Ryall Tony: New Zealand Public Health and Disability Amendment Bill — Third Reading 
Ryall Tony: New Zealand Public Health and Disability Amendment Bill — Third Reading 
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Hon TONY RYALL (Minister of Health) 
: 
 I move  
That the New Zealand Public Health and Disability Amendment Bill be now read a third time 
. I will start by thanking the chair of the Health Committee Dr Paul Hutchison and the members of the committee and its staff for their work on this bill. I also acknowledge the Parliamentary Counsel Office and the Ministry of Health for their support to the committee. 
The bill and its supporting regulations provide the statutory environment to improve the coordination of resources across the district health boards reduce bureaucracy improve front-line health services and improve value in the public health and disability sector. The bill is consistent with the Government’s pre-election commitments where we said we would make improvements to the public health service without the distraction of massive restructuring. This bill does that. 
We can indeed be proud of our public health service in New Zealand and its many achievements as evidenced by the recent improvements in the nation’s health targets. Emergency departments are seeing more patients faster. In the last year the number of patients admitted to or discharged or transferred from an emergency department within 6 hours jumped from 81 percent to almost 90 percent. District health boards delivered 105 percent of their target for elective surgery and record numbers of patients are now getting surgery. There are shorter waiting times for cancer treatment and 99 percent of all patients received their radiation treatment within 6 weeks of their first specialist assessment. In the third quarter of 2009-10 11 district health boards achieved 100 percent in the fourth quarter 17 district health boards achieved 100 percent and next year this target moves to 4 weeks. Immunisation rates have increased. The national immunisation target of 85 percent for 2009-10 was exceeded with 87 percent of New Zealand’s 2-year-olds fully immunised and in the last year the rates for Lakes District Health Board jumped by 22 percent MidCentral District Health Board increased by 13 percent and Waikato District Health Board increased by 12 percent. 
There has been better help for smokers to quit. There were significant gains over the past year in district health board staff providing smoking cessation support to hospital patients who smoke. However there is still plenty of room to improve. The results for the diabetes and cardiovascular services showed a steady improvement with the biggest annual improvements shown by Whanganui District Health Board by 14 percent and Counties Manukau District Health Board by 10 percent. 
But as noted in the ministerial review group’s report there are a number of major challenges facing the public health and disability sector: an ageing population health workforce issues service vulnerability financial sustainability and cost growth. The system itself set up under the New Zealand Public Health and Disability Act 2000 and inherited by this Government can at times hinder performance improvement. It does not provide the levers needed to optimise value for money and deliver a health service that meets the needs of New Zealanders into the future. It actually stands in the way of system-wide change and it slows coordination between district health boards which is needed if they are to significantly improve their performance. It has encouraged localism at the expense of overall coherence and performance. There is too much fragmentation with 20 district health boards reinventing the wheel 20 times and that has frustrated both this Government and the previous Government. 
We need to get the public health and disability system to act as one system with hospitals working more closely with each other and with primary-care and community services. Hospitals must collaborate better across regions and nationally. Decision making must become less fragmented and must be made at the right level in the health service so that there is better prioritisation nationally and more efficient and effective use of our limited resources. In particular we need more cooperation across district health board boundaries. 
This bill will help by firstly improving sector planning and decision making by supporting district health boards to undertake smoother more effective and better balanced planning across the service at national regional and district levels. Better national and regional decision-making supports rational and cohesive service and capacity planning. District health boards will then be better placed to grow and protect the vulnerable health services. 
Secondly the bill accelerates improvements to quality and safety by establishing an independent Health Quality and Safety Commission. The Health and Disability Commissioner is reported as saying progress in this area has been slow and patchy under the present arrangements. The new commission will be led by clinicians and it will help organisations across the whole health service to improve patient safety and service quality at the secondary primary and community levels public and private. A Peter Davis study found that 13 percent of people admitted to hospital suffer an unintended injury caused by health care that resulted in some disability. Even a 20 percent reduction in errors could save us approximately $100 million a year—money that could be reinvested into front-line services. We want gains in better and safer care—better results better patient experiences—and we want clinicians to lead this. 
The bill will also minimise administration costs and reduce bureaucracy and waste in the public health service by supporting shared administrative support and procurement services across the public health service. That will reduce the cost of district health board back-office functions with estimated savings of up to $700 million over 5 years. That money will be crucial to help us maintain and improve front-line services over the next few years. Specifically the bill amends the district health boards’ objectives and functions so that district health boards are required to work collaboratively to meet national regional and local service needs. It creates a new planning framework which supports district health boards to plan across national regional and district levels. It provides the Minister of Health with the power to direct district health boards in regard to how administrative support procurement services within the service should be obtained and who must provide those services. That is so we can make sure that there are no hold outs to our national approach. 
The bill provides the Minister of Health with the power to give direction to all district health boards to comply with stated requirements for the purpose of supporting Government policy on improving the effectiveness and efficiency of the public health and disability sector. It provides dispute resolution measures to support district health boards to work collaboratively. As I said the bill establishes the independent Health Quality and Safety Commission which will advise the Minister on health epidemiology and quality assurance matters determine quality and safety indicators lead and coordinate work with the purpose of monitoring quality and safety across the sector and perform the other functions of quality and management that are assigned to it from time to time. The bill also enables district health board elected members to be appointed to other district health boards. 
The Government and indeed all New Zealanders want a strong and sustainable public health service: one that works successfully at both a local a regional and a national level where the planning and the service delivery is well coordinated and where we can enhance the quality of health care and reduce the duplication of corporate and administrative work. 
This bill will help us to change administrative functions and the way the health service works to reduce bureaucracy and to provide a greater focus on more important priorities. I commend the bill to the House.