Estimates Debate — Health

We will now move on to the Estimates debate on health.

Thank you, Madam Chair. It’s an absolute pleasure to, as chair of the Health Committee, provide an overview of the health Estimates hearings for this year. Health is an incredibly busy sector. There’s a lot going on, and the total appropriations for Vote Health this year were just under $24.4 billion. Within that, the Minister of Health is responsible for the appropriations of just over $23.5 billion, and also the Minister for COVID-19 Response is responsible for the multi-category appropriation called National Response to COVID-19 across the health sector, of $894 million. So what we did is we had separate hearings this year from the Minister of Health and the Minister for COVID-19 Response, and so today’s debate will focus on the non-COVID appropriations, with the appropriations relating to COVID-19 and managed isolation and quarantine being covered in another debate.

So, basically, we had a whole range of discussions in our Estimates hearings on health, and that included the upcoming health and disability sector reforms, funding and the roll-out of mental health services, quite a bit of discussion around cost and volume pressures for DHBs and primary care. We talked about cyber-security, we talked about improving health outcomes for Pasifika communities, and we also talked about capital and operating expenditure, and how we can fund some of that—you know, our buildings and infrastructure. We also talked about progress on the New Zealand Upgrade Programme. We also focused on some of the new spending that we’re going to be looking at in terms of expanding cancer screening—HPV screening for cervical cancer, for example—extra funding for road and air ambulance services, establishing an Aged Care Commissioner, and also extra funding for Pharmac.

In the time available, I’d like to just go into a bit more detail on a couple of those, starting with the health reforms. As we know, in April this year, in response to the Health and Disability System Review the Government announced reforms of the health sector. This includes disestablishing our 20 DHBs and establishing two new entities: Health New Zealand and the Māori Health Authority. As many are aware, Health New Zealand will assume a lot of the functions of DHBs, taking over their contractual arrangements and their assets, and also assume functions of the Ministry of Health. The Māori Health Authority will lead the commissioning of Māori health services and co-commissioning services which significantly impact on Māori. So we heard that Budget 2021 includes $486 million over four years to implement these reforms, and that not only includes cost of restructuring but also includes the commissioning of some services. When the Minister was talking to us, he was talking about the fact that establishing these structures and looking at the respective governance and decision-making arrangements would need to be rolled out over a four-year period.

Some of the Budget is for the Ministry of Health to establish these new entities—Health New Zealand, Māori Health Authority—and some of the associated functions, but there’s also some other spending: for example, for Health New Zealand, some funding to pilot the local network planning approach that sits and underpins those health reforms, and also funding over four years for the Māori Health Authority. The Minister talked about how Tā Mason Durie is leading the steering group of Māori leaders and having discussions within Māori communities about how the Māori Health Authority might operate. He also gave examples of, for example, screening campaigns for cancers that disproportionately impact Māori as an example of where the Māori Health Authority could advocate for policy that addresses disparity for Māori.

Some of the members that were present asked, given that we’ve got a big piece of work in terms of the health reforms but we’ve also got equally big pieces of work around rolling out the response to COVID-19 and the vaccination programme, whether we could do both together. Certainly what the Minister responded with is that he’d had extensive discussions with the Director-General of Health and with the Ministry of Health, and he believed that we could be doing both simultaneously—particularly given that we’ve got additional resourcing in Budget 2021 to assist with that. We also had a lot of discussions around mental health services, given the increasing demand for mental health services across the country, and discussed the funding of a number of various programmes. There was a range of other issues that I’ve highlighted in the beginning of my speech, but what I will do is leave my colleagues in the Health Committee to ask the Minister further questions in these and other areas. Thank you.

Thank you, Madam Chair. It’s a pleasure to speak to the Estimates, which were held on 9 June 2021, and I’d like to thank the Minister for joining us today. I’m going to pose questions across five domains, a few questions in each. The first will be around health restructuring; the second, older people; third, dental; fourth, a question on Vote Health; and a fifth around Pharmac.

I have three questions in the first area, then, around the health restructuring, which is what we discussed at the Estimates, which I’d like to pursue further. The first is, he’s received at least two papers identifying transition risks in the health restructuring—my question is: what are those risks? What risks have been identified? The second question I have is: what are the indicative staff numbers for the Māori Health Authority, Health NZ, and the Ministry of Health in the restructuring? And my third question in this tranche is the costs in Vote Health were $486 million for the health restructuring, but in a written parliamentary question a few days ago we find another $60 million in the maternity health budget for health restructuring. So my question is: when we add up the total, not just the $486 million line item, but also these tens of millions in other places, what is the total number for the health restructuring? Thank you.

Thank you, Madam Chair, and I thank the member for his questions. Just in relation to what he describes as two papers on transitional risks, with every transition, with every reform, of course, there are risks. That is about making sure that the machinery of Government is geared up to get through the legislation, the policy advice, and then the implementation, and there are always risks around implementation. There’s issues of capacity, capability, and competence, and we need to be alert to do those so that as we embark on the reforms, we are making sure that those factors are taken account of, that we manage the transition process in a practical, pragmatic sort of way.

I’m very satisfied with the progress that has been made, the advice that has come to me for ongoing decisions, and the advice that is being provided to Cabinet as we reach the various milestones. The next major milestone will be the announcement of the governing boards of both Health NZ and the Māori Health Authority, who will then be charged with making sure those organisations are set up. There’s always the risk that extant issues such as the COVID pandemic cause further delay. If there is a further outbreak that requires a further lockdown, then that would have an impact on it as well. But at the moment, there is no factor that is bearing upon the implementation of the reforms.

The second question related to indicative staff numbers, and I know the member has raised this question before, including in written parliamentary questions. We know that when Health NZ is established, because it will be an amalgamation of the current district health boards, plus relevant staff from the Ministry of Health, actually its workforce will be in excess of 77,000. The current DHB workforce is 77,000. So it’ll be that, and then whatever sort of transfers in relation to the ministry. In terms of the Māori Health Authority, it would pick up some people out of the ministry and they will pick up some people out of the DHBs, actually. But I can’t give a particular figure, and until that board is in place, the interim board is in place, and they have an interim chief executive and they start the detailed planning about their organisation and how it wishes to operate and where we will be located, how it will be structured—that will be a matter for them.

They have a budget for the initial phase. Their budget, I might add, also includes some commissioning funding, and that’s roughly $100 million. They will do some initial commissioning as they get kaupapa Māori services expanded and further under way. And then they will be also setting up their co-commissioning arrangements with Health NZ. So I can’t be more specific about that. But we will have a Health NZ and a Māori Health Authority workforce that reflects the needs of a modern health system delivering equitable healthcare for Aotearoa New Zealand, which we don’t have at the moment.

Thank you, Madam Chair. I’ll put two questions together. One, in the domain of older people, the $385 million annual GP check that was cancelled. My question is: are the funds from that retained in the older people domain as a whole? We know the aged-care commissioner, I think, may have about $8 million, so that talks to part of it, but what happens to the rest of those funds? Do we have some sort of commitment that that whole $385 million is retained specifically for older people as it was in the original proposal?

My second question is around dental mobile. The campaign promised that there would be 20 mobile dental caravans this year. They are not in the Budget; they are absent. How do we explain that? What are the consequences of that?

While I’m on my feet, I’ll actually just deal to a few other questions. I’m interested to know if he received a letter from the Director-General of Health in December, talking about cost reductions—or, more specifically, “managing downward cost pressures”—and whether items such as reducing specialists at provincial hospitals were raised, whether reducing the eligibility for aged-care residential and for disability was raised in that letter from the director-general.

And the last question that I’ll ask, which actually covers all of the domains I was looking for, is around Pharmac. I’m looking for a guarantee that children who are currently receiving unfunded cancer medicines from Pharmac, and are receiving those medicines administered in the DHB system, that they will continue to receive their cancer drugs administered in the DHB system; newly diagnosed children with cancer, I’m looking for some reassurance that they will continue to be able to have the medicines that Pharmac will not fund, at least administered in the DHB system. Thank you.

I’ll deal with the last question first because that has been dealt with before and I’ve been very clear that children’s cancer treatments that are currently provided will continue to be provided. Pharmac is undergoing a review, that review is not complete, and they have been very clear that children receiving treatments at the moment will continue to receive whatever treatments they are receiving.

If I go back to the first of his four questions in that slot, in relation to the money for the senior GP check, advice was very clear that that was not a well-targeted or efficacious spend of taxpayer money or health money, and so that particular policy was not proceeded with. We know that one of the major problems we have in our health system at the moment is inequitable access and health outcomes. So we are not going to fund more policies and programmes that just add to the inequity. We’ve committed to an aged-care commissioner. In terms of the additional funding provided to DHBs this year, obviously they are negotiating their contracts with aged residential care, so there is an expectation that more will be spent in that sector as more people take up that form of care and the DHBs pick up a large chunk of that cost. So money is continuing to go into elder care or senior care. That does not change.

In relation to mobile dental clinics, no, we did not fund mobile dental clinics in this Budget, but this is a Parliament of three years. We are the Government; we have two more Budgets to go. So I invite that member to watch this space.

Finally, in relation to any letter from the director-general, I do not recall receiving any letter from the director-general advising on any of the matters that he referred to. I know the member is desperate to demonstrate that a draft of the letter that was provided is important; it wasn’t. I didn’t accept it. I sent it back. There has been no such letter as he indicated from me to the Minister of Finance. In the end, it is not draft letters that matter; it is the one that is actually sent. The one that was actually sent is the one that is reflected in the Budget that we have got.

💬 Dr Shane Reti: Yep, you received it. It’s in your thinking.

Well, the member says, “It’s in the Minister’s thinking.” It clearly isn’t, because I sent it back, because it is not part of my thinking. But I understand when you’re Opposition and the polls that you have now, you’re desperate for anything. But the reality is this: when you compare this Government’s funding record on health in the nearly four years it has been in Government to the nine years of the previous Government, what you see of this Government is considerably more investment not only in operational spending but in capital spending as well, because the reality is that we have inherited a public health system that has been so badly run down, so badly served by the previous Government, we’ve got a major catch-up job to do. I’m very pleased with the progress we are making. I wish it were faster, but we are making progress and good things are happening.

Thank you, Madam Chair. We heard from the Minister of Health about—as my colleague Liz Craig said—the appropriations that weren’t related to COVID-19. The most significant, I think we would all agree, was the reform of the health sector. In April 2021, in April of this year, the Government announced significant reforms to the health sector in response to the Health and Disability System Review. Now, its proposed changes include disestablishing the 20 DHBs, as we’ve heard, from July 2022 and establishing two new health entities, both Health New Zealand and the Māori Health Authority. So when we think of Budget 2021—as my colleague across the House, Shane Reti, said—it included around about $486 million over four years to implement the health sector reforms. So I’m wondering whether the Minister can talk a little bit more, or provide some more detail, about how performance of that appropriation will be assessed; and, specifically, what are some of the kind of key milestones in the implementation plan that’s been agreed by Cabinet. And, I suppose, more grassroots-wise, specifically bringing it home, what can ordinary New Zealanders, everyday New Zealanders, expect to see over the remainder of this term in relation to those appropriations?

I thank the member for her questions. I think, in addition to the $486 million to implement the health reforms, which includes funding for the transition unit and also for the Māori Health Agency and Health New Zealand—when those organisations are set up on an interim basis, the member might also be aware, in addition to that amount of money, there was also $380-odd million appropriated for a significant IT upgrade of the health system. In fact, there has been further funding of about $116 million for another part of the IT system that processes the 90 million payments that get made out of our health system at the moment. So what we’ve also discovered is that, in addition to rundown hospital buildings, a workforce that is stretched, and a workforce that is short of what it is needed, we’ve also discovered IT systems that are simply not up to the mark. So we have to fix all of that.

When we came to the reform process—as a consequence of the Health and Disability System Review report that we published at the end of last year that followed a very thorough analysis of the system; extensive consultation with communities around New Zealand; and a very close, considered study of our health system—it’s very clear that change was warranted. Change is needed. We’re not getting the benefits that we need in our health system when it is disaggregated across 20 different legal entities. And it is no criticism of anybody in that system, at the leadership level or otherwise. In the end, people respond to the structure they’re in and the environment that they are in, but the reality is technology has changed; the population is changing. Our health performance is revealing that we are simply not keeping up with health demand. And where people get health is changing as well. So we have to change the way we make health decisions. That’s what the purpose of this is.

We have the opportunity now to get the best across the various 20 hospital systems that we’ve got. And, for that matter, to ditch the worst. We have the benefit of scale, and that is going to be a real help when it comes to building the workforce and planning long term for the workforce. We will have all that.

In terms of implementation of those reforms, as I’ve said before, considerable work is being done. The next major milestone will be the announcement of the governing boards. That will happen in the next couple of months. Those interim boards—they’ll be interim organisations set up—their first task is to appoint a chief executive, an interim chief executive, whose job then is to start building the team that is needed to provide the leadership for those organisations. There will be engagement with the sector later this year and in the early part of next year as those interim bodies start to lay out what they’re doing, what their plans are. There’ll be an intensity of work, I think, from the beginning of next year in terms of systems, in terms of personnel, in terms of preparing for the cutover.

We’ll be working very closely with existing workforces across the DHBs at all levels to make sure that they are kept clearly informed about what is happening, but also what is expected. Where there are opportunities—because they will arise before the cutover date of 1 July—for people to pick up roles and provide that leadership, that will happen also. Then we’re looking at 1 July as, effectively, the cutover date to the establishment of a permanent Health New Zealand and Māori Health Authority. Of course, in the meantime, there’ll be legislation to pass. I expect that to be introduced to the House again in the next couple of months or so. That will go through the usual process and my expectation is that will be passed by the end of April next year. Then we will have a very clear path to the commencement on 1 July next year for the two organisations and the revamped Ministry of Health.

Of course, that’s not the end of it, because the reality is this is a significant shift for the entire public sector health workforce. So it’ll be two, three, four years of bedding in processes, procedures, workplace culture—which is going to be very important in establishing the leadership of those organisations. I have to say, everywhere I get around, every visit I make to hospitals and healthcare workers, everybody sees—in spite of the pressures that the system is under at the moment, they are truly excited about the opportunity that the reforms offer and they are looking forward to seizing those opportunities and making an even greater difference than they do at the moment.

Thank you, Madam Chair. Tēnā koe e te Minita. The current mental health system has been deeply rooted in Western science and it continues, like I said in my maiden speech, to keep my people sick. We know that New Zealand’s health system fails Māori. We can see this significantly in the staggering statistics that Māori are overrepresented in. The Ministry of Health figures show there were 31.7 suicides per 100,000 Māori males in 2016, more than twice that of the non-Māori male rate of 14.3 per 100,000. The rate for Māori women was 10.1 per 100,000 in 2016, which was just over double the non-Māori female rate of 4.9 per 100,000 people. Our mental health statistics are getting worse and they’re getting worse because the health system is rooted in Western science and built on identifying the “killer Ds”: disease, dysfunction, deficits, and disorders. Mental health funding is based on volume. The more sick people there are, the more money the Crown health agency rewards itself with, therefore, the “killer Ds” will guarantee your place in the funding banquet to feast on the disease, dysfunction, deficits, and disorders caused by this Westernised science model.

Māori have been conditioned to believe, through the Westernised science model and messaging, that we can’t cope with life and we as Māori cannot fix our own problems. That has led us to believe that we can no longer turn to our whānau, our natural support systems. As a result, we have been colonised into undervaluing our own systems rooted in mātauranga Māori, our power to create our own oranga. This solution is in Māori models of care like Whānau Ora, who received no funding in this latest Budget. This is backed by a massive body of research that supportive relationships and networks, motivation, fostering and building pre-existing skills and resources, focusing on strengths, connecting with whānau, having high hopes and expectations, and being helped with a plan tailored to their needs are the key ingredients necessary for someone to overcome their struggles. These key ingredients are what make up the kaupapa of Whānau Ora. Why? Because it is rooted in mātauranga Māori. From experience, I have witnessed amazing shifts in the confidence of our whānau through focusing on these areas. Therefore, all the Māori mental health funding should be devolved to a by Māori, for Māori approach to Māori kaupapa, like Whānau Ora, to ensure effective, enduring, caring, and inclusive Māori models of care which are rooted in mātauranga Māori. Thank you, Minister.

Madam Chair, thank you. I thank the member for his contribution. And, I think, what I take from that intervention is what we know is that there is a lot in mātauranga Māori when it comes to health that we are not acknowledging, respecting, and putting into practice to the benefit of Māori. That is why the Māori Healthy Authority will not only have an essential role to play in leadership of kaupapa Māori health but also be implementing it as well, having the power to fund new ways, new services alongside the many kaupapa Māori health services that are being funded at the moment.

That is about respecting—I think, what I’ve observed as I’ve got around is those Māori health practitioners who have that amazing skill of fusing. They impart their Western knowledge but with their mātauranga Māori, as well, and create very powerful and very effective solutions for their people. So, I think—not I think, but there will be huge opportunity for that. When I get around and I meet the Māori health leaders, there is amazing talent ready to be harnessed and ready to make their contribution and make their place in our broader health system. That’s just about recognising that when it comes to the human condition and humanity, there is no single way, and for those for whom both a scientific, a medicinal, and a spiritual response is required, then they’ll have the opportunity to have that and have all that woven together for a much stronger response and, in the end, for the benefit of all Aotearoa New Zealand, a much stronger health system, overall.

Minister, I’ve got two areas of questions that I want to go through: one around workforce and the second aspect around infrastructure. I have three questions in each of those areas.

The first is on workforce. In regards to the conversations we had through the Estimates process, how much in the Budget will specifically go to engage new healthcare workers, given the increase in workforce crisis, and has he been discussing this issue with any other Ministers?

Our second question: has he asked the Minister of Immigration to expedite residency processes for the thousand or so registered doctors and nurses who are currently in limbo in the residency queue, and if not, why not?

Lastly, we covered in Estimates the ambulance operations. What I’m interested in is whether he has received any briefings or correspondence from ambulance emergency service operators about staffing shortages in their sector?

I thank the member for his questions. In relation to how much is in the Budget for new healthcare workers, can I just say this. First of all, in the last three years, this Government has funded an additional 3,000 nurse positions—that’s just nursing—and there is a range of other additional clinical roles that the Government has funded as well. But the reality is, as the member identifies, that there are vacancies, and when it comes to the nursing workforce, we know there’s roughly, across the DHBs, 1,450 nurse vacancies. Those roles are funded, but they’re not filled, and so the challenge is not so much getting additional funding; it’s actually getting on with filling those roles.

There’s a bit of a vicious circle there too, and I suspect—and not just “I suspect”, but some of it will have to do with pay. That’s why the pay equity claim is so important, and getting that into the next phase, which is negotiating it and then getting that concluded and in place, and the conditions. So we know that the hospitals, in particular, have been under extraordinary pressure, partly because of the shortages of workforce, and then the shortages of workforce relate, for some who used to work there, to just how unattractive it became. We’ve got to address all of those things, and we’re going to address those serious workforce issues.

In terms of building that future pipeline of work, we have funded, in terms of the mental health funding, the longer-term work of additional clinical specialists. That work is under way, and we continue to work with the training providers to make sure that we are supporting that future pipeline.

In relation to the immigration issues the member raises, and I have had the discussions with the immigration Minister to make sure that the ability to get healthcare workers and healthcare specialists across the border is as easy as possible. The reality is, with COVID19, it will arrive—it is very difficult. But when you look at the exemptions granted to non-residents and non-citizens, of those coming across our border, 43 percent are healthcare workers, from your senior clinical specialists to a variety of others.

For those who are already here but who are wondering about either renewing their visas or trying to get residency, that is a piece of work under way right now, and, again, I’ve made my representations to the Minister of Immigration. We need to hold on to those that we’ve got, and I have had contact from many in that situation who are waiting patiently, who are doing an amazing job, and who we all understand that we need to make sure we have a very clear pathway for, and I’m confident that we will.

In relation to ambulance operations, the most recent advice I’ve had was actually in relation to the negotiations with the ambulance service and the road ambulance service providers, so that is under way. We’re renewing their agreement for a period at the moment, and then we’ll kind of review generally what is needed. But we continue to support those ambulance service providers, including providing support outside of budgeted appropriations. So in each of the last couple of years, we have provided top-ups to make sure that those services have attracted the people they need to fill the gaps that they’ve got and provide the high-quality service that New Zealanders expect of their road ambulance services.

Change is never easy, and, especially when it comes to health, it’s quite difficult. I just wanted to say to the Minister in the chair, Andrew Little, that we know that until the legislative changes are passed, the Ministry of Health and the DHBs will retain all existing statutory functions, powers, and accountabilities. How does Budget 2021 help DHBs to maintain and improve performances during this transition period?

Thank you, Madam Chair. I thank the member for his question. The member is right: the existing DHBs continue to be responsible for and accountable for the funding that they get and the services that they provide, and we will continue to ensure that accountability through the usual annual planning and expectation setting process, and that is well in train. The DHBs have their budget allocations for the current financial year. Their annual plans are coming back now—they’re not all in yet, but many of them are—and so they’ll be examined in the weeks to follow and they’ll be finalised and signed off.

We know that the big challenge is reining in the deficits. Pretty much every DHB has a deficit—some are significant and some more manageable. All DHBs are showing a willingness and, indeed, are demonstrating their keenness to rein in deficits for this financial year, because they understand that their legacy as the current governors and stewards of those organisations and their part of the health system is what they leave to Health NZ in terms of a well-functioning, well-operating, efficient, and financially responsible health service.

So that’s where we need it to get to. The Ministry of Health continues to work closely with DHBs, not just on financial performance but on clinical and other organisational performance too, because that remains crucial even as we’re going through this transition and as we head to 1 July next year.

Thank you, Madam Chair. I have questions regarding mental health, and, in particular, the Government’s response to the mental health crisis that is facing New Zealand. Two years ago, the Government committed an extra $1.9 billion for mental health over a five-year period—$235 million was allocated to building new mental health and addiction facilities—but we know that only five new beds have been delivered. So my question is: how many new mental health and addiction facilities are in the process of being built, and how long will it take for them to be built?

We also know that more funding, or more money being put aside for mental health, doesn’t necessarily guarantee improvements in people’s care. I would like to know, from the Minister, from the extra $1.9 billion that’s been set aside, how much of this is being analysed as to its cost effectiveness? Do we have any details on whether the mental health service wait time has been decreased because $1.9 billion will be set aside? Do we know whether there’ll be increased access to new services because this money has been set aside? Has there been a decrease in suicide attempts because of this money being set aside? What actions will the Government actually take to make sure that we have more accountability and transparency in where this money is going and whether it’s being spent, when we’re being promised that it’s being set aside to help solve our mental health crisis?

My last point I’d make is that the Mental Health and Wellbeing Commission released its first report, Mā Te Rongo Ake, and it looked into the response to He Ara Oranga, which was from the mental health inquiry. It listed that out of 36 of that inquiry’s findings, on a scale of one to six—one being the lowest; six being the highest—that the Government’s response has only got a one or two out of 23 of those recommendations. I would like to know whether that is the transformational mental health delivery that we were promised, or whether it’s a lack of that delivery. Thank you.

I thank the member, again, for her question. Just taking her points seriatim: she talked about the $235 million for facilities, and then says that only five extra beds have been delivered. So let me just disabuse her of one thing, that the $235 million allocated to either completely rebuilding or upgrading five facilities, that work has been commissioned, the planning and design is under way, but no construction has taken place.

So the five additional beds relates to the work that DHBs do from one year to the next to add capacity, or, in some cases, to reduce capacity. So if the member looks at the data over the last few years, she will see that, actually, bed capacity for mental health wards and mental health facilities fluctuates from one year to the next. Where we’re trying to get to with the new facilities is facilities that offer much greater flexibility, because there is fluctuating demand. You want to have facilities where there is enough space to do the kind of projected, business-as-usual demand, but when there are spikes, that there are spaces that are flexible enough to be able to convert into therapeutic spaces where people can be located. But that is where we’re going with those upgrades.

The member raises a very good question about the time it takes for capital works in the health system, and this is a matter of considerable frustration for Ministers, as it is, indeed, for patients, their families, and many others. But this is the system we’ve got at the moment. If you look at the last significant mental health facility that was built, it was commissioned in 2016 and it opened for business last year—no, in fact, I think it was 2015. So it was a five-year period. Myself and the Minister of Finance are driving work with the Ministry of Health at the moment to accelerate the time it takes to get capital projects that have been committed to, to actually get them built. I’m confident we will get there. So we’re working very hard to get those facilities built, because the need is there. Some of the facilities that are being replaced are kind of contrary to good therapeutic principles. So we need to get those changes as quickly as possible.

The member expressed concern about whether there is enough analysis going on to, effectively, the efficacy of the spend. I can say, when you look at what has been spent, of the $1.1 billion that is the Ministry of Health’s responsibility—that includes the $235 million capital spend. When you look at, for example, the money committed for the Access and Choice programme—so that’s the additional services provided for those with mild to moderate mental health issues—we’ve added 520 fulltime-equivalent roles across our health system. In May, they delivered 20,000 sessions to more than 10,000 people. So those are additional services. They were services that were not available and not being delivered before; they are being delivered now.

Without the benefit of a systematic review, what I can say is the feedback from all quarters is those services are making a big difference. There will be a review, because there always is, of effectiveness of spend. That will, no doubt, look at the impact of new services. Whether it’s possible to say that those new services have had an impact on, for example, attempted suicides, I’m certainly not qualified to say that, and that might be a matter that might be reviewed at some point in the future. But in terms of actions for accountability, I would have to say that the $1.9 billion appropriation is probably the most examined and scrutinised appropriation in Health that there has been for a long, long time. So there is a considerable degree of accountability being demonstrated about that. That is good; it ought to be scrutinised. We have had longstanding major problems in our mental health services, and I am very proud to be part of a Government that has really taken the bull by the horns, actually stepped up to really take seriously the need to make significant change to our mental health services. It’s a pity that it couldn’t have been done before, but this Government is doing it now. These things take time, but there are good things happening, and positive changes happening.

Thank you, Madam Chair. Minister, I have a small tranche of questions within the disability support area. Within national Disability Support Services funding, does this include any change in the $75 per day respite care payment? And if not, does the Government think it is acceptable for people who provide this respite care to be paid significantly under the minimum wage at just over $3 an hour for a 24-hour period? Is the Minister aware of how constraining that it is for families trying to secure respite care? Finally, in this tranche, are there any specific interventions planned within the disability funding to ensure equitable health outcomes for people with disabilities—given, particularly, the shortened life span of people with disabilities? Thank you.

Thank you, Madam Chair. I thank the member for her questions. What I can say to the member is that Budget 2021 provided an additional $399 million over four years for Disability Support Services. That is just to meet cost pressures. So we know that there is a significant need out there.

I’m not familiar with the arrangements for respite care. There are many different forms of respite care and many services providing respite care for those who need it. What we are determined to do is to make sure that the regime we have in place for disability support is not sort of pigeonholed as a health issue. The message I’ve very clearly heard from the disability community is that they are members of the community. They have a range of needs. One of those needs is health, but they require other social supports and psychosocial supports and what have you as well.

That is why, when we came to consider the Health and Disability System Review report, it didn’t go too far in relation to disability support services. Myself and the Minister for Disability Issues, the Hon Carmel Sepuloni, commissioned a further piece of work, which is looking at the future governance arrangements for disability support to pay respect to the very clear message we’ve heard from the community about their wish for a much better focused and much more representative level of leadership over the Government’s support that is provided to that community. So that work is under way. It’s due to report in a couple of months’ time. I’m looking forward to that, and I think the member can expect that there will be a new generation of leadership support for that critical area of support that the Government gives to that very important community.

Thank you. I want to ask a couple of questions on infrastructure. First question: is he confident no DHB patients are currently being seen in buildings that have been deemed unsafe to occupy? Second question: North Shore Hospital recently had a significant power outage. It interrupted clinical procedures—official information I’ve collected shows that it was caused primarily by ageing infrastructure—so is he confident that the Budget has enough funding to address critical infrastructure gaps in district health boards? Lastly, what additional hospital bed capacity is included in the Budget to deal with demand in the future, such as when COVID will be managed within our communities?

I move, That the committee report progress presently and move to consider the Reserve Bank of New Zealand Bill.

Motion agreed to.

Progress to be reported.