Craig LizDr Liz Craig (Chairperson of the Health Committee): Thank you Mr Chair.Matt Doocey: Point of order Mr Chair. I thought this new approach to annual reports was for the caller to ask a succinct question so the Minister would get up and answer.Hon Chris Hipkins: Mr Chairman this is a committee stage. It does allow the opportunity for members to make speeches it allows opportunity for members to ask questions or multiple questions if they wish to. As with other committee stages Ministers can accumulate a number of questions before they choose to answer them. It does mean that the member should still be able to expect to get an answer to his question.CHAIRPERSON (Adrian Rurawhe): That was actually my fault I should have given the call the first call to Dr Liz Craig as the chair to make her statement so I apologise to the committee. We'll go to Dr Liz Craig to give the speech that should have started this debate and then if the Minister would like to consider Mr Doocey's question he can do that after that.Matt Doocey: Point of order Mr Chair. Can I just have some clarity on what the Leader of the House has said. It was my understanding that the caller could engage in direct question and answer and not be interrupted.CHAIRPERSON (Adrian Rurawhe): Yeah both are correct.Hon Member: Oh great political answer.CHAIRPERSON (Adrian Rurawhe): Well it is correct. Both the member and the chair can create that dialogue if it's appropriate. But what should've started this part of the debate is the speech from Dr Liz Craig.Dr LIZ CRAIG: Thank you Mr Chair. As Health Committee chair I'd like to just provide a brief overview of the annual reviews for this year in the health sector and talk through some of the key themes emerging from the reviews that we did.So our sector comprises a number of entities and this year we did annual reviews in depth on eight district health boards along with the Ministry of Health Pharmac and the Cancer Control Agency. So some of the DHBs that we reviewed included Counties Manukau Capital and Coast Hutt Valley Waikato Hawke's Bay Canterbury South Canterbury and Southern DHB.We started off with the Minister of Health Andrew Little appearing before the committee. Some of the discussions that we had included talking about the health and disability sector reforms the upcoming review of Pharmac and the Government's inquiry into mental health and addiction and some of the implementation that happened there.Then that was followed by the Ministry of Health and we had some discussions there around the financial performance of DHBs strategies to improve Māori and Pacific health and also COVID-19 vaccines. I think in the discussions we noted a range of things including that a significant proportion of the DHBs were having deficits but a large proportion of that was also considered with non-compliance of the Holidays Act and so the need to set aside some funds for that.The Minister also spoke about some of the work under way in terms of expanding the mental health workforce and also just acknowledged some of the workforce shortages for some particularly areas like psychologists and psychiatrists the long pipeline up to seven years for training. Also just talking about the shortage of mental health specialists nurses and other specialists and also people in terms of those skills in talk therapies. So the Minister just outlined a range of workforce developments in that area including 350 full-time equivalents providing talk therapies through the access and choice programme in primary care.We also heard from the Cancer Control Agency. This was our first review with the agency because they were only established in December 2019. Their role is to provide that national leadership in cancer care. Most of the agency's first year had been around operational issues developing the operational model vision and recruiting key staff. But we were also incredibly pleased to hear about the role they'd played during the COVID response the previous year and in particular developing up some consistent guidelines so that while some of our screening had not happened during level 3 and level 4 much of the treatment had gone on because of the guidelines that they developed and that was incredibly positive.We also heard from Pharmac. Basically the annual review predated the announcement of the terms of reference for the Pharmac review. But what we did discuss was the work that Pharmac had done in relation to the disruption to global manufacturing and supply chain pharmaceuticals and the work that they'd been doing there to make sure we had a steady supply of pharmaceuticals.And then finally looking at some of the key themes emerging from the DHBs that we reviewed. As I mentioned there were a range of DHBs who had deficits and though many of them had actually then talked about how they were going to come back to break even over the next one to two years and just looking at the impact of the Holidays Act and plans for addressing that. But also the role of population growth and acute demand increases on their workforce and workflow.Mental health services was another common theme. A range of DHBs were expanding mental health service delivery or opening new units but also acknowledging increased demand and particularly for child and adolescent mental health some of the longer waiting times that we were seeing there. Also talked to DHBs about COVID-19 vaccine and their plans for roll-out.So overall it was a very busy year for the health sector. But also I just want to end by saying thank you very much to those working in the health sector. The incredible response we saw from the sector and those working in it for COVID-19 making sure they responded both to COVID but keeping business as usual and delivery of care happening during the same period. Thank you.