O'Connor Damien: New Zealand Public Health and Disability Amendment Bill — Third Reading 
O'Connor Damien: New Zealand Public Health and Disability Amendment Bill — Third Reading 
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Hon DAMIEN O’CONNOR (Labour) 
: 
 What a pleasure it was to hear particularly the last parts of that speech from Dr Jackie Blue. Dr Blue who is a good member of the Health Committee pointed out that there is duplication in the health system. Indeed I think that most of us would agree that there has been much of that. Indeed it was set up in the 1990s by the previous National Government which thought that having Crown health enterprises competing against one another would be efficient effective and market-driven. Well blow me down National members have finally discovered that a little bit of collaboration and coordination is actually good particularly in a system that has the potential to consume huge amounts of money and can have an unlimited demand for its services depending on the technology. 
The New Zealand Public Health and Disability Amendment Bill is a good bill but it offers us the opportunity to raise a few questions. As has been said it establishes a Health Quality and Safety Commission. No one could argue with the objective of trying to improve health and safety in the health system or to improve public safety. We need to get better at every opportunity and that is great. 
The bill has also introduced a mandate for collective purchasing across district health boards—that is having a Pharmac-type body that has some grunt some muscle to negotiate better prices for services goods and consumables in the health system which can get a better deal and lower the costs for everyone. It is smart; it should have been happening. 
In fact the previous National Government brought in Pharmac and I applaud it for that but when National came back into Government John Key said that Pharmac might be up for renegotiation because the US - New Zealand free-trade agreement might require some reconsideration of Pharmac’s role. Well because I have not heard that being said for a while I hope that the Prime Minister is being guided by the collective wisdom of his colleagues. He has not been there for long—I can accept that—but his colleagues know that Pharmac is the single best thing that National did when it was last in Government—I have to say that. It is acknowledged throughout the world as being the way to control the cost of pharmaceuticals. This bill allows for coordination across district health boards and that is good. 
This Government talks about customer focus market drivers user-pays and all those wonderful commercial terms. Normally customers should be able to have a say in the services they get. That occurs in this system through consultation between the district health boards and the people in their regions. These are taxpayers who fund the public health system. They expect to have a good public health system in their regions and they expect to have it delivered by the district health boards. But this bill removes the obligation for district health boards to consult the public and that is a backward step. 
Clause 10 repeals section 38 of the New Zealand Public Health and Disability Act and substitutes new section 38. That new section removes any obligation to consult. That is quite bizarre. I can state categorically that the people of the West Coast have different expectations and needs from those of the people of Manukau. It is important that the senior managers of the district health board consult the community to get a steer on what it expects from its public health system because it is not as easy as that to define. 
As members will understand another silly exercise conducted by National was the core health services review. The previous National Government thought it could identify what core health services were. It was going to define them and say that they were what the public health system should deliver that all the rest would be up to the private sector and if people wanted to purchase those services or get insurance then they could do that. 
After a couple of years—2 or 3 years; it was a long process—National discovered that one cannot define core health services. Why? Because they are different for every part of the country and for every single community. Yet this bill removes the obligation for the people in charge of literally hundreds of millions of dollars’ worth of expenditure to talk with their communities. That is a silly piece of this legislation. [ 
Interruption 
] I ask the member who spoke for National to explain why he thinks that removing the obligation to consult is a good thing. 
This bill is also about Tony Ryall’s claim to efficiency and effectiveness in front-line services and all the rest of it. We hear the figures dribbling off the tongues of the National members quite regularly. We hear about elective surgery etc. We have seen cuts being made to the investment side of health to pay for those elective surgery procedures. No one would deny that new hip replacements new knees etc. are necessary—no one would deny that. There have always been waiting lists. Because of technology and the fact that there are more things we can do in health there is always a demand. But if we invest in that end where we can easily count the procedures and take the money from the investment input end—that is preventive health care and having better knowledge in the communities—it is a zero sum game because over time it costs the Government and each and every one of us as taxpayers more and more money in health care. 
Labour had a huge commitment to primary health care. We invested literally hundreds of millions and yes we were crucified by National for doing that. We invested it at the preventive end. But right from the moment that National came in we have had cuts and cuts and cuts. Tony Ryall said that he would cut $700 million from the health system. Well he is doing pretty well. He has reversed healthy food guidelines— 
Michael Woodhouse 
: He never said that. 
Hon DAMIEN O’CONNOR 
: He made a song and dance about them and said they were silly things. Then he cut things like sending the breast cancer bus to places like Westport. People now have to travel 100 kilometres whereas the bus used to come to them. National has cut home support services in Southland and Otago—$10 million was cut from home support services. These are people in their homes who need 1 or 2 hours’ help a week to maintain their hygiene and their good health and Tony Ryall has cut those services. National members have cut anti-obesity funding oral health care funding and mental health care funding at a time when we have acknowledged the obesity epidemic. 
Jo Goodhew 
: No they have not—oral health funding has not been cut. 
Hon DAMIEN O’CONNOR 
: There is the member for Timaru. Well Timaru Hospital cut services. It said it had to cut 5000 people from coming into the emergency ward at Timaru Hospital. One just cannot do that without squeezing access to services for many many people particularly in Timaru. Radiology services in Timaru were cut by 10 percent. That means that the people who needed those services either had to travel to Christchurch or they did not get access when they should have. There have also been cuts to services for the elderly in South Canterbury in that member’s electorate. Those cuts were to achieve Tony Ryall’s $700 million of tax savings. If that member wants to go out and explain to the elderly why she has cut 1 hour or 2 hours from their home-care services then good luck to her. I think she will find out the effect of those cuts next year in the election campaign. 
This goes on and on. I could list literally hundreds of cuts across the health sector. The member for Rangitata says those cuts were in the area of low-value spending but they were not. Those areas of expenditure were in the preventive investment side of health care to improve the health status of the population across the board. When the district health board went out to consult it picked up where the most effective areas were to make those inroads. Was it in oral health care? Was it in the area of good eating or obesity? 
This bill has some good components in collective purchasing but the removal of the ability and the obligation by district health boards to consult communities is a very backward step and we will pay for that dearly in the long run.