Pae Ora (Healthy Futures) (3 Day Postnatal Stay) Amendment Bill

Committee of the whole House

Mr Chair, thank you. Sorry for jumping the gun. I want to know about this clause. In Amendment Paper 647, we’ve got a movement from six months after the date to an immediate application of this clause. While that always sounds good, the reality is we were already worried about an overstretched health system.

I’d like to know what the Minister of Health did to check out that our midwives and our nurses, particularly—we know numbers of nurses are down, but I also represented midwives for many years and I know that they were chronically short-staffed and there were real issues around safe staffing numbers. I’ll just give you one story about why that was so bad. The midwives couldn’t strike, because when they tried they breached the safe staffing numbers every time because they did not have any staff to cover those shifts. They couldn’t just take even one person off shift because they were already under those numbers. That has been an issue for many years with midwives. We have nurses where we know that’s been a really serious issue in our health system now for a while. We just simply don’t have nurses. We also have problems with other people in our health system and we have health facilities which are really overwhelmed. You walk down corridors and it says “No beds in the corridor” etc., because that’s where the beds are going.

What I want to know is: if we’re moving this time frame from six months to immediately, is that a political stunt or is there some reason why you are satisfied that people can cope with an additional requirement? Because it is election year and it is quite close. Is it so people can tick the box and get up and say this is done and there’s not enough time to see what has happened next? Because there is a lot of pressure on our health workers. Can I know what the Minister has done with regard to finding out just how people will cope with this movement forward in time? Because usually we give people a bit of time to adjust their rosters, etc., so that they can cope with this. Thank you.

Committee of the whole House

In terms of the member’s questions around capability, as I just mentioned in my previous response, this Government secured $34 million for the delivery of this programme of work. As I’ve said, Health New Zealand is confident around its existing capacity. That is why we’ve shifted the commencement to “immediate”. I think that makes a really good, positive step for mothers who would like that extended care. I’ve been confident about, as I’ve outlined, the capacity issues, and the budget is already in place.

Committee of the whole House

Mr Chair, I appreciate that you’re taking us through the bill step by step, but some of these issues about start dates relate to other parts of the bill, so I’ll take this opportunity to build on my colleague Helen White’s question, because it is clear that, in clause 2, the commencement of the bill is immediate, but it appears, if we look at the Schedule, that the provisions in the bill don’t apply until 1 July 2029.

Minister, is it the case that immediate commencement of the bill is possible, because the provisions aren’t coming until we’re well into the term of the seventh Labour Government? The budget really doesn’t kick in until the third year, either. This is the challenge, isn’t it—that really, what would have been, under the original bill, something that would have had to come into force in six months is actually—I mean, 1 July 2029 is when Part 3A comes in; so two years of the bill not really having any effect at all, and then, in the third year, women will be able to expect to have the three-day stay.

I’d just like to understand from the Associate Minister of Health why those decisions about timing were made. If she could stitch together both the issue about commencement of the bill and then the delay that comes in later.

Committee of the whole House

I appreciate the member the Hon Dr Ayesha Verrall’s questions around the concerns. As you can appreciate capacity, which is what I outlined in my previous answers, we will start off immediately, using existing capacity, and then the July 2029 position is that it will be fully implemented.

That is ensuring that we have the ability to build in a sustainable way, that we optimise safety, that we’re not creating an expectation that isn’t able to be delivered. This is building capacity over that period of time, so that by that—so the delivery of the service, as the commencement date outlines, is that we will commence the service immediately, with full capacity being delivered by that date.

Committee of the whole House

Just following on the line of questioning that I’ve heard from my colleagues, and the response from the Associate Minister of Health, when examining the commencement date and hearing that we’re going to grow capacity of the system while it’s starting immediately—and there’s $34 million allocated to it but it won’t be in full swing until 1 July 2029—submitters raised with us concern around equity and enabling better access to care for rural, for low-income, and for first-time parents. The question is around, OK, if we’re going to be using existing capacity from within the system, what is the plan for implementation via the existing capacity? And what role will equity have in the decision of where we will apply the focus if we take a staged approach? Soft hands, start straight away, and build up to full steam ahead by 2029—as submitters have raised, how do we ensure that the staged approach gets resourced in the right places at the right time? That is my question. Kia ora.

Committee of the whole House

Thank you for the question. That is what I referred to previously—that, in parallel, Health New Zealand will look to commission additional capacity, from the provider mix, that best meets the need of each community. This may include public, community, NGO, or private maternity units, or private provision. As you’ll be aware, the Nga Hau Mangere Birthing Centre is one of those examples with capacity. As we’ve also identified, some districts do have capacity at the moment: Whanganui, Nelson, Gisborne, and Whakatāne. This is the opportunity, but Health New Zealand is commissioning additional capacity as we move, and that’s, as you said, safe hands to build the capacity and working with the existing networks.

Committee of the whole House

I’m really glad that the Associate Minister of Health is answering our questions around capacity, because, obviously, there is a willingness across the whole House to see the ambition of this bill. There are some really big questions around the unintended consequences, and the questions that I have relate to how much work was done and what modelling was done to anticipate the resourcing requirements.

I say that in the context of submissions that we received, where we heard from the College of Midwives that they were concerned that women who genuinely need longer than three days could be discharged early to free up beds for those who had an entitlement. That would involve hurting people that the bill is meant to protect. I’m thinking again— without questioning the Amendment Paper, because that’s coming later—if those are the vulnerable women who don’t even know about their entitlement, that puts them at even further disadvantage.

We also heard in the select committee that the Ministry of Health itself warned that, without more beds, other women’s health services, like gynaecological and high-risk antenatal care, could be deprioritised. I’m sure that is something that none of us in this House would like to see. As much as we would like everybody to receive their entitlement for this antenatal care, it would not make any sense at all to have people who desperately need gynaecological services suffering in the way that we have seen in parts of the North Island, where some of those women’s health services have gone by the wayside, mainly because of the very workforce issues that the Minister herself has raised.

CHAIRPERSON (Tom Rutherford): I’ll just say to the member: if we could just come back to clause 2, which is focused specifically on the commencement.

Sure. This does relate very directly, and thank you for that guidance, Mr Chair, because it relates very directly to the fact that, in the first two years, there’s only about $1.6 million a year—hardly enough for set up, and certainly not enough for a single bed to be implemented. As my colleague the Hon Dr Ayesha Verrall has said, there’s a lot of things that are going to apparently take place in 2029.

What can the Minister tell us about the workforce capacity and the resourcing that is going to change between the commencement date and the implementation of some of those things. It can’t all just happen at the last minute in 2029. There’s got to be a graduated absorbing of the extra capacity that is going to be needed. The Minister herself has raised that different geographical parts of New Zealand have different levels of capacity and also different levels of need.

My question is: because we did not see it in select committee, what modelling has been done around that? What is the year-by-year budgeting that she sees? And how is that going to work, resourcing-wise, to ensure that we don’t end up with these unintended consequences around women’s health, which will disadvantage some of our most vulnerable and also mean that people who desperately need gynaecological care are not paying the price for the additional entitlement that some women will have to their maternal care—post-antenatal care?

Committee of the whole House

As I’ve said repeatedly, this is about building capacity. This is why we have the date of full implementation by July 2029 starting immediately. We’ve talked about using existing capacity and the commissioning process from commencement. That is exactly what will be done. Those decisions that you have outlined aren’t part of the legislation. It is about getting the legislation so that we can drive this piece of work.

CHAIRPERSON (Tom Rutherford): I’ll just remind members that we are on clause 2, the commencement, so I’m looking for questions related to the commencement.

Committee of the whole House

Absolutely, and also picking up on material that the Minister in the chair herself, the Associate Minister of Health, is bringing into the debate. She is providing assurances that there is going to be capacity, but I don’t believe I’ve heard any answers to the questions I’ve asked about what budgeting and resourcing have been provided. In fact, in her previous answer just now, if I heard the Minister correctly, she said that work would begin once the legislation had passed. Could the Minister please clarify whether that work is under way or whether it is going to start once this bill comes into effect? That would be useful to know.

CHAIRPERSON (Tom Rutherford): The question is that the Minister’s amendment to clause 2 set out on Amendment Paper 647 be agreed to.

Amendment agreed to.

Clause 2 as amended agreed to.

Committee of the whole House

Clause 3 Principal Act

CHAIRPERSON (Tom Rutherford): Members, we now come to clause 3. This is the debate on the principal Act. The question is that clause 3 stand part.