Menéndez March Ricardo; Watts Simon; van Velden BrookeRICARDO MENÉNDEZ MARCH (Green): Thank you Madam Chair. Seeing as the Minister talked about dental grants I guess I wanted to get her perspective in terms of the overall public health outcomes of changing the non-recoverable amount—whether she's got any views about whether the exclusion of check-ups and molar extractions actually serves to improve the oral health of our communities and people lack single services because for some reason the Ministry of Social Development has decided to exclude check-ups. I wanted to test you know seeing as the Minister mentioned it whether she's got any views as the Minister of Health about whether that's counterproductive to the grant actually meeting its full potential.Then I know the Minister talked about fluoridation as a key component in the prevention and wellbeing of people's oral health and I acknowledge that but I guess I wanted to get a sense about what other initiatives if any are happening to actually address when somebody actually has ill oral health—and obviously the goal is that doesn't happen but when it does happen—and we're seeing those hospital discharges figure representing that it has remained steady over time at relatively high numbers. What initiatives is the Government putting in place to bolster both the workforce and the public health system or anything else beyond toothbrushes to improve the oral health of our communities?SIMON WATTS (National—North Shore): Isn't it remarkable to have a Minister that's standing up and seems quite angry a little bit with our spokesperson in terms of the questions that were asked. I think what the health sector really needs from the Minister is someone who is listening to the crisis which they're facing out there and the stress that their staff are facing day in day out.Why is it today Minister that at Waikato Hospital we've got pretty much every ambulance in the region ramping and waiting up to four hours because of the bed block at Waikato Hospital today? And this is a daily occurrence across this country in terms of the blockage within our secondary care hospital units not only in emergency departments (ED) but right through the patient flow journey within those hospital units which are blocked. The system is blocked and the symptomatic signs of the ambulances banking up at the front door is systematic of a system that is broken. So what does the Minister say in regards to all of those ambulances that are ramping today? What does she say to those patients calling 111 that have an inability to get an ambulance because all of those ambulances are parked up waiting to offload their patients into ED departments across this country? What are the clinical and adverse patient incidents that have occurred as a result of the delay in treatment or the delay in collection of critically ill patients across the country as a result of these delays?All of these questions are not new factors and it's interesting the Minister refers to how well the winter plan is going. Well I'll tell you what Minister winter happens every year. This is not the first year winter has occurred but yet after six long years of this Government you continue to fail to be able to make improvements in regards to the health system. You say that we are making progress but the facts do not indicate that.I'm addressing—from the Minister: what are you doing around capital investment upgrade particularly in the Auckland region? How are you getting on with Waitakere Hospital? How are you getting on with Waitakere Hospital and the fact that that hospital supports a population of Wellington and does not even have ICU or high dependency unit capability and deals with the scale of complexity that is West Auckland and yet you've known about the requirements and infrastructure upgrades for that hospital for years and have failed to do anything of any substance. I can see you smiling thinking that this is some sort of joke but it's not Minister. These are reality and facts that our communities are facing across Auckland.When are we going to see plans around a new northern hospital? When are we going to see plans around a new southern hospital? Because six years on we've still not seen any tangible progress in regards to the growth within Auckland and the additional services required. When are we going to see that? All we seem to see is more moving of the deck chairs in a reform programme which by all accounts including those within the system has failed and continues to fail and will be a legacy of you and your work in this area.BROOKE VAN VELDEN (Deputy Leader—ACT): I have had conversations with people who have really severe illnesses and some people who don't have a severe illness but they want their medication to be funded and their medications are not funded by Pharmac. They've raised the issue of the pharmaceutical co-payment and the fact that the Government has now decided to put aside $700 million over four years to reduce the $5 co-pay and they've said Please take this to the Minister and ask: did the Minister consider at any point that it would be good for our society for our medications to be funded currently on the options for investment list at Pharmac? We would be so happy to pay a $5 fee." Did the Government consider at any point that that money could be better used to reduce the waiting list of the options for investment list at Pharmac so that people could have access to new and modern medication that would have a $5 charge? And did the Minister consider at any point whether or not that would be more beneficial for some New Zealanders to be able to have access to these medications at all rather than reducing a $5 fee for a lot of people who can already afford medications?We'd also like to know what other cost-benefit analysis the Minister did to show what other options could be on the table to help those people that she has considered to be the most vulnerable who cannot afford a $5 co-pay. Did she actually have any other suggestions on the table rather than reducing the $5 co-pay for all people who can afford a $5 fee because a lot of people have said to me "I would prefer that I was still being charged a $5 fee if it meant somebody else would actually have access to newer modern medications."I want to turn to the issue of the general practice 13 percent pay increase that was allocated in the ACT Party's alternative Budget. We've had conversations with a lot of people who work in general practice who say that they're stretched they're under resourced and they can't cover their costs. How did the Government determine that a $5 capitation increase would be sufficient for general practice when the GPs themselves have said that they need a 13 percent GP capitation increase? What analysis was done and why does the Minister believe the Government's increase is acceptable when the general practice clinics do not?"