

Thank you, Mr Chair. I’m proud to be part of a Government that’s rebuilding our health system, because, as we’ve heard tonight, after nine long years of underfunding, the health system we inherited was in a terrible state. What I want to start talking about tonight, just to begin with, is malnutrition, because I think the closest parallel I can think of to the health system we inherited is somebody that’s been facing chronic undernutrition over a very long period of time. What happens when somebody is facing that situation is that their fat reserves get burnt up first. And once they’re completely depleted, then the body starts to burn up muscle and, basically, a lot of those key functions start to drop off. And one of the most important ones that start to get impaired is the immune system and the ability to react to the challenges that get thrown at the body. So a lot of children with chronic malnutrition end up getting really bad infections.

Just looking at what’s been happening with our health system after nine long years of underfunding, pretty much all those fat reserves are completely gone; they went ages ago. But what’s happened is that the system we inherited had started to burn up its muscle and it, basically, couldn’t respond to the challenges that were thrown its way. So, when we inherited that system, we inherited a whole range of DHBs that were in deficit, but then, over the next year or so, as we had a bit of population increase and as the population was increasingly ageing, a lot more of those DHBs have come into deficit. Basically, those are the fundamentals of that under-investment and the impact that that’s having on our system.

The other thing that DHBs, in their annual reviews, were talking to us about was just the huge acute load in terms of what was coming in through A & E—just things like need for acute surgery but also a whole lot of ambulatory-sensitive hospital admissions. Those are those conditions where you could actually prevent a hospital admission if you had early access to primary care, because, again, the previous Government hadn’t been investing in the primary care system and so we were getting this problem where increasingly primary care was becoming unaffordable.

The other thing that was happening was that a lot of DHBs, to balance their books, were putting off just basic maintenance and capital investment. So, in the system we inherited, in about 19 percent of DHBs, their assets were in “poor” or “very poor” condition. So we inherited a system where we were having hospitals that were having leaking, mould, raw sewage leaking through the walls of some of our major hospitals—things in an incredible state. And so the system we’ve inherited has meant that our health system hasn’t been able to respond to some of the challenges that have been thrown at it.

So what we’re doing now is starting to rebuild that system, and I think there are a number of things that we’ve been doing. The first of them sounds really boring but is actually crucially, crucially important, and that’s what we’re doing: putting $2.9 billion over the next five years into our DHBs just so they can keep up with that population growth and with those cost pressures. That’s something that hadn’t been happening over time, and it’s crucially important. But the other thing we’re doing is investing significantly back into our health infrastructure—so $1.7 billion into our hospitals and facilities over the next two years, and that’s on top of the $750 million that we put in in Budget 2018. Some of that will be going to repairing some of those hospitals like Middlemore, which has been facing all those difficulties. But we’re also putting some of that money into rebuilding and building mental health facilities so that people can access the services they need in proper, modern buildings. Some of the other things we’re going to be doing in that space are just, basically, investing in that key infrastructure.

The other thing we’ve done—and it was a big priority in Budget 2019—is take mental health seriously, and that’s why we’re putting $1.9 billion into our mental health services. As a number of us have talked about, some of that is going to go into front-line services in primary care so that people can come into their GP clinic and they can say, “Look, I’ve got these issues.” and be able to be introduced to a mental health worker who can actually sit down and talk to them and work out what it is they need. And sometimes that mental health worker will just be able to see them for a couple of sessions, and that’ll be all that they do need, but sometimes they will need to be referred off to services. We’re also investing extra resources so those at risk of suicide can have the wraparound services that they need, and we’re also investing extra money into telephone-based counselling and internet support services as well so that people can access those services when and where they need them.

So there’s a huge amount of infrastructure investment. There’s a huge amount of funding into our mental health services and then also just keeping up with cost pressures. So I’m proud to be part of that Government that’s rebuilding our health system after nine years of underfunding. We’re actually giving the system what it needs.

Thank you very much, Mr Chair. A very good choice! Thank you very much.

We’re here tonight to debate the Estimates hearing at the Health Committee. We had the Hon Dr David Clark as the responsible Minister there to answer questions around the announcements for health, and I was asking questions specifically on the announcements around mental health. As we’ve heard tonight from many in the Government, parroting the amount of money that has been apparently announced, the problem is that—well, it is the problem with Labour Governments. I mean, first they tell you, when they’re in Opposition, around any issue, “All you need to do is get us in Government and we’ll fix it.” The problem is that, when they finally roll round to Government, they don’t have a plan. It’s not as simple as just getting into Government; you’ve got to have the plan. And it’s not as simple as just throwing money at it. I’ll give you a reason why: the State of the Nation Report in the last year of the former Labour Government said that, for all their increased expenditure, social progress had not improved 1 percent. What a damning statement by the Salvation Army, and this is what we are facing now.

The health Minister said he had an aspiration that every person in New Zealand who wanted to access a mental health service could in five years’ time. Well, we know how much that is, because it came back from the inquiry that the level of need we needed to focus on was 20 percent. Currently, we spend $1.5 billion on providing access to 3.7 percent of the population. So the question is: if we are going to meet the Minister’s own aspirational target, what do we need to do to increase that figure from 3.7 percent to 20 percent? The problem is that, when you ask the Minister and you ask this Government, we don’t get an answer. Where is the plan? Where is the modelling that will roll this out—all these programmes—and hit the 20 percent mark? Because that’s what we are here to do in Opposition: hold the Government to account and interrogate the policies and the announcements.

So we have a lot of money promised but, in fact, what we heard is that they’re actually going out on a roadshow to ask the public how they want the money spent in mental health. You’ve had a $6.5 million inquiry that kicked the can down the road. We had delayed report-backs on the inquiry reports, and now, in 2019, around April, we get a funding announcement. Well, the biggest plank in that funding announcement is a mild to moderate front-level service that’s going to be operational in five years’ time. Do you know when that service first started? In July 2017. So why have we waited two years for this new big silver bullet front-line service to be resourced when it was operational in July? And that’s the problem; we had $100 million earmarked for social investment mental health initiatives. One good example was putting mental health professionals alongside emergency responders. The police and St John were outraged when they heard that had been cut when this Government came in. And that’s a problem: they came in, they cut programmes, and then we wait two years—and then New Zealanders are told, “Well, it’s a great big amount of money, but in fact it won’t be operational for another five years.”

Part of the problem is that you can’t just announce money; you’ve got to have done the work in Opposition. Funnily enough, this Government talks about nine years of neglect—well, they’re very close to potentially causing more neglect in 18 months. And here we have 18 months in and no plan. Where is the plan for the service? Where is the plan for the workforce? At the moment, you’ve got front-line services like GP clinics being told, “Well, they’re going to get funding for this new front-line service.” Ask one GP what funding stream that will come from—what will be the funding system. They don’t know, because this Government, in Budget 2019, announced a lot of money in mental health but actually has no plan. And now they’re out there asking New Zealanders in a roadshow. After a $6.5 million inquiry that went round and had 500 meetings and talked to thousands of New Zealanders, we’re now having a roadshow.

Thank you very much, Mr Chair. It has been an interesting evening, listening to what’s going on in terms of the different interpretations. I echo the sentiments very eloquently expressed by my colleague Michael Woodhouse and also Dr Shane Reti and, latterly, Matt Doocey.

There is chaos in the health sector. There are things that remain unfunded. The strikes, the disunity, the sense of dissatisfaction I wasn’t really aware of until I came into the Health Committee, which I did in May. Since that time I have never seen so many petitions around Pharmac and what it needs to do better—the $200 million smoke and mirrors which was given back by Pharmac instead of reinvested in medicines to extend and save people’s lives. What’s going on with the moral compass here? Pharmac needs to be thoroughly investigated. There are far too many things that are not being done properly. The Metavivors, the cancer drugs—these are the sorts of things that really matter and really count.

The particular areas I’m interested in and follow specifically are around dementia and elder abuse and surgical mesh. These are all things I asked the Minister about at the Estimates hearing and I was underwhelmed by the responses—the surgical mesh, for example; that is one of the ones I feel most keenly—because, when in Opposition, they were lions. There were extravagant promises about acting urgently, setting up a register, sorting out the surgical procedures, getting people trained up so that they could remove the mesh that is causing such misery. It hasn’t happened.

So how much of “urgent” takes two years to even begin to start consulting? It’s not a working group. What do you call it when you go around asking people what you already know to continually repeat their stories? It is a waste of time, basically.

💬 Maureen Pugh: Stalling.

Stalling. That would be a good way to describe it. A stalling consultation exercise, which is a sop to public opinion and does nothing to actually further the cause of the women and the men—because surgical mesh is an issue with men and hernias as well. We’ve seen that through the ACC numbers. But why have the Government not moved quickly on this? It is not that it’s particularly expensive. When it comes to surgical mesh, there are a few things that are needed. They need to have a particular code. It isn’t particularly onerous. National has guaranteed and promised that we will set up a surgical mesh register and it will be retrospective. These are the sorts of things that this Government, particularly in health, has shown no leadership on. So much for urgency.

Pharmac, well, as I said, the petitions have been extraordinary, and I cannot understand why the Better Public Services targets have been removed. It removes the ability of the Government and the Minister of Health to actually manage what’s going on, because to measure what’s going on is to know how to manage it, and the Better Public Services targets had managed to focus the health officials and the other entities on what they needed to deliver for the money they were getting. By removing those, it has thrown things back into chaos. I think that is deplorable.

There are a number of broken promises. New Zealand First is not without blame in this—missing in action for New Zealand seniors. In the campaign, it was promised that there would be an annual health and eye check-up for seniors. Nothing has been done about it. I have asked the Minister written questions. I’ve done Official Information Act requests. There is absolutely nothing happening in that space, and I think that’s deplorable because New Zealand First got people’s hopes up and now they have been dashed and the seniors feel very aggrieved about that, and I don’t blame them a bit.

There was a promise to increase the age of breast screening to 74. It wasn’t in the Budget. These are the kinds of measures that if you put them in and if you can therefore diagnose early and make a proper intervention early, then you will save lives. And, by the way, you will save health dollars, because it won’t require such expensive interventions as people continue to progress with their disease. Bowel screening programmes: why has that not been rolled out? It has proved very successful in the Waitemata District Health Board, and it is something that needs to happen. Maybe it is because, as Michael Woodhouse pointed out, probably about 20, if not 21, of the DHBs will be in deficit. They can’t afford anything. They’re in big difficulty. The $10-cheaper doctors visits for all: that wasn’t in the Budget either—another broken promise. And the $20 million for access to lifesaving medicines for New Zealanders with rare disorders is something that comes up every week, it seems, in the Health Committee. Again today, we heard that those medications were not going to be funded. Where’s the money? Where’s the access? Why are there so many broken promises?

People’s lives count for better than this, and this Government is deplorably letting down the vulnerable older people and those who are sick in New Zealand.

Thank you very much. It’s an absolute pleasure to take this call on the Appropriation (2019/20 Estimates) Bill, speaking to health. But before I begin my contribution this evening, I’d just like to begin by acknowledging our colleague, a New Zealand First dearly loved member, Pita Paraone, who has passed away. In New Zealand First, we are deeply saddened by his passing. He was a very kind and very gentle man, and all of those who knew him, whether they worked with him in the wider community or in politics, they knew that he was a man of great integrity. We feel his loss deeply, and many of our members are so very deeply saddened, but we’d also like to reach out to our Ngāti Hine family, who have also lost their uncle, their cousin, as well, and those that are in Parliament from Ngāti Hine, they are feeling this loss as we are. I know that those in the Māori Affairs Committee who worked with him in the previous Parliaments have also expressed to me and to my colleagues how deeply saddened they are. So I did want to begin with that and acknowledge his passing. Haere atu rā, moe mai, moe mai.

I’ve just had, along with some colleagues across the party, the most amazing experience. We have formed the cross-party mental health and addiction group. We have been able to come together for the good of New Zealand. This is, for me, what politics is really all about: what we can do collaboratively together. This was formed out of the inquiry into mental health in New Zealand, and it was one of the recommendations. There were 40 recommendations from He Ara Oranga and it was number 40: that we come together as a cross-party group and work together for the benefit of all those New Zealanders who are suffering.

So it was with great pleasure that we launched tonight, along with Sir “JK”—John Kirwan—and another fabulous woman, also Ngāti Hine and a cousin of Pita, Moe Milne, who’s worked for five decades in the mental health area. We learnt from them their stories, their struggles, and the work that they have done in that mental health space, and so now we have taken it upon ourselves. We’re carrying that baton together. So I’d just like to acknowledge colleagues across the House: Chlöe Swarbrick, Louisa Wall, Matt Doocey, and David Seymour and myself on that party. We have actually opened the invitation to all other members of Parliament to come and join this group, this cross-party group, and we would welcome you to be part of that as we work towards what Sir JK said was actually our Mount Everest and it’s something that we have to knock off.

We have to ensure that we reduce the deaths from suicide in this country. That is why this Government has invested $1.9 billion into mental health, because we see the crisis that it is and we know that to fix it we all have to come together and work really hard on ensuring that we reduce the suffering in our whānau, in our communities, in our schools, wherever it is seen. We have the most appalling statistics in suicide, so I would like to acknowledge our Minister for making mental health and mental wellbeing at the forefront of this Wellbeing Budget in 2019.

We want to make sure that all New Zealanders will be able to access free mental health and addiction support that works for them when they need it and how they need it. We need community services that are on the ground and that will be developed alongside kaupapa Māori services. Community services—we’ll need to train hundreds of new staff as well. We’ll need to build new facilities across New Zealand so that we can transform our approach to mental health and addiction with significant and sustained investment.

We need to do this together. So reaching out through all of the mental health services, building up the support—also something else that I’m particularly interested in is making sure that we support people, the families that are left devastated and bereaved by suicide. Not just those with mental health issues but also the whānau, the family that are supporting those through either suicide or supporting those with mental health addictions as well.

Thank you, Mr Chairperson. That’s it for me this evening and I’m very pleased to be on the Health Committee.

E Te Māngai, tēnā koe. Tēnā koutou e Te Whare.

Tonight I stand to speak on Vote Health on behalf of the Green Party of Aotearoa New Zealand, and I want to focus on mental health and addiction, primarily. I just want to acknowledge a few of the comments made by Opposition members, in particular, about the likes of the strikes which we have seen particularly in the health sector. I just want to state that anybody who thinks that these events occur in a vacuum are kidding themselves. These things did not just happen overnight but instead they were the end point of an accumulation of a lack of investment, which this Budget is ultimately trying to redress.

But I want to get to the point that anybody in this country who is experiencing mental distress or distress with addiction or substance abuse issues who has been watching this debate in the House tonight, and watching politicians shout back and forward at each other, probably isn’t feeling very good about the state of affairs with regards to our progress moving forward. If I can offer an alternative vision, it’s what we saw tonight with every single party in Parliament coming together to form the cross-party group on mental health and addiction wellbeing, which I’ll get to later.

But included within Vote Health for the past year, which we are obviously reflecting on—it’s important to, obviously, note the $1.9 billion in investment, which I note members of the Opposition have said it’s important to not just talk about the amount of money that’s being spent but to talk about the outcomes. Members of the Opposition have critiqued the co-design process that this Government is currently working through to ensure that these services are culturally appropriate, but, ultimately, as was stated by the Minister in front of the committee when they were grilling him on this Budget—and it is contained within the select committee’s report-back to this House—the point is to get to a position where in this country any New Zealander who is experiencing a mental health or addiction problem is able to get culturally appropriate, accessible, and affordable services that work for them whenever they need them.

One of the most obvious manifestations of this that we’ve seen so far is the Piki pilot programme, available for 18- to 25-year-olds throughout the Greater Wellington region. Myself and the Associate Minister of Health, the Hon Julie Anne Genter, just earlier this week were out there announcing in the Hutt Valley the final stage of this roll-out that encompasses three district health boards. This is a crucial part of delivering on the Green-Labour confidence and supply agreement, particularly to make sure that we have fit for purpose mental health service provision for young people in this country.

An important part of that process is recognising that different people need different things at different times. So we’re not just looking there at telehealth services. Nor are we looking just at face-to-face counselling, but indeed we’re also looking at developing a peer-support service, in which notably all of those who are involved and have been trained up as peer support workers will be paid the living wage.

We have also throughout this process—it was in November 2018 that He Ara Oranga, the Government initiated inquiry into mental health and addiction report, was finally released. This is a crucially important cornerstone of the Government’s response to mental health and addictions. Importantly, what it did was set the foundation, or the blueprint, for no longer seeing mental health and addiction, the wellbeing of all New Zealanders in this country, simply through the lens of something that is medicalised or pathologised, but instead something that occurs in the context of their broader life. Importantly, as was stated in He Ara Oranga, even if people have underlying biological susceptibility towards manifesting mental health issues, it is their environment which can either exacerbate or minimise the manifestation of those problems. So, ultimately, the point I’m getting at is that we need to ensure that we are providing people with that security in terms of housing, in terms of income, and in terms of security of their future.

Finally, just to briefly round off tonight, we launched the cross-party group on mental health and addiction. Of course, service provision is never going to be a panacea for ensuring the wellbeing of all New Zealanders in this country. What we need to do is ensure that we are providing a culture that is conducive to that wellbeing and support for all.

I call Anahila Kanongata’a-Suisuiki. You actually have to verbalise your call.

Oh, right. Kia ora, kia ora, Mr Chair. It’s a privilege to stand and make a call on the health Estimates. Before I do that, it would be remiss of me not to comment on some of the—I’m not sure of the contributions from the other side in terms of them saying, “They’ve had 18 months to do something. Can’t they do something now?” Reports have said there is evidence that in the nine years of National, many of our social issues, including the health system, were being ignored, and now we are paying the price for them.

I want to acknowledge Dr Liz Craig’s contribution and her analogy that New Zealand was malnourished—in her analogy of New Zealand under National, we were malnourished. In fact, it was shown, especially in South Auckland at Middlemore Hospital, where sewage was seeping out of hospital walls. There was no plan for cancer, underfunded Pharmac, and an underfunded health system by over $2.3 billion.

I want to acknowledge the leadership of the Rt Hon Jacinda Ardern, and I want to take us to the priorities of the Wellbeing Budget. It’s always a privilege for me to stand and make a contribution. The Wellbeing Budget, I want to remind everybody—I could just say it’s medication for what National has left us after nine years: taking mental health seriously, improving child wellbeing, supporting Māori and Pasifika aspirations, building a nation, transforming the economy. What that is saying is that we are looking 30 years ahead, not just three, and unlike National, who were basically doing nothing in the last nine years.

I want to acknowledge the Minister the Hon David Clark in terms of our vision. Our vision for the future is one where people in distress—the support they need is when, where, and how they want it. That’s why, as a Government, we have asked for the report of the Government inquiry into mental health, He Ara Oranga. The reason why is that we needed to hear from people about what they needed, and that’s what happened. Mental health is an example of how actions speak louder than words—actions speak louder than words. We said we’d do an inquiry, and we’ve heard from the chair of the Health Committee that the majority of those recommendations from that inquiry are being undertaken by this Government. What that is saying is we have a plan for mental health. What we’ve seen, when we say we’re taking mental health seriously—if we take us back to the report of the Health Committee, on page 3 what it talks about is that Vote Health has been allocated $827.3 million over four years, with a total of 16 new policy initiatives, where there was underfunding for mental health and wellbeing. We’ve heard that the priority was identified, like I said, through talking with New Zealanders, as identified by the He Ara Oranga report.

I want to just share some of the package in terms of when we say we’re taking mental health seriously, in terms of a free, nationwide, front-line mental health service that is easy to access and immediately available for anyone suffering from mental health issues, benefiting hundreds of New Zealanders. We are in an era where we are talking to ourselves more than ever, individually. Technology, social media—every New Zealander speaks in their mind every day in terms of social media, and what that is saying is that we need to look in those areas and invest in mental health.

I want to take us again to the Health Committee Estimates report, on page 4, where it talks about how it aims to have access for mental health. The pivotal words in there are “access to mental health”, and that’s what we’re doing. That is what this Government is doing, and I want to acknowledge the Hon Jenny Salesa there, who’s in the chair, in terms of her previous Budget announcement about rheumatic fever in South Auckland, something that the National Party was doing really well, but then they stopped funding it—doing something well and they stopped funding it. I want to acknowledge the Minister on her leadership in that investment back again into South Auckland. Thank you.

Thank you so much, Mr Chair. I’d like to first of all acknowledge the passing of Mr Pita Paraone. I know that he was one of the colleagues, a former New Zealand First MP from Ngāti Hine, and he is related to so many of our Māori MPs, and he will be missed—such a humble man of integrity. I wish his family well. May he rest in love.

After nine years of underfunding, after nine long years of neglect in the health sector, I want to first of all touch on infrastructure. Our Government is investing in rebuilding the health system, and we are investing in building and maintaining our hospitals. When we came into Government, one of the things that Treasury told us was that it would take an investment of up to $14 billion—$14 billion—just to fix our hospitals and to make sure that they are well maintained right throughout Aotearoa. When one of our speakers was talking earlier on, quite a few of the folks over on the Opposition side were kind of shouting out, “Oh, the hospitals are not really that bad. It is rubbish.”—that, you know, we do not need to fix our hospitals that badly. Middlemore Hospital is a hospital right in my electorate in South Auckland, and just over the weekend I was actually spending some time in the hospital visiting a relative, and I can tell you there were at least two of the big hospital buildings in Middlemore that were all covered in plastic. Why? Because they are fixing it up, because the walls are rotting, because it has been leaking—and, yes, as per the Minister of Health, there has been some sewage that has been going down the walls at Middlemore Hospital.

We came into Government, and in just over two Budgets we are investing $1.7 billion to fix up our hospitals. Our last Budget, we’re investing $850 million, and that’s in addition to the investment that we made in our first Budget. Compare that to the previous Government. Their last Budget investment in terms of capital for hospitals was $150 million. Now, how can you fix up all of the issues in hospitals with only $150 million when Treasury tells us that it will take at least $14 billion to fix our hospitals up? There have been nine very long years of non-funding and neglect, and we are investing to rebuild our hospital systems up.

The other thing that we’re doing as a Government that is different to what the last Government did is we are actually partnering with industry, because we know as we are fixing up our hospitals, we also need to train and to attract young people to come into the building and construction sector. We know that industry is also very interested in ensuring that we train up our young people.

In terms of cancer, we hear the calls from the Opposition saying, “Where is the Government’s plan in terms of cancer?” Well, I’ve got good news. On Sunday, our Prime Minister, the Rt Hon Jacinda Ardern, will be announcing our cancer plan, and I cannot wait to hear more, because we are a Government that has really invested in fixing things long term. We do not just come in and tinker around the edges. We are about fixing things long term.

In terms of Pacific and Māori, we’re investing $12 million in terms of rheumatic fever, because we know that two-thirds of the rheumatic fever cases are in Auckland, and especially in South Auckland. But we also know, because the feedback from Māori and Pacific providers and our families—they’ve been telling us that the services that work for them are when they actually have a say in designing those services. So we are ensuring that “by Māori for Māori” and “by Pacific for Pacific” providers have a big say in ensuring that those services get out to them.

In terms of wellbeing, we are also investing $47.6 million in the Ministry of Health, the Ministry of Education, and Sport New Zealand, because we know that in order to address things long term for our young people, we need to ensure that our nutritional guidelines in our schools are actually something that the Ministry of Health is working on. We also need to ensure that more of our schools have water only in their schools, and we also need to ensure that our children are eating nutritional, healthy foods, because that is the way to address health long term. Thank you, Mr Chair.