Hague Kevin: New Zealand Public Health and Disability Amendment Bill — Third Reading 
Hague Kevin: New Zealand Public Health and Disability Amendment Bill — Third Reading 
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KEVIN HAGUE (Green) 
: 
 Hear hear! Iain Lees-Galloway made a great speech. 
I begin by echoing the comments made by both Paul Hutchison and Ruth Dyson—and indeed by me in my second reading speech—praising the other members of the Health Committee for their work and also the officials and the submitters; it was a great experience to be part of. 
It was a shame that the Minister of Health in his speech to open this debate could not resist the temptation to talk about what he sees as the achievements of this Government in the health sector. Inevitably that opens up the territory to members like me who see this Government’s achievements in health as particularly negative. 
For example I need to respond to the Minister’s comments by pointing out that in its two Budgets so far this Government has slashed funding for health services in real terms. In this year’s Budget we are at least $150 million down on what is required for the health sector to tread water in real terms. That is being measured right across the sector and services that are being cut are struggling now to maintain parity with the task that has been set for them. 
We have also seen the Government whittle away the targets that the health sector has and focus those targets on particular areas of performance. For example Paul Hutchison talked as the Minister did about increased elective surgery. Well elective surgery is one of the few targets left in the health sector so that is what the sector chooses to focus on rather than everything else. As it happens elective surgery makes up about 5 percent of what we ask the health sector to do and if we asked most of the experts in health they would say it is the least important 5 percent. And it is occurring at the expense of the most important aspects of the health sector which are public health and primary care. 
We have not seen from this Government any kind of coherent plan for dealing with the crisis in rural and provincial health services. Indeed just 2 weeks ago we heard from Murray Horn who chairs the National Health Board comments along the lines of “when” hospital services for West Coast people are centralised in Christchurch. Well for West Coast people that is an alarm bell because it suggests that the Government in fact has made a decision about the future of health services and the future of rural hospital services is to be centralised in city hospitals. That is certainly one of the options but I think most rural people were hoping that the Government would instead support the retention of hospital services in rural areas and would have something sensible to say and do about the retention of primary care services in rural areas also. Sadly no. 
It is early days but as yet we have not seen any kind of coherent plan for dealing with the crisis in the health sector workforce. We certainly look forward to the Minister having something to say about that issue. We have a Ministry of Health that is currently in disarray and there is critical erosion of capability largely as a result of the significant change that is occurring leaving the ministry effectively in irons. I could go on but I make these criticisms as I said because the Minister himself opened up this territory. 
Collaboration is an important area and it is one that the Green Party has advocated strongly for. Collaboration between district health boards and between other entities in the health sector enables us to have a health sector and a health service that is able to respond in an intelligent way to the fact that some services need to be organised very much at a local level while others require a regional or national focus. So the effect of this bill the New Zealand Public Health and Disability Amendment Bill in enabling better collaboration between entities in the health sector is good and a far far preferable alternative to restructuring the sector once again and forcing mergers between district health boards and other entities. I do not need to say anything more about that. 
The Health Quality and Safety Commission is also a really important advance. Debates on earlier stages of this bill have highlighted the enormous potential to extract gains in the health sector from improving aspects of quality such as accessibility of services the acceptability of those services their effectiveness their efficiency and the safety of services. The potential for gain is very great indeed. 
It will be important when the commission begins work that it focuses right across the sector on all aspects right from public health at one end—those services intended to keep people well—through primary care secondary care tertiary care and even quaternary services and also disability support services and aged-care services. It is also important that it not only deals with those aspects of health services that are about the interaction between individual clinicians and individual patients but also reflects on and works to create improvements in system-wide effects—the systemic effect of health services and the systemic situation of those people using health services. Iain Lees-Galloway referred to the effect of inequality on health and that will have an important impact on the work that this commission does. 
I thank both Paul Hutchison and Ruth Dyson for their kind remarks about the amendment to this bill that I brought to the House. Indeed I congratulate the House and all of its parties everyone represented here on the unanimous support for the amendment. I probably do not need to go over the arguments which have been well-rehearsed in the House save to say that had the self-funding model that originally appeared in the bill been allowed to stand the consequence would have been perverse incentives that would have produced suboptimal outcomes and indeed hamstrung the commission in its work. I think it is to the House’s credit that that model has not been allowed to stand. Instead we have a rational and sensible basis for funding the service. 
I want to finish by referring to a couple of the next priorities. As Gareth Morgan pointed out in his book  
Health Cheque 
 some of the real outstanding priorities for the New Zealand health sector are firstly to massively increase the investment and focus of the sector on public health services—those services intended to keep people well in the first place and prevent illness and disability. As Gareth Morgan points out those services have far and away the best return on investment. The second thing that Gareth Morgan says we should be doing is leading a focused debate amongst New Zealand citizens on how we should make decisions about allocating the limited dollars and resources that are available to the health sector. On the first of those priorities we have a Government that is currently moving in the wrong direction. It is taking money away from public health and putting it into the more specialised end of services. That is absolutely wrong. On the second of those priorities we are still waiting to hear from the Minister about the progress that is being made in reforming the National Health Committee and the Public Health Advisory Committee to actually undertake precisely that task that Gareth Morgan suggests is important which is to start a national conversation about how we best prioritise scarce health resources. 
This bill is an important start but we now need to move on to the really important work that lies before us. Thank you.