New Zealand Public Health and Disability (Southern DHB) Elections Bill — First ReadingText is incorporated into the Bound VolumeNew Zealand Public Health and Disability (Southern DHB) Elections Bill — First Reading[Sitting date: 08 December 2015. Volume:710;Page:8608. Text is incorporated into the Bound Volume.]New Zealand Public Health and Disability (Southern DHB) Elections BillFirst ReadingHon Dr JONATHAN COLEMAN (Minister of Health): I move That the New Zealand Public Health and Disability (Southern DHB) Elections Bill be now read a first time. I nominate the Health Committee to consider the bill. At the appropriate time I intend to move that the bill be reported to the House by 11 April 2016. The effect of this bill is to allow for the term of the Southern District Health Board commissioner to be extended until the triennial election scheduled for 2019. This provides the commissioner with sufficient time to develop oversee and implement a financially sustainable turn-round plan for quality health services for the people of Otago and Southland.Without legislative change the commissioner would have less than 18 months to improve the position of the Southern District Health Board. The bill will provide for the Southern District Health Board to be exempted from holding an election for its board scheduled for October 2016 in the triennial cycle as currently required by legislation. In June 2015 I dismissed the board of the Southern District Health Board and appointed a commissioner for the district health board following my serious dissatisfaction with the performance of the board—in particular its management of the district health board’s finances had caused me to lose confidence in its ability to deliver on its strategy for the region including delivering much-needed capital redevelopments at Dunedin Hospital.Financial deficits have been a feature of the performance of the Southern District Health Board for some years. However earlier this year the situation deteriorated considerably. The district health board recorded a deficit of approximately $27 million for 2014-15 which was nearly twice its originally budgeted plan of a $14.8 million deficit. For 2015-16 the district health board submitted draft budgets as part of the annual plan process that ranged up to a $42 million deficit. I have recently agreed to a planned result of a $35.9 million deficit. This is an improvement on previous budgets submitted but needs to continue to improve in future years.Early indications from the commissioner are that resolving the Southern District Health Board’s financial issues will take some time and that they are unlikely to be completely addressed by the end of her current term on 2 December 2016. She has developed a work plan to begin to address the financial challenges which she has been consulting on with the district health board’s staff. The plan spans a range of solutions including more medium-term actions that need to be implemented after December 2016. It is important that the district health board’s financial performance improves so that the Government can invest with confidence in the health infrastructure for the region.In parallel with the work undertaken by the commissioner on the district health board’s financial and clinical sustainability the Government is working with the district health board on two streams of capital development. In September the Government approved $22.5 million for urgent hospital maintenance as well as upgrades to gastroenterology audiology and intensive care units. These projects will ensure that the immediate demands around delivery of services continue to be met while planning for the major redevelopment progress. To ensure the robust oversight of this significant project I also established the Southern Partnership Group in September. The Southern Partnership Group will work closely with the district health board and commissioner to oversee the redevelopment of Dunedin Hospital. I have also recently appointed an experienced clinician to work with that group.I did not propose the cancellation of a local district health board election lightly. The bill therefore impacts on only one election at the Southern District Health Board and will help ensure that the next board to be appointed as part of the 2019 local body elections will begin its term on a more secure financial footing. I have asked the select committee to report back early on the bill because preparations for local elections will begin around May next year. The appointment of a commissioner offers an opportunity to resolve the district health board’s financial challenges and to help secure more sustainable health services and health facilities for the people of the southern district. The commissioner has already begun to address the deficit challenge and it is vital that she is given time to complete this important work.It is also challenging work and I want to acknowledge and thank the commissioner Kathy Grant and her deputies Richard Thomson Graham Crombie and Dr Angela Pitchford for all the work they are doing. I also want to acknowledge the input the advice and the ongoing support of my National Party colleagues based in the Southern District Health Board region. They are doing a great job. I am also looking forward to Labour Party colleagues based in that region getting behind the Government’s plans for the Southern District Health Board because in the end this is all about getting the best possible health services available for the people of Otago and Southland. [Interruption] I greatly look forward to the contribution of the member for Dunedin North as he steps in to endorse the sound work that we are progressing in the Southern District Health Board. I commend this bill to the House.Dr DAVID CLARK (Labour—Dunedin North): This bill cancels the 2016 triennial general election for the Southern District Health Board. It is not a bill we should passing lightly. Democracy was suspended at the district health board 6 months ago and so far as far as outputs go we have not seen a lot from the commissioners.We have got a one-page strategic planning document that looks more like a Christmas card than a plan and that is it. The partnership group which was supposed to be appointed a long time ago has only finally received its last member in recent weeks. It has been asked by this Minister of Health to produce very little and it seems to be obliging.This Government has been slow to act in the Southern District Health Board given years of deficits and months of adverse publicity—months and months that have turned into years. Perhaps the most surprising thing about the appointment of the commissioners was the fact that it took the Minister so long to act.I guess that is the problem. This Government has been struggling with this district health board amongst many for such a long time. It has tried to maintain the façade of an arm’s-length arrangement. The Minister always chooses the board chair and five out of 12 board members. He has effective control of the board. He had a Crown monitor on there or his predecessor had for nearly 6 years before this commissioner group was appointed and still the Minister and his predecessor made no progress.The Minister is now tied to the outcomes. I made this point in an earlier contribution to the House. Any remaining impression of ministerial distance from decision making was sacrificed with the appointment of the commissioner. I imagine the Minister now has a few sleepless nights because he now has a commissioner team in place and New Zealand and particularly those in the south is expecting results. Mr Coleman has nowhere to hide. He can no longer blame the board.Fixing the Southern District Health Board will not be easy. The cultural challenges indeed are well canvassed and some departments have some work to do to work out how to work together since the boundary between the southernmost district health board and the Otago District Health Board was removed along with $30 million of cross-border funding.Of course funding matters—funding matters. The inquiry that Jonathan Coleman launched into the national health funding model is entirely narrow. It seems designed to fit public demand for some kind of inquiry without delivering a result. There is certainly a prima facie case to reform the funding model. It seems to have an adverse effect on some district health boards and particularly in the south.We know that the health workforce training appears to be more expensive than the compensation given to the Southern District Health Board. It takes a long time to treat patients whilst training students at the same time. We know that having the largest geographic area in the south—a district health board the size of Belgium—is not matched with the largest rural funding component. That needs some explaining. We know that old buildings—and this one is over 50 years old—force less-efficient older ways of operating.It is there for the explaining and the Government does need to front up and have a full review of the health funding formula. It has been 10 years since the last review and Labour was in power then. It is time the health funding formula was reviewed and made more transparent.The glacial progress under the commissioner team towards a hospital rebuild should bother us all. Delays are a big deal. The hospital has lost accreditation across a number of areas. It has lost Medical Council training accreditation for house officers it has lost orthopaedics accreditation it has lost intensive care accreditation for training—and the latter being directly attributed to old buildings.This loss of status has a knock-on effect: it harms the medical school it harms the university and it harms the city of Dunedin and the district right across Otago and Southland. It also means that we cannot attract the calibre of staff that we would want to. There is so much uncertainty in the district health board that specialists around the world are going to think twice before they move to the south.This Government needs to give some certainty of direction. It needs to give assurances it needs to put capital up front and it needs to outline a credible plan for an appropriate rebuild. The Beca Group consultancy report last year confirmed that the clinical services building is outdated and that the ward and clinical layouts are beyond their use-by date.The modern clinical services buildings that are being built across Australasia have a wider footprint. They have more ceiling space to allow for ducting and modern surgical equipment to be housed in them. It just means that everything happens a little slower in the old buildings and that carries a cost which adds to all the other costs that the Southern District Health Board is carrying and the depletion in the funding that it appears to have. These problems are not going to go away overnight but the Government needs to act credibly. It needs to lay out a plan and it needs to stop dilly-dallying and duck-shoving.We need the urgency. The signalled appointment of the partnership group was delayed time and again. The Southern Partnership Group appointments the last of which has just occurred are now in place but the deliverables are minimal. The previous Minister of Health Tony Ryall indicated he expected a business case to go Cabinet this year for a hospital rebuild the current Minister Jonathan Coleman indicated in February he expected it by the end of this year and now the latest timetable has merely a scoping report by the Southern Partnership Group being delivered at the end of next year.The time frames continue to slip and there is no indication once this strategic business case is completed of a time frame for that to go to Cabinet for decisions to be made and for people in the south to have assurances about their health system. The Minister simply must step up. It is not good enough that previous assurances that a business case would be considered this year have been pushed out into the never-never. The only thing we have certainty of now is that it is not going to happen this year. We have got an amorphous promise of a rebuild being completed in around 10 years’ time. Without a concrete start date and committed capital the promises and assurances the Minister is giving amount to little more than duck-shoving making the rebuild the problem of some future Government.The real test of commitment from this Government is a guarantee that before this term of Government ends in late 2017 there will be bricks and mortar being built—that there will be a rebuild under way during the term of this Government. I very much look forward to the speakers who follow me confirming that.Perhaps those who are in the south—and I expect some of them to speak; perhaps Mr Barclay opposite will speak—will assure us that this will happen because the Minister has said they have been very supportive. Well I have heard nothing but sycophancy from them. I want to hear the concrete steps that will be taken to deliver a hospital to people in the south. I think it is shameful—shameful—that members down south are parroting the Minister’s words and offering platitudes and obfuscation to the citizens whom they represent.Those members need to step up. They need to encourage their own Minister to get focused get on with the rebuild and give some assurances to the people of the south that they are being taken seriously that their taxes matter and that the rebuild will get under way. Affordable access to decent health care should be something every Kiwi can count on but something that we have come to expect of right is becoming harder and harder to access under this Government.We have had an independent report done that shows $1.7 billion worth of underfunding under this Government’s watch—$1.7 billion of health underfunding. That is why when Jonathan Coleman admits—and he has admitted to this House—that he is not funding the health system to keep up with cost pressures New Zealanders are now seeing the level of health care declining. That is the reason why the Prime Minister is saying that Pharmac will not fund Keytruda. That is why the Government is dancing on the head of a pin when it comes to every health question.If you underfund a system by $1.7 billion it is no wonder that health care is suffering and that New Zealanders are suffering in a way that they have not before. This Government is simply not committed to public health and here we have a bill that suspends democracy and no assurance from this Government that it will not do the same thing if it is re-elected for another term—that it will not suspend democracy further.We have seen it do it with Environment Canterbury—we have seen it do it with Environment Canterbury. It has pushed out democracy and pushed out democracy and pushed democracy with no respect for the community representation that comes through with that. And now we have a similar situation here. We need assurances from the Minister—Mr DEPUTY SPEAKER: Sorry to interrupt the member but his time has expired.SIMON O’CONNOR (National—Tāmaki): I am thinking as I stand to speak on the New Zealand Public Health and Disability (Southern DHB) Elections Bill that we may have to move an immediate amendment to appoint a commissioner to replace the previous speaker David Clark. We have just heard around this particular bill a long sort of diatribe if you will around problems in health. It is the same usual tired material we have heard from the Opposition. It is tired for two reasons. One is that it is constantly repeated. The second is of course that it does not go with any of the facts.Just to give very quick context actually about the Southern District Health Board and I am sure you will hear it more from the excellent members who represent the people down in that area the Southern District Health Board has actually benefited from over $800 million of funding. In fact there has been an increase of over $130 million for that district health board over the last 7 years. There are 66 more doctors and 195 more nurses but in saying that this Government is very clear—very clear—that there is always more that can be done.In fact that is one of the falsities if you will that has just been put out by the Opposition. Somehow there is the idea that there is a magic number that can be spent in health and that all of a sudden everything can be taken care of. Those of us who have engaged with or have worked in the health sector public or private know that there is an insatiable need and the question for the Government is to work in the best way to ensure the best access to health care for all New Zealanders be it in the Southern District Health Board or in any of the others.In fact the other area that was incorrect was this talk about needing to look at the funding models. It is all very well and good for the Opposition to say that. It is what Oppositions do. Of course those who were on the Health Committee last week would have heard that the Ministry of Health is looking at the funding models. So there is actually proactivity there from the Government and there has been for a while. I just encourage the Opposition to get a bit more involved and up to speed.This bill is a very simple bill. As has been noted it is basically suspending the elections at the Southland District Health Board next year. It is common sense. It makes an enormous amount of sense. A commissioner has rightly been appointed very recently to assist this district health board particularly around its fiscal management and it does not make any sense at all to de-appoint the commissioner and reappoint board members just as the commissioner has begun the job.This is a simple bill. I think it is an excellent bill. It is a prudent bill. We want I think as a Government to see the commissioner and the team have a bit more time. I fully support it. The Health Committee is a busy committee. We have moved through quite a bit of legislation but we welcome more coming to us. I agree with what the Minister is saying around the report-back time. I think without presuming the committee’s business that we will take that into account. Again this is a fairly simple and narrow bill to achieve a path back to democracy and a path back to better funding. Thank you.CLARE CURRAN (Labour—Dunedin South): This is a bill that is not just little and simple as the previous speaker Simon O’Connor said. This is a bill that suspends a democratic process and it could otherwise be titled the “Buck Stops Here Bill” because this bill if it passes through Parliament will put the buck firmly with the Minister of Health. The Minister will be ultimately accountable for what happens in the Southern District Health Board area and for whether or not we see real and meaningful change. He will not be able to duck for cover. He and his Government will be accountable.We would not have had to leave the commissioners in for a longer term in the Southern District Health Board if the Government had acted sooner in putting our district health board on a credible path to financial stability. The problems have been evident and they are complicated and the issue behind this—the underlying issue—is the funding model despite what the previous speaker said.These problems have been evident for some time. There was a Crown monitor appointed in 2009. The board was under intensive monitoring by the National Health Board way before the appointment of the commissioners. In 2013 and 2014 we had front-page stories and we had stories on television every night about our leaky hospital and the problems in our hospital. Earlier this year we had asbestos in Dunedin Hospital. The need for action the need for change has been evident for a long time.The need for significant change and the deep problems in the district health board have been evident for a long time. The underlying problem as I said is the population-based funding formula. We need the Government to be announcing a comprehensive review of that funding formula that decides how much money each district health board is allocated. That is what is ultimately needed rather than just passing a bill that suspends democracy and tries to make it sound as if it is just an everyday occurrence. This is not an everyday occurrence. If you ask the people of Otago and Southland what the major issue on their minds is right now the state of the health system in our region is the top one and the Government ignores that at its peril.The posted deficit of $35.9 million for the Southern District Health Board and its new vague plan for the future is a real cause for concern. The Minister gave the district health board $7 million to stop its deficit going into the $40 million range which was what was predicted—around $42 million—and it was basically evidence of the stop-the-haemorrhaging approach that this Government has taken.Dunedin Hospital is in a real crisis. It has lost as my colleague David Clark said its Medical Council accreditation to train house officers. It has lost orthopaedics accreditation and intensive care accreditation. These things are really significant and the question you have got to ask is: what is next? What could happen next? Are there going to be job losses? I am hearing reports that there are significant job losses coming in Dunedin at the university and at the medical school. I hope it is not true but given that the buck stops with the Minister on this we need the Minister to be giving us reassurance that we are not going to lose more accreditations that there is not going to be a slippery slope for our medical school in Dunedin and that there is not going to be a slippery slope for our dental school. We need reassurance on these things.A bill that stops democracy and stops the election of people from our region to govern our district health board is not giving us that certainty. It is not giving us that comfort. What we are left with is just a load of questions and we need answers.This has been a year of immense stress in the Otago-Southland district around our health system and where it is headed. If it was not for that insufficient Government-funding model the district health board would not be in the woeful predicament that it is in now. We have the only major metropolitan hospital in New Zealand that has not had an upgrade or a rebuild. Labour pledged to rebuild Dunedin Hospital in 2014 and we stand by this commitment. We want to know a date and we want to know a timetable for a rebuild.An amount of $22.5 million has been announced to be spent on interim works at Dunedin Hospital. This is a band-aid remedy in response to the public outcry. This is what this Government does. It offers band-aid remedies; it does not do real substantial change that gives comfort and certainty to the people of Otago and Southland where money is being poured into short-term measures rather than into long-term planning. Four years of a commissioner at the district health board—it is an unprecedented decision to bypass those elections. We need certainty on when there is going to be a build announced. It is an erosion of democracy. We know that there are times when this is needed but what we need is not vague statements. What we need is a concrete plan so that the people of Otago and Southland can be reassured.We have many many people who are desperate for health services who are waiting for hip surgery who are waiting for breast-reconstruction surgery who are waiting for bowel cancer surgery and who are needing home-based equipment to maintain their ability to be independent and mobile in their homes. All of those services are being eroded in our area at the moment in Otago and Southland.I know that the member for Dunedin North David Clark and myself in Dunedin South have a steady stream of complaints from people who are not getting the kinds of services that they have had in the past who are being turned away who are not being allowed to get on waiting lists who are not being able to see specialists who are receiving a degraded service of home-care support in their homes—and the list goes on and on. All there is in our region is uncertainty—an uncertainty that is being reinforced today by a bill being put through Parliament that takes away the democratically elected ability for local governance. And what is left in its place? No certainty and no sense of when there is going to be a plan.There are deep concerns. There is no easy panacea for the woes in our local health system. The major issue is the funding formula and this Government refuses to acknowledge it. But with this bill the buck certainly stops with the Minister. If our local health system continues to be starved of funding patient care will suffer. If our hospital continues in a state of neglect patient care will suffer. If our democracy continues to be eroded in the bypassing of elections patient care will continue to suffer.So it is time for the Government to listen to what people are saying in Dunedin in Invercargill in Otago in Southland and in all of the towns and communities in between. This is the biggest issue on their minds and it is the biggest stress in their lives as to where and what is happening to the health system. The buck certainly stops with the Minister and the buck stops with the National Government.BARBARA KURIGER (National—Taranaki - King Country): It is a pleasure to speak briefly on this bill this afternoon. We have heard quite a bit this afternoon about Dunedin Hospital which is an important component of what the Southern District Health Board does. I have been down there recently with my good colleague here Todd Barclay and the people out in the open spaces are really thinking about primary health care and how it is delivered close to where they live.I really support the reappointment of the commissioner and the delaying of the election because a plan will be developed. Something was not working down there before and they are really having a look at how the plan may be developed. There will be new ways of thinking there is consultation going on with staff there will be consultation going on with the community and hopefully there will be something that will come out that is much better than it was before.So I support this bill. It needs time. A good picture will be built and a good plan will be built and I commend this bill to the House.METIRIA TUREI (Co-Leader—Green): I really hope we get to hear some of National’s southern MPs speak on this legislation given that they are the MPs who represent those voters in that area—the National Party voters in that area. We would expect to hear from some of them rather than from people who have no idea what they are talking about no connection with the place and actually not even any awareness of the legislation.This is the way the National Government treats the democracy of communities in New Zealand—by putting up people who have got no clue what they are talking about—when the legislation here is designed expressly to remove from the people of the southern regions the deep south their right to a democratic say. I guess that is what we have come to expect from the National Government of course. The Government is gaining a great reputation—a fantastic reputation—for being allergic to democracy and to communities in the regions being able to exercise their democratic rights. An example of that is in this bill today.The Green Party will oppose this legislation. The year 2019 is too far away—too far away—for the people of the southern area to have their say on their district health board. I have listened to the contributions from the MPs from the south who understand what they are talking about and I agree—you know we have had terrible issues with the Southern District Health Board over a number of years. You know it is a very close community down there everybody knows what is going on and it has caused real harm to those who have needed high-quality health support. It has caused real harm to those who know the people involved in the district health board and to those who work for the district health board and the families there.The appointment of the commissioners was welcomed in order to try to get some progress on what was going on with the Southern District Health Board but let us not forget how important these kinds of agencies are. Where you elect the officials and those people you know them and you can have contact with them as community members.These kinds of agencies are critical to a community’s engagement with the things that affect them every day. Health services affect New Zealanders every day. That is one of the reasons why we have elections for district health boards. It is the direct connection between the decisions that they make and the well-being of families—of our older people of our kids and of our families.District health boards play a critical role in our communities around the country and so the retention of democratic engagement is absolutely critical. But this is a Government that will take any opportunity—the merest opportunity—to take away from communities their right to have a say. Environment Canterbury has already been raised. I mean just look at what has happened after 5 years. There is still no right for the people in Christchurch and of the Canterbury region to have a say over Environment Canterbury. Environment Canterbury is essentially being run by Wellington. If this bill proceeds as it is that is what will happen with the Southern District Health Board in the deep south. The Southern District Health Board will be run by Wellington according to Wellington interests and the people of that region who have already suffered a great deal from weather events from the loss of jobs from the failure of this Government to have any kind of regional economic development approach—all of those things—and who are really suffering as a regional area will now also be removed from having a democratic say.I want to just acknowledge my colleague Kevin Hague who led the call actually in urging the Government to look at the massive financial discrepancies of the Southern District Health Board more than a year before the Government finally decided to take any action. These are serious issues and that is why the commissioners are in place. Most people support the commissioners in the work that they are trying to do. People have a lot of confidence in a number of those commissioners and we certainly have supported their stepping in.But there is no justification for this legislation coming into the House. There is no justification now for the removal of the elections in 2016. Even if this bill passes—and it may do at its first reading—we will be seeking advice and submissions and talking with people who live in the region who are affected by this bill about when they might want to next have elections because mid-term elections are also possible. Not in this legislation of course because the Government does not want there to be a democratic engagement with the district health board there but mid-term elections are also on the table. That should be a proposal that is available in this legislation and it might have helped build more community support.The whole point here is making sure that we maintain the strongest possible the most open the most transparent and the most engaging democratic process around the world. New Zealand prides itself on its democracy. We can maintain that pride only if we respect the right of New Zealanders to have a say. This bill strips that away. This Government has no respect for the rights of New Zealanders to have a say over their democracy. This is yet another attack which the Green Party will not support. Thank you.RIA BOND (NZ First): I am proud to rise on behalf of New Zealand First to speak to the New Zealand Public Health and Disability (Southern DHB) Elections Bill. This is because I actually reside in Invercargill in Southland and I am really passionate and proud to say on behalf of New Zealand First that we passionately oppose this bill.I have three main objections to this bill that I would like to talk about today. The first is that this bill is an appalling affront to the southerners’ democratic right to vote for their own health board representatives. Secondly we know very little about the work done by the current commissioners to date but we are expected to take it on trust that they are doing a great job and give them the job until 2019. Thirdly the real culprit for the state of the Southern District Health Board’s fiscal woes is the Government’s terrible population-based funding and the amalgamation of the Southland and Otago district health boards. That has been referred to as a science experiment and we feel that there has been a hidden agenda that will see lead services redirected to Dunedin Hospital and Southland Hospital playing a lesser role.But first what this bill means for democracy in this country. One of the basic principles in this country is the right to vote. It is how I got my job; it is how the Minister of Health got his. In New Zealand First we respect democracy but this bill is an appalling affront to democracy. The Minister wants to play this down as one election but what this really is is another example of this Government putting all the power in the hands of a small unelected few because it believes that it knows better than anybody else and because it thinks it knows better than Southlanders and Otago residents—residents who have been kicked off the waiting list residents like Dave Savage who was a victim of the system and who like many other New Zealanders spread across this country was simply kicked off the list.Southlanders are entitled to a right to vote on who should be managing their local health-care needs. Locals know our regional concerns better. Southerners understand the state of our local district health board. They are not naive to the problems it faces but they want them fixed now more than ever. We oppose this bill because New Zealand First objects to the Government taking the decision-making power away from the people.This bill also is a complete and utter turn-round from what the Minister told southerners in June when he appointed the commissioner. The Minister is quoted in the Otago Daily Times from a press conference he held as saying: “The plan is really for the commissioners to stay on as appointed members of that board and new elected members to come on in at the local body elections.”I cannot understand why this could not still be the case. Why the change of heart? What happened no one knows. It is all cloak and daggers. Why can the elections not go ahead and allow Southlanders on to the board to have their say as well? The irony here is that this bill strips Southland and Otago residents of the right to hold a referendum on the work of the current commissioners—this from the Government that never met a flag referendum it did not like. But when it comes to the vote that actually means something not just a third-term vanity project suddenly these elections are a nuisance that interrupt the process.It has been touted out there that this non - holding of the election will be at a cost saving to the Southern District Health Board of $300000. I ask this Minister: are you serious? Maybe the Minister knows that Southlanders are totally fed up with how slow and secret these changes have been. I am sure that the Government members sitting there across from me have read all the many articles about the uproar opposing this bill.I would like to read a little bit from the Southland Times from what a former board member has actually said. This is what it says: “The move has left former SDHB member Kaye Crowther mortified. She said the axing of next year’s SDHB board election had taken away the opportunity for Otago and Southland residents to have a voice in their health care. The commissioner’s team has achieved little and its reduction of the deficit after six months was ‘peanuts in the grand scheme of things’. The government’s move to axe elections so a commissioner could take control signalled the future for other DHBs she believed. ‘I think it’s the beginning of a process that will change the beginning of the DHB structure.’ Another former SDHB member [Mr] Cook said the Government’s move showed the problems faced by the sacked board were never a quick fix. ‘It wasn’t a whole lot of bad board decisions it was an underlying problem with amalgamation [of the Southland DHB and Otago DHB] which you can’t fix overnight’ … With Southland board members out of the way and no Southlanders on the commissioner’s team this could now happen [Mr] Cook said.” We could see the move away from Southland Hospital giving its lead surgery to Dunedin Hospital.It was also reported in the Otago Daily Times: “SDHB: Was there any choice? Many may view last week’s announcement to extend the term of the commissioner appointed to oversee the Southern District Health Board by three years (bypassing the 2016 local body elections until those in 2019) with shock and outrage.”My second point is the competency of current commissioners. We are told to trust the Government and that the commissioner and her team are doing a stellar job. Well if the commissioner and her team are doing such a wonderful job why can they not run in the election and stand on their own merits? Maybe because we do not know what material changes the commissioners have made to achieve the deficit projection of $35.9 million. For all we know this could just be some creative accounting. We are told the projected deficit was $42 million and now it is $35.9 million but projections are prone to fluctuations. What has the commissioner actually achieved in the past 5 months except rack up $1400 a day which capped her at 3 maximum working days per week? Let us not forget the temporary head of finance for the Southern District Health Board who was being paid more than $10000 in July and August.These are the types of decisions that Southlanders have a right to consider when appointing their district health board representatives. We hold elections for the district health boards just like we do for Parliament as a referendum on job performance. Are the current commissioners doing a good job?Todd Barclay: Yes.RIA BOND: That should be up to the Southland and Otago residents to decide—and Mr Barclay you would not know.I am from Southland and I am yet to see or hear anything that would warrant giving the current commissioner and her deputies a generous salary for another 3 years without any review. The Government’s funding of district health boards is the real culprit as to why the district health board and so many others are struggling to stay fiscally sound. If the current system was actually adequately funded the Southern District Health Board would not be in the mess it is today. In fact neither would the other health boards spread across this country.Maybe that is the vote that we need to be having in this House: how are we going to fund district health boards in this country? The population-based funding formula does not support regional health care. Does the Minister have any idea whether the funding of our district health boards is sufficient or whether district health boards are just not managing their budgets appropriately when New Zealanders are being refused medical treatments for conditions that severely impact on their ability to work and live life productively? It is high time we looked at this funding formula; it is high time for a review. New Zealand First would also like to know from the Minister what the deficit is for the Northland District Health Board in the 2015 financial year because we cannot seem to find it.In conclusion this bill is bad for democracy it is bad for southerners wanting to make sure their health board is working well and working hard and it is bad for the country because it does not address the root problem affecting all district health boards in this country—the funding model. Southland and Otago residents have the right to choose who represents them on their district health boards. The Government may think it knows better but really it is not up to the Government to decide. That Minister and that Government are not God almighty—may they remember that.I question why this Government chooses to pay ridiculous amounts of money to a temporary commissioner and his subcommissioners instead of employing an effective chief executive officer who could work to ensure the district health board serves the region for the long-term success—that is what Southland and Otago people deserve. New Zealand First opposes this bill. It is anti-democratic—Todd Barclay: Put New Zealand first.RIA BOND: —and we would like to put the people of Southland and Otago first. Mr Barclay you might want to try to do that in your office.JACQUI DEAN (National—Waitaki): I regret that the Opposition has chosen once again to oppose a piece of legislation that has the interests of the people of Otago and Southland at its heart. I regret that because I think that in its so doing it completely misses the point of this bill and it completely misses the point of the process around appointing commissioners in order to address the many issues surrounding the Southern District Health Board.I have had many conversations with the chief executive officer and with members of the board I have met with the commissioners and I have met with the boards and management of the smaller hospitals around the region and they are focused on what is important. They are focused on doing the best for their people. That is something that has been missing in today’s debate. There have been conflicting arguments from the New Zealand First member about it taking too long or it not taking long enough and there has been a mix of arguments from Labour—well it used to be the major Opposition party—about just what its position is but I very seldom heard the expression of what is good for the people and what is good for the patients who use the services of the Southern District Health Board.In my communities the people spoke long and loud about the proposed 10 percent cut to their funding and rightly so. There were public meetings and there were rallies. I went to as many of them as I could because I too share their concern at the potential loss of 10 percent funding. The placing of the commissioners into the Southern District Health Board is going to address those issues. They are listening to our concerns they are listening to the concerns of the smaller hospitals and it is not a job that can be done in the next 12 months. Why the Opposition refuses to acknowledge that is beyond me. Who does it care about? Does it care about the patients? I do not think it does.JAN LOGIE (Green): I rise to take a short call as the second speaker for the Green Party on the New Zealand Public Health and Disability (Southern DHB) Elections Bill. We have just heard from Jacqui Dean the previous speaker on behalf of the Government about the need to focus on the needs of the community and on what is good for patients and I think this is where we seem to have a disagreement in perception with this Government. The Government seems to be telling us that it understands from Wellington the needs of communities and patients better than locally elected representatives could.That is the view that we have heard again and again from this Government in relation to Environment Canterbury where just as surprisingly the Government’s needs represents its vision of an irrigation-heavy economy as opposed to the identified needs of the local community. We have heard it again from this Government in terms of the Auckland transitional authority plans where the Government thinks it can appoint the commissioners and that it would be more appropriate to do so than have the Auckland Council do that and we are seeing this again here.The Green Party supported the initial appointment of commissioners in the Southern District Health Board. As has already been pointed out my colleague Kevin Hague had been raising concerns for over a year before the Government took action around some of the financial challenges that were being experienced by that district health board. However I have not heard any argument from the Government about either why mid-term elections would not be possible or—as has already been pointed out as signalled by the Minister initially—why that commissioner could not continue the job alongside locally elected board members. I would like to hear an argument against that.I am from Invercargill. I still have family down south and I have worked at Otago University at the medical school. The people whom I know are absolutely capable of providing fantastic leadership and accountability and representing their community. Although the commissioner may be doing a good job the people I know would also do a fabulous job. It seems to me that this Government again and again underestimates the knowledge and the ability of people in our local communities. That is not the Green Party vision. We do not believe that Wellington and people in this House have a better idea of the needs of local communities than the local communities themselves. If this bill does pass we will be putting up an amendment for there to be interim mid-term elections and we certainly will be listening very carefully to find the arguments about why a commission alongside a locally elected board is not possible.I would also just like to echo some of the other concerns that have been raised in the House regarding the population-based funding model and its impact particularly on Southland Otago and Dunedin where we have remoter populations. That model does not seem to be working so well. Otago and Dunedin in particular separately from the remote needs has one of our most prestigious medical schools and the fact that Dunedin Hospital has lost accreditation for training in several areas is a real problem for us as a country. That medical school is critically important for us as a country and we need to ensure that that knowledge that is based in Otago and that the local oversight are there to be able to do credit to the importance of that institution and the health needs of those communities. So it is unfortunate that the Green Party is not able to support this bill.JENNY SALESA (Labour—Manukau East): Thank you for the opportunity to speak on the New Zealand Public Health and Disability (Southern DHB) Elections Bill. This bill will exempt the Southern District Health Board from the 2016 triennial district health board elections and it will enable the elected commissioners who are currently there to stay in place after December of that year so that they continue to govern the district health board for another 3 years. As far as I know this is the very first time that such a 3-year extension has been applied to the health sector.The Labour Party supports this bill to the next stage but we have some concerns. One of those concerns is that there is a lack of transparency around the district health board’s actual situation right now. Earlier this year in April the Minister rejected rumours that a commissioner would be brought in to sort out the Southern District Health Board financial mess. However the struggling board members were fired just 2 months later in June. Public meetings were also scrapped in the same month.Communication with staff and the public has since that time also been questionable. In June the Minister stated that the 2016 election for the Southern District Health Board would go ahead and that new members of the board were expected to take up their roles after the next local body elections in September and October of next year but a spokesperson for Dr Colemanthe Minister of Health said that a return to an elected board next year had not actually been promised as stated in the Otago Daily Times. And here we are in December debating the law change needed to delay democratic elections in the usual cycle and leave the appointed commissioners in place for several more years. In a statement last week Dr Coleman said that the commissioner and her deputies were starting to turn the deficit challenge round. Apparently an improved deficit position of $35.9 million for 2015-16 for the Southern District Health Board has been agreed which shows that progress is being made. Staff on the other hand report no discernible difference.The district health board runs crucial public health services vital to the lives of many many people in the south. The funding model for health is indeed broken. The Government continues to under-resource health services and that is one of the main issues here. The Government has underfunded health by $1.7 billion in real terms since 2010. Refusing to carry out a full review of the funding model is having adverse effects across the country for the Southern District Health Board and many other district health boards—nine the last time we counted.The Southern District Health Board area is the largest geographically here in New Zealand. The problems that it is today facing partly flow from the merger of the Otago and Southland district health boards 5 years ago. At that time very little thought was given as to how the merger would impact on the region. Figures released earlier this year seem to show that the Southern District Health Board had actually been starved of the necessary funds that it needs. The Government should ensure that adequate funding of the region’s health needs is not put at risk. The Government must develop a plan. It should have a map. It should have genuine deliverables and ensure adequate resourcing with a plan that is robust and it should actually make these plans available to the public.The Minister cannot keep pushing the responsibility for sorting this financial mess out on to the commissioner behind closed doors. If indeed as the Minister states the situation is showing improvement why not return to democracy and public accountability at the very first available opportunity—at the next local board elections? It is very unclear why or even whether a 3-year extension is suddenly required.I look forward to the debate and clearer information as this bill progresses through the select committee. Thank you.TODD BARCLAY (National—Clutha-Southland): It is an honour to speak in support of this bill as one of the few members who has spoken today who actually understands what is going on there—one of the few members who has spoken who has actually met the commissioner Kathy Grant and her deputies who has actually met the chief executive who follows the updates in the media who knows what is going on and who is in touch with their constituency.After going around and talking to my local health boards and small community groups I can say they are in support of these changes. There has been such a mess for so long that it is about time that something is happening to rectify the situation. People want confidence in their health system. The Greens are so out of touch. They clearly have not spoken to any of the constituents in Otago or Southland nor have New Zealand First members. Finally for a change there is certainty and there is direction moving forward in health and we can start to see that through the commissioner’s updates.To touch on David Clark’s questions around the progress around the upgrade it is part of a six-stage process. They are already in the strategic assessment stage to be followed by four design stages. It is going to take some time obviously because it is a significant capital upgrade and it needs to go through Treasury’s Better Business Cases for Capital Proposals model. Following on from the strategic assessment stage there will be a concept stage a preliminary design stage a developed design stage a detailed design stage and then construction. It just goes to show how much the future Mayor of Dunedin Clare Curran pays attention to these sorts of processes because she clearly is wrong once again.With regard to the Government’s contribution to the Southern District Health Board over the last 7 years we have increased funding by over $134 million to a record $852 million. This organisation is almost a billion-dollar organisation. The commissioners need time they need space and they need fresh air—without these democratic elections coming up next year which will interfere in the work they have already done—to start making some changes. We do not want to slash and burn; we want a medium to long term work programme that will see a systemic change in health in that area which will benefit patients and will benefit our communities.It is an honour to speak on this bill and I would like to congratulate the Minister of Health and the commissioner Kathy Grant and her team on all the hard work that they are doing.PEENI HENARE (Labour—Tāmaki Makaurau): Tēnā koe e Te Māngai o Te Whare tēnā tātou katoa. If indeed the member who just resumed his seat Todd Barclay has talked about time and space it is clear that according to his assertions he has given a lot of time to going around and meeting these people. Now he is suggesting that he give them a bit of space—space to fix the wrongdoing that has happened under the watch of his Government.I doubt very much that in fact the member Todd Barclay has actually toured the entire region of the Southern District Health Board. I guess that he has probably kept within his own little patch. But just for the advice of the House the estimated resident population of the Southern District Health Board area is just over 300000 people. It is a land area of just over 60000 square kilometres and it is considered the largest of the district health board regions in New Zealand. I doubt very much whether the member who just resumed his seat has covered all of that area and canvassed all of those people whom the Southern District Health Board is there to serve.It has already been mentioned in this House not just in relation to the Southern District Health Board that health is a big issue across our country. I pick up the point of the member Clare Curran who has already pointed out that all of the people who come into her electorate offices have already mentioned that health is the biggest issue. For most of those who come through it is either health or housing: “h” and “h”—health and housing. One of the sad things with a bill like this is that it will remove the community’s voice in appointing the people to best represent them in appointing a district health board that reflects the people who live within the catchment area of the Southern District Health Board.It has already been mentioned and I want to echo the point that it does seem to be a suspended state of democracy. This is not something new given that in recent times this particular Government has put the country through this state several times in my time here in this House. Just recently we have pushed through under urgency a series of legislation that I am sure the wider population the people of New Zealand would relish the opportunity to be able to provide submissions on to a select committee. They would relish the opportunity to have their voice heard on the issues that are affecting them. This legislation is another case of that voice being taken away.But I say to the people who fall into the catchment of the Southern District Health Board do not fear. Although this bill may take away their rights to an election of the district health board there is another important election coming up in 2017 and I hope that their voice is heard. That one will tell this Government that what it has done in its time while managing the Southern District Health Board has failed. It will send a clear signal to this Government that we cannot tolerate the demise of and the reduction in services—in particular health services—in our regions.My colleagues have already talked about the hospital. They have talked about how the people of Dunedin and the people of Otago deserve a hospital that is state of the art. They deserve a hospital that provides to them the services that they need to be healthy to be wealthy and to be wise. They deserve a hospital that will see them when they need to be seen. They deserve a hospital where when they walk in they do not fear any secondary illnesses that may come because of the poor state of the hospital.They deserve all of these things and it is sad that the state of the Southern District Health Board has fallen this way. It is sad and it is also sad that this Government has ignored this problem for some time now. It has been raised with the Government by many members—not only on this side of the House but I am sure by a few on that side—but sadly their cries their pleas their kōrero and their statements have been ignored. Now we are left here to deal with a serious problem a problem that has seen the deficit blow out to over nearly $40 million and a problem that has seen millions and millions of dollars poured into this particular health board to make sure that it falls under the $40 million deficit mark. That cannot be tolerated. We want to see that money go to the places where it needs to go. It needs to go to the places where our people are able to receive the services that they deserve and the services that they require.What does this erosion of the democratic process do? What it does is it erodes the trust that people have in the institutions of this land. In this particular case it is the Southern District Health Board. In other cases it also falls down to this august institution and that is a concern. It is a concern because as we see there are low levels of participation across the country when voting whether it is in a silly flag referendum or whether it is in the actual general election. We are seeing a drop in numbers. I ask myself why it is like this. Clearly from what I hear when I am out talking to the people in the good constituency of Tāmaki Makaurau it is because they do not have faith in the system that is here to serve them. We are going to see a repeat of this here on this particular bill by removing the democratic rights of the people who fall within the catchment of the Southern District Health Board. They will be taken away stripped away until 2019.How many people I ask will suffer between now and then? How many further services will see a drop in funding or potentially be cut between now and then? Although we are talking about some of the major centres within the Southern District Health Board I wonder what it means for the more remote regions within this particular catchment area of the Southern District Health Board.All of these questions—I wonder can they be solved by one person? Can they be solved by one person who if we give more power to that person can make sure that the people within this area will receive the services they require? I question whether or not that person in this particular time frame will be able to tidy up what has happened. We have already come through 8 years of this particular Government and the problem has got worse.There still remain many questions from this side of the House. All of this said we do support the bill which will go forward to the select committee. We hope that more and more people from the Southern District Health Board catchment area will make submissions. I note too that in the departmental disclosure statement it talks about the cost savings that will happen when you do not have to have an election. It says it costs approximately $300000 to run an election for membership on the district health board. I wonder whether at the time that was supposed to be given to elections—the one that is being proposed to be taken away—this Government will say: “Well done. We’ve saved $300000.” The Government will have saved $300000 by taking away democratic rights.In conclusion I want to just repeat what I said earlier: do not fear because there is another important vote coming up before 2019. It is in 2017. I hope the people who fall within the Southern District Health Board catchment area make their voices heard make their voices known and stand up for the rights that they deserve from a responsible and caring health sector that makes sure their health requirements are met. Kia ora.Dr SHANE RETI (National—Whangarei): It is a pleasure to take a short call on this bill. Over a period of time I had the privilege of three consecutive appointments to a district health board. They are complex entities they can be slow to change and they take time to have real effect. You push on one side of a district health board and it bulges on another side that you did not quite expect. It is not as if you are breaking linkages; you are breaking people if you get it wrong so you really need to take great care when you are changing things.We have heard from Opposition members about funding. They have bandied around the term population-based funding formula or “PBFF”. Well that rolled easily off the tongue—especially for the member from New Zealand First! She really needs to know what she is talking about because she has made the claim that the population-based funding formula does not cover funding for the regions. Yes it does. There is a whole major arm called adjusters and under adjusters some of the components are rurality and unmet need. You need to be very careful using these terms which raises this point. My observation with newly elected members to boards is that it can take 3 to 6 months sometimes to pick up some of the really complex funding terms of the district health board—diagnostic-related groups inter-district flow or even population-based funding formula.It is a really hard area to work in and it is hard when the district health board is doing well. No one disagrees that the Southern District Health Board has got a challenging environment. In that environment I think it would be particularly unfair and inappropriate to ask newly elected members to step in and have an impact. On that basis I totally support and commend this bill to the House.A party vote was called for on the question That the New Zealand Public Health and Disability (Southern DHB) Elections Bill be read a first time.Ayes 95New Zealand National 59; New Zealand Labour 32; Māori Party 2; ACT New Zealand 1; United Future 1.Noes 26Green Party 14; New Zealand First 12.Bill read a first time.Bill referred to the Health Committee.Hon Dr NICK SMITH (Minister for the Environment) on behalf of theMinister of Health: I move That the New Zealand Public Health and Disability (Southern DHB) Elections Bill be reported back to the House by 11 April 2016.Motion agreed to.