King Annette: Financial Review Debate — Procedure In Committee Speaker Recalled In Committee 
King Annette: Financial Review Debate — Procedure In Committee Speaker Recalled In Committee 
[Volume:616;Page:11877] 
Hon ANNETTE KING (Minister of Health) 
: 
 I thank the two members who have contributed to this evening’s debate on health. I think health is possibly the largest expenditure we have in Government. Currently for 2003-04 it stands at $9.4 billion up from something like $6.5 billion when National was last in power. There has been a huge increase in Vote Health under this Government. One would have thought that a vote as important as this would command one speech from the National Party. One would have thought that there would be one member of the National Party who would stand up tonight and put forward policy argument and debate on one of the big issues that any Government faces. There will be no debate from the National Party on health tonight. Why not? Because National members decided today to use all their speeches in what I think was a smokescreen to cover up for the fact that Don Brash was not going to take part in the debate in the Parliament today. 
So having put all their speakers up to debate the Prime Minister’s department they ensured that there were no members left to debate health education social welfare or housing—the great issues of New Zealand. They were interested only in protecting their leader who would not participate in the House of Representatives where people who are elected to come and debate are paid to do that. He would prefer to be on the  
Holmes  
show and grandstand on television than allow one member just one member of his caucus to debate health. I say to Sue Kedgley and Barbara Stewart: “Thank you for your contribution.” 
I will begin mine with the points raised by Sue Kedgley. I know Sue Kedgley’s commitment to issues of nutrition and diet and her long-term interest in them. I share her interest. I do not share her approach to this issue. I believe that the only way we change behaviour is to work with communities and individuals to ensure we educate them. It is no good saying: “Thou shalt not eat French fries! Thou shalt not have sweets in thy pocket!” That approach does not work. What we have to do is ensure that parents are given the tools to be able to make those decisions. 
I believe that what we are doing in New Zealand and what we have to continue to do is providing those tools to parents for them to make those decisions. After all a poor old schoolteacher sitting in a classroom cannot have influence over everything a child eats. That starts in the home. What parents need in the home is the education the tools the information to be able to know what to put in the sandwiches and what to feed their children. They do not need to be judged or criticised; they need the tools to be able to do that. 
So the first thing we need to do is to ensure that we have a proper strategic approach and that is Healthy Eating - Healthy Action. We are one of the few countries in the world that has now got a strategy and what is the World Health Organization saying? It is saying that every country needs to develop a strategic approach to healthy eating and healthy action. In fact this topic is the topic of discussion at the World Health Assembly in Geneva this year. New Zealand will be able to go along and say that we have made huge progress in terms of identifying it as an issue putting forward a strategic approach but more than that an implementation plan to help make sure we can improve the nutrition and eating habits and the action the physical activity of New Zealanders. The member Sue Kedgley praised the guidelines from the UK. What do guidelines do other than give guidance? They do not change anything unless action is taken by the people we want to take action. 
I now move to the comments made by Barbara Stewart. She recognised that there had been a huge increase in the vote and she said we needed to spend about 10 percent of gross domestic product (GDP) to have enough expenditure for a good health system. It is not the amount of money that is spent it is how it is spent and I shall give a very good example. The United States of America has the highest expenditure of GDP of any country we know of. It spends over 14 percent of its GDP on health. The recent Commonwealth Fund survey of comparative health systems in the United States Canada Britain Australia and New Zealand showed that the country with the best system that came out as No. 1 as judged by the patients and not by the politicians or providers was New Zealand. The country that came out last was the United States of America. 
So it is not necessarily how much money is spent but how that money is spent. New Zealand spends about 8.9 percent of GDP on health. Out of that we do remarkably well; we do extremely well. 
I am particularly proud of the expenditure that has gone into mental health funding in New Zealand. For years the area of mental health did not receive the amount of funding it needed nor the emphasis. I would like to share with the Parliament that in the 1997-98 financial year we spent $523.4 million on mental health. In 2003-04 we will spend $914 million. That is a huge increase of almost 100 percent in that short period of time. But still we need more. Still we need to do better in mental health. However that shows the commitment to try to improve a very important part of health for New Zealanders. 
One of the big changes has been in waiting times. Barbara Stewart raised the issue of people on waiting lists. She may not be aware but in 1996-97 86620 New Zealanders were sitting on waiting lists. Many of them had been on them for years. They had never been reassessed. Many of them had already had operations shifted to Australia died or no longer needed an operation. However they were sitting on a waiting list with nothing happening to them. This Government said—as the previous Government had said—that people had to be assessed to see whether they needed operations and then given certainty that they would have an operation. People needed certainty. They needed to be told that they would be booked for an operation and if they were not booked at that point they would have ongoing health management of their condition. 
Before no one cared what happened to those people; they were just on a list. I have had some very sad letters from people who said they were on a waiting list for 8 years and never took a holiday because they were worried that the letter might come to tell them that they would have an operation. 
The member is correct. People want certainty. They want to know they will have an operation and that they will have it in a timely fashion. There was no list for first assessment until Labour brought one in. There was no waiting list for first assessment. It was the hidden list. Thousands of New Zealanders had never been assessed but they were not put on a list. Now we do have a list for first assessment and people are told they need to be seen within 6 months. That has taken a huge amount of work by clinicians and nurses and a commitment by district health boards. It is not working properly yet but it is so much better. I am committed to ensuring that we get it as best we can. 
The member also mentioned dental care and she is right. I am extremely interested in that. One of the problems we have had for many years is to ensure that adolescents do access free dental care. I know from my own experience over many years that when young people leave primary school they are very reluctant to sign up to ongoing dental care. The best way to address that is to put services where the kids are. If members want to see where there has been a big increase in enrolment it is with services like Mighty Mouth mobile health services and dental services that go into secondary schools and provide services where the adolescents are. We will see more of that following the Ministry of Health’s review on the way dental services are provided. Also we now have a new contract with dentists—one that pays them in a different way from the old service where they were considerably underfunded for many years.