Pae Ora (Healthy Futures) Bill

When we last considered this bill, we were up to call No. 10, which, of course, is the Labour Party.

Thank you, Mr Speaker. It’s a real pleasure to speak on the second reading of this bill, which I think provides a once-in-a-generation opportunity to transform the health sector. And I’d like to start by thanking all of those who submitted on the bill, because a lot of their suggestions led to some really useful changes. I think a lot of those have already been canvassed in previous speeches.

What I’d like to focus on is strategic planning, which is a core part of the bill, because what the bill does is it establishes a whole suite of key strategic documents. Within those four strategies—a New Zealand health strategy, a Māori, a Pacific, and a disability health strategy—basically, what we have is a lot of submitters that then suggested that we added other strategies to that, focusing on children, the rainbow community, Asian people, refugees, rural communities, rare disorders, mental health and addictions, women, and medicines. I think one of the challenges the Pae Ora Legislation Committee had is thinking about how you could actually achieve overall consistency if you ended up with a whole lot of different strategies, which each pulled a particular issue off into its own separate strategy, and then how you would consider the strategic direction as a whole, because there was a real concern that you may end up with fragmentation.

So what we also looked at is whether, in some of the existing suite of policy documents within that, you could include the health needs of those particular groups and, in particular, for example, the new Government policy statement (GPS) on health. What that does is it sets out the Government’s overall priorities and objectives for the health sector over three years. In addition to Māori and Pacific and disabled people within that, which are already included in the strategies, it also states that the GPS must include the Government’s priorities for improving health outcomes for women, rural communities, and other populations. So there are some of those aspects already touched on in the overall GPS. Then, also in locality planning, the requirement was that Health New Zealand had to consult with those within the localities, not only those in the community in terms of service users but also their service providers, and their input, too, could be included in terms of particularly thinking about strategic approaches to rural communities. We were also advised that there wouldn’t be anything precluding other strategies being included in future.

So we were happy that the strategic policy documents with the addition of a women’s health strategy would cover the areas we need, and I commend this bill to the House.

Thank you, Mr Speaker. I rise for my first opportunity to take a call on the Pae Ora (Healthy Futures) Bill. And while I would commend, as the National Party spokesperson for women, the inclusion of a women’s health strategy, and acknowledging the Minister for Women in the Chamber this afternoon, please, please, don’t let this opportunity pass you by, because I would say, of the rest of the bill, what a missed opportunity. What has been touted as a generational reform, a once-in-20-years reform, this bill is the Government’s so-called answer to the recommendations made in Heather Simpson’s report released a couple of years ago, which sought to actually improve the delivery of healthcare across the country. Unfortunately, what we see in this bill will most certainly not achieve that.

All I can tell from this bill is that it is going to rip the guts out of community healthcare providers. It disestablishes district health boards; their services will instead be run by locality commissioners, locality coordinators, and up to 80 locality networks, which will add layers and layers and layers of bureaucracy between patients, providers, and the Minister. In the entirety of this document, a $500 million reform, there is not one target for a single improved outcome. I would have thought half a billion dollars on a sector-wide reform would demand some improved outcomes at an absolute minimum.

Labour seems to think that you can achieve better health outcomes by putting more power in the hands of bureaucrats. As a rural Cantabrian, let me tell you this is not the case. If it is passed as it is written, this bill will simply make the system less responsive to the health needs of Kiwis, especially those who live rurally, and that is where I’d like to focus my comments this afternoon. Heather Simpson’s report mentioned “rural” at least 30 times—I think 34, to be exact. This bill mentions it once—once. This is an extraordinary indictment of the Government’s view on 750,000 New Zealanders, 15 percent of the population, who contribute 50 percent of our national GDP. In a stroke of irony, on the Primary Production Committee today, we have had the Office of Rural Communities in front of us. Their role is to pass a rural lens over legislation like this, which passes through the House.

💬 Chris Bishop: How’s that going?

Now, well, that’s the point, Chris Bishop. How is it going? I asked them that. I said, “What tangible outcomes, what results, what changes have you as an office been able to make on bills like Pae Ora, like three waters, like fresh water reform?” Answer: “We don’t measure them. We haven’t really had much impactful change.”, which says to me, once again, that a Government who thinks it can run everything from Wellington is a recipe for worse health outcomes in underserviced communities, not better.

I would love to hear this Government face up in Leeston to the Friends of Ellesmere Hospital. This is, to be fair, a 95-year-old building that’s been running in this community all that time, servicing the needs of aged care and those convalescing post-surgery. There are just 10 beds in it. It is the beating heart of this community. It was shut during the pandemic to try and centralise all services into Christchurch. Thirty minutes’ drive away in Darfield, at the other end of my electorate—talk to me about the trustees of the Darfield Hospital and all the time and effort they put in to service their local community; also shut. Now, here’s the clincher: when I go and speak to the DHB about whether or not there are plans to continue the provision of these services in these rural communities post-pandemic, they all say—they throw their hands in the air, they look at me and ask us, and they all say, “We don’t know. We cease to exist from 30 July.”

I would also recommend that the Government take it from the experts that appeared during the select committee process. There were a number of rural health groups that highlighted their concern, as well as those who are actually operating in the field in rural New Zealand. The Rural Health Alliance said that they were “very concerned with the lack of focus on rural communities” and that “it is well documented that rural communities have poorer health outcomes than urban communities.” The Rural General Practice Network said that “rural New Zealanders need to be added to the list of priority populations. Health inequities will remain and might well worsen if focus shifts elsewhere.” Both these organisations that have spoken at the Pae Ora Legislation Committee on this bill want to see rural communities added as a priority group in the legislation. This priority group would therefore mean a targeted rural health strategy and specific rural health outcome measurements. The report—the one written by Heather Simpson—said that “rural services should be specifically planned for, recognising the unique challenges of [those that live rurally]”.

So, to put it simply, my challenge to the Government: it has one more opportunity—when this bill gets to the committee of the whole House stage, it has one more opportunity—to prioritise rural people, to enshrine their needs in the legislation so that there are targets, there are outcomes. Fifteen percent of this population—750,000 New Zealanders—should not be forgotten by this piece of legislation and by this Government. Please, my plea to the Government, do not forget these people. Take this opportunity to enshrine it in law, otherwise this is a massive—massive—missed opportunity.

E kore e taea e te whenu kotahi. Ki te raranga i te whāriki. Kia mōhio tātou ki a tātou. Mā te mahi tahi o ngā whenu, mā te mahi tahi o ngā kairaranga, ka oti tēnei whāriki. I te otinga me titiro tātou ki nga mea pai ka puta mai, ā tōna wā me titiro hoki ki ngā raranga i makere nā te mea he kore anō kei reira.

[The tapestry of understanding cannot be woven by one strand alone. Only by the working together of strands, and the working together of weavers, will such a tapestry be completed. When completed, we should look at the beauty of the work, and sometimes we also need to look at the dropped stitches as there may be errors there.]

It’s right to begin my speech with a whakataukī o pōua Kū Tirikatene, an advocate for the health of Māori and wellbeing of our people, and a thoughtful leader, and a proud Cantabrian. The whakataukī is salient when we consider the change case for our health system.

Stitches have been dropped over many years, which have resulted in poor outcomes for many people, most starkly Māori and Pacific communities. Improving the equity of health outcomes achieved in New Zealand requires first that we acknowledge the current inequities are not acceptable, and that we see those stitches that have been dropped and understand their message. The old health system was not set up to understand the needs of individuals, whānau, and communities, and so the system could not design and deliver services to address those identified needs.

There’s a lot I’d like to say on this bill, but I want to acknowledge some of the comments of my colleague Dr Shane Reti which I was disappointed by, and I want to thank the members of the Pae Ora Legislation Committee, its advisors in the Department of the Prime Minister and Cabinet, and its clerk, Anna Platten, and her team. Those comments that Dr Reti made about the disrespectful and deceitful start to the committee were a disappointment to me—

💬 DEPUTY SPEAKER: Order! Order! I’m on my feet; you have to sit down. No, you cannot say that another member is deceitful. All members are honourable, so you must withdraw and apologise.

Sorry, Mr Speaker. May I clarify?

💬 DEPUTY SPEAKER: Just withdraw and apologise.

I withdraw and apologise. What I intended to say was that that member said that there was a disrespectful and deceitful start to the committee that was the Pae Ora Legislation Committee. I wish to bring a perspective: that those specialised committees have an important role in generating the kind of debate which is consensus building in this House, and engaging on technical points of law. I thank the committee, the clerks, the submitters, for rising to the challenge of this new mechanism that we have.

Nā reira he mihi tēnei ki Te Whare e tū nei.

[Therefore, I acknowledge this House that stands here.]

It’s always a privilege to serve in this place with you all, and a delight when we’re making a project like this.

The question is, That the amendments recommended by the Pae Ora Legislation Committee by majority be agreed to.