Estimates Debate — Health

Members, the committee is resumed. We now have the Minister of Health. The Minister is available to speak to that portfolio from 7.30  p.m. to 8.30 p.m. I’ll give the call to the chairperson of the Health Committee, Sam Uffindell.

Thank you, Mr Chairman. It’s good to be able to rise and speak on the Health Estimates, and I just wanted to run over a few things that we saw. The Government looks to be funding an increase of $5.5 billion across hospital and specialist services. There’s also a significant focus going forward in this Budget. There’s also an increase in around over a billion dollars for additional cancer treatments. There’s an expansion to urgent after-hours care services, and I want to, of course, note my hometown Tauranga, which is one of the fortunate beneficiaries of that—the new 24/7 digital GP service—as the Government looks to take a load off and help to address some of the challenges that we have in that space, which has already supported over 21,000 consultations. Obviously, Elective Boost has been a very significant focus looking forward for this Government coming out of the Budget.

My questions for the Minister would be if he could give us a little bit of thought around Elective Boost, the wait-list progress around the primary care action plan and the progress on the Government’s 2025 Budget investments in primary care, something around the new cancer medicines—a billion dollars in that space—and also the primary care funding booster. If I can get some thoughts on that, that would be appreciated. Thank you.

Well, thank you, Mr Chair, and thank you to the chair of the Health Committee for your address. The Government is delivering record investment in our health system in Budget 2025. Across three Budgets, we’ve committed an additional $16.68 billion in funding to ensure our hospitals, doctors, nurses, and health professionals have the resources they need to be able to provide timely, quality healthcare to all New Zealanders.

This is the largest investment in health in our country’s history, because we know that putting patients first requires a system that is properly resourced and focused on outcomes. That investment is translating into more staff on the front line. Since 2023, we’ve seen over 2,100 more nurses and more than 600 additional doctors join our health workforce. These are the people who make the difference every day for patients, and our Government is backing them to succeed. The Budget also builds on this record with new funding for modern health infrastructure. It strengthens primary care so people can get access to GP care closer to home, and it supports initiatives across cancer services, extended prescriptions for patients, and elective treatment to ensure New Zealanders receive their hip operations, knee replacements, and cataract surgeries when they need it.

The investment in our new cancer medicines—and I want to acknowledge my Associate Minister of Health, the Hon David Seymour—is a record investment in new cancer medicines: 33 new lifechanging cancer medicines, which will be helping thousands of New Zealanders to be able to have access to treatments they would otherwise not have been able to receive. That is absolutely life changing and is a huge focus of Budget 2025.

The investment into Health New Zealand is also allowing us to get on top of wait-lists, which have grown too long, with too many New Zealanders waiting too long to get the care that they need. Just this week, we announced that our Elective Boost at the beginning of this year performed over 16,000 additional outsourced elective procedures to ensure more Kiwis get access to the treatments they need, and puts us on track to meet the 2024-25 milestone of 63 percent of patients receiving treatment within four months. We know that too many New Zealanders are still waiting too long to get the care that they need, but that is why we’ve put in place the health targets.

We’re providing record investment in health funding and we’re focusing the system on delivering services that New Zealanders need in a timely and quality manner. By putting patients first, we’re making sure that New Zealanders can get that care that they need. I’m proud of the record this Government has, but I acknowledge that too many New Zealanders have been left waiting for too long. We have a significant task ahead of us, and that’s why my expectations of Health New Zealand are incredibly clear: to stay focused on their health targets, put patients first, and deliver the timely, quality healthcare that all New Zealanders deserve and expect.

Mr Chair, thank you. Thank you to the chair of the Health Committee and to the Minister for those opening remarks. This Government campaigned on making cuts to back-office services in order to be able to, in their logic, free up more funds to support clinical services. I’d like the Minister to describe how the programme of cuts for the current financial year will go ahead, what level of cuts have been identified, and whether that quantum of money to be released by cuts matches the difference between the deficit at the end of the last financial year of $900 million and the projected deficit of $200 million at the end of the current financial year.

I have a pātai to the Minister in relation to the hauora Māori appropriations and am wanting to examine where the spend has gone. What gains have been made in terms of reaching the proposed targets for closing the life-expectancy gap between Māori and nonMāori, and what are the specific initiatives that are funded through new money in the hauora Māori appropriation? Further, I’m wanting to understand from the Minister in terms of the pilots undertaken to inform Māori outreach and the extension of the immunisation services into the community, particularly in the Wellington region. What happened from those pilots, and then where did we commission services from there, and what are the targets associated with those new services? Kia ora.

Thank you. Perhaps the best way to progress would be to have some back and forth with the Minister on some of these big issues relating to the overall shape of Health New Zealand’s financial position and the Vote. I would like to have the opportunity to discuss that in some depth—firstly, the savings programme, the scale of the cuts that are needed to be able to make that $200 million deficit, and the items that are currently being progressed to reach that deficit. I’d like it if the Minister could engage in some back and forth on these issues.

Thank you, Mr Chair. I’ll address firstly the questions from the Hon Dr Ayesha Verrall in relation to Health New Zealand’s budget. I would point her to page 38 of Health New Zealand’s statement of performance expectations, which outlines Health New Zealand’s revenue and expenditure for the financial year that has to do with this Budget. It points out in that statement that total revenue for the 2025-26 year for Health New Zealand is projected to be $30.58 billion and total expenditure is expected to be $30.78 billion. That is an increase in expenditure from $29.05 billion the previous year, so that is an increase in expenditure of $1.7 billion in investment in our health system through Budget 2025.

That’s more funding going into personnel, that’s more funding going into services, it’s more funding going into services provided by funded sectors, it is more funding going into infrastructure and non-clinical supplies. I’ll point the member to that forecast statement of comprehensive revenue and expenditure, which actually shows the significant investment this Government is making in health and where that money is going in terms of providing additional services for patients and for New Zealanders, and it shows the real commitment this Government is making to deliver more access to services so that all New Zealanders can get the timely, quality healthcare that they need and deserve.

Thank you very much, Mr Chair. The question, however, related to the scale of the cuts or the, you might prefer to call it, “savings programme” or “efficiencies”. We know—and Health New Zealand has spoken frequently about its plans to achieve savings—that at the time of the last election, there was a programme of work that appeared to be important to the Government. Could the Minister please outline what is on the Government’s agenda in order to make those savings?

Well, as I said, we’re focused on the delivery of services, and as pointed out on page 38 of the statement of performance expectations, we are investing more into Health New Zealand than ever before. They will be spending more money than ever before. Our focus is on making sure they deliver more for patients than ever before so that we can get the timely, quality access to health services that New Zealanders deserve.

When it comes to the organisation and how it operates, ultimately, my expectations are very clear: I want to see as much delivery for patients as can be done with the funding that we have provided. That’s why we put in place the targets. That’s why we’ve got programmes in place like the Elective Boost. That’s why we’re focusing to make sure that we can reduce wait times and wait-lists for patients who have been waiting far too long to get the specialist appointments, the surgeries, the treatments that they need and they deserve.

I point the member to the statement of performance expectations, which clearly demonstrates that this Government is investing more, Health New Zealand will be spending more than ever before, and our expectation is very clear that that needs to deliver increased services for patients up and down this country.

The Minister can direct me to a document that does not answer my question as much as he likes, and I will take this opportunity to be clear that the question wasn’t answered. It does make me wonder why it was so important for this Government to point out at the election that they felt that there were massive opportunities for cuts or savings in Health New Zealand and that there was wasteful spending, and yet they cannot account for the cuts that they are undertaking in the health system now when they have to debate the health system’s budget. Yet thousands of New Zealanders have lost their jobs because of the Government’s programmes of cuts at Health New Zealand. The people at home listening know this programme is happening, and yet the Minister speaks of unrelated documents when he takes a question on that. I would like the Minister to consider what his obligations are to taxpayers to explain what is happening with their money. Would he reconsider answering what programme of cuts is under way at Health New Zealand?

As I’ve said on a number of occasions, I’m focused on delivery for patients. There have been change processes done, but those change processes have been completed. There are no major change programmes under way at Health New Zealand. I’m focused on delivery for patients and ensuring the organisation delivers the services that New Zealanders need and deserve. That is my expectation of the organisation. As with all parts of Government, there will be opportunities to do things in a more efficient manner. Our expectation of all parts of Government is that they find the most efficient ways to deliver things so we can get as much value for taxpayers’ money so that more patients can get the treatments that they need in a more timely manner. My focus, very clearly, as Minister of Health is to ensure that this record investment in Health New Zealand is delivering results for patients and that it is supporting the front-line services to be able to deliver that service so that patients can be seen in a more timely manner and receive the quality of care that they rightfully deserve.

Thank you, Mr Chair. Prior to the Estimates hearing, we knew from released documents that Treasury had warned the Minister of Finance that Health New Zealand could not make the cuts required to go from a $900 million deficit to a $200 million deficit in one financial year. The Auditor-General has also issued a similar warning. Can the Minister confirm: is it the Government’s position that that $200 million deficit target no longer applies at the end of this financial year? Is Health New Zealand going to get a capital injection in order to reach that target, and, if not, what is the expected deficit now for Health New Zealand at the end of the current financial year?

Well, as I stated earlier, if the member looks at page 38 of the statement of performance expectations, the organisation has a projected deficit of $200 million. That means that their expenditure will be $200 million more than their revenue. The Government is supporting Health New Zealand to deliver services and for the organisation to spend more than what it has been provided in its revenues so that we can maintain and deliver the services that it needs. If you look at the appropriations the Crown is providing, Crown funding is increasing from $24.296 billion to $26.218 billion. That is a direct almost $2 billion increase in direct appropriations. Other funding from Crown or Crown entities is increasing from $3.1 billion to $3.395 billion, third-party and other revenue is increasing from $428 million to $889 million, and there’s a slight reduction in interest received.

Overall, there is increased revenue for Health New Zealand and increased expenditure being provided for. My expectations are incredibly clear: I want to see Health New Zealand deliver more services for patients, reduce those wait-lists, which ballooned under the last Government—a 6,400 percent increase in the number of patients waiting more than four months for a first specialist assessment under Labour. That’s their record—6,400 percent increase.

Hon David Seymour: Didn’t they increase spending by two-thirds?

Hon SIMEON BROWN: Well, this is the magic from the other side: they appropriate money on Grant Robertson’s magic money tree and then don’t expect any outcomes.

Hon David Seymour: I thought it didn’t exist.

Hon SIMEON BROWN: Well, apparently it’s in Dunedin at the moment! But the point is: they don’t expect outcomes. They removed the health targets, let wait-lists balloon out of control, allowed patients to languish on wait-lists, and we’re now addressing that with things like Elective Boost so we can actually get patients seen in a more timely manner.

Point of order. Thanks, Mr Chair. The Minister’s answer—we’ve engaged here with a series of questions about the financial situation at Health New Zealand, none of which have been addressed and answered in the Minister’s responses. They’re pretty straight up and down questions about numbers relating to Health New Zealand’s financial performance, not answered in the documents that he refers to. We seem to have pivoted to some matters that are not really related to the Estimates at all. We just want answers for our questions. The New Zealand taxpayer deserves answers about their health budget. We’d really like to know what’s happening with the Health New Zealand deficit.

Thank you for that point of order. If I can draw members’ attention to Speaker’s ruling 144/2: “On the Estimates a member may ask a question relative to the expenditure of an appropriation voted the previous year, but may not debate it—discussion must not travel outside the items which are to be appropriated during the current financial year.” If you could contain your questions within that ambit, that would be useful for the committee. But also, I note that many answers that Ministers will give will not satisfy all members as well. I would encourage members to continue to probe if necessary, but if those answers continue to not be to your satisfaction but are still being addressed, can I also encourage members to move on. Also, to note for members as well, there are other Ministers that are available here if there are questions for them as well. Let’s continue.

Speaking to the point of order, if I may. I think the point was not that the question—well, partly that the question wasn’t addressed, but the key point was that the Minister was straying into Budgets of years gone by, which have nothing to do with the Estimates. If the debate that we are to engage in must relate to the current Estimates, then surely the Minister’s responses have to relate to the current Estimates.

Actually, I take the member’s point. I would ask Ministers’ responses to also focus on this appropriation as well, as opposed to looking back. Let’s continue.

Thank you, Mr Chair. We heard from the Minister of Health about the revenue and expenditure in Health New Zealand; we would really like to hear about the deficit for Health New Zealand and how the deficit from the 2024-25 financial year will be addressed. Is it by revenue from the Vote or by a different capital injection?

I’m going back to the hauora Māori appropriation again, seeking answers from the Minister of Health in relation to what new money has eventuated in terms of spend for hauora Māori services.

Going back to our babies, our mokopuna, we have set targets around immunisation, commissioned services that were based on pilots that were delivered into communities. How is the direction of travel being achieved in terms of tamariki Māori, particularly in the first eight months, as to the targets of achievement for the services that have been commissioned—the hauora Māori appropriation initiatives specifically that the Minister can put on the table that will close the life expectancy gap between Māori and non-Māori?

I’m further wanting to discuss with the Minister in terms of his view of the spend in maternal health and the access of pregnant wāhine to lead maternity caregivers, and how is that direction of travel and the spend going into community services.

Then one further question: for kaupapa Māori mental health youth services, how are we treading in terms of both the funding that has gone into those services and what targets may have been set for our young people to be accessing those kaupapa Māori hauora services?

It’s a hauora Māori pātai for our babies, our mokopuna; our mothers accessing maternity services; and then further for youth mental health.

Thank you, Mr Chair. In terms of hauora Māori services, there’s been an increase in the appropriation. Again, the statement of performance expectations highlights total revenue increasing from $484 million to $555 million. The expenditure is projected to be $555 million in the Budget 2025-26 year. One of the key initiatives—and the member touched on it—was in relation to the immunisation target that we have set. Of course, there’s been a significant decline in the number of children who have been immunised at two years of age, from 92 percent down to 77 percent in 2023. We are starting to see that result start to turn around, which is good.

Programmes such as Immunising Our Tamariki are central to doing just that. I’m advised that, as of 31 May 2025, more than 125,000 immunisations had been undertaken by hauora Māori partners across the country through that programme—12,952 of them in May alone. That is a significant initiative, which was launched by the previous Minister of Health, Dr Shane Reti, to help increase immunisations amongst our Māori population. Ultimately, for us to meet the target of 95 percent of two-year-olds being immunised, we have to ensure we increase the rate of immunisations amongst our Māori communities. That’s where that appropriation is so critical to help and support initiatives that help drive that increased immunisation.

We are seeing increased immunisation rates within our Māori population. It’s increased, I’m advised. In 30 June last year, 63.3 percent of Māori twoyearolds had been fully immunised. That increased to approximately 68 percent at the middle of this year. Clearly, that’s a long way behind other populations, and that’s where this programme is so important to address that critically important health issue.

Thank you, Mr Chair, and thank you to that member for questions around mental health. This Government is committed, through its mental health plan, to delivering faster access to support, growing the front-line workforce, and a better crisis response. We are turning the corner and seeing our mental health plan working—almost 10 percent more front-line mental health roles since coming into office—and we know people are accessing specialist services by well over the target of 80 percent in three weeks.

In fact, this Government set the first targets for this country ever in mental health—five mental health targets. Three of them are around faster access. One specifically the member referenced for our young people: accessing specialist services. The target we set is 80 percent to access specialist services in three weeks. The latest data for quarter three of the financial year 2024-25 is a national average of 82.4 percent. There was a question more specifically for the access rate for Māori, and I’m happy to report Māori are accessing our services faster than the national average, at 84.9 percent.

Mr Chair, if I can please then ask the Minister for Mental Health, just following on from those questions about under-19-year-olds—the Mental Health and Wellbeing Commission has got data showing that there are worsening trends in youth access to specialist mental health services—I’m sure he’s aware of it—to March 2025, where, for GP referrals for under-19s, nearly 30 percent were declined. That was up from nearly one in four last year. Is the mental health Minister now saying that that has improved—and I’m speaking here about specialist mental health services, not about accessing services for more complex needs.

Well, the first thing I’d say is the reason that we can actually measure the access to mental health services in New Zealand is because this Government has put targets in, and not only for primary mental health and addiction services but for specialist services as well. There’s nothing more accountable to myself, as the mental health Minister, and this Government than actually setting New Zealand’s first targets for access to mental health services.

I can report that the access has increased. If you look back at specialist services for under-25s, in quarter one of the financial year 2024-25, the access rate was 72.8 percent were being seen within three weeks. In the following quarter, quarter two, that went up to 77.1 percent—so from 72.8 percent to 77.1 percent—and in the latest data we have for quarter three, it even goes up again, to 77.5 percent. We’re due to release soon the quarter four data, and I’m looking forward to that, because for the first time, we’ll be able to have a trend line of the last 12 months.

Let’s be very clear: in Budget 2025, this Government invested more into the mental health and addiction ring-fence. Broadly, we’ll go from $2.6 billion to $2.8 billion, and what we have learnt in mental health from previous Governments is that it’s not just about how much money you announce. It’s actually ensuring that you get the outcomes from that investment, and that’s why it’s important that we have these targets to drive performance forward.

I’m wondering then if the Minister can explain in Official Information Act response 00092305, released on 11 July 2025, why the numbers are showing that the number of young people being declined and not being referred from general practice services has risen under his watch rather than declined? Is this because he is measuring different things, and is he prepared to provide a response to that question, which is from his own officials?

Well, I think you’ll agree that when you look at the reasons for people being declined, more often than not it is because there is a more appropriate service than the service that the individual has been referred to. I’d only look to investments into programmes like Gumboot Friday: an extra 10,000 young people seen, an extra 30,000 sessions. In fact, if we look at the investment: an extra $5 million into the mental health innovation fund that funded organisations like the Rotorua Youth One Stop Shop and other youth services as well. That’s why we have more services offering more timely access to support to young Kiwis in a time of need.

Thank you. I’d like to take the opportunity again to go deeper on another topic in back and forth with the Minister of Health in relation to the affordability of general practice. I’d like to start with the findings of the last New Zealand Health Survey that shows that one in six New Zealanders have missed going to the general practitioner because of the cost of a visit. My question to the Minister is: what initiatives does the Government have under way to reduce the cost of general practice visits?

I acknowledge that for many New Zealanders it has become too hard to see a GP, and for many New Zealanders the time to see a GP has become extraordinary, and that has impacted on the access that they have. There’s a number of things the Government’s doing to improve access to general practice. A significant part of this Budget is aligned with supporting general practice in a number of ways: increased capitation funding, increased funding to support practices to make them more accessible, performance-based funding to improve immunisation outcomes, and $26 million in additional funding to help GPs keep fees capped for community services card holders and those on low incomes, and to ensure those under 14 continue to receive free GP access.

The Budget also continues to support the Very Low Cost Access Scheme, which supports many thousands of New Zealanders to have access to lower-cost general practice. The Budget has a number of targeted initiatives to continue to support those who need help the most: through the community services cards, through the children under the age of 14, through the Very Low Cost Access Scheme to make sure that they are able to access their GP.

Also, we acknowledge the fact that we need to speed up access to general practice and make sure that people have more timely access to a general practitioner, and that’s where the Primary Care Tactical Action Plan, announced as part of the Budget, has a range of initiatives to support primary practice, including around workforce, helping to get more doctors working in primary care, more nurse practitioners working in primary care, more nurses working in primary care; helping to advance the education of nurses to become nurse practitioners; and getting overseas-trained doctors who have passed the New Zealand registration examinations exam funded placements to be able to start work in primary practice. This is all about increasing access and making primary care more accessible.

As my colleague Sam Uffindell mentioned earlier, we’ve also invested in urgent and after-hours care services, which we’ll be starting to roll out in coming months, as well as the new 24/7 digital access to general practice, which allows people to be able to book an online GP appointment any time, anywhere around the country. We’ve had over 20,000 consultations in the first couple of months that that’s been live. The numbers are increasing every single week. That is helping people get more timely access to general practice. Of course, that comes with subsidies for those who need access the most so that they are able to access that service at a lower cost so they can get a more timely service. Of course, those subsidies help them to access that at a lower cost as well.

Thank you, Mr Chair. If I may just conclude these set of questions on primary care costs, or on general practice costs. Will any of the initiatives that the Minister listed bring down the cost of seeing a GP during this cost of living crisis?

As I outlined in my answer, there’s a number of initiatives that we do to provide lower-cost access for New Zealanders: those community services card holders, to make sure they can access GPs at much lower cost than non - community services card holders; the Very Low Cost Access scheme, which has been in place for many years, that continues to support access for many New Zealanders living in low socioeconomic neighbourhoods and communities to be able to access lower-cost general practice. As I said, the 24/7 digital GP service has subsidies attached to it so that people can access that service in a timely manner at a low cost if they have a community services card, or if they’ve got a child, they can access that service at a much lower cost than if they don’t. This is about increasing access to those services and also supporting those critical ways of making sure we can provide access at lower cost for those who need it the most.

Is it acceptable, in a cost of living crisis, to pay $94 for a standard GP appointment?

Well, the vast, vast majority of New Zealanders don’t pay that much money to see a GP—and the misinformation being put out by the Labour Party, when the vast majority of patients pay far less than that to see a GP. Ultimately, what I’m focused on is making sure that those who need it the most have access to those subsidies which are in place: community services card holders, Very Low Cost Access schemes, making sure that children under the age of 14 can access a GP for free—those are critically important services which we continue to support as a Government so people can get access to those services.

The reality is that too many New Zealanders are waiting too long to see a GP, and that’s why we’re investing in our workforce, and also in digital solutions, so people can get that access where they are, across the country, anytime, anywhere. I acknowledge the issue that the member is raising, and I’d point to her record when GP fees continued to increase when she was the Minister of Health.

Ultimately, what I’m focused on is improving access and fixing the problems she left behind—making sure we can reduce the wait time to see a GP. That’s why we’re putting in place a target to actually ensure New Zealanders can see a GP in a timely manner. That’s why we’re investing in the workforce. That’s why we’re making sure those overseas-trained doctors can actually practise here in New Zealand. That’s why we’re training nurses to become nurse practitioners to work in primary care. That’s why we’ve got the 24/7 digital service. That’s why we’re investing in urgent and afterhours care. By the way, when she was the Minister of Health, she was pretty happy with Kenepuru after hours potentially being closed. Well, we’ve put in place an urgent, after-hours care service so that we can actually maintain and enhance access to urgent and after-hour care services up and down our country. That is what we are doing as a country. When they were in Government, the 24/7 service in East Auckland was—

CHAIRPERSON (Teanau Tuiono): I want the discussion to focus on this appropriation.

Hon SIMEON BROWN: The appropriation enhances access to urgent and after-hours care services, which were diminished under the previous Government. We’re investing in front-line services so that more New Zealanders get the access they need in a timely and quality manner.

Thank you, Mr Chair. I’ve got three questions about primary care, and I am hoping I get answers, not political rhetoric. My first question is: is the risk structure of the capitation funding going to include addressing health inequities along ethnicities, and, if not, why not? This is something that’s future looking. The second question is: does the Minister accept that costs—

CHAIRPERSON (Teanau Tuiono): Can you repeat the first question again?

RICARDO MENÉNDEZ MARCH: Will the restructure of the capitation funding model include addressing health inequities along ethnic lines?

The second question I have is whether the Minister believes that cost is a barrier to accessing a GP and whether any new initiatives he has brought forward will lower the cost of seeing a GP face to face.

Thank you, Mr Chair. I thank the member for his questions. In terms of the re-weighting of capitation, the factors that will be considered will be age, gender, deprivation, multi-morbidity, and rurality. Those factors are critically important to ensure that the capitation funding is targeting on the basis of need. It is critically important to ensure that all New Zealanders can get the access to those services that they need. That work is now under way by the Ministry of Health and Health New Zealand, with the intention for the re-weighting of capitation to flow through into capitation from 1 July next year. Of course, that needs to go through the Primary Health Organisation Services Agreement Amendment Protocol negotiations with the sector, which will no doubt take place in the first half of next year.

In terms of the member’s other questions, ultimately, there’s a number of initiatives in this Budget to support access to primary care to ensure those patients and those communities who need access at lower cost can access primary care at a lower cost. That’s why we have the community services card, That’s why we have the Very Low Cost Access scheme. That’s why we have free GP visits for under14-year-olds. That’s why we’re investing in the 24/7 digital service, which also has subsidies applied to those patients so they’re able to continue to get timely and quality access to the healthcare they need.

Just following on from that, does the Minister of Health accept that cultural safety is clinically relevant for patient outcomes?

Well, this is getting into very much a sort of—it’s gone from the Budget to more of a philosophical debate here in terms of policy.

Ingrid Leary: Point of order. I think this is highly relevant to the funding decisions that the Minister’s made.

CHAIRPERSON (Teanau Tuiono): How is it relevant?

Ingrid Leary: Because the Minister has changed structures and funding streams that deal with cultural safety. My question is: is that clinically relevant for patient outcomes, in the Minister’s view? It’s a simple yes or no question.

Hon SIMEON BROWN: Well, ultimately, the role of our health workforces is to ensure that they are providing services which meet the needs of a variety of cultures who live in New Zealand, and a variety of ethnicities. Yes, there is a significantly important role that our health workforces play when it comes to providing those services that they do on a daily basis. I think the member’s referring to a consultation document that’s out under way with regards to the Health Practitioners Competence Assurance Act. Ultimately, there has been a submission process; those submissions are being considered. Once Cabinet has made decisions, ultimately, those will then be announced.

Further questions for the Minister for Mental Health—he’s raised the fact that referrals might not be being made to specialist mental health services because there may be better places for them to get treatment. I’m interested to know if he’s talking about the community sector, and, if so, what is he doing, and is he satisfied that there is sufficient funding in that sector?

I refer to what is happening in Waikato, for example, where there’s bed locking happening at the hospital because people are reaching crisis point—they cannot access community services. They are reaching crisis point in the hospital and then they are unable to be discharged because there are no community services available for them to be able to access, so they’re taking up beds. My question to the Minister for Mental Health: is that the type of community sector/service he is referring to, or what specifically is he referring to for specialist mental health services, because Gumboot Friday is clearly not that?

Secondly, is he satisfied that the Waikato situation is providing value for money? Thirdly, what does he say to community providers who were promised to be able to access funding through the mental health innovation fund, who still have been locked out of the funding because of the cofunding requirement? Is that building the community sector and providing those alternative treatment sources for those not referred onwards by GPs?

I have a two-part question to two different Ministers to go back to primary care to discuss with the Minister around the revision of capitation funding and how those decisions were made to focus on the multimorbidities, on the gender, on the rurality, all of that. That came from, I believe, an analysis across 18 primary health organisations. Are you able to give us more of a fulsome explanation as to how you landed in that space and how the Minister and his officials believe that that will reduce or improve health equity and the outcomes of those high-need populations that you are seeking to improve access for primary care?

Then my part two question is to the Minister for Mental Health in terms of child and youth mental health through Health New Zealand and those particularly that are sitting within the main system—not funded services. Child and youth mental health have heard from staff whereby there are long waitlists at the moment for those families who are trying to access both—I think this is more of a northern region thing that I’ve heard, where there are challenges in terms of accessing. The wait-lists are long, Minister. Are there any intentions, thinking future-focused, how we can have an injection of support to reduce wait times for families, which can be up to six months waiting for that oneonone support from child and youth mental health?

Thank you, Mr Chair. In terms of the re-weighting of capitation, effectively, the work the Ministry of Health and Health New Zealand are doing, yes, has analysed—and there’s been a piece of work done which does analyse—practices in a range of primary health organisations to look at need. Decisions have been made in relation to what the factors are, which will go into that re-weighting, as I outlined earlier in relation to the question from your colleague.

What this will mean for practices is that those practices which have patients who have a higher degree of deprivation or multimorbidity or rurality is they will receive extra revenue which will allow them to be able to support their patients. For some clinics, that may mean the ability to employ more staff; they may use that to reduce the fees; they may do a range of things to improve access for patients to services which help support the patients that they have on their books in those clinics.

I speak to many of my rural colleagues in particular who talk about the difficulty in rural communities accessing their general practitioner. This is critically important for our rural communities to increase access by re-weighting that funding to support those clinics to be able to—whether it’s hire the staff, pay the GP more, extend the hours; whatever it takes to be able to improve the access in those rural communities. I think that is where the re-weighting of capitation—which has been called for for a very long time—is going to have some of the biggest difference across New Zealand once that’s rolled out and which I’m looking forward to delivering next year.

Thank you, Mr Chair. I’d like to turn to investment in the health system infrastructure. The Minister received a briefing that was directed at identifying if the health system had the capacity to particularly meet demand for surgeries and planned care. That briefing said that the health system was short by 500 beds in Te Manawa Taki and Central North Island hospitals were short 107 beds. In this region, the Central region, hospitals were short 55 beds. Te Waipounamu were short 76 beds, and the Northern region was short 209 beds. In that region, 120 new beds were created by the building and opening of the Tōtara Haumaru Hospital on the North Shore of Auckland by our last Government. I would like to ask the Minister: what progress is being made now to address that bed deficit so that we can meet today’s demands, much less the future’s?

Thank you, Mr Chair. I just want to respond to some of the questions directed to me as Minister for Mental Health. There was one question quite rightly looking at the Government’s focus on how we can support faster access to timely mental health support, and the question was using an example of the Northern region, which I think is a very important question. The first thing I’d say is that it has been the focus of this Government by bringing back the four regions within Health New Zealand, we have regionalised Health New Zealand, because we believe that, actually, rather than centralising, we want to return decision making back as close to the front line as possible.

What that means in mental health is when you look at the mental health targets that this Government set for the first time in New Zealand, if you take the target around specialist mental health services—a target of 80 percent of people to access specialist mental health and addiction services within three weeks—I’ve always been very clear and said quite publicly, as mental health Minister, I’m not going to be happy just with the national average. Why I say that is now we have set the targets, we are measuring against them, and we are reporting on the data. We can actually drill down to the 20 health districts. We can actually drill down to urban and rural, to other population groups, and young people as well. Why that is important is I’ve worked with the deputy chief executives who head up the four regions. They are now called regional directors, and they report on the data for their regions and are required to put action plans in place.

My expectation this year—the $2.8 billion we will spend on the mental health and addiction ringfence funding is for areas or regions that are not delivering to that expectation of a three-week wait time, then investment goes into those areas to bring them up to the desired performance level. One way of doing that is bringing in the community sector, and I’d just like to link in Ingrid Leary’s question about what the Government is doing to support the community sector for mental health. We call it the “funded sector”. Already—the question was around the mental health innovation fund—the first-year tranche funded MATES in Construction, Youthline, the Sir John Kirwan Foundation, Rotorua YOSS, Mental Health Foundation, Wellington City Mission, the National Collective of Independent Women’s Refuges, and a number of other community organisations.

The question was around why we went for match funding. Well, I just put it to you—that fund was $5 million, and because of the match fund, that is now $10 million this year. We’re just to announce year two; that will be another $10 million. We get the ability through match fund to deliver twice the activity and scale that up as well.

The member did, quite rightly, ask the question around an important issue where we have people on our mental health inpatient facilities that might be clinically ready to be discharged but there, potentially, is not the support services there. That is another task I’ve given the regional directors to look at—the occupancy rates of their inpatient facilities within their respective regions, and to ensure that we build out the system, that there is step-down care that we can discharge people into the community.

Because this is an Estimates debate, I’d point to Budget 2025, where we not only invested an extra $51 million to our forensic acute inpatient beds for Health New Zealand but funded a number of community and NGO beds in the community so people can be referred out into step-down care to increase that flow into our inpatient facilities.

I thank the previous speaker for the question in relation to infrastructure and I acknowledge the infrastructure deficit, which is a challenge that we’ve inherited, but is also something which—if you look at the average age of health infrastructure, I believe the average age of health buildings owned by Health New Zealand is 47 years. This is a challenge across Governments, whether it’s in roads or hospitals or schools—the need to invest more in our health infrastructure to make sure that we have the capacity.

That’s why, as Minister of Health, we have released the Health Infrastructure Plan, which outlines the need to invest, but we also need to make sure we’re investing quickly. That’s why in this year’s Budget we allocated funding for modular wards to be able to be built rapidly at a number of hospitals. We’ve announced two of those hospitals where those will be built—one at Hawke’s Bay and the other at Nelson Hospital. This allows us to actually build that capacity quickly whilst we are also doing the work on the business cases for the additional long-term investments that are required.

We’ve obviously, in this Budget, also funded the Nelson Hospital redevelopment. There is planning work under way in Hawke’s Bay, in Tauranga, in Palmerston North, and, ultimately, we need to continue to build that pipeline of health infrastructure projects that can continue to be delivered so that patients up and down our country in our health workforce have modern, reliable infrastructure which supports patients, supports our workforce, so all New Zealanders have access to the timely, quality healthcare that they need.

Thank you. I wonder if the Minister could elaborate on some of those points. Why is it that the Health Infrastructure Plan did not set out those initiatives to have the modular hospital beds created and the number—why didn’t it state the bed deficit? Why didn’t the infrastructure plan name the number of beds to be added this year or in the next five years or in the next 10 years? In fact, there was more specificity in the Health Infrastructure Plan around the building of car parks than there was around the building of hospital beds. Can the Minister elaborate what new beds are coming in the next year or two or five?

Well, as I’ve just outlined in my answer, the Budget funded modular bed wards are to be built in a number of hospitals so that we can provide extra capacity. Business cases are under way on a number of major builds, which will outline how many beds will be required and how many will be delivered and, ultimately, the capacity and services that will be delivered in those hospitals. That is what we are doing with the Health Infrastructure Plan.

This Government didn’t inherit a health infrastructure plan. We have had to put a health infrastructure plan together. When the last Government put Health New Zealand together, they thought that they could just jam 20 district health boards together, change the letterhead, and think, “Job done.” We are now having to do the work of actually delivering the infrastructure, the services, getting on top of the wait-lists, making sure that we’re actually delivering for patients. That is what this Government is doing so that all New Zealanders can have access to the timely, quality services and healthcare that they need. That’s the work we’re doing. I’m proud of the work that’s been delivered. This Budget delivers on that, but there is so much more work to do.

The Health Infrastructure Plan, I note, doesn’t specifically talk about what is going to happen regarding the reduced dementia and psychogeriatric beds which were taken out of the Dunedin Hospital. You are on record, Minister, saying that that’s because the beds are better in the community, and I don’t actually disagree with the philosophy. However, what work has been done under your Government to create those beds in Dunedin so that those people needing beds, who will no longer be able to get them in the new hospital, will be able to get the care they need in the community? What specific steps have you done?

There’s a range of work under way. Ultimately, the priority is to get the new hospital built. That’s my priority as Minister of Health: getting the new hospital built. We’re very focused on doing that. Once that construction contract is awarded, once we get that under way, there’s obviously a lot of work to be done around making sure we’re implementing, putting the models of care in place. That is my expectation of Health New Zealand—that they’re doing that work so that when it goes live in 2031—I believe is the time line—their work has been done before then to deliver those models of care in the community or in the hospital so that patients in Dunedin get access to the timely, quality healthcare that they need and deserve.

Can I just confirm, then, Minister, that when you said to the Otago Daily Times that work was under way to provide those beds in the community, in fact, nothing had been done by your Government?

Work is under way, and that work will continue to be done by Health New Zealand. As I said, my expectations are very clear that as that hospital is being constructed, that work around making sure it is operational, that the models of care are delivered—

Point of order, Mr Chair. Sorry, I think the Minister of Health misunderstand my question. It was the work in the community, not the work in the hospital. If he could answer that, please.

Yeah. Members, the Minister’s time in the chair has now come to an end. We now have the Minister of Justice—you being the Minister of Justice. The Minister is available to speak to that portfolio from 8.30 p.m. to 9.30 p.m. Do we have someone from the Justice Committee?

Justice