Annual Review Debate — Health

Thank you, Madam Chair. It’s a pleasure to lead off the debate for the annual review 2021 for health. As chair of the Health Committee, I’d first like to take just a couple of moments to thank the clerks attached to the Health Committee, thank all of the officials who worked for and with the Health Committee, and to the members of the committee for all of the mahi that goes into the annual review period.

During the course of this annual review, we, like other select committees, held a hearing with the then Minister of Health to cover the overarching issues in the sector, and we thank the Minister for the chance to discuss the results of those appropriations. We also held individual hearings with 12 particular agencies within that health sector.

We were reminded during the course of this annual review that there had been, in fact, significant changes to the structure of the health sector during the period under annual review. On 1 July 2022, the Pae Ora (Healthy Futures) Act 2022 gave effect to a fundamental reform of the health and disability system. The 20 district health boards—DHBs—and the Health Promotion Agency were disestablished, and two new agencies, Te Whatu Ora and Te Aka Whai Ora, were established. The functions of the Health Promotion Agency have also been incorporated into Te Whatu Ora.

As part of this review process, when we heard from the Ministry of Health, in particular—the Ministry of Health, as a little bit of background, sets out the direction and policy for the health system, it advises the Government on funding and system settings, regulates the health system, and monitors health outcomes—the Auditor-General assessed many of those functions and found that the system, in general, was working at a good level. It assessed the ministry’s management control environment. It assessed its financial information and supporting systems and controls environment, and the performance information and supporting systems controls environments. All of those were found to be working good.

It did make some recommendations for improvements, as to be expected, with regards to procurement: in particular with regards to information technology and with regards to inventory management. The Auditor-General also recommended that it was appropriate, at least, for the ministry to consider ways in which the health system would measure its performance following these significant health reforms. Indeed, we heard that several mechanisms had been introduced to understand whether the system was heading in the intended direction. Te Pae Tata Interim New Zealand Health Plan is one such example, as were other mechanisms, including the ministerial advisory committee, who work outside, independently, who review the whole system and the processes of the reforms to ensure that the system is heading in the right direction.

Other structural changes were made; in particular, the Public Health Agency—within the ministry—which is responsible for operation of public health policy strategy and intelligence, and which, essentially, brought together the previously 12 public health units. We also spoke about the fact that one of the challenges with public and population health is that it actually could take many, many years to see the fruits of those labours and to see the outcomes that are sought. But we were informed during the course of this review that the focus on determining the social determinants of health, such as housing and education, and working with partner agencies was an absolute priority of this group.

We also note that the response to COVID-19 offered some really good models of work, particularly with Māori, with Pasifika, and with other vulnerable communities. We asked during this review process to be assured that the ministry and the agencies were acknowledging that and had learnt those lessons and were inculcating those lessons into future work, which they assured us that they were.

Workforce planning came up. The director-general identified it as a really critical issue, and said that it was the number one priority across the system, and gave us several examples of initiatives that were being utilised to help in that area.

We also heard about the 16 mental health infrastructure projects that had been undertaken, the trend that New Zealanders were living longer than ever before, and the fact that the gap had been narrowed, but not by enough, between Māori and non-Māori.

So, with that said, the Health Committee recommends that the annual review for health 2021 be accepted.

Madam Chair, thank you for the opportunity to address the committee today, and I want to thank the work of the Health Committee for their diligent work in the review. And I note, in future, the process that the select committee is part of—that of the democratic governance of our health system—should be hugely simplified by the reduced number of agencies that report to them, and clearer performance monitoring that has been outlined by the chair of the committee.

The year referred to under review is the financial year 2021 to 2022. If I reflect on that period, having lived through it, I’d say that must be one of the biggest years for our health system in so many ways. The year started with the Delta outbreak in Auckland. It was followed by the biggest ever health mobilisation in the form of the vaccine campaign—the vaccination roll-out. It included the widespread transmission of the novel infectious agent Omicron in February and going into winter. All of these were sources of disruption for our health system, and, as the committee will be aware, some of the consequences of that are still in our health system. However, despite it all, the amazing people that work in our health system managed to achieve the lowest death rate of any country coming out of COVID restrictions that had similar processes to us. So, yes, it was, at many times, in many ways, a tough year, but also the achievements are ones to be proud of.

It was also, as has been noted, the first year of transition to the new health structures, and the new entities were stood up. But, of course, as all members of this House will be aware, the process of setting up the transition to a new health system is not complete just with the legal existence of the entities and the passage of the Pae Ora (Healthy Futures) Bill. And that work is work that is ongoing from July 2022 to today and beyond. It was the year we took the historic step of recognising Te Tiriti in our health system structures. It was a year of phenomenal service-level innovation, as has been pointed out by the chair of the Health Committee, in terms of much more by Māori, for Māori in the context of an emergency health response, and by Pacific, for Pacific services as well—all achievements that we want to continue to build on.

The new health entities enable us to tackle some of the long-term challenges that our health system faces, as well as tackle some of the consequences of the pandemic response. I’ll leave my remarks there and welcome questions from colleagues.

Thank you, Madam Chair. And thank you to all of those who did their work around the annual reviews and replied to questions and did their very best to get us the information that we require to sign off these annual reviews, and the accountability that we have to the New Zealand public to say that we held the Government and held the officers to account as appropriate and as is required in the annual review process.

I have a sequence of questions, and when they’re not a yes/no answer, I’ll have a little bit of narrative behind them so that the Minister can either write it down or check with officials to make it easy to reply. Then I’m hoping to have a riposte back to whatever the answers may be. My first question, then, looking at the year in review, is: what was the total consolidated debt across all district health boards (DHBs) in their last financial year, and did the Government subsequently absorb that debt? So it’s a question around the total consolidated debt for DHBs before they ceased existence.

The second question is: which of the tagged contingencies in Budget 2022 have been drawn down, and by how much? Now, there were a number of contingencies. Some of them, most of them, had, in fact, multimillion-dollar contingencies in Budget 2022 that also came into effect during the year in question. They generally required a business case and a sign off by the Minister of Finance, and significant Treasury involvement. So I am interested to know which of those tagged contingencies have been drawn down and by how much—that’s question two.

My third question talks back to consultants and contractors—areas that we’ve been concerned about—and asks: across the whole DHB sector, how many consultants and contractors were there? Now, we know that a review was done—I think Jim Green led it, actually—afterwards, around about October as I recall, looking at how many contractors and consultants there were in this sector, what they called the “contingent workforce”, but it only focused on those in the Ministry of Health. We’re interested: how many consultants and contractors were there across the whole sector? And we know, we’ve heard figures that maybe there’s 200 PR people, that the vast majority were in the Ministry of Health, some in Health New Zealand now, but just looking back beyond just the Ministry of Health would be useful. As far as we can tell from that review, there were maybe a thousand in the contingent workforce, but what is that total figure? That’s question three.

Question four asks whether the Minister will release the independent inquiry into Te Hiringa Hauora vaccination campaign, “That’s Us”, that occurred on her watch and under her delegation that resulted in resignations and significant funds being put at risk. Now, this was a vaccination campaign where there were allegations that by the time the campaign got under way, the vaccination need of the target Māori audience had reduced substantially. And there were also allegations of conflict of interest of significant stakeholders inside Te Hiringa Hauora employing family and boyfriends/girlfriends of family, and a range of other things. An inquiry was held, and there was no accountability and no follow up to that inquiry. So my question to the Minister, question four, is: whether she will release the results of that independent inquiry. I think we can’t just leave that out there and say “Oh, a couple of million dollars, it was all just whatever” when there are significant allegations to address.

Question five is more specific and it was partly addressed on Q + A this Sunday, but the Minister has said that there is no midwifery crisis, in written parliamentary question 29465 (2022) and then went on to say when asked “Are midwifery services coping in the regions that have maternity and midwifery shortages?”, “Yes.”—29466. I wanted to reflect on that, whether that is a correct statement over the period of time that we’re looking at under this review. That’s question five.

Question six starts by asking: over the year, did the wait-list for those waiting more than four months to see a first specialist increase or decrease? So the target and the promise for a first specialist assessment has been four months, and it’s a simple question: over the year in review, did the first specialist assessment waiting list increase or decrease?

Madam Chair, I think I’ll sit here. I have four other questions, but I can see I’m coming to this point in time. So I might conclude here and, hopefully, come back for another session, please.

Thank you, Madam Chair. I wanted to point to the report from the Association of Salaried Medical Specialists that details the amount that people are spending to access dental care, and the petition that they have launched. So I wanted to get an understanding as to whether the Minister had done any work or her ministry had done any work at looking at expanding free dental care for those over 18, and, if not, I guess I want to get her reflections around the state of access to dental care in Aotearoa.

Another point that I wanted to ask was regarding the migrant workforce in the health sector and whether she was confident that migrants coming in to fill roles in the healthcare sector could be guaranteed that they could be in areas where they pay at least the median wage, and whether that was something that she had certainty upon. And then whether, for those that may not have pathways to residency that may still be working there, whether she has concerns that that may affect retention rates as well.

I thank the member for those questions, and the earlier member Dr Shane Reti as well. Some of the first set of questions are quite technical in nature, so we’re just making sure that we have the correct data to inform our response on those.

With respect to dental care, it is an incredibly important area for one’s health, and a priority area for action for this Government. My belief with so many areas of health is that prevention is better than cure, and that’s why this Government moved recently to enable greater action to fluoridate water supplies. We know that that halves the rate of dental caries for young children. We’ve done that by enabling taking the politics out of this debate, which was one that was subject to misinformation, and by enabling the Director-General of Health to make directives to fluoridate water supplies when that is supported by good evidence.

With respect to the matter that the member raised around extending State-funded subsidised dental care, there is no work under way to extend that at the at the moment, but I understand that that is an important need for people, and especially when there are pressures on the cost of living.

The earlier question about migrants and their role in the health system—firstly, one of the great pleasures of being a healthcare worker is working in a multicultural workplace where there are workers with experiences from around the world and experiences of diverse health systems. There is a lot we can learn from our migrant health workforce. The member will be aware that there has been, coming out of COVID, an immigration rebalance, and health workers have been a priority in that, and that now we have over 40 roles on the green list with a fast track to residency, securing their ability to stay in New Zealand in return for the service they give in our health system.

I am aware that there are some parts of the health sector where an exception has been made for the wage requirements, and that is in aged residential care. The Minister of Immigration has the ability to periodically review that over time, so that the industry has a pathway to be able to raise wages over time. But the alternative, which was the huge pressure on the aged residential care workforce when migration was interrupted, would have led to there not being able to be a workforce sourced in those areas. So that is how that particular issue is addressed.

Thank you very much, Madam Chair. What an important day to debate the annual reviews for Vote Health, and I think nothing typifies Labour’s absolute failure in mental health more than the news on the weekend that a mental health patient had waited 94 hours in the emergency department (ED). One doctor reported that it was the longest wait in the history of emergency departments in New Zealand for a mental health patient.

Let’s be very clear: the Health and Disability Commissioner has called on this Labour Government for a plan. Who would have thought that six years later, after $1.9 billion, we’re getting a record for how long a mental health patient will stay in an emergency department? Why this is important is because, as we heard today from the Minister herself, $27.5 million was announced a year ago, in Budget 2022. As of the end of March, no money of that $27.5 million had been spent to date, and, in the Minister’s answer in question time today, potentially only about $800,000 will be spent by the end of the financial year. That is the important context of the last 12 months of mental health in New Zealand under Labour: no plan and things going backwards. Where did that $1.9 billion go?

What’s interesting is that in the annual review for the Ministry of Health, when we look at question 162 about full-time vacancy rates, I would say that the biggest barrier to timely mental health and addiction support in New Zealand today is our mental health and addictions workforce crisis, which this Government has had its head in the sand over. It has failed to accept the crisis, but it has done little to actually stop the exodus out of our health system.

When you look at question 162 for the fulltime-equivalent vacancy rate for psychiatrists, in June 2021 it was 33.9. In June 2022—because that is the period we’re covering in today’s debate—it was 76.3. In the last year of this annual review debate under focus today, vacancy rates in psychiatry have increased 125 percent. That is why people are sitting in the ED department for 94 hours. That is why vulnerable Kiwis are sitting on waiting lists. That is why vulnerable Kiwis and their families cannot get the access to the care that they need.

Look at the discipline of psychology for this annual review. The full-time vacancy rate for June 2021 to June 2022 has increased from 72 fulltime-equivalents to 114.9, an increase of 58 percent.

Registered nurses for mental health: the vacancy rate is 212 for the same period. At the end of this period we’re reviewing, it is 407—a 91 percent increase in vacancies—and we wonder why people are leaving under the stress of covering multiple roles that are vacant.

This is the pressure on our mental health workforce, so I want to hear from the Minister today what has gone so wrong. When they announced $1.9 billion for mental health—and, let’s be frank, last Budget, they announced another $100 million for workforce pressures. So now we’re up to $2 billion, but the vacancy rates are increasing.

There is no plan. The Health and Disability Commissioner said on the weekend that they wanted to see a plan. The Mental Health and Wellbeing Commission, in its first, damning report in 2021, said that there was no plan. Why is there no comprehensive plan for the mental health workforce crisis in New Zealand? That is the biggest barrier to timely mental health and addiction support in New Zealand.

Thank you, Madam Chair. I would like to pick up some further questions with question seven, if I may please, and that question talks to the surgical waiting list and asks: over the year in question, did the surgical wait-list for those waiting longer than the promised four months for their surgery increase or decrease?

Question eight I’d like to ask the Minister is: how does she explain the 31-day faster cancer treatment times being some of the worst, if not the worst, figures reported at annual review by Bay of Plenty, Northland, Nelson-Marlborough, Lakes, and Wairarapa? How do we explain that very important faster cancer treatment time—the 31-day faster cancer treatment time—being some of the very worst ever reported? That’s question eight.

Question nine is: have emergency department wait times to target increased or decreased over the past year—the year in review?

Question 10: why did health officials not progress a collaboration with Kaweka developers opposite Hawke’s Bay Hospital to co-develop linear accelerators? This looks like it was making progress through the district health board (DHB), and then more recently they’re reporting that it has been, as they say, completely kiboshed, is what the report was—what’s that?—four, five, maybe six days ago. I’m interested, and I’m sure the people of Hawke’s Bay are interested, to know what happened with that collaboration over the year in review that led to that conclusion. That’s question 10.

Question 11: what hospitals have had water leaks, sewage leaks, or black mould identified as problematic in hospital buildings? Now, I have a particular interest in this because Northland Base Hospital in 2021, as referred to in written parliamentary question (WPQ) 41177, had a leak which was a sewage leak in the main stack. And when we checked its progress, it was well later in 2022—so almost a year later, WPQ 40832—where the statement is “I am advised the initial leak has now been contained however further leaks have been discovered and are being remediated.” So just in that hospital alone, we have sewage for what has now been for a year. I’m interested to know about water leaks, sewage leaks, or black mould. And we know, of course, some of the leaks in the emergency department in Waikato, but that’s a little bit outside the scope of what we’re looking for in this annual review, but which other hospitals had similar concerns.

Question 12 is more general: can the Minister name any health metrics for Māori—Māori health measures—that have improved over the year in question?

Question 13: did she receive any communications on the impact of any potential Australian announcements of New Zealanders being given residence and the impact of that on our health workforce, and, if so, what was that impact?

Question 14: are answers to written parliamentary questions correct that in the first three months of establishment of the Māori Health Authority, there was no financial budget—a multimillion-dollar entity had no financial budget for the first three months of its existence—if that is correct, how do we explain that?

Question 15: the Minister in one of her replies described opening the green list for health workforce. The question would have to be—because we would contend that was horribly late; that the letter from Keriana Brooking 18 months to two years previously pointed out, on behalf of all DHBs, the importance of opening those immigration settings. And so my question would be: did she actively lobby the Minister of Immigration during the year in review to more quickly open up the day one fast-track to residency for nurses?

Question 16 is: why was the cancer target removed for the first half of the year in question; why was it not one of the 12 health indicators front and centre as a measure of the health system?

And the last question I have—question 17—is: did those 12 health indicators, which were collaborated with the Health Quality and Safety Commission (HQSC), only last for six months before the HQSC was removed from the project and a completely new set of health metrics brought into place? Those are the questions I have.

I understand, in a year where we have had the challenges of a pandemic, that many New Zealanders would have come out of the year under review with all of that disruption, and their mental health would have been under pressure. But I want to assure the committee that our mental health system has never been stronger. The Access and Choice Programme that is the cornerstone of the Budget 2019 mental health roll-out is really hitting its straps, and now over half of New Zealanders are enrolled in a general practice, and they can walk in and, often on the day, get mental health support in terms of their health issues and also coaching on how to address other mental health wellbeing issues. That service—we designed it intentionally to address some of the equity gaps we know exist with mental health, and I am proud to say that, rather than being set up in the ways of many other services, this service is actually being used more by Māori and Pacific than you would expect as a proportion of population, because we’ve set it up with their needs in mind.

In addition, the Government is taking action on the wider influences of wellbeing through the Mana Ake programme and the Piki programme that is being rolled out in many parts of the country. We are taking more innovative approaches, using telehealth more or mental health apps, which we know brings in people into the mental health system who might feel that an in-person consultation was too confronting for them. So this is another way in, and it’s more convenient.

We have set up the structures within Government to be able to coordinate with other social agencies because we know mental health issues also touch on policing issues, they also touch on housing issues, and, often, people in need of mental health support also require support from other Government agencies, including the Ministry of Social Development.

In addition, the work we are doing on our mental health workforce is paying off, and this is what happens when a Government shows leadership rather than brushing things under the carpet as has been done in the past. When you show leadership, work in this area becomes more desirable and that’s why, for the first time that I can remember, the psychiatry training programme is oversubscribed. We are training more psychologists than ever—and, yes, there is a mental health workforce plan. It is being redeveloped by the new agencies as well. But we are well on the way, in mental health, to building the workforce of the future.

Thank you very much, Madam Chair. I just wanted to take a slightly different track, and elucidate for the many listeners and viewers today the issue we had at the Health Committee about hearing the annual reviews, because I think it’s actually reflective of the reform in Pae Ora. What I mean by that, with the health restructure, is that normally the annual reviews—and I’m sure Dr Shane Reti will agree with me—are an important time for the Opposition to ask questions of the organisations and entities and hold them to account. Normally, at that select committee, when there was a district health board (DHB) structure, the chief executives and teams of maybe up to six, eight, or 10 of those leadership teams would attend so that they could answer every question in detail.

The issue we had this time is, of course, when each DHB turned up, there was only one or two health professionals who could answer very little of the questions. So, in fact, the reason why some of the reports are—well, in fact, to be honest, the reason why we haven’t even received some information from the DHBs, and the ones we did when we wanted to drill down into the issues deeper, we had representatives from those entities who weren’t over the issues.

Why I think this is reflective of what we’re going to experience going forward for the annual review process in Parliament, but also the experience of the public and constitute MPs, is that now that we have this mega-entity, there is, in fact, going to be no people who can answer questions on the ground. As a constituent MP, when I have an issue about one of my constituents who needs better healthcare, I used to be able to go to the DHB CEO; I can’t do that any more—in fact, I’m given a generic email address to go to customer inquiries and fight my way through that bureaucratic process. That’s what our experience was on the select committee. I’m not sure how select committee members are going to be able to drill down to health issues in their region, when we’ll have people who won’t understand where Rangiora is and they won’t be able to understand the pressures of North Canterbury.

So it is going to be interesting to ask the Minister to take a call today and explain to us how Health New Zealand is going to be able to respond better than they did during the annual reviews that we experienced in the Health Committee.

I can address some of the questions posed by Dr Reti. So, firstly, question one: the unaudited deficit was $378 million across all district health boards, which is $172 million favourable to budget. The final audited result is still to come because of evaluations about the impact of Holidays Act liabilities on that number.

The Te Whatu Ora Budget 2022 contingencies for operation expenditure that have been drawn down to date are $742 million. Te Whatu Ora inherited, at July 2022, as a new agency, 1,100 contingent workers, and that is reduced to 850 at the end of March.

The question about consultancy, I can tell the member that the person concerned is no longer an employee at the health agency where they were working, and also that the review is under consideration for release, at the moment, by officials.

With respect to question six about first specialist appointments: over 2021-22, they increased during the COVID period but now we are seeing an increase reflecting improving access to care. Of course, the member knows we continue to work very hard on those figures.

Thank you, Madam Chair. There are further questions I would like to ask. The first would be question 18: why does the Health New Zealand website currently state that nursing wages and salaries in New Zealand are comparable to Australia, and does the Minister agree with that?

Question 19: I want to look back over leaked documents we had in the year in review from the Bay of Plenty District Health Board (DHB), and it was signed on behalf of every single senior medical officer (SMO), every single specialist, and they made a number of points. Two of them were particularly pertinent. One of them was about haemodialysis patients where the specialist was saying patients say to them they would rather die than travel to Hamilton for their haemodialysis. Now, I do believe there may have been some improvement in that situation with new seats at Waikato DHB, but that was a very serious statement to make. But it was followed up by the SMOs at Bay of Plenty DHB, which was what I think was as serious a statement. That is, that people who had been waiting for management of bowel cancer, who were curative at the time, had waited so long that they became palliative. That’s a very serious statement for surgeons and for medical people to make, and I think there is some response required as to how we address that. It’s just that one DHB—and I did allude to it—with the 31-day cancer treatment times.

I think the other question I’d ask the Minister, because she did talk about holiday pay as being one of the factors why the accounts are unaudited—this is getting to be a long period of time now; we’re almost coming up for a year, and the accounts are still unaudited. And I don’t know what the statutory requirement is, but that must be pushing the envelope. But what I would ask her is: the home-care and support workers legislation concludes on 30 June; how much has been put aside or will be appropriated, and what is the size of redoing that 30 June home-care and support workers’ pay equity legislation? My understanding is it’s a big number. So my question is: what is that number, and how has the Minister taken that into account?

I spot amongst some of the member’s questions some that also feature in my written parliamentary question list, so I can reassure the member that, no, I have not had any conversations about the impact of New Zealanders’ new residency rights in Australia on the New Zealand health system.

The member mentioned the faster cancer waiting-times performance metric, and my comment to the member about that is this is a metric where I think it’s really important to dig into the detail of what it means. So the metric applies to people who have quite a high probability of cancer at the time that they are first seen—so people with visible bumps, or growths in some cases. So what that means is these are the people who are likely to have the worst outcomes from their cancer treatment. They reflect probably a fraction—maybe 20 percent—of the people’s situation who have cancer at the time of their diagnosis. And it is desirable that the majority of people—in fact, it would be great if it was all people—had their cancer diagnosed at an earlier stage, because that’s when you get the best outcomes for them. So that particular target applies to those who have the worst prognosis, and so I caution the member about taking that as an indication of cancer services overall, because if we were to optimise our system for that indicator, we would not be using one that would really drive the best outcomes for all of the people with cancer that we seek to look after.

I think an important thing to remember about the year under review is, around the world, cancer services were disrupted significantly, and we saw challenges in cancer system performance all around the world. And in some international comparisons, the New Zealand system really shone, because of the work that our cancer agency was able to do in a joined-up system, making sure that a similar approach to clinical care was taken by clinicians all around the country, making sure that best practice was shared in terms of how you address COVID in these really complex clinical settings. And in some ways, that’s an indicator of the type of joined-up system and fast action we can take when we’re in an emergency situation that is enabled by the health reforms that were brought in.

A few other measures I can tidy up for the member now. The first three months of the establishment of Te Aka Whai Ora—they were yet to have their appropriations transferred at that stage, and so that is the situation for them in the first three months of the current financial year.

When I go out door-knocking and talking to Kiwis, a comment I receive often is “It feels like the Government is taking more of our money, the Government is spending more of our money, and yet we don’t feel like we’re getting any added benefit from it.” I want to look at the core Crown expenses of health. In 2018, the Government was spending around $17 billion on the healthcare system; in 2022, it was $28 billion. We’ve seen health spending increase by around 60 percent in four years, and yet it feels like our healthcare system has gone backwards. We have seen wait times increase for surgeries, for the emergency departments, for dental care. We have more and more people waiting longer for their CT scans and their MRI scans. How is it possible that this Government is spending more and more money and yet people feel like our healthcare system is moving to being Third World? What added value are we getting for all of this increased spending, and is it good enough?

I can reply to the question about home and care support workers that this is a negotiation that is currently ongoing, so, for obvious reasons, we won’t be stating the amount that has been put aside for any settlement there.

In terms of the black mould discovered in Middlemore in the year under review, the cladding has been replaced to the sewerage system joints to stop further leaking. There was a historical problem with leaky buildings, and that work has been completed in 2021.

With respect to Ms van Velden’s questions, I see the matter very differently. I reflect on the time I worked in the health system, which was a time during the global financial crisis where, essentially, there was a policy of austerity for the health system; where we didn’t get our regular uplifts in terms of wages in the health system; where we didn’t get increase in spending for medicines, so our purchasing power for lifesaving treatments decreased; where there wasn’t investment in capital expenditure—some years, zero; absolutely zero. You think about the size of the capital that we own, and to put nothing aside for health system capital is absolute malpractice on the part of that Government that her party supported. So we have had to play catch-up in terms of raising wages, which we have done—nursing wages are up 34 percent under this Government for graduate nurses; over 40 percent for senior nurses, and we’ve made progress across a range of other vital clinicians in terms of addressing their very legitimate claims for pay. Medicines budgets have gone up, and that is what is giving people Trikafta and Spinraza and treatment for HIV and preventing HIV, for multiple forms of blood cancer. That Pharmac budget under our time has increased 43 percent, and that is having a very real impact on the lives of New Zealanders that those medicines are saving.

When we came into Government, we had to reverse the effect of that austerity on our health system, and it would take time at the best of times—and then there was a pandemic. So we’ve backed our health system through that pandemic, we have backed our workers and kept them safe where around the world over a hundred thousand healthcare workers died in COVID—we didn’t have that experience here in New Zealand. I accept there is much more to do, but I heartily reject the austerity in our health system. That was the policy of the last Government.

Thank you, Madam Chair. I want to pick up on the Minister’s comments. We’re talking about $11 billion of increased expenditure over four years. The Minister has talked about small increases to the pharmaceutical budget, some increases for the pay of nurses, we’ve talked a little bit about an increase due to COVID, but during COVID, the expenditure was sitting around $20 billion to $23 billion. We’re talking about $28 billion last year. Where is that money going? It’s not going to the nurses’ increased funding. It’s not going to increases in pharmaceutical budgets. What added value are we getting from that money?

I think the member’s question has been addressed. I’ll turn to the early comment about comparable salary with Australia, seeing we’re on the topic of nurses’ salaries, which have been put up by this Government and part of the interim pay equity payment that was made just a couple of months ago to nurses who work in Te Whatu Ora brought those base pay rates. To be clear, that is what we are talking about: the base pay that you get for working a regular week in New Zealand to be on par with New South Wales, Victoria, and Queensland. Subsequent to that, in April, Queensland raised its pay rates so that they are ahead of New Zealand and other states now.

But all of us, New Zealand and the Australian states, stay in ongoing pay negotiations. So while I am sure that those numbers will bounce around from time to time, we are in a much better position than we were before, where we had a major gap between New Zealand and Australia. So it’s a very important lever to making nursing an attractive profession to go into and to stay in and for other people to come from overseas.

In addition, not just in Te Whatu Ora but in the funded sector, we’ve implemented pay parity for nurses. So now we are halfway through a process of rolling out pay parity, whereby those nurses, who work in roles, say, in aged residential care, and Māori and Pacific providers, have an avenue for their pay to be increased. That’s a $200 million commitment that we’re rolling out there.

It’s very easy to say that we need to do things about workforce, but the Government has been doing that work for some time to raise these pay rates and show that we really do value these important workers.

Thank you, Madam Chair. A couple of points that the Minister has raised; she’s made the point—or tried to make the point—that there were some years when there was no capital expenditure. Can she identify those years then, please?

Secondly, she’s wanted to take some issue with the 31-day cancer treatment target. Can she explain, then, why it’s one of the Health New Zealand performance measures that are reported every quarter? If it wasn’t so good, as we’re raising the question, why is it now a health performance measure?

The third point, she sort of liked to attribute everything to COVID. Without doubt, it’s had impact, and I’m not saying that it hasn’t. Of course it has. But what I’d say is if we look back at the metrics before COVID even arrived, how were surgical wait-lists doing then? How were first specialist assessments doing, and emergency department wait times? They weren’t doing so good, even before COVID hit our shores. So while I accept it’s been a contributor, I’m not prepared to say, “Oh, this is all a COVID responsibility”. And if you talk with people like John Bonning, who was spokesperson for the Australasian College for Emergency Medicine out of Waikato, and he was very clear: “This is not a COVID blip”. So while I accept it’s been a contributor, I do not accept that it’s totally responsible.

What I also just wanted to talk to, then, was during this period in review, the Canterbury gynaecology referral pathways—which were created in December 2021, and said that they would not accept gynaecology referrals unless they needed to be seen within four weeks. That is, unless they had a degree of urgency within four weeks. That went in place on 1 December 2021—was due to be reviewed December 2022. At that time, it was reviewed and they’ve now stayed in place, and I’ve received a number of emails and communications from women in the Canterbury region saying, “Why do we have to be that urgent to get on to the gynaecology referral pathway?” So maybe the Minister could talk to that as well. Thank you.

Noa‘ia, Madam Chair, fạiȧkse‘ea. Minister, I just want to say thank you for answering some of our questions. You’ve already answered a couple of mine. I do have two just to target, but I appreciate the work that’s been done in terms of the mental health Access and Choice programme, especially what you’ve mentioned about our Māori, Pacific, vulnerable, and youth-specific programmes that target these groups.

I just want to focus on the public health and the winter preparedness. I know there’s work in progress being done on workforce, waiting lists, but also on the winter preparedness plan as well. When it comes to these public health initiatives, we want to make sure that equity is one of those things—inequities in our community, whether it be flu, respiratory syncytial virus, COVID19, the various initiatives that we’re doing in the sector to help our communities. So that’s one question: what initiatives are up to plan?

Number two is also in the year in question, about the COVID-19 response and what lessons has the ministry, the sector learnt. Again, I want to point out to the many providers that have done great work, whether it be primary care or secondary care, in order to vaccinate, treat, and manage those with COVID-19 and those with comorbidities as well—the hard work from the sector in protecting our community. So what lessons have been learnt during that time? Thank you.

I thank the member for his question. When I think about the winter plans that we’ve seen during just this term of Government, there’s been successive improvements in every one and a strong focus on hospital management in the winter of 2020 and 2021, and, essentially, an emergency plan much like was part of any pandemic or flu plan, that wards would be shut down and hand care suspended in order to make space for an anticipated large volume of patients. In the end, because of the COVID response and subsequent vaccination response, those worst-case scenarios never eventuated, but it is certainly the case that there were disruptions in the system, and planned care in particular suffered as a result and we are catching up from that.

This year, the stand-up of the new health entities enables a much more sophisticated approach to winter, making sure that we respond as a whole system, not as 20 different silos. That enables us to look at areas where there’s been fantastic local innovation and disseminate that innovation across the system.

I visited an excellent service run by the pharmacists in Upper Hutt, the same ones that did mine and the Prime Minister’s COVID vaccination, and they run a minor ailment service there. Children with skin infections, scabies, or lice, and children with fever can get treatment direct from the pharmacy. There’s a GP available in support if that’s necessary, but it’s usually not, because these pharmacists are very experienced. It’s just one example of the way we’re working to make care more equitable, to make sure that care is delivered near your home so it’s convenient, and to make sure that all of our professionals are working at the top of their scope rather than having to jump through hoops through the system, which ultimately doesn’t respect them and is inconvenient for patients.

I do want to speak about some of the lessons learnt, and for that member, I know, the Delta outbreak was particularly impactful on his community. I think there were considerable lessons learnt by our public health teams in terms of how to work with community, how better to build trust when you’re talking about illnesses, infectious diseases that are stigmatised, and when there is a lot of public interest in in those things. I could list a number of things, a number of innovations, which we are lucky to continue to benefit from. We have excellent contact-tracing infrastructure and that means that we are responding rapidly to things like measles cases in a way we haven’t been able to before, all underpinned by state of the art technology that we developed for COVID. We have the tools of community mobilisation that we built up during COVID, and we’re much more keen to use those to have communities mobilising themselves around their vaccination needs, knowing that harder-to-reach communities are more likely to come forward when they see familiar faces in trusted spaces.

We have a much more sophisticated technology for our recall for immunisations and we’re much more able to target our resources—for example, we know exactly where we need to be in terms of getting the measles vaccine out in Auckland at the moment. All our hospitals’ ventilation has been upgraded. We have expanded ICU capacity. Every ICU I go to looks like they have new facilities where they are able to take care of more patients and safely with safe ventilation there, which is good for COVID but good for the long-term resilience of our health system. We have tools in epidemiology like whole genome sequencing and waste-water epidemiology. That means whatever infectious diseases threats come our way, we are much better able to respond and we have an experience and knowledge of health at our border that will help us be able to deal with any international threats in the future.

Thank you very much, Madam Chair. Fair to say, I think, as a parent, one of your worst nightmares would be realising that your child had or was developing an eating disorder. What we’ve seen under Labour since 2017-18 is that when they came into office, 49 percent of young people who needed eating disorder treatment were seen in the first three weeks. By the end of 2021-22, that had dropped down to 24 percent—a decrease of 51 percent of the number of young people who are accessing lifesaving eating disorder treatment in the first three weeks. And of course when that access is constrained, it’s clearly obvious what’s going to happen, and we can see that in the statistics, with hospitalisations for eating disorders over that same period increasing from 542 to 802—an increase of 47 percent. So the number of young people being seen under the five years of Labour go down 50 percent, and the number of young people who have to pitch up to hospital to get a level of care increases by 50 percent.

Despite the $1.9 billion announced for mental health, funding into eating disorders has been quite static, at about $8 million. Now, the Minister, I’m sure, will get up and say that, in the last Budget, they announced a few million dollars for eating disorders, but after what we learnt today about their announcement for crisis services, and people waiting in the emergency department for 94 hours—the longest in the history of New Zealand—who would actually have faith that this Government spends the money that they announce? Because time and time again, we find out that money is still sitting there while the need increases.

So my question is to the Minister. When you speak to the eating disorder sector, they are calling for an independent review—that’s what they want. They say investment is good, but they don’t even know, themselves, where you’d put that investment—until you’ve had an independent review that would inform an eating disorder strategy in New Zealand and then a subsequent investment strategy. When we’ve asked the last health Minister, Andrew Little, he’s refused. He’s said no. An independent review, that’s not going to happen under his watch. He did not listen to the eating disorder sector. So I’m asking the Minister today if she could get up and say whether she supports the eating disorder sector’s call for an independent review into the lack of access and services for our young people who are suffering from eating disorders today.

I am returning to an earlier question about emergency departments and also to the issue of the winter plan, because those two issues about acute demand in our system are related. In that area, we have a focus on keeping people out of the emergency department, and we’ve talked previously about community initiatives to enable GPs, pharmacists, and others to do more. We can also improve the flow within the emergency department. This includes making sure that telehealth services are better available, and also, sometimes, we can provide virtual care as well. These options, some of them, have been piloted at Middlemore emergency department, and are being rolled out in other places.

I think, in relation to the last question on eating disorders, if I look across the mental health system generally, there has been a considerable number of reviews and pieces of work done around what the appropriate way of structuring our mental health system is. I think it’s important to get on with it and keep growing the services that we have rolled out both through the 2019 funding and 2020.

Members, our time with the Minister of Health has ended. The Minister of Education is now available for one hour to respond to members’ questions.

Education