Hague Kevin: Estimates Debate — In CommitteeText is incorporated into the Bound VolumeHague Kevin: Estimates Debate — In Committee[Sitting date: 30 July 2013. Volume:692;Page:12080. Text is incorporated into the Bound Volume.]KEVIN HAGUE (Green):I would like to start by endorsing everything I think that Annette King has said in those two contributions and in particular the quotations that she made from Ian Powell’s address. That focus on the goals and targets and the inappropriate use of them by this Government is I think entirely to the point because although goals and targets are very important and they are a very useful tool the Minister of Health must be incredibly careful about choosing the rights ones. The inevitable result of focusing on some particular things is that the system will apply less focus to everything else. This Government has chosen the wrong ones.In this contribution I have got the time to talk about just a couple of things that are relevant to the estimates debate. The first of those is elective surgery which you would think was the Government’s star performer because literally any question about health that is asked in this House is responded to by the Minister saying: “Oh look elective surgery has increased.” And it is true. The number of operations that are being provided by district health boards has increased and actually that does reflect that there is greater investment in that particular area of sector performance. But elective surgery is just 5 percent roughly of what the whole sector does. So that 5 percent has more resource at the literal cost of every other part of the sector.But there is more. Not content with just shifting resource from other health services into elective surgery there is also some game playing going on. There is a measure of effectively complexity of surgery that is used called “case weighting” and one of the issues that I asked the Minister about when he appeared at the Health Committee was declining case weights. The fact is that case weights—the average complexity of the surgery being performed in elective surgery—have been declining under this Government. In 2007-08 the average case weight was 1.299 the following year it was 1.29 the following year it was 1.27 the following year it was 1.252 and then last year it was 1.247. That is not a big decline but it is a steady decline of about 1 percent peryear. Over 150000 operations that amounts to a very substantial reduction in the complexity of surgery that is being performed. It explains why in an environment of increasing elective surgery the person who has serious and complex needs may still be struggling to actually get the help that they need. So even the jewel in the Government’s health crown is actually a pretty lacklustre one.In contrast one of the other areas that I have been asking about is diabetes. We have the PricewaterhouseCoopers estimate that the cost of health services alone for diabetes will in just 8 years’ time be $1.7 billion per annum. We also know that the cost of non-health services coming from diabetes—the other cost to our economy to our families and to the individuals—is more than that again. To any independent observer who is considering those statistics let alone any person with diabetes this is an urgent and catastrophic problem that requires desperate action. Yet when I asked the Minister what the Government is doing to prevent diabetes his answer was—let us see—oh Fruit in Schools nutrition and physical education public health campaignsKiwisport Health Promoting Schools the Green Prescription programme and newborn and toddler nutritional programmes. All of those are certainly programmes with some merit. We would be doing those too. But the fact is that there is too little investment by a factor of probably 100 and what is more the Government is entirely allergic to those responses that we know are most likely to have an effect. Those are the regulatory responses that control the entire environment that drives the diabetes epidemic in the first place. This is a Government that is committed to doing nothing because it believes that that is the best way that it can control its political risk. That is not good enough.