Dean Jacqui; McLellan Tracey; Reti ShaneHealthCHAIRPERSON (Hon Jacqui Dean): Members the sitting is resumed for the Estimates debate. We now have the Minister of Health and the Minister is available from 7.30 until 8.30 p.m.Dr TRACEY McLELLAN (Chairperson of the Health Committee): Thank you Madam Chair. Kia orana. It's a privilege to make some opening comments as the chair of the Health Committee as we consider the Estimates for Vote Health and the various appropriations that come under that umbrella.In 2023-24 total appropriations sought by Vote Health are $26.51 billion. Two appropriations in particular cover most of the health services across New Zealand accounting for nearly 80 percent of the funding. The proposed allocations are delivering hospital and specialist services with funding requested of $12.72 billion and delivering primary community public and population health services with funding of $8.16 billion.We heard from the Minister of Health the Hon Dr Ayesha Verrall on 28 June 2023 and there were various areas of interest that members asked questions about that largely revolved around five or six themes. We asked the Minister to take us through those themes. One of the themes that I think is worth mentioning in particular is removing prescription co-payments. We asked the Minister whether she expects that initiative to improve health outcomes particularly for people on low incomes and particularly in winter so there was plenty of information on that. The Minister did explain to us that essentially removing the $5 co-payment the rationale behind it was about saving money to the health system as well as saving people from harm and the fact that it was evidence-based and there was plenty of information to go on. She added that there was very strong evidence that the decision ultimately will benefit both people's health and the health system.Now somewhat related to that we also heard about the changing role of pharmacists who are obviously at the heart of this initiative as well. It has been quite a game-changer I think for a lot of those pharmacists who often are small businesses because the large pharmaceutical outlets who haven't previously charged for the co-payment were able to use that as a loss leader and disadvantage those community pharmacies.So the Minister noted—which is quite interesting—that 98 percent of New Zealanders live within 20 minutes of a pharmacy and highlighted the various different ways that their role has changed through the COVID experience in so far as being able to pick up immunisations rapid antigen tests and various other bits and pieces and Te Whatu Ora had ensured that there was certain funding available to increase that. It was all part of what the Minister described to us as the 2023 winter health plan.Another big part of what we heard about through this Estimates process was about primary and community care. The Minister acknowledged that there were some general practice workforce issues. We looked at GPs in particular and she was able to tell the select committee that the Government had recently announced 50 additional places for medical schools and also that there was an expectation that those medical schools would expose those trainees to more general practice and certainly Te Whatu Ora also backed that up by saying that they had funded several initiatives that affected general practice in general so to speak.We learnt that with regard to mental health that the ring-fence for mental health was maintained. We heard that the total ring-fencing funding for 2023-2024 is $2.3 billion nationally and Te Whatu Ora explained how it had maintained that ring-fencing from the previous sort of district health boards.We asked various questions about the progress on the restructure of the health system which was an integral part of this. There was talk about efficiencies that were maintained and various other issues to do with setting up those localities. The other I suppose major theme was about the health capital envelope and this proposed funding for this multi-year appropriation is $989.54 million with a total of $5.45 billion over the five years. So there were several questions asked from members about that and likewise the increased funding for Pharmac in this Budget so the 10.5 percent of the national pharmaceuticals purchasing appropriation which actually brings the total to $1.31 billion. So I look forward to hearing questions from members and look forward to the Minister's answers to those questions as we go forward. Thank you.Dr SHANE RETI (National): Thank you Madam Chair. We asked a range of questions in the Estimates hearings to hold this Government to account for the projected spending of public funds. We asked why dozens of performance measures were discontinued from Budget reporting and we highlighted ophthalmology wait times and cardiac wait times that will no longer be reported. Effectively the Government said that it will only report these internally and not for public scrutiny anymore. The verbatim phrasing is reporting of these metrics continues at a district level and is internally circulated."The question would have to be: why is it a good thing to remove these from public scrutiny? This was at Budget document level as well not just at a quarterly dashboard level. Why is it a good thing to remove ophthalmology targets? There were actually cardiac targets as well. How is any of that a good thing? In fact dozens of targets were removed and I can't find a good answer as to why this is good. So they're still collected. They're internally reported—well and good; that's great for internal consumption but what about that public reporting back to the public? I don't think we got an adequate explanation for that.We asked how many contractors and consultants transitioned from the Ministry of Health into Health New Zealand because we've been very concerned with both the number and the cost of contractors and consultants particularly with the Public Service Commission reporting around about $150 million if I recall correctly of consultant and contractor fees through Vote Health in the last year. So we were particularly interested to find how many had transitioned—at that July 1 transition time how many had moved from the Ministry of Health into Health New Zealand.The answer that came back was an astounding 990 consultants and contractors who had transferred across. When we look at the Ministry of Health in that calendar year they had roughly 1700 fulltime-equivalents so that means roughly every third person at the Ministry of Health was a consultant or a contractor. A 2:1 ratio of staff to contractors and consultants—not clear how that can be a good thing. Really need to see the value that they would bring to that. I have seen some documents talking about how that might need to be addressed around contingent as I believe consultants and contractors but looking back at how that money was spent I think that still needs a large degree of accountability.We asked about Nelson-Marlborough and Hawke's Bay hospitals and where they were in progress and maybe the Minister can give us some guidance because if we look through the approvals process for large upgrades like that the Capital Investment Committee is always an important part of that approval process and so it's concerning to find out that the Capital Investment Committee has been disestablished. So this is a committee of external people with external domain expertise over many years and in several parts of the pathway with the initial business case it goes to Capital Investment Committee and back. With the detailed business case it goes to Capital Investment Committee and back. Now with that the committee is disestablished the questions I have to ask around that are: when was it disestablished why was it disestablished and what replaces it? I think those are very important discussions that arise from the discussion we had around Nelson-Marlborough and around Hawke's Bay Hospital—we were very interested to know what progress it had particularly with the recent announcement on Nelson-Marlborough. So a large circle of query around the Capital Investment Committee.We asked about the promise in 2020 that the Government would deliver an extra 4000 more people in the Te Ara Oranga methamphetamine programme pathway. We checked whether this was incorporating the existing pathway in Northland which is well established—one of the best meth pathways in New Zealand in my mind—or whether this was on top. In written question No. 31310 the Government made it very clear that the 4000 promise was on top of those being delivered in the Northland programme. So when the written questions returned from the Estimates and the answer was that there is 1845 people who have gone through the Te Ara Oranga programme the vast majority of that—everything short of about 100—must have been through the Northland programme. That was not the promise; the promise was 4000 on top of the Northland programme. Murupara is the only clinic I can see that's been enabled; they project between 100 to 200 people progressing through Te Ara Oranga. So I want to put that back on the table that that question has not been well answered. It looks like 1845 new people through Te Ara Oranga all in Northland; only 100 towards that 4000 promise. It would be useful if the Minister could address that. Thank you Madam Chair."