Chadwick Steve: Points of Order — Member’s withdrawal from Chamber ; Debate on Crown Entities Public Organisations and State Enterprises 
Chadwick Steve: Points of Order — Member’s withdrawal from Chamber ; Debate on Crown Entities Public Organisations and State Enterprises 
[Volume:609;Page:6223] 
STEVE CHADWICK (NZ Labour—Rotorua) 
: 
 I am proud to speak in this State-owned enterprise debate because this is a chance to demonstrate that this Government is committed to ensuring that Crown entities and State-owned enterprises are now working together with their communities for the benefit of all New Zealanders. I cannot believe the old hoary chestnuts being brought up by the Opposition. 
I will cover today the issue of district health boards. They are complex but I endorse that these entities are coming into their stride. They are getting into step now with leadership from the Minister of Health and the ministry on national standards such as the booking system and we need to educate clinicians about how to use that system consistently. They have consistency of service delivery and strategic direction—which they have not had for the last decade—and now they are also moving into funding certainty. 
I want to mention the national booking system which seems to be confusing some in the Opposition. It is a nationally consistent guideline and clinicians and hospitals need to understand how to interpret and allocate its points. Labour is committed to a vision for primary healthcare. Even the Opposition is not arguing with that. National is actually saying in the latest general practitioner journal that it supports putting more money into primary healthcare and we all know that we have to front-end fund to keep people well. That is what we are committed to; we are not obsessing about the other end because we are confident that district health boards are doing a good job. We are about keeping people well and keeping them in their communities because prevention is better than cure. We are about reducing inequalities in health services. That is what it is about but a model based on need not on race. We are prepared to meet that need head-on and target it. 
I cannot believe the arguments used about population-based funding formulae. Ethnicity is only one criterion in this standard. We have rurality and deprivation in the formula and as the member knows it is not race-based. This funding is going where it needs to be spent to make the difference to the health status of all New Zealanders. The Opposition fails to understand that the indices of health are about poverty and its elimination the treatment of poor housing unemployment and also the state of the environment. We are pouring money into those indices. They all impact on health services particularly mental health status. It is not about more beds in hospitals; it is about keeping people well and out of hospital. On Tuesday there was a UMR Insight poll in New Zealand about whether New Zealanders really believe there is an improvement in health. It was not about the number of treatments in a hospital. Fifty-two percent of New Zealanders feel that the health status of New Zealanders is being improved. 
I want to go on to discuss National’s policy—the Opposition’s policy. I ask whether there is any; we are seeking to find it. Will they sell hospitals? We are starting to hear flickers about that. Will they flick off the easy bits like the cherry-picking bits? Will they give surgery—especially heart surgery—to private hospitals but still depend on secondary public hospitals and their purse for intensive care unit and critical care unit follow-up when things go wrong? There was a very very weak attack by Lynda Scott in question time this week on the Capital and Coast District Health Board and its decision on heart surgery. I applaud that board for sticking to that approach to surgery. We need a robustly funded public health service. 
 Will they revert primary health organisations back to independent practitioner associations for their supporters? Here is a letter from Dr Lynda Scott on 6 May stating: “I say to GPs retain your independent practitioner associations.” I say to Dr Scott that she will not be able to incite them for ever and I want to let her know that we are moving on to more and more New Zealanders enrolling in primary health organisations. There are now 34 formed with over a million New Zealanders enrolled and everybody is starting to see that primary health organisations are not about medicine managed by independent practitioners associations only. They are about opportunities for pharmacists and other health practitioners to manage health out in that community and they are starting to understand it and take that opportunity. 
Will they cut benefits for parents who do not vaccinate? Yes we have heard that already. I cannot believe how punitive that would be. Will the Opposition take away the democracy now being enjoyed by district health boards? Oh yes I am sure we will go back to the appointment of old mates on to district health boards. When will Opposition members realise and stop carping on about secondary outputs instead of outcomes and when will they realise that the market model failed? The performance of those district health boards and the focus on health gain is starting to build community confidence. 
Let us look at that district health board sector of which a large part is hospital-based. We have just completed six out of 21 financial audits of district health boards and even though they received $137 million funding for smoothing the way towards a population-based funding formula most boards will eliminate deficits by 2003-04 and that is a wonderful result. Most are tracking ahead of planned deficits. The net deficits at March of this year were $124 million already a $5 million improvement and 13 out of 21 district health boards are showing improvements in their deficit-tracking. That is something about which even the ministry has gone out and said that they are doing well and that it will be working with them to make boards debt-free. 
How can the Opposition keep carping on about the deplorable financial state of the operating arm of district health boards? Four were picked out as achievers by John Hazeldine of the ministry alone this month and he said that there is more work to be done. This is a 10-year pathway from the last decade of privatisation of health. We are in year 3 and yes we have a long long way to go. 
There are sensitivities in the operating arms of district health boards. Sometimes acute workload gets in the way of cardiac surgery. Staffing is a problem especially in mental health. We have to do a lot more about that. There is the potential of risk in the winter months of things like severe acute respiratory syndrome and there are industrial challenges. The funding in that sector is so finely tuned that some of those impacts can really disrupt their ability to work towards becoming debt-free. 
I want to talk about a previous 10 years of no workforce planning and poisonous staff relationships—staff who were dissatisfied and undervalued. Just this last week one of New Zealand’s areas with five district health boards withdrew notice to strike. That is a working-group that is starting to say that it is on the pathway to recovery and being valued. That was huge for New Zealanders. It causes major damage when we go out on strike in the health sector. I congratulate those boards in the central North Island and the New Zealand Nurses Organisation on working together to find a solution. We are on the pathway to recovery and the pathology that the Opposition keeps carping on about in the health service certainly is not half as bad as it is making it out to be. 
We have different formulae for those primary health organisations at the moment and we are moving towards one formula for primary health organisations but we will not get there until we have addressed the inequities that now exist in health and until we are prepared to face those and keep targeting the funding for low access to general practitioners interim access and care plus. I am glad we have the flexibility of those different funding formulae to reflect the needs of all New Zealanders. We have 28 primary health organisations now where patients pay no more than $20 per visit and they are loving it. They are going to their doctors and that is about keeping well and not needing mental health beds or cardiac surgery. We are starting to work on the indices that keep people well and I applaud the district health boards for the work they are doing.