Clark DavidBUDGET DEBATEDebate resumed from 11 June on the Appropriation (2019/20 Estimates) Bill.Hon Dr DAVID CLARK (Minister of Health): It is my real pleasure to bring more good news from the 2019 Wellbeing Budget. Members of the House will recall that there were five priorities in the Budget: taking mental health seriously improving child wellbeing supporting Māori and Pacific people's aspirations building a productive nation and transforming the economy. I want to speak a little about taking mental health seriously. This Government takes mental health seriously. In our first 100 days I launched the inquiry into mental health and addiction. All parties in this coalition—Labour New Zealand First and the Greens—campaigned on having an inquiry into mental health and addictions because we knew that these issues need to be addressed.He Ara Oranga came back with 40 serious recommendations. It was a serious inquiry. This Government has stepped up and accepted—accepted in principle or accepted for further consideration—38 of those 40 recommendations. The first 12 recommendations related to broadening access and choice in primary care for mental health services and they talked about the missing middle. This report talked about the people who had mild to moderate mental health needs be they anxiety depression or other and the lack of services that have traditionally been available to support people who are coming forward for support to work through those mental health challenges. We have accepted or accepted in principle all 12 of those recommendations relating to broadening access and choice. We are putting out a new approach which puts people at the centre when it comes to dealing with mental health.Budget 2019 the Wellbeing Budget allocated $1.9 billion across a range of portfolios to people's mental health and addiction concerns including $200 million in capital expenditure specifically for investment in mental health and addiction facilities. The portfolios of health education corrections justice and housing all contributed to the package around mental health and I want to thank colleagues for the collegial way in which they've worked together to ensure the wellbeing of our nation is put to the fore in a new way.The centrepiece as I mentioned was a $455 million investment in broadening access and choice in primary care to get to the mild and moderate needs of those in the missing middle. Over five years that programme will be rolled out. In the fifth year we expect it to support 325000 New Zealanders with mild to moderate needs—and every year thereafter. I think people will recognise that that is a significant improvement on where we are right now in our support of people with mild to moderate mental health needs. One in five of us at any time could be wrestling with a mental health challenge. People know people in their own families in their wider friends and whānau group in this room in Parliament. We recognise that a lot of people are wrestling with these challenges and as a Government we have stepped up to provide a way to address them.There is also in this Budget $213 million going into the district health board (DHB) ring-fence for mental health support to ensure that existing services particularly those struggling with really difficult mental health challenges are better supported. We are also rolling out nursing in schools—starting to roll it out to decile 5 schools having rolled it out now to decile 1 to 4 schools and also for nurses in schools we're strengthening the existing support in decile 1 to 4 schools. Resilience-building of course is important. We need to look at the prevention end around mental health and wellbeing. We are providing resources for over half a million primary and intermediate school children making those resources available for resilience-building and we're investing in digital and telehealth also—already rolled out of course in mental health. We didn't wait for the report to come back. We invested in those things we knew already had evidence behind them and made sense.So we rolled out Mana Ake into the primary and intermediate schools in the Kaikōura and Canterbury region making sure that children wrestling with the legacy of the quakes had support at the coalface in schools. We rolled out nurses in schools as I've mentioned already to ensure schools up to decile 4 have that support in their schools. We rolled out the Piki pilot. I want to acknowledge the Green Party for their contribution there to the Greater Wellington region ensuring that 18- to 25-year-olds have support for mild to moderate needs with talking therapies. We've invested in facilities like the Auckland City Mission—the addiction facilities there new detoxification beds. We've invested of course in the community services card initiative which means that for 540000 New Zealanders—Hon Jenny Salesa: How many?Hon Dr DAVID CLARK: —540000 will be able to access cheaper doctors visits as of 1 December last year meaning that they will be able to access services through their GP recognising that for a lot of people that is the way into mental health services for people. That also goes to the fact that a large number of New Zealanders historically have said they can't afford to go to their GP. This Government has been listening. We've wanted to make primary care more affordable and accessible and we have already done that.Infrastructure—I have a diagram here which I think illustrates this very carefully and well for those who are watching at home showing the investment in Budget 2019 really is significant. Over two years $850 million per year over the next two years in capital investments topping even the $750 million we put in last year and obviously well ahead of the investments under the previous Government recognising that capital stock has been strained for a very long time. We're investing $1.7 billion in health facilities in this Budget; $1.7 billion so that we've got a capital pipeline so that we are investing in the public delivery of health services because we believe in the public delivery of health services. We believe every New Zealander should be able to access public health services. That is what we believe on this side of the House.On top of that we have committed to fully funding Dunedin Hospital. Excuse me if I get a bit excited about that. Dunedin Hospital will be fully funded. It's in a contingency above and beyond that $1.7 billion dollars of capital spending. I had the pleasure of announcing the first of the investments out of that capital envelope in the Hauora Tairāwhiti Gisborne Hospital: a new inpatient mental health and addiction facility. Just last week I was able to confirm that spend.Of course we know that the impact will be more modern safe fit for purpose facilities not only for patients but also for the staff the hard-working staff in our hospitals and healthcare system who have been under stress for so many years as the previous Government failed to invest adequately in our health services.Of course that history of under-investment can't all be made up overnight. No one pretends that we can make up for nine years of neglect in one or two Budgets but we're on the way. We are certainly investing in mental health we're investing in our DHBs—$2.8 billion into our DHBs over four years. Again I have a wonderful diagram here—a little harder to see at home; I'll explain it carefully so people can follow here—showing the investment uplift under the previous Government's time and into our Government where the lines start to take off because we are investing in a sustainable health service to make sure those people working in our hospitals are paid adequately.But also let's acknowledge that since we took office there are 1300 more nurses in this country. There are 440 more clinicians. There are over 300 more allied health workers. We are making sure those services are sustainable there's enough people to deliver the services and that they're adequately compensated because we believe in the public delivery of health services making sure all New Zealanders no matter how deep their pockets where they live can access quality care. That's what they do and I want to thank those clinicians for the hard yards they put in over many years of underfunding and for the hard yards they continue to put in as we start to right the ship after the years of under-investment by the former Government. We care about those staff and clinicians and we recognise the hard work that they do for all New Zealanders to make sure they get the care that they need and deserve.Specifically in this Government we're also investing in Māori and Pacific wellbeing in the health sector. We have a Māori Health Innovation Fund that's got an extra $4 million in it. We've got a Pacific Provider and Workforce Development Fund that has an extra $10 million in it. We've got a Māori workforce development fund that will help hundreds of Māori into health professions—that has another $10 million in it. We've got $4.3 million set aside for wraparound services to get Pacific midwives and nurses through their training because we recognise we need more. There's another nearly $10 million into the Pacific Innovation Fund. We're investing in our Māori and Pacific communities particularly in the health area because we know we need to strengthen those workforces. On top of that our Wellbeing Budget includes an extra $12 million over four years for rheumatic fever programmes.I do want to acknowledge the Hon Jenny Salesa who's sitting next to me and who has advocated for Māori and Pacific communities alongside her colleagues in the Māori caucus. I want to pay a nod around the House here because that Māori caucus has I think seen some significant investment—over half a billion in this Budget—and I want to specifically label in our primary care initiative that $62 million of that is set aside for kaupapa Māori services. We're recognising that most Māori continue to access mainstream services but that actually kaupapa Māori is becoming an increasingly important vehicle for the delivery of services. There should be services available for people in the style and nature that they can access built with the community to ensure everyone is getting the care that they need.This Budget put the biggest ever boost in for disability support services $72 million. The need has been going up—36000 people now access disability support services. That is a good news story. More people are accessing these services than ever before and that record boost came on top of a record boost the year before for disability support services. There will need to be more money going in; that demand is going up for those services but we're a Government proud to stand with disabled people to support them as they contribute to our society.We've invested a lot more money in a number of other things: rural health and midwives-but my time has expired. Thank you.