Clark DavidHon Dr DAVID CLARK (Minister of Health): Madam Assistant Speaker can I first congratulate you on your appointment. It is delightful to see you in the Chair and I look forward to seeing you in the Chair many more times. It is a real pleasure to have your input into this House after your already acknowledged service to your fine electorate further south. It is of course from our perspective also good to be on this side of the House looking from a different perspective across the House.I wanted to reflect a little on the election and the new Government's ambitious programme resulting from that election. Before I get too far into that I do also want to thank the good people of Dunedin North who have invested their faith in me to put me back in this House again for another term. The good people of Dunedin North I think voted—at least two out of every three of them—for the Government that sits on this side of the House. They are disproportionately wise in that part of the country. In fact it would be foolish of me to quibble with their choices. So I thank them for that and I hope that I can also live up to the faith that they have put in me.It is a real privilege I have to say to serve as the Minister of Health. In the four weeks that I have been in the role I have really enjoyed the opportunity to get around to speak with those people in the sector who have been struggling who have been stressed and who have been frustrated from nine years of a Government that had not prioritised the health of New Zealanders. The system of course has continued to work well for those who can get into it. Every day I hear stories from people who have been well served by our health system. They are incredibly grateful for the fine clinicians the allied health workforce the nurses across the country—those people who serve day in day out in our health system to make sure that people are looked after; those caring professionals that train to be health professionals because they want better health outcomes for New Zealanders.But there's no doubt and we've all seen the statistics that sickness has gone up that absenteeism at work and burnout have gone up during the period of the previous Government. So many of the people in that workforce have been doing it tough and more than anything else they're expressing relief to me that there is a Government that has committed to putting more money into the health sector—that has committed to making health a priority once more—and a Government that up front says We want affordable access to quality care for all New Zealanders."This is a Government that's not afraid to be ambitious that's not afraid to want to make sure that New Zealanders have better access to quality care. I feel very proud to stand on this side of the House with the support of the coalition partners for an approach to health that will mean better healthcare—that will genuinely mean better healthcare for New Zealanders. The people in the sector who get into the sector because they care too are also delighted with the change of Government. So I thank them for their acknowledgment and I want to acknowledge their ambition.I also want to ask them for patience because of course we can't fix everything overnight. Nine years of neglect in the health system—Chris Bishop: Aw rubbish.Hon Dr DAVID CLARK: —will take some time to put right. We don't need to look any further in fact than Dunedin Hospital now that Mr Bishop quibbles with what I'm saying. We know that that hospital is long overdue for replacement. In fact in 2014 I asked the then health Minister when they would begin to address the delays in the hospital rebuild—in 2014—and still they had not done anything about it come this election. They had not got a plan together despite advice from many sectors that that ought to be quite possible.What's worse is that they had not put money aside for it. No there was nothing—no capital put aside. There was a contingency of a few hundred million when in fact we now know that a build is likely to cost $1.2 billion to $1.4 billion. They imagined I think that this money would mysteriously arrive on some kind of money tree perhaps—I'm not sure. We know now that they'd put aside $5 billion for capital projects when in fact they knew $13 billion were already on the way.That's the kind of bookkeeping that we have seen from that Government during their time. They have actually left a whole lot of things that are going to take time to address and the full extent of that is still being uncovered. I know in my portfolio in health I am still finding more rundown assets that need to be looked at that need to be replaced over time and that of course cost money. But you can't sweat assets forever. You can't sit on those assets forever and not expect the system to be under strain.We know in Dunedin Hospital for example surgery gets cancelled when it rains. The operating theatres cannot function because they are leaking. That is not a first-world hospital. That is unfortunately the kind of thing you might expect to see in a developing country but it should not be happening in New Zealand—certainly not in a hospital where many of New Zealand's clinicians are trained.It's not the only example. Up and down the country there are other hospitals that are showing wear and tear and no provision has been made it seems from that previous Government to address those issues. And you know with existing buildings that have passed their use-by date they also force old ways of doing things—more expensive ways of doing things. The previous Government simply has not kept up. It has not had the vision for New Zealanders to have access to quality healthcare at an affordable price and we've all borne the cost of that.Instead they had a focus on short-term targets. So we saw that Avastin injections have skyrocketed under their watch and skin lesion removals and those things counted towards their elective targets that they wanted to parade about but frequently many of those were done in primary care previously at lower costs. So we've had these distorted behaviours with an exclusive focus on short-term targets. All of these things will need to be addressed.What I've also found out since I have been the health Minister is that none of the district health board (DHB) annual accountability documents have been signed off. None of them—none of them—and we know why that is. It goes right back to the time when they made that blunder in the Budget where the health Minister did not see that the wrong amounts had been allocated to the different DHBs around the country. Two weeks out from the financial year beginning the DHBs didn't know the correct amount of money they would be allocated in the Budget. Long after the Budget day two weeks out from the financial year beginning the DHBs around New Zealand did not have the correct figures for how much money they would have to spend in that financial year. So of course everything has been pushed back and the previous Minister—goodness knows what he was doing. But all 20 DHBs had not been signed off with their accountability documents and how many months into the financial year are we now?I think it's a disgrace. It speaks to the low priority placed on health by the previous Government and I can assure this House that this Government takes responsibility much more seriously in the health space—as it does in education as it does in housing. We are a Government that is concerned for a kinder more caring society; a Government that has empathy; a Government that will manage fiscal responsibility. We have set ourselves the Budget responsibility rules which we will keep to. We will manage in a fiscally responsible way but we won't prioritise building new prisons or pet projects in the roading sector or whatever else it may be. This will be a Government that looks to look after New Zealanders' interests; that spends money wisely; that is concerned to provide decent education for all New Zealanders so every kid can get a world-class education at their local school; that wants to provide affordable access to quality care so all New Zealanders can access quality care regardless of the depth of their wallets.We'll do that in part by reducing the cost of access to primary care. Currently people going to see their GP—we know that over half a million people in the past year have not gone to see their GP because they couldn't afford it. How can that be in a country like New Zealand that over half a million people—and growing—every year cannot afford to go to their GP when they need to for reasons of cost? So we've said we'll lower that barrier. We will reduce GP fees by $10 so that New Zealanders will be able to afford to go and visit their doctors because we believe that all people should be able to afford that quality care not just those who are already well off.In the health sector we will have other priorities too. We've said we want to kick off a mental health inquiry. We want to have an agreed approach because the current approach clearly has not been working. There's been a 60 percent increase in the number of people accessing mental health services over the past decade and less than half of that in terms of additional funding to meet that need. But we want to have a review first so we fully understand how best to spend any new money in that sector so we get the best outcome for New Zealanders. We want to make sure that there's a good public health system and we want to make sure that the disparities that we see across different ethnic groups are reduced because right now there are clearly not equitable outcomes in the health sector. As I've said we want to address the issue of primary care. We want affordable access to quality care for all New Zealanders."