Estimates Debate — Health

Members, the sitting is resumed for the Estimates debate. We now have the Minister of Health, and the Minister is available from 7.30 until 8.30 p.m.

Thank you, Madam Chair. Kia orana. It’s a privilege to make some opening comments as the chair of the Health Committee, as we consider the Estimates for Vote Health and the various appropriations that come under that umbrella.

In 2023-24, total appropriations sought by Vote Health are $26.51 billion. Two appropriations, in particular, cover most of the health services across New Zealand, accounting for nearly 80 percent of the funding. The proposed allocations are delivering hospital and specialist services, with funding requested of $12.72 billion, and delivering primary, community, public, and population health services, with funding of $8.16 billion.

We heard from the Minister of Health, the Hon Dr Ayesha Verrall, on 28 June 2023, and there were various areas of interest that members asked questions about that largely revolved around five or six themes. We asked the Minister to take us through those themes. One of the themes that I think is worth mentioning, in particular, is removing prescription co-payments. We asked the Minister whether she expects that initiative to improve health outcomes, particularly for people on low incomes and particularly in winter, so there was plenty of information on that. The Minister did explain to us that, essentially, removing the $5 co-payment, the rationale behind it was about saving money to the health system as well as saving people from harm, and the fact that it was evidence-based, and there was plenty of information to go on. She added that there was very strong evidence that the decision, ultimately, will benefit both people’s health and the health system.

Now, somewhat related to that, we also heard about the changing role of pharmacists, who are, obviously, at the heart of this initiative as well. It has been quite a game-changer, I think, for a lot of those pharmacists, who, often, are small businesses, because the large pharmaceutical outlets who haven’t previously charged for the co-payment were able to use that as a loss leader and disadvantage those community pharmacies.

So the Minister noted—which is quite interesting—that 98 percent of New Zealanders live within 20 minutes of a pharmacy, and highlighted the various different ways that their role has changed through the COVID experience in so far as being able to pick up immunisations, rapid antigen tests, and various other bits and pieces, and Te Whatu Ora had ensured that there was certain funding available to increase that. It was all part of what the Minister described to us as the 2023 winter health plan.

Another big part of what we heard about through this Estimates process was about primary and community care. The Minister acknowledged that there were some general practice workforce issues. We looked at GPs, in particular, and she was able to tell the select committee that the Government had recently announced 50 additional places for medical schools, and also that there was an expectation that those medical schools would expose those trainees to more general practice and, certainly, Te Whatu Ora also backed that up by saying that they had funded several initiatives that affected general practice in general, so to speak.

We learnt that with regard to mental health, that the ring-fence for mental health was maintained. We heard that the total ring-fencing funding for 2023-2024 is $2.3 billion nationally, and Te Whatu Ora explained how it had maintained that ring-fencing from the previous sort of district health boards.

We asked various questions about the progress on the restructure of the health system, which was an integral part of this. There was talk about efficiencies that were maintained and various other issues to do with setting up those localities.

The other, I suppose, major theme was about the health capital envelope, and this proposed funding for this multi-year appropriation is $989.54 million, with a total of $5.45 billion over the five years. So there were several questions asked from members about that, and, likewise, the increased funding for Pharmac in this Budget, so the 10.5 percent of the national pharmaceuticals purchasing appropriation, which actually brings the total to $1.31 billion. So I look forward to hearing questions from members, and look forward to the Minister’s answers to those questions as we go forward. Thank you.

Thank you, Madam Chair. We asked a range of questions in the Estimates hearings to hold this Government to account for the projected spending of public funds. We asked why dozens of performance measures were discontinued from Budget reporting, and we highlighted ophthalmology wait times and cardiac wait times that will no longer be reported. Effectively, the Government said that it will only report these internally and not for public scrutiny anymore. The verbatim phrasing is “reporting of these metrics continues at a district level and is internally circulated.”

The question would have to be: why is it a good thing to remove these from public scrutiny? This was at Budget document level as well, not just at a quarterly dashboard level. Why is it a good thing to remove ophthalmology targets? There were actually cardiac targets as well. How is any of that a good thing? In fact, dozens of targets were removed, and I can’t find a good answer as to why this is good. So they’re still collected. They’re internally reported—well and good; that’s great for internal consumption, but what about that public reporting back to the public? I don’t think we got an adequate explanation for that.

We asked how many contractors and consultants transitioned from the Ministry of Health into Health New Zealand, because we’ve been very concerned with both the number and the cost of contractors and consultants, particularly with the Public Service Commission reporting around about $150 million, if I recall correctly, of consultant and contractor fees through Vote Health in the last year. So we were particularly interested to find how many had transitioned—at that July 1 transition time, how many had moved from the Ministry of Health into Health New Zealand.

The answer that came back was an astounding 990 consultants and contractors who had transferred across. When we look at the Ministry of Health in that calendar year, they had roughly 1,700 fulltime-equivalents, so that means roughly every third person at the Ministry of Health was a consultant or a contractor. A 2:1 ratio of staff to contractors and consultants—not clear how that can be a good thing. Really need to see the value that they would bring to that. I have seen some documents talking about how that might need to be addressed around contingent, as I believe, consultants and contractors, but looking back at how that money was spent, I think that still needs a large degree of accountability.

We asked about Nelson-Marlborough and Hawke’s Bay hospitals and where they were in progress, and maybe the Minister can give us some guidance, because if we look through the approvals process for large upgrades like that, the Capital Investment Committee is always an important part of that approval process, and so it’s concerning to find out that the Capital Investment Committee has been disestablished. So this is a committee of external people with external domain expertise over many years, and in several parts of the pathway with the initial business case, it goes to Capital Investment Committee and back. With the detailed business case, it goes to Capital Investment Committee and back. Now, with that the committee is disestablished, the questions I have to ask around that are: when was it disestablished, why was it disestablished, and what replaces it? I think those are very important discussions that arise from the discussion we had around Nelson-Marlborough and around Hawke’s Bay Hospital—we were very interested to know what progress it had, particularly with the recent announcement on Nelson-Marlborough. So a large circle of query around the Capital Investment Committee.

We asked about the promise in 2020 that the Government would deliver an extra 4,000 more people in the Te Ara Oranga methamphetamine programme pathway. We checked whether this was incorporating the existing pathway in Northland, which is well established—one of the best meth pathways in New Zealand, in my mind—or whether this was on top. In written question No. 31310, the Government made it very clear that the 4,000 promise was on top of those being delivered in the Northland programme. So when the written questions returned from the Estimates and the answer was that there is 1,845 people who have gone through the Te Ara Oranga programme, the vast majority of that—everything short of about 100—must have been through the Northland programme. That was not the promise; the promise was 4,000 on top of the Northland programme. Murupara is the only clinic I can see that’s been enabled; they project between 100 to 200 people progressing through Te Ara Oranga. So I want to put that back on the table that that question has not been well answered. It looks like 1,845 new people through Te Ara Oranga, all in Northland; only 100 towards that 4,000 promise. It would be useful if the Minister could address that. Thank you, Madam Chair.

I want to turn my focus to the issue of oral health, and I acknowledge that, for many of our communities, accessing decent dental care services remains out of reach for them because they’re inaccessible. Some of the figures that the Minister of Health has provided in written parliamentary questions show that there has been consistent—around 13,000—discharges where the primary diagnoses was diseases of oral cavity, salivary glands, and jaws over the last few years. So my question is around what initiatives the Government is working on to reduce the incidences of these diagnoses and to improve people’s oral health and whether Te Whatu Ora’s relatively low number of fulltime-equivalents (FTEs) working in the public healthcare system, when it comes to dentists and the oral health workforce, needs bolstering and whether the Minister is comfortable with the fact that the majority of the provision for oral health services sits within the private sector. There’s such a low number of FTEs within that workforce there. So any strategies that the Minister can illuminate on improving people’s oral health would be welcomed.

Thank you, Madam Chair. During the Estimates, we asked about the number of staff at the Māori Health Authority. We were interested in this because the previous Minister of Health struggled to give an adequate answer, in my view, to multiple written parliamentary questions, and yet this is a question we ask of every entity: what is your fulltime-equivalent (FTE) growth like? The first time that we got a really good look at that was when the briefing to the incoming Minister (BIM) came in in February and it was identified that there were 220 since February 2023, that there were 227 fulltime-equivalents. When we asked this question in Estimates, the answer we got was 321—that was subsequently corrected in written parliamentary question No. 20630 to 388 FTEs, or 400 headcount. That’s quite a substantial change; almost a doubling from the BIM in February of 227 through to the projected final headcount of 388. While we talked about those numbers, there needs to be some explanation to that and how many of those projected FTEs at establishment are vacant spots. I understand there could be a hundred of those places still vacant. In that same brief, it would be useful to know if there’s actually a financial officer permanently appointed.

I have a number of issues around the Māori Health Authority, not an increase in confidence with the recent announcement of new board members. Effectively, half the board—remember, in legislation, there can be up to five to eight members of the Māori Health Authority board—jettisoned and another four brought in. Sharon Shea, Dr Sue Crengle, Lady Tureiti Moxon, and Dr Chris Tooley, as far as I can determine, have been jettisoned. Thank you for your service. One year—just one year—later, and four new people have been brought in. That needs some scrutiny, some explanation, as well, I think. But one year later, half the board gone—why is that?

I suspect some of those answers are in the Ernst & Young report that the Minister will not release—if she’s prepared to put a time frame on that, preferably this side of the election, then we will know what she knows or what the sector is telling me. So I come to that point that the Ernst & Young report may well address some of these issues, and that was received on her desk on 5 May. Some of the things we know that it’s likely to go over, which are part of the Estimates, include the fact that the statement of performance expectations that was tabled in November 2022 did not include the full financial intonation required to meet the Crown Entities Act 2004. So there are financial issues with the Māori Health Authority that I believe that document may well explore, and I think it should be in public domain.

We asked about why the 20 mobile dental caravans that had been previously promised had never eventuated, and we’re asking this question again today. It was a very firm commitment in the previous Minister’s hands, which sits inside this purview. We were assured—in fact, the comment was: “Just wait. There’s still more of the parliamentary term still to come.” Well, no, there’s not; there’s about another three weeks, or another 11 or 12 sitting days, maybe, and that’s it. I just can’t see 20 mobile dental caravans on the horizon. So it would be useful to know about that.

There are parts of information technology in the Estimates that need some serious scrutiny. If the Minister wants to explain exactly what Hira is supposed to deliver in a concise sort of way—this is a multi-hundred-million-dollar project. I’ve looked at it many times and I understand the interface that it’s trying to have with multiple different providers. I understand that it’s to enable patients to get access to their own information. All of that sounds like a flash personal health record to me. Why we are spending hundreds of millions of dollars alludes me somewhat. So it would be illuminating to have the Minister expand on that large part of the IT budget.

In the same breath, the southern digital transformation—again, hundreds of millions of dollars. Exactly what that is doing, one presumes it’s associated with the Dunedin Hospital build. My understanding is that there were five options and we chose the gold-plated option. I’m happy to be corrected on that but I would also be happy to understand that better—to understand its progress, how it is doing with the triple constraint of time, scope, and cost, because for hundreds of millions of dollars in the Budget, I think it’s reasonable to expect some report back on that. We did look to touch on that in Estimates, but it’s certainly appropriate to put that on the table here as well tonight. Thank you, Madam Chair.

Thank you, Madam Chair. I want to talk about safety. This year we have found that the safety of staff in our hospitals has been appalling. The number of assaults has more than doubled in the past year in our hospitals, and I have had conversations with people who work in hospitals who say, “Look, I don’t actually want to get paid more, I just want to feel safe when I turn up to work and walk down my hospital wards,” and people don’t feel like they have the ability to do their jobs and do them adequately because they’re fearful of being assaulted or threatened when they’re in the hospitals.

I’m curious whether there’s been any funding allocated in these Estimates, or any analysis done on how much money—extra—the Government should be spending or allocating in this Budget towards improving the safety and wellbeing of people in our hospitals.

Thank you, Madam Chair. The previous speaker raised the question of the winter preparedness—I say again that the Government’s first speaker, Tracey McLellan, raised the question of the Winter Preparedness Plan, and I think that does bear some scrutiny in as much as that its purpose, amongst other things, is to decompress hospital emergency departments (EDs), and yet what we know is that Greymouth hospital is at 100 percent capacity in their general ward, Oamaru Hospital had to close their ED overnight on Monday, and send patients to Dunedin and Christchurch—that’s right, this was the Pegasus clinic last week that had to close, which is a primary care clinic, and one would imagine some of that overflow went to ED as well.

So the Winter Preparedness Plan is supposed to relieve some of the pressure on EDs. I’m not seeing it. I’m not feeling the love from that plan, not seeing huge benefits to that, yet this is part of what the funding in Budget 2023—not part. It’s a substantial amount of about $189 million, if I recall correctly, and it’s supposed to be reducing the capacity and the load on these emergency departments, but even here today in these past 48 hours, we’re not seeing that. Could this possibly be because the Winter Preparedness Plan, apart from the Telehealth component, is only for the eight hotspot EDs in the eight hotspot areas?

So for example, the scope extension of pharmacy to minor ailments, which I’m supportive of scope extension—I think there’s a role for that—but it really needs explanation as to why it’s just these eight regions. Because what we have is we have pharmacists from Waikato and from Rotorua saying, “What about us? It’s not like we’re an area that’s extremely well served and have a well-healed population, and yet we’re completely missing from that part of the Winter Preparedness Plan.”

I think that’s a really, really good question to raise. I have no explanation as to why this was not ubiquitous across the whole country. I think it probably should have been, and so I’d like to see the explanation for that, given the substantial sums of money in the Winter Preparedness Plan.

To follow on with another point that the first speaker raised around the “strong” evidence for co-pay relief, I think that needs some challenging. One study that the small numbers were questioned both by the authors and by the reviewers does not a summer make. I also think that the fact that 145,000 people were not able to pick up their prescriptions in the previous financial year, I think it was, due to cost which is being held out as one of the reasons for this wide-ranging policy. I think there are questions around that. It’s been called a small number by a number of commentators. I get that 145,000 is some, but in the context of all the prescriptions, it’s not a lot.

Secondly, when you probe into that—and that data was done by the Health Quality and Safety Commission (HQSC)—and say, well, how many of those had community services cards or were SuperGold card holders, because that that’s the alternative policy that we are proposing, the reply is, “Sorry, we can’t tell you that, we don’t have that much granular data.” Well, that’s kind of not useful. That doesn’t let us have that contest of ideas. It starts with what’s been quoted as a smallish number anyway, and so I want to just contest this idea that the evidence is strong.

There is some evidence, and let’s remember the primary outcome of the Otago study in question failed. The primary outcome was actually decreased length of stay. It was a failed outcome. There were some small pockets of pathology that benefit, but if you read the report, it was a failed primary outcome. It did reduce the number of people that went to hospital. That is fair. So it did achieve that goal and that that’s a desirable goal, don’t get me wrong, but let’s not presume it was overwhelming or “strong” evidence that the Government has put forward for the co-pay reduction. It’s still struggling to map that concept that wealthy people will get the same co-pay relief as those who are most vulnerable. It’s just a principle that doesn’t make it over the line. It just doesn’t get there.

I personally don’t need to pay for the co-pay and I’m happy to pay for it and I know there are a large number of New Zealanders who feel similar. So I want to contest that this is a strong policy and put up a contest of ideas that in fact it should be for the most vulnerable—those with community services card holders and SuperGold card holders is what I’m proposing, and unfortunately the data is not held by HQSC to actually look at what that number of 145,000 is.

So, you know, we don’t seem to be able to go any further down that path at the moment, but I think it’s an important point to make. Again, if the Minister could explain, to come back to my first point, why it is only eight regions, eight hotspots in New Zealand who are benefiting from the Winter Preparedness Plan—apart from Telehealth; I understand that has extended further. That would be useful. Thank you.

Well, there you have it: an argument against targeting on the one hand and an argument for targeting on the other—total absence of logic in the last part of that question. We saw the fig leaf being wheeled out, didn’t we? We saw the fig leaf of, “Well, I’ve read the study and one endpoint said this and one endpoint that.” and that’s the warming us up for the cuts that National are going to make to the very effective and popular policy to make medicine free—to make sure, as the member said, that we keep people out of hospital. Going back to the first part of his question, it was “How do we keep people out of hospital?” Well, there’s one way.

We also have the winter plan, and, yes, many of the initiatives are targeted. There are a wealth of targeted initiatives in our health system, and the first year of the winter plan, the first time our country has had a comprehensive winter plan that spans across pre-hospital, hospital, and post-hospital care—that first time, yeah, we did decide to approach it in a targeted way. We will be reviewing that and see if we cannot make improvements in the future.

There have been some very successful parts of the winter plan. I’m told the minor ailments scheme in pharmacies is going exceptionally well. Thousands of visits there, lots of people making use of it. Sometimes when people do come to hospital, they have been to the pharmacy, so they’ve had the basics already done. The kid with fever has already had their paracetamol, and that means that they actually are in need of coming to hospital at that point.

I contest the idea that every single output that was measured in the health system is actually the appropriate measure to take with us in perpetuity. It may not be. We are trying to change our health system to reorient its priorities to have a greater emphasis on equity, to have a greater emphasis on keeping people well in their communities, and that will mean that in trying to get a broad, representative set of indicators of performance, we will need to make changes. It’s quite a complicated thing to pick the appropriate indicators and work on that is ongoing at the moment, and the appropriate vehicle for resolving that will be through the Government policy statement process, which will be concluded over the coming six months.

In terms of questions about dental care, I thank that member for that question. I’m very proud to be part of a Government that’s taken the step to depoliticise fluoridation and make that an official decision. That is one of the most impactful measures we can have on young people—on all people, actually, but particularly young peoples’ oral health and dental care. The changes we made have the potential to take our fluoridation rate from 50 percent up to 80 percent of people having access to a water supply that is fluoridated. The decisions that underlie that are now taken by the director-general and involve local authorities.

In addition, part of the child and youth wellbeing strategy involves other aspects of looking after young peoples’ oral health. In some poorer communities, we are providing families, via community health providers, toothbrushes, toothpaste, and education on proper dental hygiene there. Then, in addition, the really important change was to the emergency grants for dental care, which has resulted in a $30 million increase, I’m advised, in hardship grants that have been paid out.

On the matter of consultants in the Ministry of Health, there were a lot of consultants in the Ministry of Health as the pandemic wound up. So of the 990 contractors in the Ministry of Health, 574 moved to Te Whatu Ora. They were data and digital contractors. So 184 were in COVID vaccination. Clearly they were going to be on a contract and not long-term permanent staff in most cases, and 89 were also in other parts of the COVID19 response.

I think the member who asked the question about Te Aka Whai Ora staffing numbers received a letter from the chief executive of Te Whatu Ora—and it was not via written parliamentary questions—an apology for the mistake made there, which was an honest mistake—[Bell rung]—about the number of staff reported at select committee.

Does the Minister seek another call?

Hon Dr Ayesha Verrall: No, Madam Chair.

Thank you, Madam Chair. Seeing as the Minister talked about dental grants, I guess I wanted to get her perspective in terms of the overall public health outcomes of changing the non-recoverable amount—whether she’s got any views about whether the exclusion of check-ups and molar extractions actually serves to improve the oral health of our communities, and people lack single services because for some reason the Ministry of Social Development has decided to exclude check-ups. I wanted to test, you know, seeing as the Minister mentioned it, whether she’s got any views as the Minister of Health about whether that’s counterproductive to the grant actually meeting its full potential.

Then I know the Minister talked about fluoridation as a key component in the prevention and wellbeing of people’s oral health, and I acknowledge that, but I guess I wanted to get a sense about what other initiatives, if any, are happening to actually address when somebody actually has ill oral health—and obviously the goal is that doesn’t happen, but when it does happen—and we’re seeing those hospital discharges figure representing that it has remained steady over time at relatively high numbers. What initiatives is the Government putting in place to bolster both the workforce and the public health system, or anything else beyond toothbrushes to improve the oral health of our communities?

Isn’t it remarkable to have a Minister that’s standing up and seems quite angry, a little bit, with our spokesperson in terms of the questions that were asked. I think what the health sector really needs from the Minister is someone who is listening to the crisis which they’re facing out there and the stress that their staff are facing day in, day out.

Why is it today, Minister, that at Waikato Hospital we’ve got pretty much every ambulance in the region ramping and waiting up to four hours because of the bed block at Waikato Hospital today? And this is a daily occurrence across this country in terms of the blockage within our secondary care hospital units, not only in emergency departments (EDs) but right through the patient flow journey within those hospital units, which are blocked. The system is blocked and the symptomatic signs of the ambulances banking up at the front door is systematic of a system that is broken. So what does the Minister say in regards to all of those ambulances that are ramping today? What does she say to those patients calling 111 that have an inability to get an ambulance because all of those ambulances are parked up waiting to offload their patients into ED departments across this country? What are the clinical and adverse patient incidents that have occurred as a result of the delay in treatment or the delay in collection of critically ill patients across the country as a result of these delays?

All of these questions are not new factors and it’s interesting the Minister refers to how well the winter plan is going. Well, I’ll tell you what, Minister, winter happens every year. This is not the first year winter has occurred, but yet after six long years of this Government, you continue to fail to be able to make improvements in regards to the health system. You say that we are making progress, but the facts do not indicate that.

I’m addressing—from the Minister: what are you doing around capital investment upgrade, particularly in the Auckland region? How are you getting on with Waitakere Hospital? How are you getting on with Waitakere Hospital and the fact that that hospital supports a population of Wellington and does not even have ICU or high dependency unit capability and deals with the scale of complexity that is West Auckland, and yet you’ve known about the requirements and infrastructure upgrades for that hospital for years and have failed to do anything of any substance. I can see you smiling, thinking that this is some sort of joke, but it’s not, Minister. These are reality and facts that our communities are facing across Auckland.

When are we going to see plans around a new northern hospital? When are we going to see plans around a new southern hospital? Because six years on, we’ve still not seen any tangible progress in regards to the growth within Auckland and the additional services required. When are we going to see that? All we seem to see is more moving of the deck chairs in a reform programme which, by all accounts, including those within the system, has failed and continues to fail and will be a legacy of you and your work in this area.

I have had conversations with people who have really severe illnesses and some people who don’t have a severe illness, but they want their medication to be funded and their medications are not funded by Pharmac. They’ve raised the issue of the pharmaceutical co-payment and the fact that the Government has now decided to put aside $700 million over four years to reduce the $5 co-pay and they’ve said, “Please take this to the Minister and ask: did the Minister consider at any point that it would be good for our society for our medications to be funded currently on the options for investment list at Pharmac? We would be so happy to pay a $5 fee.” Did the Government consider at any point that that money could be better used to reduce the waiting list of the options for investment list at Pharmac so that people could have access to new and modern medication that would have a $5 charge? And did the Minister consider at any point whether or not that would be more beneficial for some New Zealanders to be able to have access to these medications at all, rather than reducing a $5 fee for a lot of people who can already afford medications?

We’d also like to know what other cost-benefit analysis the Minister did to show what other options could be on the table to help those people that she has considered to be the most vulnerable who cannot afford a $5 co-pay. Did she actually have any other suggestions on the table rather than reducing the $5 co-pay for all people who can afford a $5 fee, because a lot of people have said to me “I would prefer that I was still being charged a $5 fee if it meant somebody else would actually have access to newer, modern medications.”

I want to turn to the issue of the general practice 13 percent pay increase that was allocated in the ACT Party’s alternative Budget. We’ve had conversations with a lot of people who work in general practice who say that they’re stretched, they’re under resourced, and they can’t cover their costs. How did the Government determine that a $5 capitation increase would be sufficient for general practice when the GPs themselves have said that they need a 13 percent GP capitation increase? What analysis was done and why does the Minister believe the Government’s increase is acceptable when the general practice clinics do not?

Thank you, Madam Chair. We’re just wondering if the Minister in the chair, Ayesha Verrall, is going to answer the questions around the 20 mobile dental caravans—she talked about dental—whether she’s going to answer the questions around Te Ara Oranga, the promised 4,000 extra consultations. The written parliamentary question around the number of fulltime-equivalents in the Māori Health Authority is No. 20630—I just want to clarify that. We really just want to know, both my questions and my colleagues’, whether the Minister has any intention of answering them tonight in this debate, which is the purpose.

Let’s also put the Capital Investment Committee, which was reasonably asked and described, into that mix as well. I understand that a number will be extremely surprised that it has been disestablished, as was I an hour ago. So I think it’s a reasonable question to ask. When was it disestablished, why, and what replaces it? This was a very important pathway to millions and millions—literally, billions of dollars. Now we find out it’s disappeared. So really it’s a question: is the Minister going to answer the questions in this debate or not?

I completely agree with Dr Reti. I would really like to know what expenditure was set aside for staff safety in hospitals. We know the number of assaults has doubled in our hospitals in the last year. When I have people in hospitals coming up to me saying, “I don’t feel safe when I’m at work, and I don’t actually want a pay increase; I just want to feel safe when I’m doing my job.”, and they don’t feel listened to by this Government—why the Minister won’t answer that question.

We need to know what the Minister has done to listen to these concerns, because it’s genuinely fearful for people turning up to work, and if people are fearful of turning up to work in our hospital systems, that doesn’t give us faith that more people will want to join that profession. We need to know people are going to be safe when they’re at work, especially when they’re helping some of the most vulnerable people at the most vulnerable points of their lives. How much money has the Government put aside, in addition to what they had before, to make sure that there is security, to make sure that there is safety, to make sure that people are not being assaulted when they’re in the hospitals?

As discussed in the select committee debate, this is an area of a profound concern for Te Whatu Ora and for myself. I am aware that for a long time there has been absolutely unacceptable behaviour directed towards staff from members of the public and that does make them feel threatened at work, and that is absolutely not appropriate. There is a considerable presence of security in our hospitals. Te Whatu Ora has over 800 fulltime-equivalent staff in security, and also in some districts there would also be external contractors providing that service. There is a renewed priority put on that work, and that’s why Te Whatu Ora has engaged with unions on that matter to decide collectively what additional work can be done to address that. I know, in some hospitals that I’ve visited, efforts to make sure that waiting rooms in the emergency department are more proactively managed and there’s more support for the people waiting helps address some of the frustration that might be behind some of the unacceptable behaviour there.

In terms of some questions about capital, the Southern digital transformation project is for modernising the information technology in Dunedin Hospital. That includes some of the infrastructure required for the build, such as cabling, but it also includes transformation in terms of digitising notes and other clinical systems—for example, room bookings—and potentially regionalising those systems as well.

We also at the committee discussed the approach to medicines of this Government, and I think this Government can be very proud of the comprehensive approach we’ve taken to improving access to medicines. We have lifted the Pharmac budget by over 40 percent. There have been hundreds of new drugs or indications for drugs funded as a result of that change. While it is easy to have a go at Pharmac because not everything is available through it, there has been a substantial access to medicine through that effort.

In addition, we are also making sure that the benefits of that technology are equitably shared, and that is part of the rationale for the co-pay policy. It is not just a matter of having one approach to our medicines policy but having an integrated approach. The importance of being able to lift people’s access to medicines through that co-payment is one of the priorities of this Government, and it’s fantastic to see how warmly welcomed that policy is by the public.

We did discuss the reasons for the uplift for community services, including general practice being 5 percent. Traditionally, and this financial year, the uplift has been based on the annual statement of increase. That looks at capital cost, supplies, and workforce costs, and it was based on that—that was 4.9 percent; the 5 percent uplift was in addition to that. It is the highest uplift that has ever been given to primary care and community services.

Kia orana, Madam Chair. Kia orana to the Minister, the Hon Ayesha Verrall, as well. I just thank the Minister for answering some of the questions, especially on the Winter Preparedness Plan. It is the first of its kind—the investment into 193 additional front-line clinical staff, which will be funded in Budget 2023, but also to see the investment of an extra half a billion dollars for primary and community care—obviously, I will still push for our community providers there—and also to see the $5 co-payment gone, which will definitely help, and has helped, many of my community members in South Auckland.

One of the focuses I want to speak about is around our young people and how the extension of school-based health services supports the physical and mental health of our young people. Looking at Cyclone Gabrielle and the affected areas there, how will the roll-out of the successful Mana Ake programme to our primary and intermediate schools in the Hawke’s Bay and Tairāwhiti areas make an impact to support our tamariki in those areas? Thank you.

Thank you, Madam Chair. I’d actually be interested to hear a little bit more about the funding in Budget 2023 to reduce waiting lists and also to standardise access to healthcare. There were some recent announcements around cataract surgery. Being from down South, I hadn’t quite realised just how many more points those residents in the Southern region needed to get cataract surgery than some of those further North. So I’d just like to hear a little bit more about what investments in Budget 2023 are being put in place to ensure that we can get equity around the country in terms of cataract surgery—also, though, looking then at how that approach could be used to look at other equity issues, in terms of reducing the postcode lottery for other elective surgery and other interventions. I’d be really keen to hear more about that as well.

Just circling back to make sure I’ve dealt with all of these questions on the list, I can reassure Dr Reti that the Capital Investment Committee was disestablished as part of the transition to the new health system, but its function is carried over to a subcommittee of the Te Whatu Ora board. It includes board members as well as external experts.

In response to the question about cataracts, that has been a persistent inequity in our health system and one of the ones that has really been illustrative of the inequities that existed when we had 20 district health boards. Literally, in Dr Liz Craig’s part of the country, and in Canterbury, people would have to be legally blind before they were able to qualify for publicly funded surgery for their cataracts, whereas in other parts of the country surgery could be done much earlier, because that was just the difference in how the DHBs chose to, or had to, allocate their funds. So being able to allocate some of the funds that were prioritised to wait-lists towards the initiative of getting over 3,000 additional cataract operations done has meant that, over time, we can progressively bring that threshold back to the place where it is the same across the country, because that is fair and what every citizen and taxpayer in New Zealand should be able to expect.

These situations actually exist across all of our wait-lists. There are variations across the country, in various different access criteria in different districts, so there is an opportunity to go through each of them and identify opportunities for standardisation. I know officials at Te Whatu Ora are working on that, and they’ll progress that as opportunities present themselves. Of course, the other important thing with wait-lists with that allocation of funds—$118 million—is to make sure that we continue to push for wait-list reductions. I’m very pleased to report that I have been advised the wait-lists are reducing in all parts of the country, and that challenge of moving through with the ultra-long waiters is going incredibly well—for example, all people waiting over three years have had their surgery. They’re working through people who have been waiting for a second year. Te Whatu Ora’s target is for no one to be waiting for longer than one year, and at the end of this year, other than for orthopaedics, where that will take a little longer—but there is a similar plan for that, and those plans correspond to targets for each part of the country. Those targets have been allocated and are monitored week by week.

Thank you, Madam Chair. I’m just hoping to circle back to oral health and, I guess, to put to the Minister whether she thinks that the oral health of our communities is suffering because of the cost barrier to access treatment, including check-ups—which the Minister touched on about the dental grant and the access to the dental grant in this year’s Budget—and whether the exclusion of check-ups is actually contributing negatively to the oral health of our communities. Then, to go back to my previous question, I also wanted to get an understanding that beyond fluoridisation and initiatives that may provide targeted free toothbrushes, for example, what else is the Minister doing to reduce the cost barrier that many of our communities face to access treatment and have good oral health?

I thank the member Ricardo Menéndez March for reminding me of his question. Yeah, indeed, the purpose of the hardship grants is for treatment and a check-up is not included in that. However, I agree with the member’s point that it is beneficial to have them because that allows early treatment. However, I’m not sure, were we to do that, whether the hardship grant would be the right mechanism for achieving a check-up which is a regular preventive part of one’s healthcare. Indeed, I am aware that cost is a barrier to accessing that, and one that I am concerned about.

I also thank the member for the question about health of children in schools and particularly in those cyclone-impacted areas. The Mana Ake programme is a well-tested programme—it grew out of the Christchurch and Kaikōura earthquakes—for mental health support for those little children who themselves and their families and their parents have gone through a disaster. One of the things that we learnt in Christchurch and from disasters around the world is that those mental health impacts can come on three years afterwards, so the response to a disaster is phased. The Mana Ake funding was in the extreme weather events pre-Budget announcement, and now Te Whatu Ora is working to set up Mana Ake in collaboration with the Ministry of Education, and further work with schools in Hawke’s Bay and Tairāwhiti. In general, the whole system works on having very strong relationships with the local community, between the kaimahi from the health system and education, and those relationships are being developed now. As I said, this is not part of an emergency response. It is about building the resilience over the months and years that follow, and that is the reason why that does take some time.

Thank you so much, Madam Chair. This has been a really interesting evening’s conversation. My stepmother’s just had cataract surgery, although not here—in the UK—so I’m aware of the importance of that particular piece of work. Minister, I would just like to talk a little bit more about the focus that this Government has on high-quality health infrastructure which we’ve seen, and I was curious to hear a little bit more about the recent announcement of funding for the Nelson Hospital. I’d just love to know what this means in terms of a stronger health system for the people at the top of the South Island, but also to follow up on what the Minister was talking about with regard to disaster preparedness.

We’ve seen from the North Island weather events that there’s obviously a really clear need to have a plan in place to reduce the devastation of future natural disasters, and you were talking, Minister, about the effects of the Canterbury earthquakes on mental health. But I just wondered how the planned hospital would support people in the wider Nelson area and Wellington region, as well, should the worst happen and a significant earthquake occur on the Alpine Fault line?

Thank you, Madam Chair. I will refer to the earlier question about health infrastructure in general and also in Auckland, and I just think it’s really exciting. I visited with Shanan Halbert, the local MP, Tōtara Haumaru, the new build for elective surgery on the North Shore: 150 beds, and eight theatres and endoscopy suites. It’s looking really good, and the opening is just months away. So that’s a very exciting facility there, and it’s part of that process to make sure that we separate our planned care from acute care so that we can keep planned care going, whatever the pressures are that we have on acute care.

I’m very proud that this Government has prioritised funding on health capital and hasn’t cut it back just when our times have got difficult, because these are such long-term projects that you really do require continuous investment. That is the only responsible way to be able to make sure our country gets the hospitals our people need.

With respect to Nelson Hospital, that is a very exciting development for the people of Nelson. We were able to announce the move to phase one of that project, with over $70 million for the detailed design to be funded and for studies on the site. There are issues with resilience with the existing building, and so the plan for this one is for it to be built to IL4 standards so it can continue to operate if there was a serious earthquake. The building proposed is for an acute services block that would contain the emergency department—an enlarged emergency department—theatres, of course, surgical, medical, and maternity; and then refurbishing and strengthening existing buildings on site to make sure that other services, including community health and other ancillary and support services such as rehabilitation, are available there. Indeed, it would be a very important building for the region, and I’m very pleased that our Government is able to take a significant step in the development of that building.

Tēnā koe, Madam Chair. Minister, recently, sadly, I found out that my youngest sister was diagnosed with breast cancer. Fortunately, it was caught early in the piece, and she went through the process, but she kept it so herself. She’s the sort of person who wanted no pity, and we found out later when she was on the mend, which was great news. But nevertheless, of course, like with anyone in any whānau, it’s a very concerning matter when it comes to any kind of cancer.

So my question is around explaining, please, in terms of the Government’s major upgrade of the breast-screening register, how this initiative improves the uptake of screening appointments, Minister. In addition, please, with regard to Budget 2023’s $118 million in funding to reduce the waiting lists, how does it help New Zealanders to access the cancer treatment more quickly? Kia ora.

I thank that member for her question. The upgrade of the breast-screening register is an incredibly important initiative. It is dated, and that means that there are risks in terms of the ability to keep making sure the service is properly provided and for the security of the system. That work is under way, and I believe it is next year that that project will be completed.

The important thing about that project is that many of the things that you’d think your health information system should be able to do, you can’t currently do with the breast-screening system. So, for example, I know that members of this House ask quite logical and reasonable questions about breast-screening coverage and about who is and who isn’t screened, but that cannot be extracted from the register as it currently is, which is frustrating and it stops us from being able to improve the system.

The second thing that is a problem is that many of the more sophisticated outreach tools that we used over COVID—for example, text messages or emails that incredibly cheaply helped get more people to be aware that their visit was due—will be able to be done with the new system, which we can’t currently do. So that is a huge advance, as well. So those opportunities to make sure people who should be screened are being screened to improve the equity of the breast-screening service are incredibly important.

The $118 million for action on wait-lists in Te Whatu Ora’s budget—one of the key priorities for that is implementing the response to the task force report. Now, all cancer surgery is highly prioritised in all of our hospitals, so that goes without saying. But challenges over COVID meant that some people who had surgeries that could have been deferred were having to wait far too long, and that money is going towards making sure that theatres are efficient and that we’re doing all of the work to be on top of how many operations we need to do to catch up, and then doing the catch-up and, in some cases, outsourcing.

Would some member like to move that the committee report progress?

I move, That the committee report progress.

Progress to be reported.