O'Connor Simon: Estimates Debate — In CommitteeText is incorporated into the Bound VolumeO'Connor Simon: Estimates Debate — In Committee[Sitting date: 28 July 2015. Volume:707;Page:5405. Text is incorporated into the Bound Volume.]SIMON O’CONNOR (Chairperson of the Health Committee): You can rest assured Mr Chair that we will happily be speaking to the main findings of the estimates for Vote Health from the Health Committee. I always say it when I stand up but it is an excellent cooperative committee. It is one of those committees where generally we are in agreement with what we have to do for the betterment of the country. By and large and I see my colleague Barbara Stewart nodding we get that right. Obviously there are a few tensions. You can indicate and see those in the report.As context for what came through the estimates report we are in a fine space for health. We know that the under-13-year-olds are now getting free GP visits and prescriptions—a really positive step there. One thing that I thought was really neat which I had not been aware of until I was reminded was that 94 percent of those under 8 months of ageare now fully immunised. It is a huge step forward. If I may make a plug—Chris Bishop: How much?SIMON O’CONNOR: 94 percent. May I make a plug to those people out there to please vaccinate. It does not matter if it is your children your teenagers or older. It is very positive—there have been 44000 more elective surgeries compared with 2007-08. So this is the context in which the estimates began and were heard. There is a 62-day target for patients to get their first cancer treatment. I will not go into the context of the past but that is an incredibly good period of time and something that I think the select committee—Brett Hudson: We’re up against the world.SIMON O’CONNOR: I think it is world-leading actually Mr Hudson. But this is the context in which the committee began its discussions. We are putting in it was acknowledged further funding to allow 4000 more elective surgeries a year. So again bear in mind that we have increased by about 44000 surgeries a year and we intend to push that higher towards 48000—I would hope eventually 50000. Hopefully none of us will have to avail ourselves of this particular target but 95 percent of those going into the emergency department are seen within 6 hours.Vote Health is the second-largest vote in Budget 2015. It accounts for about 17.8 percent of the total appropriation so be in no doubt—as this Committee will know—that health is a serious issue. We noted in our report that the vote increased by approximately 4.9 percent so we are now spending about $15.868 billion—in fact that is not approximate as that is what we are spending; let us be precise about that.In fact one of the things that we noted in our report is that $55 million of non-departmental capital has been moved and provided to help district health boards around deficit support. I mention that because I do not think we are under any illusion as a select committee and hopefully as a House that it can be tight for some district health boards. That was acknowledged also in the estimates with the Minister of Health. It goes without saying that the Minister is the Hon Dr Jonathan Coleman and when I was reading out those positive lines at the start I think it is incredibly important to note to the Committee that they are not purely the musings thoughts insights or feedback of the chair of the committee; that was in fact the feedback of the select committee itself to the Minister.I quote: “We congratulated Dr Coleman on his appointment last year as Minister of Health and expressed our satisfaction with the working relationship he has established with us.” Those were the words put forward at the questioning but also written up in the report and I would like to thank all the members who contributed to that and the continuing positive relationship we have with the Minister of Health.We noted that there has been a change in sector leadership. Those who follow the health sector will be aware that we have had an acting director-general for a while Mr Chai Chuah. Very shortly before we moved into this estimates hearing he was made the director-general. We were curious about how that was beginning and amongst other things we noted that surveys done recently have shown improving staff engagement and we are looking forward to seeing more of that as it goes along.Other areas we looked at were the demographics particularly around chronic disease. It is something that crops up in our informal conversations from time to time and it certainly has been in front of the Health Committee. When we are talking about chronic disease we are talking about things like “COPD”—that is an acronym for chronic obstructive pulmonary disease—and we also have got the likes of diabetes. Diabetes is very much at front and centre of debates at the moment and in fact over the weekend we had quite a constructive conversation in that space about how we engage with diabetes particularly around healthy decisions around food and sport.When we are looking at these chronic diseases the Minister noted—quite rightly I thought and I hope I am not stealing his thoughts for later on—that new models of care are needed. Although we have always been around “sooner faster more convenient” we I think as a Government understand the need for people to be able to obtain their health needs closer to home from particularly GPs medical practitioners they trust—sorry health practitioners; I should be clear on that particularly as we have a new bill before the House—and how we might work with them.I have spoken to the House before about how we better work the scope of practices. I use again the examples of nurses doing endoscopy GPs doing skin work and so forth. This is part of how we can better engage and we can do it in these chronic areas. One thing that has been announced—and we touch on it later in our report—is around the development of pain teams. Strictly speaking orthopaedic issues are not chronic—I do not think they are; I will have to take some medical advice on that. But the pain teams are pulling together—Hon Annette King: They can be chronically awful.SIMON O’CONNOR: The honourable member notes they are very painful and what we are trying to do is to have a lead provider in the community to help drive the care. So again you might have a GP a specialist a nurse or an occupational therapist who is going to take the lead in that support.I thought that the other thing that was really useful that came out was the whole notion of promoting healthy lifestyles. In fact if I recall the session correctly I asked the Minister of Health—who is not only the Minister of Health but also the Minister for Sport and Recreation—whether that was a coincidence of those two portfolios coming together which of course it was not. It was a good insight of the Prime Minister to see how that was going to work together.The Minister noted of course the Healthy Families New Zealand pilot which has been launched and I think well lauded in the health community. There is also work that has been undertaken to see how we might get that crossover particularly for our young people in schools around sport and healthy eating—two things I am quite passionate about when I visit my primary schools. Some will be in the most effectively wealthy suburbs in the country and then I go to other areas that are amongst the poorest if not the poorest. You look at the lunches and the choices that are being made there—I think we can make improvements not only through working with the principals but obviously through working with the families.The other aspect is activity. In fact I think it was on Prime news tonight or TV3 about how much time is spent in front of digital devices and so forth—so how do we get our young people active? The other thing I would note and we noted in the report from the Minister is encouraging activity. There is the notion of cycleways—I just have to put in a plug for that. The Government put out some money recently and the good people of Tāmaki are most pleased to have got the biggest chunk of that as we put in a cycleway from Glen Innes through to Tāmaki Drive. I am very much looking forward to stopping my running one weekend and actually jumping on a bike.Smoke-free targets—there is some really good work going on there. Speaking personally—and it is noted in the report—I think many of us still have concerns particularly with young Māori women who have an almost 50 percent smoking rate. I think there is stuff that we need to do and must do there. I think that is an important signal to the community as well.We have indicated that about another $12.4 million has been allocated to extend the bowel screening programme which is being done in the Waitematā so that has been extended again. A little bit like prostate work as well—you do this as a pilot you see what is possible and you take those learnings and then see whether it is feasible to roll it out across the country.I am conscious that we are probably coming close to time and I have got quite a number of pages to go. The one I did want to finish if I can is around the flu vaccine. It is coming out of time now but the committee was interested as to why there was an apparent delay. The long and the short of it was that as the flu vaccine was coming into the country the officials were made aware that some strains could be introduced to the vaccine. In other words there were new strains of flu out there and it seemed from the reports that we heard that it was actually better to get the new vaccines in so that those New Zealanders choosing the latter vaccinations could be fully protected from those new strains. There was a small blip at the start but I think we have got every confidence that that will continue and work well next year. I just wanted to mention that. I do not think we want any impression certainly from the Health Committee that somehow there was bad planning or a lack of vaccines available. It was a prudent health choice to look at the best medical and scientific information out there and to say: “Hey new strains.”—I am sorry but I cannot quote what they are—“Let’s get them into the vaccine and make sure New Zealanders are good to go.”An area I am always keen on is palliative care—$76 million - plus has been invested in that. That is going to work in a number of areas. It plays back into that original discussion I was having about “sooner faster more convenient”. A lot of it is for hospice care which importantly is done from home.