Pae Ora (Healthy Futures) Bill

I present a legislative statement on the Pae Ora (Healthy Futures) Bill.

💬 DEPUTY SPEAKER: That legislative statement is published under the authority of the House and can be found on the Parliament website.

I move, That the Pae Ora (Healthy Futures) Bill be now read a third time.

Tēnei tātou katoa e whakarongo ana ki te pānuitanga tuatoru o tēnei pire, he kaupapa whakahirahira mō te hauora o Aotearoa whānui.

[Greetings to everyone who is listening to the third reading of this bill, a very important matter for New Zealand - wide healthcare.]

This is a very important day for the future of the New Zealand health system. The Pae Ora (Healthy Futures) Bill sets out now, or charts, a new course for the health system for Aotearoa New Zealand. It starts at the very beginning of the legislation with its fundamental purpose, and that is it is to provide for the public funding and provision of services in order to protect, promote, and improve the health of all New Zealanders. That’s the starting point of this legislation.

This is a once-in-a-generation change for our health system, and there are a number of people I want to thank who have contributed to getting us to this point today. I want to thank my predecessor but one, the Hon Dr David Clark, who started the process of reviewing our health system, and he put in charge of that process Ms Heather Simpson, who chaired the Health and Disability Review group and who reported to the Government once they had completed that review. I want to thank Ms Simpson for her work and the others who were on that review group.

I also wanted to thank the review group’s Māori expert advisory group. They actually put up a dissenting opinion when it came to the final report, arguing for a conception of a Māori health authority that was different to what the review group itself had put forward. I can say that we were persuaded by the compelling arguments that the Māori expert advisory group put up, and that is reflected in the structure of the system that this bill represents today.

I want to thank the members of the special select committee, who reviewed submissions and reviewed the bill and made some very sensible changes to it. In particular, I want to thank the chair, Dr Deborah Russell, and also the deputy chair, Tāmati Coffey. I think that group did a stunning job. They had hundreds and hundreds of submissions, they heard hundreds of submissions, and they worked tirelessly and produced, I think, an excellent bill when they reported back.

I want to thank all those who submitted to the select committee as well and who told their stories, not just those who have been through the system as consumers of our health services but also the various experts and medically qualified people who also spoke and brought their insights and expertise to the committee.

I want to thank the tens of thousands of health workers who work in our public health system for the job they do every day—the job they’ve been doing for years, in many cases—putting up with a system that has put a lot of pressure on them. It hasn’t given them necessarily the best working environment, but we’ve heard what they have to say. They want change.

Everywhere I go, everywhere I listen to people, they tell me they want change, and this is the change that people have been asking for. For all those New Zealanders outside the health system but users of it who have also said, “We need to change. What we’ve got now isn’t working for us.”: Māori, Pacific, disabled people, women, those in rural communities, the rainbow community—everybody has said that we need to do things differently. If we want to allocate resources and we want to have a system that’s consistent, coherent, and fair across the motu, we need to make change, and this is the change we’ve got.

There’s one other person I want to give a huge thanks to, the person I have worked alongside in terms of these changes, and that’s my colleague the Hon Peeni Henare. I could not, as Minister of Health, have worked alone on this bill, and I could not have achieved what we have achieved as a party in Government but also as a House without the cooperation and collaboration with the Hon Peeni Henare. I thank him very much for his insights, his mahi, and his incredible connections through his networks that has enabled us to get where we are today. So I say thank you to everybody.

There are a number of changes represented in this legislation to the health system. The first and foremost is the principles now that will govern the system. That will govern the entities in the system, that will govern the Minister, and that will govern others in the system, too—those six principles that are set out in the legislation. They set the foundations for the system.

The first is that the health system should be equitable and that everybody should be treated consistently and fairly, because we don’t have that at the moment, and if we want to overcome the postcode lottery, this is the change we need to make. Every New Zealander deserves to be able to have access to the health services that they need when they need them, where they need them.

The second principle is that the health sector should engage with people to ensure that the services reflect their needs and aspirations, and that will be delivered through the locality planning process that we do in a way that we haven’t been able to do before. We will have much rich input from communities across the country into what they expect of our health services.

The third principle requires the system to provide Māori with the opportunity to make decisions that are important to them. That’s nothing less than the commitment that was made by the British Crown under Te Tiriti o Waitangi. It’s nothing less than the obligation that the Crown owes to Māori under the Treaty, and that’s what this legislation will deliver. It will allow Māori to make their decisions to exercise their rangatiratanga on this very important matter of the health of their people, and we saw it amply demonstrated in the COVID-19 vaccination campaign, where we handed over leadership and responsibility to Māori. They took it and they made the difference in the health of their people. Let Māori lead when it comes to health, and this legislation will allow them to do that.

The fourth principle is that the health sector should provide a choice of quality health services to everybody, and that means culturally safe services in our health services. It means a workforce that is representative of the community and services based on clinical leadership, technology, and lived experience. Those are all principles that are now woven into the way our health services will be led and managed and run. We will have health services operated in a way, as far as communities see, that works for them, and it’s about lifting the wellbeing of everybody. We need a health system that is connected with what is happening in housing, with what’s happening in employment, and with what’s happening in other spheres of people’s lives, because these are the determinants of health as well. So it must be well rounded and it must be enriched.

The fifth principle is that the health sector should protect and promote wellbeing. It’s not just about the person who fronts up to a doctor or a nurse practitioner or a health worker and says, “I’m feeling crook.”, because we need to know, if we’re going to help that person, what sits underneath that. Is it just the physical ailment, or are there other things that need to be attended to?

So principles alone won’t change things, but these principles, this legislation, and the structure that we’ve got, backed by the investments that this Government has made most recently in the most recent Budget—that is what is going to make the difference. That has been the pathway for this Government as we sought to address a health system that has been under-resourced and underfunded for so long and has needed a Government prepared to lead.

We saw it when we first took office, and we knew there was a mental health crisis because the mental health system had been so badly neglected for nine years under the previous Government. We did a review and we made the decisions, and we’ve made investment that has now added more than 900 new roles to the front line of our mental health services.

We saw that Pharmac did not have the confidence of a lot of people, so we reviewed Pharmac. We’ve now got that review back and we’ve now got the opportunity to make a set of changes that will bring in Pharmac as an integral part of our health administration, our health system, so that they can work in collaboration with all those other vital parts to make sure that their decisions are relevant decisions to improving the health needs of all New Zealanders.

We’ve seen it in the record investment in health this Government has made, not just in Budget 2022 but in pretty much every other Budget since. This is a Government that is backing the health system, and it’s a health system that continues to be under pressure, but we’ve funded extra positions—thousands of extra roles—in our health system, and we’ll continue working with that sector and working with the health system to make the improvements, to grow the workforce, and to make sure that New Zealanders have access to the best possible health system that we can produce.

In Budget 2022, we’ve corrected the historical funding shortfall in our system and we’ve put additional funding in on top of that: in addition to the funding shortfall, another $1.3 billion alone this year and every year thereafter. Then, from next year, another $1.3 billion on top of that and every year thereafter, and we’ve funded specific areas as well: more money into mental health, more money into ambulances, and more money into workforce development.

This is what you do when you take health seriously. This is a Government that has gripped up a health system that was in desperate need of attention and support and care, and we’ve given it. We’ve funded it and supported it, and we’ve now got the structure that will make sense. That means that we can make good decisions and treat all our hospitals as part of one health system for a population of 5 million - plus people.

We have one major piece of reform work to go, and that is the Therapeutic Products Bill. That will take legislation that is more than 40 years old governing our pharmaceuticals and our medicines and all those sorts of things, and we’ll modernise that.

This will be a Government that will go down in history as the health Government of the 21st century. I commend this bill to the House.

The question is that the motion be agreed to.

Thank you, Mr Speaker. History will look back and record 2022 as the time the Ardern Labour Government finally broke health in this country, and the damage they do here will last for years. The 36,000 New Zealanders waiting more than four months to see a specialist do not see their hips, knees, and cataracts being done any time soon. They only see an ideological health reform in the middle of a pandemic and at a time when New Zealanders are still dying from COVID every single day. The timing is terrible.

The 36,000 New Zealanders on waiting lists see ward closures at Auckland, Christchurch, and Dunedin hospitals. They see people with typhoid fever being told to sleep in a car at Middlemore Hospital, and they see their appointments being pushed further and further away. The timing is terrible.

The 50,000 women backlogged for breast cancer mammography do not see their appointments any time soon. They don’t see the $15 million required to fix that backlog or the backlog for cervical smears. All they see is Andrew Little letting $25 million of vaccines expire last month—enough to fund the backlog for both mammograms and smears. The health reforms have distracted this Government from cancer management, and there is a price to pay.

While I’m talking about cancer, I will send a warning straight up the middle of this Labour Government right here, right now. Many of us saw the section in the Government response to the Pharmac report last week that suggested changes to free cancer care for children. It read, “Pharmac is currently reviewing suitability of the child cancer treatment pathways”. If this Labour Government removes free cancer care for children, the 8lb. exception, I will fight you, the National Party will fight you, New Zealanders will fight you—and you will lose.

Under these health reforms, the regions and the provinces do not have locally elected voices at the table. Elected voices are removed, and all the regions see is a socialist Labour Government goose-stepping to the cadence of “Wellington knows best, comrades”. This could have been all different. If Andrew Little had resourced ICU beds, we might not have had to protect the health system by cancelling so many operations. Maybe lockdowns could have been shorter and the economic impact less damaging if he had built ICU beds instead of doing a premature COVID victory lap.

This Labour Government voted down my Supplementary Order Paper (SOP) demanding a health workforce strategy. The workforce is exhausted, and we are not a welcoming international environment. If Andrew Little had kept his promise to fully implement the safer nursing accord, if he hadn’t instituted a pay freeze for nurses, and if he had kept his pay negotiation promises, maybe we would have had more than just three critical care nurses employed to April in his much vaunted and then delayed Kiwi Health Jobs campaign—a sure reflection of our international perception.

The tsunami of mental health has had no trickle-down benefits from the $1.9 billion for mental health. There is no trickle in mental health—just a river of tears from blighted promises and outcomes that the mental health commission says do not meet the promises.

This health reform loses its moral imperative by removing health need as the sole arbiter and sole utility in the health system. In its place are inequities and Treaty responses. Neither are the same as health need. An unfair distribution of resources which defines an inequity does not necessarily describe the area of greatest need.

There are two ways to reduce inequities: the rising tide lifting the lows, or pushing down the peaks. Both seek to level the playing field. The belief is that maybe in the middle is where services might actually end up, but myself and others do not believe this Labour Government has any chance of delivering that middle. The Government does not have a track record of delivering in health and even less of raising the base. What they do have is taxpayer money, and, as we have seen, the way they use it in health is more money, more bureaucrats, for worse outcomes. This Labour Government’s ideological attempts to reduce inequities in health will simply drive services and outcomes to the lowest common denominator. That is where all will be equal—at the bottom.

This Labour Government voted down my SOP demanding an older people’s health strategy. This Labour Government cancelled a $300 million promise for free GP visits. This Labour Government decided their poorly targeted cost of living sham was not necessary for those on a pension. For these reasons, older people will vote this Government out.

Where is the place for general practice in these reforms? Not a word in the Minister’s speech. It burns his mouth to say general practice. General practice is the safety net that picked up the pieces when COVID couldn’t be managed any more in managed isolation and quarantine, the safety net that daily picks up the pieces when hospital beds are full, the safety net that daily sees patients when the emergency department is full. Where is the value acknowledgment for the role of general practice that these reforms hold out as solutions and yet fail to value and fail to fund?

There were signals of Labour’s arrogant posturing towards general practice well before they offered 3 percent in recent cost pressure negotiations when they knew that 12 percent is the real cost of their bungled management of the economy and inflation. A further signal of general practice being dismissed was in the recent request to primary care the week before that they stop work and help this Government design the health system and to take time off and to do so without being recompensed.

There were even earlier signs. The very first signal of general practice being taken for granted by this Government was the appointment of the interim Health New Zealand board without primary care representation. That was the first signal, a signal on a pathway that I believe seeks to break general practice and eventually nationalise GPs like the NHS—something Helen Clark tried to do and probably still is. General practice needs to be urgently supported and funded to be the cornerstone that it is.

To Māori, I reiterate that you are being thrown under the bus with these health reforms. If inequities and Treaty responses—anything other than health need—are the foundation to these reforms, then tomorrow it will be the depth of your pocket, and the next day it will be your value to society, and Māori will do poorly. It is the principle of health need that arbitrates fairness, and anything else condemns to the politics of the day. We support a strong Māori health directorate, not a standalone third system Māori Health Authority.

To Māori, look at these health reforms and ask yourself this. Where has the much vaunted Māori health veto gone? Why were iwi-Māori partnership boards deleted from Schedule 3? And why is the only redaction in all of the Government’s key health reform documents the section on the Māori Health Authority titled “Financials underpinning the bid”? This aligns with the $40 million for the Māori Health Authority in last month’s Budget that has been derided by many commentators as being insufficient.

National will talk the language of health outcomes for Māori. We will focus on function, not form. We will start with the two big inequities: cancer and cardiovascular disease. We will set targets and hold ourselves accountable. For Māori health, under National, we will get things done. National will talk the language of health outcomes for all New Zealanders.

There is much in these reforms that we would not do, but there is some we would. The formation of a public health agency, for example, has merit, and there are some things, like a semantic terminology, that simply have to be owned by a central Ministry of Health.

These reforms have no plan. Everyone is saying, “What is the plan?” There is none. The buzzwords evangelising primary care as the saviour for health are empty and hollow and cold. The buzzwords “looking for excess fat in the system” are fanciful in their naiveté. National has a plan, and over the next year as New Zealanders see that plan they will see that we understand health, that we are pragmatic, and that we get things done. For health, National has a plan. Follow us. Thank you, Madam Speaker.

Thank you, Madam Speaker. Thank you very much to take an opportunity to speak on such a significant occasion. Approximately 100 years ago, Sir Māui Pōmare was appointed as the National health Minister. He was the first Māori to be appointed to that role. And, then, of course, we come into more recent times, to the likes of Te Puea Hērangi, who continued to push for Māori health outcomes through the end of World War I, through the depression, and into World War II. And in recent times, again, in 1984, I remember the likes of Dr Pat Ngata, I remember the likes of Irihapeti Ramsden, I remember the likes of Erihapeti Murchie, Dr John Macleod, Eru Pōmare, who fought hard to make sure that Māori health inequities have a voice strong enough to challenge a system that continued to deliver status quo outcomes. And those status quo outcomes were clearly that Māori life expectancy was worse in the country, that Māori access to health services was some of the worst in the country, and that Māori have continued to be underserved by the health system for many, many decades. And when I look back on those times and I think of the likes of my matua Mr Rob Cooper, who fought hard to make sure that we could change the health system to better serve not just Māori but all New Zealanders, I look back and think of those names with great joy on a day like this.

It’s with great pleasure and optimism that I stand to support this bill, and I want to endorse the Minister the Hon Andrew Little’s words of thanks to many who work in the health system today, to the many who contributed to making this bill and where we’re taking the health reform work, and to the many who have contributed to make it better. I want to acknowledge the Minister himself. He was brave, he was bold, and he was prepared to work constructively to make sure that we can deliver to New Zealand a health system that they deserve. I want to acknowledge him and, of course, the rest of our colleagues in this Government for the support on this journey to make sure that we can continue to do the hard work, to make sure that off the back of a number of key announcements in the Budget just gone—as well as the Budget of last year—we can continue to deliver the services that our people deserve.

And in the House today, I took the opportunity to talk about bowel screening. That is a classic example of key decisions that we can make in a system that will allow those deliverables to be achieved, and that can actually make a huge difference for people’s wellbeing. Lowering the bowel-screening age is massive, but it can’t be massive on its own; it’s got to be in part with a sector reform, which is what this Government has undertaken.

A key part of the bill which drew a lot of attention—in particular during the committee stage—was, of course, the establishment of a Māori Health Authority. Dr Reti just said he would make a stronger Māori policy unit in the health system. Well, that is the status quo; that’s what’s already been there for the past 20, 30 years, and yet the health outcomes that Māori deserve have not been achieved. That is why we have to be bold. That is why we’ve made sure that we’ve established a system embedded in this legislation that will see powers across all levels of the health sector: to make sure that this health service and the future health service can continue to provide equitable outcomes for communities across this country. And I want to be clear. This isn’t separatism. No. This is a strong health system that will cater for all. If, at the bottom of that heap, improving equitable health outcomes for Māori will continue to lift health outcomes for all New Zealanders, then I’m disappointed the other side of the House won’t be supporting this. I’m proud of this piece of legislation. I don’t want to go on too much longer, because as much as we’ve worked hard to get to this point, there is still much more work to be done.

In the last minute of my contribution, I want to speak to the future generations. I want to talk to our tamariki and mokopuna. I want to speak to my mokopuna Te Ōmeka; I want to speak to my girls, who are nine and 10; and I want to say to them, “We promised you, and your ancestors promised you, a healthcare system that will deliver equitable health outcomes for you.” And I’m proud to say to them that they will look back on this day in the passing of this legislation as setting the record straight. We still have more work to do for all of our grandkids and our tamariki and mokopuna, but I’m proud that this day starts that piece of work off. It makes sure that we have a system that can deliver better equitable outcomes to our people, and I say to them, “We’ll continue to fight for you, and we’ll continue to fight for better health outcomes for our people.” I endorse this bill to the House.

Thank you very much, Madam Speaker. I’ll be rising on behalf of the National Party this afternoon to oppose the Government’s Pae Ora (Healthy Futures) Bill. I want to set the scene of where New Zealand is at today with healthcare. Today in the New Zealand Herald, the headline said “Wellington Hospital: Woman claims she sat in urine-soaked clothes for six hours in Wellington ED”—“Capital and Coast DHB says emergency department patients can ‘generally expect to be moved to a ward in a timely manner - but ED has been operating at full capacity in recent weeks.’” On Saturday, we had, in Radio New Zealand: “Health system hit hard by winter illness while ‘stubborn’ Covid-19 numbers persist … Last night, Dunedin Hospital closed all its wards to visitors after patients and staff on several wards were exposed to Covid-19.” The Dominion Post last Tuesday had a headline: “Hospital Emergency departments struggling as winter illnesses add to existing pressures”—“The demand for urgent medical attention is so high in some emergency departments they cannot physically fit all the sick people inside.” Finally, last week the New Zealand Herald reported: “Patient with typhoid fever slept in car due to lack of beds at Middlemore Hospital … He’s warning the South Auckland hospital is ‘imploding’, and says he’s terrified of what could happen if the usual respiratory viruses take hold over winter.”

That is the environment we are in. We are dealing with a pandemic, and, on top of that, the winter viruses are starting to occur and are gridlocking our hospitals. And what do we have? A Labour Government with its vanity project of trying to reform the health system in the middle of a pandemic, against all advice, throwing billions of dollars into bureaucrats, into consultants, into looking at things that won’t actually deliver better care on the ground tomorrow. Where are the priorities? Because this Government, they’ll call a big game; they’ll say “Look, you know, we’ve been looking at this, and we’ve listened, and we’ve responded—oh, let’s centralise.” That’s all they’ve got. The Labour Party playbook is centralising. Whether it be the polytech mergers, whether it be the Water Services Entities Bill that will be debated for the first reading on Thursday, and now the health system restructure, same old record. If there’s an issue, it’s socialist central planning—you centralise it. Because of course their bureaucrats in Wellington know how to deliver good healthcare out in rural and regional New Zealand. Well, that’s what this Government thinks. That’s why they’re going to throw money—good money after bad—into bureaucrats and consultants. Nothing in this process of the Pae Ora (Healthy Futures) Bill legislative process in Parliament over the last few months has given me confidence, and I don’t think it actually gives New Zealanders confidence as well.

You look at the issue around mental health—you’ve got a Government telling us today they’re trumpeting record announcements in health. But when you actually look at their track record, they trumpeted $1.9 billion for mental health and then the first report from the Mental Health and Wellbeing Commission said, despite the announcement of money for mental health, no material improvements. So here we have mental health—$1.9 billion and no material improvements. Yet this Government says, “Trust us. We’re going to pump billions of dollars into an ideological reform.”

And they can quote Heather Simpson as much as they want with the health and disability review, but, of course, the recommendation of the Heather Simpson report was to reduce 20 DHBs to eight to 12. Not take a wrecking ball to 20 DHBs in the middle of a pandemic, and in winter. And here we have them saying, “Trust us, we’re going to throw money at this. We’ve actually got a pretty poor record—KiwiBuild, Auckland light rail, the Auckland Harbour Bridge, mental health, the list goes on.”

Because when they say, “Look, we’ve been travelling the country and the health workforce is asking us for change”, I disagree. Because when I talk to the health workforce, what they tell me about the Government’s reforms is that they’re actually preoccupied, quite rightly, responding to a pandemic. So they are preoccupied. They’ve actually accepted change—they know no matter what they can’t change this; it’s coming in like a steam roller so they’ve just put their hands up and accepted it.

But what the most concerning thing about this legislation is—and talk to people on the Pae Ora Legislation Committee, talk to submitters, talk to the health workforce—there’s actually no detail in the bill. There’s no detail. I mean, for example, “locality planning”—no one actually knows what it means. And that’s the problem. That’s why there is the apathy for these reforms. No one actually knows what’s going on.

Then we had in the committee of the whole House stage, after the Government refused to put in a rural health strategy—they denied it to all the submitters who requested it. They went out into the media—the health Minister, Andrew Little—and said “No, it won’t be a priority group for us.” Then in the committee of the whole House stage—because the polls are starting to go south and their rural and regional MPs are getting the pinch from three waters and health reforms—they do a flip-flop. The audacity of it, after rural New Zealanders had to go through the heartbreak of thinking they hadn’t been listened to.

But, of course, it gets worse, because there is a group that they should have listened to in this bill and they haven’t. The mental health stakeholders turned up to the select committee and made it very clear what they thought about this bill. The Mental Health and Wellbeing Commission said mental health was invisible. How can we end up today with a Government who promises to transform the mental health system, but the peak stakeholder group says mental health is invisible in this bill and the Government refuses to do anything? The Mental Health Foundation of New Zealand said the lack of mental health, and the reference to it, in this bill is symptomatic of this Government’s lack of ownership and leadership in mental health. Because, of course, when the Mental Health and Wellbeing Commission came out with its damning report, not only did it say it didn’t find any material improvements, it actually said there was a lack of leadership in this Government. It actually said there was no clear, well-managed plan to execute change.

So for a Government who claims to want to transform the mental health system, they bring in a once-in-a-generation reform of the health restructure and mental health is invisible in the bill. And they won’t put in a mental health strategy, yet what they told us—Andrew Little told us today—the first principle of their bill is equity. OK, fair enough. What about the equity with people with mental health issues? People with mental health issues in New Zealand have a shorter life expectancy of 20 years in New Zealand. Yet this Government couldn’t even bring themselves to put in a mental health and wellbeing strategy in the bill. Listening? No. This is all about ideological reforms in the middle of a pandemic.

💬 Dr Shane Reti: Wellington knows best!

Exactly. Wellington knows best, the bureaucrats know best! They’re taking the local out of local people’s views. And I take great heart that, in 14 months, we will have a health Minister who actually knows about health: Dr Shane Reti. And he made it very clear today that when National is back in Government, we will bring back local people’s views into their health system. Because time and time again, this Government talks a big game, they say they’re listening, but then they bring out a pre-prepared solution: centralising. Centralising because they think Wellington knows best, but we know it doesn’t.

A shocking speech from the Opposition, but we’re getting used to it. The Opposition wants to denigrate all our attempts, in terms of finding some equity within the health system, simply because themselves and ACT, they see us as collateral damage in terms of the whole free market. It’s just shocking, really.

💬 Matt Doocey: Labour brought in the free-market reforms.

No, no, no—we know who brought in the free-market reforms. In terms of the Māori Health Authority—and I want to address my friend Shane Reti here—it was supported by the Cancer Society, the Lung Foundation, Kidney Health New Zealand, the Stroke Foundation, Breast Cancer Aotearoa Coalition, and the Gynaecological Cancer Foundation. Everywhere, right across the spectrum, we saw NGOs supporting the Māori Health Authority. You have to ask yourself: is it acceptable to keep propping up a health system that is failing so many of us, not just at Māori level but rural level, at Pasifika level, and in the disabled area? We should be able to obtain some of the standards of care that everyone in New Zealand enjoys. This bill introduces a set of health system principles that provide common expectations across the health system at all levels for all people and groups, and the principles describe the key aspects of a modern, compassionate, and responsible health system.

Now, the Opposition and the ACT Party, sadly, have been trying to frame some of the values in terms of Māori as divisive—not just Māori but Pasifika and the disabled—and somehow there’s some secret agenda that we don’t deserve. But when your people are dying seven years earlier—seven years earlier—than Europeans and when the Waitangi Tribunal says that Māori health is at a catastrophic, catastrophic state, that demands a change in terms of the system. That’s why I’m proud to support this kaupapa. I’m proud of the Labour Party. I never thought in my political lifetime that a mainstream political party would be so brave and so courageous to implement this type of kaupapa.

So we, particularly in the Māori caucus, thank our colleagues and thank our Prime Minister for being brave, for being courageous, despite the rubbish that comes from the ACT Party, in particular, and others out there who will accuse us of being separatists and racists and having some sort of set-up exclusively for Māori. We have weathered that storm and we have taken into account what has been happening to our people, and we thank our fellow politicians, particularly all our colleagues who have been through different times with Labour over the years, but it takes some courage to do this.

I ask the Māori Party also today to stop their nonsense. We heard some of that nonsense last week, so stop talking rubbish about a Budget and going on about 0.0 percent and 1 percent. This is a Budget where Māori, particularly in health, can have a say right across the spectrum—right across the spectrum. We’re talking $1.2 billion over three or four years in terms of the Māori Health Authority, but you’re talking about having access to the other $11 billion. For the first time, Māori will have a say, will have an opportunity on everything that concerns them. They will get to work in partnership—partnership; that’s something that the National Party used to believe in—with Health New Zealand, and have a say on every area in terms of Māori health.

It’s such an opportunity. It is such a historic time. This is a precedent that I never, as I said, would have thought would happen in my lifetime, to see a mainstream party support a Māori Health Authority. That’s why I asked Dr Reti to consider some of his kōrero. This establishes an opportunity that we’ve never ever had before, and it’s an opportunity that so many in our community are looking forward to: a by Māori, for Māori strategy, working in collaboration and in partnership with Pākehā New Zealand, mainstream New Zealand.

In finishing: the Opposition merely want to play politics with the health system of New Zealand whereas we in this Labour Government want to do the mahi to fix the inequalities in the system. Labour want to build, but National and ACT only want to destroy the communities this new health system will serve. We will remember that. Kia ora.

Tēnā koe, Madam Speaker. I rise on behalf of the Greens to support the Pae Ora (Healthy Futures) Bill.

Nā te mea tuatahi—he tohu aroha ki te wāhine toa Dr Elisa Lavelle Wijohn. Tiwhatiwha te Ao, tiwhatiwha te Pō. E te kotuku rerenga tahi, whatoro mai o parirau kia rongo anō ai mātou i to wairua e topa ana i te whare whakaruruhau mō tō tinana. Rere tu tō tātou kotuku i te hau aroha ō whānau. Whaīa te ara o Hine Tuākirikiri ki Te Toi o ngā Rangi okioko ai.

[Deep sorrow for passing. Kotuku represents the tūpāpaku returning among her loved ones for the last time. Begin your flight following the trademark coastline of Hine Tuākirikiri to the resting place of your tūpuna in the uppermost heavens.]

Elisa passed away from cancer just yesterday. She was a staunch advocate for Patient Voice Aotearoa, and she was instrumental to the 100,000-strong petition they presented to Parliament in May of last year. They sought to double the funding for Pharmac and to reform that agency. Patient Voice Aotearoa also submitted to the Pae Ora bill, where they asked for a medicines and a rare diseases health strategy. They asked for a broadening of Pharmac’s statutory objectives to make it more patient outcome - focused, to give it a fairer form of economic assessment, and to look at the full health picture—good, simple advice. We see the success of that advocacy through the increased funding for Pharmac, the higher levels of compliance required in this legislation, the review report that was released in February, and the Government’s response that came out just last week.

You’ve fought the good fight, Elisa, and we’ll continue that fight in this House. Ka nui te aroha ki a Leon, Josh, Maia me te whānau kātoa i tēnei wā pourinui.

[I send loving greetings to Leon, Josh, Luke, and Maia and the whole family at this very, very sad time.]

Most of us have lost someone to cancer because in this country it is our single-biggest cause of death. As our population grows and gets older, it will just continue to grow. Many cancers can be cured if they’re found and treated in time, and even if those cancers can’t be cured, more effective treatment means people can live longer. Part of the success of Pae Ora - Healthy Futures and the Government’s response to the review of Pharmac can be directly measured by the reduction of cancer in this country and the longer people can live with it, because they can get access to the medication they need when they need it, where they need it.

Finally, I mihi to all of those who are living with cancer right now, and the whānau who care for them. Kia kaha koutou.

It is not often where we see the Government putting its money where its mouth is in such a timely fashion. Budget 2022 allocated eye-watering amounts of funding for Pae Ora, including to establish the Māori Health Authority and create the iwi partnership boards and the Hauora Māori Advisory Committee. These are absolute minimums. These are required to address the health disparities for Māori. These existed in our health system long before COVID came along to make it worse.

We agree with the many submitters who thought that the Government’s commitment to Te Tiriti o Waitangi could be more clearly spelt out—in particular, with the addition of the term “tino rangatiratanga”. We raised this in the committee of the whole House, to no effect. But the Greens look forward to a generation of children and young people growing up speaking te reo Māori so that a term used in our so-called founding document 182 years ago is commonly understood and is, unsurprisingly, included in our legislation.

We—point of order, Madam Speaker. Do I not have 10 minutes? I think we started with five. OK, ka pai, I’ll just haere tonu—

ASSISTANT SPEAKER (Hon Jacqui Dean): Would the member like to take a point of order? The member calls for a point of order.

Kia ora. It’s just that the time appeared to—

ASSISTANT SPEAKER (Hon Jacqui Dean): Order! Order! I’ll try and sort it out, but the way to ask for a point of order is to say “Point of order.” Then I acknowledge the member, and then the member raises what they want to. But I think we get it—just a moment.

Yeah, ka pai. Me haere tonu? Kia ora. Ngā mihi.

[OK. Should I continue? OK, thanks.]

So we applaud the Government for deciding to include strategies for women and rural communities, alongside those dedicated to Māori, Pasifika, and people with disabilities. Although I was able to get the term “takatāpui” added to New Zealand legislation for the first time, we were unsuccessful in getting a rainbow strategy, which so many submitters had advocated for. I’d like to take this opportunity to thank Te Paati Māori and the National Party for supporting our Supplementary Order Paper (SOP) on this. We were very much behind the SOP for a mental health strategy as well.

I’m not entirely convinced by the Minister’s suggestion that what the strategy would do could be met by having a lot of locality plans that address this. I’m not sure how that national consistency can be achieved. However, I am convinced that there are people in this Government and in those Government departments with the heart to want to make this happen, and that’s just what we’re going to need. So in the absence of such a strategy, we look forward to community organisations having an input into how pae ora can best deliver on gender-affirming services for trans and non-binary people, national guidelines and referral pathways for gender-affirming healthcare, and best practice healthcare for intersex children and young people that enables them to make informed decisions about medical interventions, and then develop all of the training and workforce development that’s required to make that happen.

All of these things, so far, our communities have been advising and advocating to DHBs for, for years, as volunteers. We hope this Budget recognises them for the specialist consultants that they are, because the Government cannot achieve these goals without them.

Tā Mason Durie first published his Māori health model Te Whare Tapa Wha in 1985. The Māori health strategy He Korowai Oranga was based on it and was released in 2002. It was updated in 2014 to the Pae Ora - Healthy Futures, but still our people have the worst health outcomes because none of the band-aid solutions address the systemic issues that cause it.

We know that 80 percent of social determinants of health lie outside of the health system. Children need to grow up in warm, dry and affordable homes. Whānau need enough income to live in dignity. People with diverse genders, sexualities, and sex characteristics need to be safe in their own homes, their communities, their schools, and their places of worship. Migrants, refugees and asylum seekers need recognition of their cultural and spiritual needs as much as the practical issues that they face. Nearly 40 years after he created Te Whare Tapa Wha, Tā Mason Durie has helped design Pae Ora - Healthy Futures.

Māori have waited a long time for a Government that would do what needs to be done, that genuinely acknowledges Te Tiriti o Waitangi, and that recognises Māori leadership and mātauranga Māori. We have high hopes and high expectations that it is this Government that will do that. I acknowledge Minister Little, Associate Ministers Verrall and Henare, all of the officials, those who submitted, and my colleagues on the Pae Ora Legislation Committee, and I commend this bill to the House. Kia ora.

Thank you, Madam Speaker. I rise today on behalf of the ACT Party to oppose the third reading of the Pae Ora (Healthy Futures) Bill. That is because of a very basic point: that this bill has nothing to do with better healthcare, it is all to do with co-governance. This bill is an exercise in co-governance rather than putting healthcare at the centre of the healthcare system.

This bill reforms our healthcare sector by taking away 20 district health boards. It replaces them with Health New Zealand and the Māori Health Authority, and it then carves up New Zealand into localities with separate locality plans. There are up to 80 localities but, as of today, we still have no idea from the Minister whether it will be closer to eight or 80 localities. It also then puts in place the iwi-Māori partnership boards who will be consulted on and who will set in place these localities. But as of today, we don’t know who the iwi-Māori partnership boards will be because that’s up to the whim of the Māori Health Authority, and we don’t know where the localities will be.

So in essence, we are taking away 20 district health boards, adding up to maybe 80 separate localities—maybe more, who would know?—under two separate systems that separately commission health services based on people’s race. We fundamentally believe that if we’re going to reform the healthcare sector, we should be reforming to simplify the system and not make it more bureaucratic and make it more complicated, because that won’t go any way to addressing having better outcomes for New Zealanders; it will simply focus on co-governance and administration rather than on healthcare and people.

The real problem here is that the Minister has focused his attention on co-governance and administration, and not on patients and not on New Zealanders. This reform has been completely flawed from the start. We should keep people and patients at the centre of our healthcare sector. And the Minister, at the introduction of this bill, said that this bill was about meeting our Treaty obligations. It wasn’t about better healthcare, it wasn’t about all the discrepancies, about access through New Zealand; it was about meeting our Treaty obligations. What the Minister is really saying by that is that this is the Treaty-at-the-heart-of-everything approach that the Government has taken across the board in governance in this term in Parliament.

💬 Hon Meka Whaitiri: That’s a good thing.

It’s got nothing to do—oh, and we have a Minister saying “That’s a good thing.” The Treaty at the heart of everything, co-governance at the heart of everything—well, the ACT Party believes that we should put New Zealanders at the heart of everything, not co-governance. We should put outcomes in the centre of our healthcare sector.

The Minister, throughout this entire debate, has never addressed the question: how will this reform get better treatments to more New Zealanders faster? That has been missing from this entire debate. And I have spoken to doctors who have simply laughed when I’ve asked: how will this reform help you in your job? They said it won’t—it won’t. It won’t lead to faster access to treatments for everybody. Patients won’t see better, quicker access to more modern medicines—they won’t. Rural doctors have no idea how this will make access to rural patients easier. It’s all been about co-governance of administration, and the people have been forgotten. And we’ve forgotten about the outcomes.

Now, I put up three amendments to this reform during the committee of the whole House stage, to say that we needed to make this bill better if it was to pass. And that was to put in place a rural health strategy, to put in place a medicines health strategy, and to remove the Māori Health Authority.

I want to pick up, firstly, on the rural health strategy. We wanted to create a rural health strategy because, for 750 New Zealanders who live rurally or remotely, there is inadequacy of access to care in our rural areas. And this Government often forgets about rural New Zealand. I’m proud of the role that ACT has taken in this Parliament to remind the Government of those discrepancies for the people who work hard up and down New Zealand in our rural and remote areas, who do have worse health outcomes because they live in rural areas. We put up the amendment and, thankfully, the Minister finally listened and adopted the ACT Party’s recommendation that we put in place a rural health strategy. I’m proud of the role that ACT has done by listening to New Zealanders and putting their voices in this House, in Parliament. We have changed this law to make sure that rural New Zealand is not being forgotten and that has made access—I hope—in the future, better for rural New Zealand.

It was with this change to the bill—this last-minute change to actually acknowledge rural health—that we hoped that the Minister would also adopt two of our other recommendations. That was, firstly, for the medicines strategy and the Māori Health Authority. Now, Pharmac last week—at the time we were debating—they had their Pharmac final report come back from the Pharmac Review. In that review they talked about a lack of transparency, they talked about the problems with medicines access for all New Zealanders, and they said that a medicines strategy was needed—they called it a crucial omission that a medicines strategy was not part of this health reform.

Well, I think it’s a shame that the Minister had an amendment ready to go, under the ACT Party, for a medicines strategy that was called for, because you have to think of medicines access if you’re trying to reform the healthcare sector. The Pharmac review said it was essential, and the Minister shot it down. So he did not think about patients; he did not think about their wellbeing; he did not think about how do we get better, modern medicines to New Zealanders faster—he forgot about the patients and all he cared about was the co-governance. We should have had a medicines strategy in this bill. He focused too hard on the Māori Health Authority, believing that the Treaty at the heart of everything will solve New Zealanders’ problems—and it won’t. It will make our society more divided—and divided on the basis of race. Our healthcare sector should focus on the needs of people—not on their race. And that is fundamentally why we cannot support this bill.

We want to have a healthcare sector that has better health outcomes for all New Zealanders. We need to acknowledge that we live in a multi-ethnic society—over 260 different ethnicities in New Zealand. We are no longer white and Māori. We are a diverse society and our laws should reflect that. It should not be one separate system for Māori and one system for everybody else. We should acknowledge the needs of all of our diverse New Zealand populations, and I think it’s a shame the way that this bill has been written to divide New Zealanders based on their race.

So, in conclusion, this has been a messy process from start to finish. We, at first, had this not being seen in the Health Committee, as it should have been. It was a separate organisation that was set up, a select committee that had both Māori Affairs Committee and healthcare members of Parliament—I think that was a shame. And it points to the whole reason why we’re here in the first place: that this Minister believes that he can set up institutions based on people’s race and their identity groups, rather than their needs and on the analysis and debate of good ideas. Everything this Government touches is divisive, and it makes for a worse New Zealand. ACT stands for a better New Zealand that is inclusive of all New Zealanders and that actually puts patients at the heart of the healthcare system.

We don’t want to get roped into exercises of politics and exercises of co-governance, and forgetting about the people and health. We want to strengthen the healthcare system, not divide it. Thank you, Madam Speaker

My contribution will be brief. I want to just simply respond to the previous speaker from the ACT Party and say that I found that inane contribution appalling. When she said about the need to address the health of all New Zealanders, I did not believe that I was part of the New Zealand she was describing. In fact, what came to mind was very much the rhetoric of the 1970s—the rhetoric of the 1970s—where the authorities of the time did not recognise Cook Islanders, Māori, Niueans, Tokelauan, who are part of the Realm of New Zealand, as New Zealanders; where they questioned their identity in words such as “They don’t look like us, therefore they’re not part of this country.” That’s what was coming from them. And to make it worse, they have already declared they will get rid of Te Puni Kōkiri, they will get rid of the Ministry for Pacific Peoples, they will get rid of the women’s affairs department, youth—they’ll get rid of human rights that are so fundamental to the diversity of this country. The fact that she continues to ask “Why the Treaty?” indicates the ignorance of that party, ignorance of where her place is in Aotearoa New Zealand, ignorance of the value of the Treaty as a fundamental pillar of this nation.

It also reveals the ignorance of why the reform is necessary. It is driven by expert advice. It is driven by the needs that have remained unmet for several decades. There are a number of reports. And can I also say that the fact that she’s trying to claim credit for the Government’s recognition of the rural—I want to thank our rural sector MPs for their championing and advocating for that strategy. ACT had nothing to do with it, and so I just want to put that on the record. I think it’s important that we recognise the value of evidence, and the value of evidence that’s driving this reform.

There are a number of reports and they all highlight the inequities and the barriers that the most vulnerable members of our communities have faced. Māori, definitely; Pasifika, definitely; people with disabilities, definitely; people in isolated rural areas, definitely. And so let me just give you a quote from the Bula Sautu report, which I suspect they’ve never read. It identifies inequities across a number of factors for Māori and Pasifika. And for Māori and Pacific peoples, I want to say we have continued to live and breathe the inequities that all of these reports outline. But no one—not when National was last in, they didn’t take any notice of that at all. And so what this is about is to say we cannot accept as normal the inequities and that we’ve got to address it. Because for far too long, the health system, guided by certain political views, has just observed the inequities growing and growing and growing.

In midwifery care, it’s inaccessible for our Pacific mothers. Less than half of pregnant Pacific women are involved with a midwife for crucial screening and health checks in their first trimester. This leads to identified complications, blood loss, and, for 10 years, consistently higher rates of mortality for Pacific mums and their babies. Why have the system and past Governments allowed that? Four out of 10 Pacific babies in their first year of life missed out on the five core Well Child / Tamariki Ora health checks for them and their families in 2018. That’s a 20 percent equity gap and 700 Pacific babies and their families in total who didn’t get checked on. Subsequently, between birth and age four, Pacific babies end up in hospital for serious skin conditions like cellulitis at much higher rates. This pattern is the same for dental issues, asthma, and other issues.

It’s worse for Māori in many respects. You’ve heard the Minister, Peeni Henare, also address the issue of addressing bowel cancer screening, bringing that in early, and that’s about saving lives. So this legislation is groundbreaking. It is a groundbreaking piece of legislation that will change the way health works in New Zealand, and for those most vulnerable it will mean a much fairer and a more equitable system. So we can’t rely on political rhetoric such as that. We have to rely on the evidence that has been collecting dust on the shelves year in, year out. This Government is what is going to do something about it.

So in addition to the Māori inequities, in addition to the inequities faced by people with disabilities, in addition to the inequity faced by people living in isolated rural areas, we also have inequities faced by Pasifika people. And for me, in the way that I’ve managed to oversee the development of this, I’ve been wanting to make sure that for our Pasifika people and those who are in need, it would mean a much fairer, much more equitable system, and much more responsive system to those needs.

I want to see culturally intelligent people at the top of the new health structure and a Pasifika-facing policy at all levels in the new structure. This will fit into a Pacific national health strategy, and this new focus on Pacific health will endure over the decades. So the line of sight is having Pasifika lead the work for Pasifika from the top all the way down. The localities where our Pacific providers are going to be are going to be crucial. We saw how our Pacific providers led the work and protected our communities in the last two years in the roll-out of vaccine.

So I would say to those listening in: don’t listen to the crap that you’ve heard from the other side; listen to the experts.

Thank you very much, Madam Speaker. I wish to stand on behalf of the National Party, as a member of Parliament for North Shore, to oppose the third reading of the Pae Ora (Healthy Futures) Bill. It is with some disappointment that I do that, having spent nearly half a decade working within the public health system in New Zealand in a variety of roles and continuing to work as a volunteer with our ambulance service. It is very disappointing that we aren’t in a position where we’ve got consensus in terms of how we progress and build and improve our health system going forward. Because importantly, our health system is critical to the success of this country. Our health system is one of those pillars that will serve us all at periods of our lives, and the reality of where we stand today is that we do not have agreement across this House in terms of how that will look in the future. That is a grave shame because this is not an area which we should look to change or continually move from one point to another. But we are here for reasons that have been articulated already before: we need a health system that is based and focused on health outcomes; a system that targets resources based on need. If you do those two elements, you deal with the challenges that have been covered already in the House today.

New Zealand is out of step in terms of the way in which we are progressing with these reforms. Nearly every other country embarking on large-scale health reform—of which there aren’t many during a pandemic of global scale, but those that are progressing are moving to a devolved system, the complete opposite to the centralisation model that has been adopted by this Government. That is a challenge for a number of reasons. Not only is New Zealand out of step in terms of what we are doing, we’re actually looking to adopt models that have been tried and failed in the past. And so we are missing the opportunity to use this opportunity to improve and do what could and will bring significant value in the future.

Our system has a number of challenges, and we all agree that that needs to be improved in different areas. But the workforce element within the health system is probably the most critical and fundamental aspect that is broken today. The aspects around retention of the existing staff who work within our system were pretty much forgotten in regards to the last Budget process articulated by this Government. Yet those are the very individuals across our district health boards, across our primary care sectors, across our front-line ambulance providers, across our allied health areas, across our aged-care sector that need our support. Retention is the single biggest factor—in terms of investment—that will be able to retain people within the system. Once they’re gone—and New Zealand’s health system leaks like a sieve to other countries, particularly Australia—it is very challenging and very expensive to get them back.

We also need to overlay outcome measures and targeted resources, and reduce the level of bureaucracy. Having worked within the public health system, there is a significant element of bureaucracy within our system, but that will not be enhanced by further centralisation and further bureaucracy for Wellington. We need to remove that bureaucracy. We need to remove that overhead and provide certainty to not only the front-line clinicians that are working very hard day in, day out within our system, but also to those many staff who work in the back offices supporting our front-line health providers.

Ideological change by this Labour Government will not result in better outcomes. Centralisation will result in a loss of local voice. Bureaucracy will not deliver better outcomes. In 2023, a National-led Government will inherit a wasteland of failed reforms. Having worked in the system for many years, the conversations that I hear from past colleagues are that there is no clarity in terms of what and how this reform will be implemented. There is significant fatigue, and many of my past colleagues are looking at options to move offshore, not because they don’t care about the health system and want to do everything within their power to improve it, but they are tired. This reform will simply make that situation worse.

We need a health system that is sustainable—that is not only in regards to the fiscal elements in terms of how we fund it but also in terms of the people that operate within it. National opposes this bill.

Debbie Ngarewa-Packer—five minutes.

Tēnā tātou e te Whare. It’s a pleasure to rise on behalf of Te Paati Māori to speak to the third reading of te Pae Ora (Healthy Futures) Bill. As health spokesperson, it’s been revealing, following this bill as it has progressed through the House. I want to begin by acknowledging the significance of this day for tangata w’enua in Aotearoa. Our people have never had a place to stand with the health system. Generations of Māori have faced institutional racism and systemic barriers that have led to persistent inequities and entrenched health disparities for tangata w’enua. The real impact of this is devastating. We’re dying young from cancers, from Third World diseases, but worst of all from neglect from indifference, from racist policies and racist people, and ignorance. Our people die on average at least seven years younger than non-Māori.

That is why a new vision for the health system in Māori health was put forward by Tā Mason Durie, a rangatira who has spent his life fighting and advocating fiercely for hauora Māori. That is why Te Paati Māori supported Tā Mason’s vision and included the Māori Health Authority in our policy manifesto in the 2020 election. The establishment of the Māori Health Authority and Health New Zealand is the biggest reform to the health system in generations. We have an opportunity to finally address the barriers that hold us back, even though some are in denial. Therefore, this House must not yet again set up Māori to fail under the new system. Tangata w’enua must have our decision-making authority recognised in the legislation. There are rights guaranteed in Te Tiriti o Waitangi. Let’s not forget this isn’t our first attempt to own our own health solutions as Māori. We remember well that our tupuna Māui Pōmare achieved many of his health strategies only to be later removed as the Minister of Health as it was considered improper by non-Māori—many, like ACT—who didn’t believe that natives should hold such an important portfolio. For too long, our people have needed a truly transformational health system—by Māori, for Māori—that truly unapologetically addresses our needs.

That’s why Te Paati Māori will support this but put forward amendments at the committee stage which would have strengthened the bill and made it more compliant with Te Tiriti. The first Supplementary Order Paper (SOP) would have included tino rangatiratanga in the legislation and replaced references to the Treaty preferences with reference to the articles of the Treaty, the actual contractual text that was signed in 1840. The second SOP would have established a Māori Director-General of Health to lead the operational management of the Ministry of Health alongside the Director-General of Health. As we saw during the pandemic, even when Ministers instructed the release of Māori data and the courts backed them up, the Director-General was able to block it from happening. The third SOP would have strengthened the language in the bill so that Health New Zealand would require the agreement of the Māori Health Authority before carrying out its functions. While we challenged all parties to support those SOPs, only the Green Party supported, and we thank them for their support and for being the one party willing to work with us on eliminating these legislative barriers.

I acknowledge also my tungāne Rawiri, who covered me last week while I was stuck home with COVID. In closing, the Government must not see the passage of this bill as the end but the start of the road to reforming our health system and restoring power to tangata w’enua to look after ourselves. We cannot achieve the health outcomes we want to see with 2 percent of the health budget for a population that makes up more than 17 percent of the country. We cannot achieve self-determination and self-sufficiency, our tino rangatiratanga, when our resources and decision-making mandate is channelled through a Pākehā bureaucracy in the Ministry of Health. Therefore, we will continue to fight for an Aotearoa hou, a nation where tangata w’enua are free to live as our true selves, a nation where we’re trusted to manage ourselves, look after ourselves, and use the wisdom of our tūpuna to create a better future for our tamariki and mokopuna. Nō reira, tēnā tātou katoa.

Last week, I sat in this House and listened as a member of the Opposition said of this legislation sententiously, “First, do no harm. There should be no change, because first we should do no harm.” But a claim like that ignores the harm that is being caused by the status quo. Retaining the status quo does harm in itself. We know this because of the failures with respect to the health of Māori. We know this because of failures with respect to the health of our Pasifika peoples. We know this because the current system is not working. Contrary to claims of the Opposition, decentralisation has not worked for New Zealanders—for all New Zealanders. We all know that the district health board system was no longer working, and, as the status quo, it was doing harm. So change is needed.

This Pae Ora legislation is bold, transformative change brought to us by a Minister with vision and courage and conviction—a Minister who has the guts to set up a separate select committee which drew expertise with the chair of the Health Committee on that committee, with the chair of the Māori Affairs Committee on that specialist committee, with people drawn from all areas of the House to oversee this specialist reform, this transformative reform.

The Opposition opposed it because they do not understand difference. “Everyone should be treated the same” they say. “Everyone should be treated the same.” But would they like to be treated the same as Māori? I don’t think so. Would they like to be treated the same as Pasifika? I don’t think so. What they mean is that everyone should be treated as a middle-aged white man or white woman. But we need to understand and recognise difference in the way we govern ourselves in this country. We need to understand and recognise difference in the way we do health in this country. We need to support different ways of doing health so that we can—as this legislation says right in its purpose statement right at the start—protect, promote, and improve the health of all New Zealanders, so that we can achieve equity in health outcomes among New Zealand’s population groups, including by striving to eliminate health disparities in particular for Māori and build towards Pae Ora (Healthy Futures) for all New Zealanders.

That is the purpose of this transformative legislation. It is an excellent goal. I support this from the bottom of my heart.

Thank you, Mr Speaker. I rise to join my colleagues in our very strong opposition to the Pae Ora (Healthy Futures) Bill. This is a piece of legislation that’s been shaped time and time again by polls and by public pressure, and certainly not by policy. It is a piece of legislation that started out as Labour’s answer to a once-in-a-lifetime or generational opportunity to reform the health sector, but it’s finishing up as nothing but the shifting of the deck chairs on the Titanic. I think every New Zealander would agree that we have an exceptional health workforce. Our doctors and our nurses and our health practitioners across the spectrum have gone beyond the call of duty over the last couple of years particularly. But they are working in a system that is creaking and groaning and all but sinking, and as much as Andrew Little has been warned by the sector, he is still ploughing ahead—full steam ahead—paying no heed to the warnings or the danger signs.

What Government in its right mind would force a sector through reforms like this during one of the most deadly pandemics this world has seen in a century, at a time when doctors and nurses are sick; they’re suffering extreme exhaustion, burnout; they’re working from home; they are following complex home isolation rules; they’re managing the health of their own children and families; the borders are closed, and there is no migrant workforce on standby to step in and breach the gap? This bill purported to fix the system, but, as most would rightly predict, we on this side of the House say it is going to fail and fail miserably.

But there was no need for it to be a failure. In fact, if the Government had listened to their very own person, Heather Simpson, and her recommendations, it might not have. This bill is the so-called answer to the recommendations made by Heather Simpson in her 2020 report, which actually sought to improve healthcare across the country. It proposed to disestablish some health boards. Now, we on this side of the House would agree that not all district health boards (DHBS) have performed to expectation, and there is certainly a case to reduce by potentially merging some. But instead of streamlining the system, the Government, in its infinite wisdom, has chosen instead to bloat it—to inflate it. We would say that DHBs should be reformed, but to keep that locality of them. We would say that the Government’s answer, of bloating the system with layers of bureaucracy between we the patients, we the public, and Ministers, is unacceptable. Labour, though, seems to think that you can resolve all issues, that you can achieve better health outcomes, by putting more power in the hands of bureaucrats. But we say it is better in the hands of locals—in the hands of those at the grassroots.

I think it would be fair to observe that any public policy that is informed by poll results is a recipe for disaster. It should be informed by stakeholders and user groups. For example, this bill started out life without a dedicated women’s health strategy. And, as the National Party spokesperson for women, I was very, very pleased to see the response of huge pressure from organisations like the Gender Justice Collective, so women now have at least been identified as a priority population. But it is just another strategy. There are no health plans. There is no wellbeing plan. There are no targets. There is no money tagged to these targets. There are no outcomes. We say the Government needs to immediately respond to the 50,000 women who’ve missed a mammogram, the 50,000 women who have missed a cervical smear test, the year 13 girls who’ve missed out on their HPV vaccines, and the 130,000 women and girls who spent almost nine years waiting for an endometriosis diagnosis. Where is the urgent response in this bill to addressing those backlogs? Where is the advocacy for more maternal beds, for more midwifery training, for longer post-natal stays?

And while we’re on the topic of public pressure, how about that eleventh-hour inclusion of a rural health strategy? It is equally as laudable as it is laughable. Thank goodness for the relentless pressure from this side of the House and our colleagues in ACT, and thank goodness for the relentless pressure from organisations like the Rural Health Alliance and the Rural General Practice Network. At least they have recognised the specific needs of 750,000 Kiwis who live rurally or remotely. Both of these organisations have pushed to see rural communities included as a priority group in the legislation. This will mean targeted rural health strategies and specific rural health outcome measures. My message to the Government is: do not squander this opportunity; make it count. It should also mean parts of New Zealand’s health system will be held accountable for ensuring outcomes and the equity that has been promised.

But I return to the Heather Simpson report, which is the driving force behind this bill. The report said that rural services should be specifically planned for, recognising the unique challenges of living rurally—and there are multiple challenges to living rurally. I wouldn’t mind betting that the rural people of New Zealand who have the misfortune of being landed with a Labour MP have been hammering on the doors of those MPs and making their views known. And wasn’t it a stroke of irony when Andrew Little said to this House during the committee of the whole House last week that he was responding to his rural MPs—and yet he did not respond to the rural health practitioners.

Unfortunately, though, he’s still ignoring the mental health advocates, the aged-care advocates—and let’s wait to see how their health outcomes fare under this new regime. He’s also ignored Dr Shane Reti’s excellent Supplementary Order Paper that would have bedded in workforce planning, and, equally, Erica Stanford’s tireless advocacy for overseas health workers. And, as we know, this workforce is burnt out. GPs are ageing and retiring in droves. There is no structure in place to continue this workforce and the workers who are dealing literally with life and death every single day. It is such a crying shame, for a small country that used to punch well above its weight on every social metric, just about, in society, that this Labour Government has reduced our health sector to what some might call just about Third World, and that is not good enough. New Zealanders deserve better. We deserve First World standards and services, no matter who we are, no matter where we live, and no matter how much we earn. The National Party opposes this bill in its entirety.

I understand this is a split call. I call Tangi Utikere—five minutes.

Kia orana, Mr Speaker, thank you. It’s my pleasure to rise and take what I understand is the penultimate contribution this evening in support of the Pae Ora (Healthy Futures) Bill.

In doing so, can I acknowledge the Minister of Health and his wider ministerial team for bringing to the House a bill that will make an absolute difference. Members opposite might not think so, but I know for the constituents of Palmerston North, this will make a huge difference.

Can I also acknowledge the chair of the Pae Ora Legislation Committee, Dr Russell. In my first reading contribution, it was my hope that the committee would hear from submitters and they did that and what we have in front of us is a very good bill.

There are a number of issues that have led to the introduction of this piece of legislation. A significant one is that of equity—or inequity—for some members of our community, and it’s unfortunate that we can define those members by a particular cohort: they are our Māori members of the community, they are our Pasifika, they are our disabled members, they are women, and they are members of rural community as well.

Let’s make no mistake. For the benefit of those who are listening and watching at home—and for the benefit of the record—a vote against this bill, this afternoon, is a vote or a sense of endorsement for inequity; for a continuation of inequity; an acknowledgment that the system ain’t broke. That’s what a vote against this bill is tonight: an acknowledgment that the system ain’t broke.

Quite frankly, I think it is rather unfortunate that people in this House have that view when we have members of Pasifika, Māori—

💬 Matt Doocey: Don’t make things up

—and wider community who do suffer from inequity.

💬 DEPUTY SPEAKER: Order! Interjections like that, Mr Doocey, are out of order—as you well know. You will stand, withdraw, and apologise.

💬 Matt Doocey: Withdraw and apologise.

This bill will allow a dedicated, connected health service for all New Zealanders. But we acknowledge that there is some support that’s needed for some parts of our community and this bill delivers on that.

It is a proud day to be a member of this Government, a Labour Government that will create change within health, one of the fundamentals of any society. I commend this bill to the House.

The district health board (DHB) system is broken and it has been for years, and it has not served rural communities well at all. Today, this Parliament has an opportunity to vote for reform that will serve rural communities much better, and actually deliver access to services that they have been deprived of for generations.

That side of the House are not going to vote for this bill. For all their grandstanding and cheap political points about strategies here and strategies there, they weren’t going to vote for it anyway. They can stand there and say that they wanted a strategy here; even if they got it, they weren’t going to vote for it. What a crock.

This bill is necessary, and I want that side of the House—next time they are in Wairarapa—to explain to the people there why they are satisfied with the status quo, why they are satisfied that there are no dialysis services in Wairarapa. I want them to go to Takapau and say that they are satisfied why the Hawke’s Bay District Health Board is not funding their community service. I want them to go to Dannevirke and explain why the people there have to pay $120 for an X-ray when those in Palmerston North get it for free. I want them to explain to the people in Eketāhuna why they can’t access their closest hospital in Masterton because of some arbitrary DHB boundary in between. They can’t. It’s broken. But they are not prepared to accept that the Government is going to do something for rural New Zealand. They would rather grandstand and try and present the spurious political argument that is not backed up. At the next election I want to hear how they can justify going back to the status quo that is depriving rural people of access to health. They can’t. They know it. It is absolute nonsense.

I am proud to lend my vote today on behalf of my constituency in Wairarapa, the Tararua district, and Central Hawke’s Bay to finally give them the access to health services that they deserve.