Scott Lynda: Questions for Oral Answer — Questions to Ministers 
Scott Lynda: Questions for Oral Answer — Questions to Ministers 
[Volume:617;Page:13059] 
7.  
Dr LYNDA SCOTT (National—Kaikoura) 
 to the  
Minister of Health 
: Has she received any correspondence from the Minister of Finance regarding concerns over the decline in productivity in the health sector; if so what are those concerns? 
Hon Dr MICHAEL CULLEN (Leader of the House) 
 on behalf of the 
 Minister of Health 
: Yes the Minister has received a letter from the Minister of Finance noting that district health board output data as at October 2003 suggested such a conclusion. This reinforces concerns the Minister has about the measurement of productivity in the sector because that data refers to inpatient activity only. This is only about half of district health board activity; it does not reflect what we expect the true picture to be. 
Dr Lynda Scott 
: Does the Minister believe that the decrease in the number of patients receiving cataract and joint replacement operations revealed last December and today’s revelations that hospitals are doing fewer operations overall are indicative of a health system that is failing the nation’s people; if not what possible other answer can the New Zealand public take in light of the facts placed before them? 
Hon Dr MICHAEL CULLEN 
: What they can probably take is that less surgery is being done for people as inpatients— 
Dr Lynda Scott 
: Less surgery. 
Hon Dr MICHAEL CULLEN 
: No more surgery is being done as part of outpatient provision. What is not clear is what those totals are and work is proceeding on that. I note of course the member is once again promising to spend vastly increased money on her colleague’s promised tax cuts. 
Dr Ashraf Choudhary 
: What work is being done to improve the information available on actual hospital outputs? 
Hon Dr MICHAEL CULLEN 
: Officials are working with district health boards to improve the availability of information on the fuller picture of activities including procedures previously undertaken in inpatient settings but now undertaken in outpatient settings proceedings undertaken in emergency departments oncology radiology and laboratories that were not previously reported and where significant growth has occurred and procedures previously undertaken in secondary-care settings that are now undertaken in primary-care settings. [ 
Interruption 
] 
Mr SPEAKER 
: The member interjected the whole time during the question and now wants to ask a question. I do not want too much interjection. The odd comment is allowed—but the odd comment not a frequent flow. 
Barbara Stewart 
: What registration costs will be picked up by district health boards as a result of the Health Practitioners Competence Assurance Act and what impact will payment of those fees have on district health boards’ already burgeoning bureaucracy costs? 
Hon Dr MICHAEL CULLEN 
: That is a long way from the original question. Unfortunately I do not have the information in front of me to be able to answer. I suggest the member puts down a separate question to the Minister of Health. 
Heather Roy 
: What evidence is there to show that a letter from the Minister of Finance has any effect when he wrote to the Minister of Health in January 2003—I have the letter here—raising the question of declining productivity and stating that he looked forward to hearing from her; and are the Minister of Finance and the country not still waiting to hear what she intends to do about it? 
Hon Dr MICHAEL CULLEN 
: I can promise the member that the Minister of Health speaks frequently to the Minister of Finance and vice versa. The Minister of Finance is particularly pleased to learn that so I understand the officials are working with district health boards to provide better information. The member may well find that at the end of day there are increased numbers of procedures being carried out but more are being carried out outside of inpatient services. 
Judy Turner 
: Does the Minister agree that the Minister of Finance’s concerns about the embarrassing decline in productivity in elective services despite a 6 percent increase in funding over the last year would be addressed by a review of how the relationship between public and private hospitals could be better strengthened to ensure that private hospital capacity is being utilised as effectively as possible; if not why not? 
Hon Dr MICHAEL CULLEN 
: No I do not. I think the much more fruitful opportunity is to do what is being done already—that is to concentrate on primary health-care services and also to concentrate on expanding the usage of outpatient services. There is not always a need for inpatient services to be provided unless one has a vested interest for some reason in the most expensive form of medical care. 
Dr Lynda Scott 
: Does the Minister agree with Pat Tuohy who believes that the drop in the number of operations is because “hospitals are not counting all the operations performed”; if so is she worried that hospitals are not counting other figures such as patients dying while on waiting lists patients on waiting lists patients waiting longer than 6 months for their first specialist assessment medical errors and hospital deficits? 
Hon Dr MICHAEL CULLEN 
: I will take just the last point: in fact the hospital system is ahead of budget in terms of the deficit for the current year contrary to all the predictions made by that member after last year’s Budget. 
Barbara Stewart 
: What plans does the Minister have to halt the decline in productivity by district health boards caused in part by initially non-urgent operations becoming more complex because of time spent on waiting lists? 
Hon Dr MICHAEL CULLEN 
: The average time spent on waiting lists has dropped over the last 2 or 3 years. The member continues to make the incorrect assertion that there has been a reduction in the number of procedures carried out. No people in their right mind running a health system would prefer to carry out more procedures in the most expensive part of the system as opposed to more efficient procedures carried out in outpatients or in the primary health-care system. 
Dr Lynda Scott 
: Can the Minister give the public of New Zealand many of whom are now in agony waiting for surgery some explanation as to why less cataract and major joint replacement surgery was performed in 2002-03 than in 1999 when National left office; and does the Treasury report not just confirm that this Government has made good its election pledge to reduce waiting lists by simply culling patients not curing them? 
Hon Dr MICHAEL CULLEN 
: No not at all. As the member is no doubt aware there will be significant announcements around the time of the Budget in terms of increased operations in some of the areas that she mentioned. The fact remains that the member is referring to about half of the total provision of services and it is a declining proportion of the total. An outbreak of logorrhoea on her part will not help matters at all. 
Dr Lynda Scott 
: If the Minister is receiving worried correspondence about the state of the health sector from one of her fellow Ministers—[ 
Interruption 
] 
Mr SPEAKER 
: I am sorry Dr Scott. Somebody will very nearly be leaving the Chamber. That is the only warning. Please start the question again. 
Dr Lynda Scott 
: If the Minister is receiving worried correspondence about the state of the health sector from one of her fellow Ministers does she not think it is a measure of how deep a problem health is; and in light of Annette King’s statement: “The buck stops with me.” should New Zealanders not expect the Minister to stand by her remarks and finally resign? 
Hon Dr MICHAEL CULLEN 
: What the Minister draws is the conclusion that this Minister of Finance is a sharing and caring Minister who shows a concern for health services unmatched by any previous Minister of Finance in New Zealand’s history. 
Dr Lynda Scott 
: I seek leave to table a letter from the Minister of Finance to the Minister of Health stating that despite significant revenue increase volumes in this sector are static if not declining. 
Document by leave laid on the Table of the House. 
Dr Lynda Scott 
: I seek leave to table the  
Health and Independence Report 2003 
 which shows clearly that major joint replacements and cataracts are at lower levels than under the National-led Government. 
Document by leave laid on the Table of the House. 
Heather Roy 
: I seek leave to table another letter from the Minister of Finance to the Minister of Health outlining his concerns about declining productivity written in January 2003. 
Document by leave laid on the Table of the House. 
Hon Dr MICHAEL CULLEN 
: I seek leave to table a statement from the Minister of Health’s acting Deputy Director-General Clinical Services explaining the false nature of the statistics. 
Document by leave laid on the Table of the House.