New Zealand Public Health and Disability (Southern DHB) Elections Bill — Second ReadingText is incorporated into the Bound VolumeNew Zealand Public Health and Disability (Southern DHB) Elections Bill — Second Reading[Sitting date: 05 May 2016. Volume:713;Page:10838. Text is incorporated into the Bound Volume.]New Zealand Public Health and Disability (Southern DHB) Elections BillSecond ReadingMr SPEAKER: I call on Government order of the day No. 1. [Interruption] Order! To Kris Faafoi when the Clerk is on his feet announcing Government order of the day No. 1 the barrage must cease. I apologise to the Clerk.Hon Dr JONATHAN COLEMAN (Minister of Health): I move That the New Zealand Public Health and Disability (Southern DHB) Elections Bill be now read a second time. The effect of this bill is to allow for the term of the Southern District Health Board Commissioner to be extended from December 2016 until the triennial election scheduled for 2019. That provides the commissioner sufficient time to develop oversee and implement a financially sustainable plan for quality health services for the people of Otago and Southland. Without legislative change the commissioner would have had less than 18 months to improve the Southern District Health Board’s position.In June 2015 I dismissed the Southern District Health Board’s board and appointed a commissioner following my serious dissatisfaction with the board’s performance. The board’s management of the district health board’s finances had caused me to lose confidence in its ability to deliver on its strategy for the region including delivering much-needed capital redevelopments at Dunedin Hospital. Resolving the Southern District Health Board’s financial issues will take some time and that is unlikely to be completely addressed by the end of the commissioner’s current term on 2 December 2016.The commissioner has developed a work plan that has begun to address the financial and service challenges that she has been consulting on with the district health board staff and the southern district’s communities. I note that the district health board is currently performing better than the forecast budget for 2015-16. These are the first steps in achieving sustained financial performance improvements. In parallel with the work undertaken by the commissioner on the district health board’s financial and clinical sustainability the Government is working with the district health board on two streams of capital development. In September 2015 the Government approved $22.5 million for urgent hospital maintenance as well as upgrades to gastroenterology audiology and intensive care units. These projects will ensure that the immediate demands around delivery of services continue to be met while planning for the major redevelopment progresses.To ensure the robust oversight of this project I also established the Southern Partnership Group in September last year. The Southern Partnership Group has been working closely with the district health board and the commissioner to oversee the redevelopment of Dunedin Hospital. The Health Committee examined the bill and recommended that it be passed without amendment.From public submissions the committee raised a concern that Ngāi Tahu felt that its access to decision making was diminished under the new governance arrangements. The committee strongly urged the commissioner to engage with Ngāi Tahu to ensure that Māori can contribute to district health board decision-making and that the principles of the Treaty of Waitangi are upheld. The commissioner has confirmed that Ngāi Tahu will be engaged by the district health board’s iwi governance committee to provide nominations for Māori representation on the district health board’s statutory advisory committees. Furthermore the commissioner has previously affirmed the status of the district health board’s Treaty relationship agreement with local iwi. Through this relationship agreement and other established communication mechanisms the principles of the Treaty will continue to be recognised and applied.The Health Committee encouraged the commissioner to consider how its work can be made more transparent. It recommended that the commissioner set goals and targets and report on these to the public at the end of each year. The commissioner has confirmed that going forward the public will be able to attend statutory advisory committee meetings in the same way as at other district health boards. The 2016-17 district health board annual planning process is currently under way. Initial goals from the commissioner’s plan published in December 2015 are expected to be included in this document. This is the key district health board accountability document and the statement of intent which forms part of it is publicly reported on at the end of the financial year. The district health board’s annual report which is also publicly available provides information on the key aspects of the district health board’s performance.Finally the committee acknowledged some submitters’ concerns that the bill would affect their democratic right to elect a district health board and considered whether a requirement to consult with the community should be added to the bill to overcome the perceived reduction in democracy. When appointing the commissioner I noted my expectation that she work closely with southern district communities. This expectation will continue during the extended term. I understand that since her appointment the commissioner has held meetings and forums with a wide range of stakeholders and regularly updates the public on district health board issues through updates in local papers on the television via the radio and via the district health board website. The committee considered that there are appropriate mechanisms for public consultation and so no change to the bill would be required.I do not propose the cancellation of a local district health board election lightly. The bill therefore impacts only one election at the Southern District Health Board and will help ensure that the next board to be appointed as part of the 2019 local body elections will begin its term on a more secure financial footing. The appointment of a commissioner offers an opportunity to resolve the district health board’s financial challenges and to help secure most sustainable health services and health facilities for the people of the southern district. The commissioner has already begun to address the deficit challenge and it is vital that she is given time to complete this important work.It is challenging work and I want to acknowledge and thank the commissioner Kathy Grant and her deputies Richard Thomson Graham Crombie and Dr Angela Pitchford for the work that they are doing. I also want to acknowledge the support of my colleagues based in the southern district as well as the cross-party support for this bill. We all want to ensure the best possible health services are available for the people of Otago and Southland. I commend this bill to the House.Hon ANNETTE KING (Deputy Leader—Labour): The Labour Party supports this bill. As the Minister of Health said this bill has been to the Health Committee. We had a number of submissions—not many but a small number of submissions—on this bill and the select committee considered them. We raised a number of issues which I will go through in a moment but we did not vote against the bill and we did not make amendment to it. It does not mean that we were not concerned about the issue of curtailing democracy in a district health board. We did our best in terms of this bill itself to raise the issue that this was to be a short-term solution for one triennial period of a district health board election. Our expectation is that there will be elections—the next one in 2019.The reason we have supported this bill is that this is a district health board that has been in serious trouble for some time. In fact from 2009 the Government had put in a Crown monitor. It had also put in intensive monitoring of this district health board. I do not blame the district health board for the problems it was getting into. If you go back and look at what was happening to that district health board you will see there was a decision made—a political decision—by the then Minister of Health Tony Ryall to merge two district health boards: the Southland District Health Board and the Otago District Health Board. He merged them without the background work that was needed to see what the impact and cost would be on that region and it became quite clear after a number of years that the funding formula for that part of New Zealand does not fit that particular now-amalgamated district health board. In fact if you look at the funding formula—and I am sure the local members who are sitting here today will be aware of this—the funding per head of population for the rural component of the population-based funding formula is higher in South Canterbury than it is in the Southern District Health Board.So this is a district health board that has been under financial pressure for some time and struggling to do what was required of it. It got itself into a position where there was a lot of loss in confidence in the board itself—a loss of confidence by the public a loss of confidence by the staff. There was certainly—the Minister said—a lack of confidence in the board which led to him dismissing the board. I have to say that a number of us asked why he was not taking action a lot earlier because of the impact it was having on the morale of the people and the staff in the Southern District Health Board. Then having made the decision and put in a commissioner the Minister followed up with this bill which requires the district health board as I said to not hold an election in 2016 and to postpone that election and keep in place a commissioner.We looked very closely at that decision and one of the things we are keen for—if there is not going to be an election—is that there be far greater transparency and openness by the commissioners than there had been by the board. Unfortunately there had been a loss of confidence in the board for some of the decisions that were seen to be made in private without the public being aware. The members from Southland will be particularly aware of discussions the board was having at that time to cut the budget in places like Ōāmaru Maniototo Queenstown Dunstan and Balclutha by up to 5 percent to try to save money. So there had been a considerable loss of confidence in what the board was doing. Now a commissioner has been put in and we said: “Right there has to be a lot more transparency and a lot more consultation with the people of the southern area so that they can have some confidence that the change process that is being put in place is going to work.” At the select committee—and we represented at that committee the National Party of course the Labour Party the Green Party and New Zealand First—we did ask questions about what that transparency would look like. In fact we asked that it be written into the bill that there be transparency—that the commissioner must consult.Interestingly it was not that long after that that the commissioners themselves announced—actually on 27 April—that they were now going to be more transparent. They were going to be holding district health board committee meetings in public from this month. This was due to the power of the select committee I think because we made it very clear that we expected more openness more consultation and more transparency. It was reported—in the excellent reporting I have to say done in the Otago Daily Times by Eileen Goodwin who had done a brilliant job in holding the board to account as far as was possible but is now holding the commissioners to account—that they will be holding open meetings for the hospital advisory committee the combined meeting of the disability support advisory committee and the Public Health Advisory Committee. These will be held in public so I am taking that as a win.There was a submission from Ngāi Tahu. They wanted to know whether it was able to be provided for them as a representative to be appointed as a deputy commissioner. We received a letter at the select committee from the clerk of the committee. The clerk of the committee advised us that such an amendment if we were to put it into this bill would be beyond the scope of the bill as it was introduced. We did consider it but on the advice of the Clerk of the House it was not possible to consider it and to put it into this bill if we had decided to do that so now we have got to the position where we have returned this bill without amendment and without any minority views.We do not say that it is a good thing that we cancel democracy but it is not the first time that it has been done and what must be the overriding issue here is that we do return to open elections by 2019. The Labour Party will certainly be doing that in Government but—heaven forbid—if we have to have a fourth term of thisNational Government we will certainly be saying that we will not tolerate what happened with Environment Canterbury where a promise was made to hold elections and then delayed with some jiggery-pokery going on about how the Government wants to restructure the organisation of Environment Canterbury. We will not tolerate that and we will make that clear in putting it on the record now.It is until 2019 that this election is delayed and in that time we would expect that in the budgets that are coming the proper adjustments are made to help the Southern District Health Board meet its obligations. There has been a review of the funding formula and much to my disappointment there is little or no change so how it is going to address the funding problems of the southern area I am not yet quite sure. But I am sure—as the Minister said 21 sleeps to go—we will be waiting to see exactly what is done to address one of the fundamental problems of that area: the funding and the funding formula for it.We do support the second reading of this bill. I will be pleased when the Minister is in the chair for the Committee stage for I want him to say on record that he expects and will guarantee that there will be elections in 1919—in 2019 not 1919 although he probably comes from that era when you listen to him sometimes—that there will be elections in 2019 at the Southern District Health Board in line with every other district health board in New Zealand. So yes we do support the second reading of this bill.SIMON O’CONNOR (National—Tāmaki): I am very pleased to take a call on the second reading of the New Zealand Public Health and Disability (Southern DHB) Elections Bill. The second reading is the opportunity to speak to the select committee’s report and in doing so I want to thank the Health Committee for its work. As the previous two speakers have indicated this is a bill that has cross-party support and I would like to thank all the members for that. This was one of the simpler agenda items that the committee is dealing with and by its nature it was something that we were able to return to the House relatively speedily. As context the actual select committee at the moment is dealing with four bills four pieces of legislation and I think at the last count we are up to 21 petitions that we are working through. So it is really good that we have had the opportunity to return this particular bill to the House.It has been noted that it has come back with no amendment. That is not completely unusual but I thought I would just point out particularly for those following this with keen interest that the reason there is no amendment is that first and foremost the drafting of the bill was excellent and thank you to the Parliamentary Counsel Office which was involved with that. But also the purpose of the bill is very very simple and I will touch on some of the elements of that as we go through.It is very simple because ultimately we are saying that we are not to hold an election for the Southern District Health Board this year in order that the commissioner may continue her work. May I echo the Minister of Health’s words in thanking her and her team for the work that they are leading there. The intention of this bill is to delay that election and to see that the Southern District Health Board will then go back—or rather a board would be re-elected by the public there in 2019. We had a number of submitters—not a large number as you might expect. I want to thank those who wrote in and then submitted to us orally.There were sort of three themes that came out of the bill. The first was around Māori representation. Those from Ngāi Tahu were very keen that there be a formally appointed person put in a position to work with the commissioner. We discussed this both in principle but also how you could actually make it happen. The advice was very clear that this was out of scope. The reason again is—coming back to as I mentioned earlier the simplicity of this bill—that the purpose of the bill was to extend or push out the next elections. It was not about who is appointed as commissioners deputy commissioners advisers or whatever. The committee being a hard-working insightful committee wanted to make sure our thoughts were clear on this and we have encouraged the commissioner and the team to engage with Ngāi Tahu more. I understand that that is beginning. It is certainly my hope that that is beginning.There were a few questions raised around transparency. Look we have heard already about the efficaciousness of the Health Committee—all nine of us. We wrote down in our report that we wanted to see more engagement more transparency and that is happening. I am not going to go through all the ins and outs. There are certain requirements of the commissioner when she is acting as the board of what she can and cannot do in terms of public engagement. But it is also clear certainly to the committee that more could be done and I am very pleased that that is happening.The second-to-last point is that some were encouraging more community engagement. They were quite concerned about democracy and the loss of a vote. I sort of understand that but the purpose of democracy is not simply to vote. You vote for a purpose and the purpose is good governance and ultimately with the Southern District Health Board there were issues around governance and I think it has been and remains very important that the commissioner is in play. Simply having elections so that people can exercise a vote for no other reason than exercising a vote does not make much sense to me at all.Finally I just want to acknowledge particularly my four colleagues down in the South Island who are part of this district health board: Mike Woodhouse Jacqui Dean Sarah Dowie and Todd Barclay. I have appreciated the work that they have done in supporting their communities there. I have also been grateful for the advice and thoughts that they have given me—the times that they have just pulled me aside and given me some insights into what is happening. So to them I say thank you for the work that they do supporting the community there and I commend this second reading of the bill to the House.CLARE CURRAN (Labour—Dunedin South): Well let me be very clear. The reason that we are here today is because this Government allowed the Southern District Health Board to get to the point where it could no longer manage. Jonathan Coleman the Minister of Health and the previous Minister Tony Ryall and their Government are responsible for this mess—the mess that has put the Southern District Health Board between a rock and a hard place. Its problems have been obvious for years and we heard Annette King say that in 2009 a Crown monitor was appointed and the district health board has been under intensive monitoring by the National Health Board since that time. Annette King called for a commissioner to be appointed in April last year and was dismissed by the Minister Jonathan Coleman. He dismissed it—and what happened a few months later? He all of a sudden realised that something had to be done quickly and he dismissed the board and appointed a commissioner.The Southern District Health Board is underfunded. That is what is wrong here. That is what is at the root of the problem. That is why we are in this mess. The previous board could not fix it because it is a fundamental issue out of its control. The existing commissioners are clearly struggling. There is no long-term plan to date. There is very little transparency. It is a big issue. It is a big problem. There is a huge deficit. They are in a hole and this Government and this Minister Jonathan Coleman are responsible.The only reason we are supporting the New Zealand Public Health and Disability (Southern DHB) Elections Bill—and I have to admit that it does gall me to do so—is because it makes Jonathan Coleman directly responsible for the fixing of our district health board and because it would be a poisoned chalice for any newly elected board right now. I am informed that there is support across the House from the other parties on this bill and that it is for those reasons. I am a standard-bearer of democracy and accountability. I love my city. I love my district health board. I love our region. I am immensely proud of our teaching hospital in Dunedin and the people who work in it and I am proud of the services across the region but they are so stretched and so under pressure.However since the commissioners took over last June we have not seen a lot of action. There has been a turnover of senior management—of some senior management—and there has been a major listening exercise undertaken. It is a major listening exercise that has cost a quarter of a million dollars and it has come up with a set of draft values—things such as: “Our kindness fosters better care and better teamwork. We listen here and communicate openly and honestly with consideration for others. We bring a positive attitude and are always looking to do things better.” And: “Our success comes from nurturing and building on our strengths in the community.” Well that is all very well but if you are not properly funded you cannot deliver the services properly and you end up in a hole with a huge deficit and that is where our district health board is at the moment.The district health board commissioners have been to see me recently. They have delivered the message that they have to come up with a plan where the district health board can live within its means. However how they do that is still very vague. There are very vague statements being made. They could not tell me specifically what the deficit projection is for next year even though there is a deficit projection on their website. I am now told that a business case for a new clinical services block will not be ready until mid - next year despite in February the Minister saying that it would be at the end of this year. Why is it taking so long? What plans are being put in place for the board to live within its means? What the hell is Jonathan Coleman going to do about this situation? When is there going to be an acknowledgment that our district health board is seriously underfunded?If these commissioners cannot do the job that they have been given to do because it is a poisoned chalice what will happen then? Will they be dismissed and will we see new ones? Is not the fundamental problem underfunding? Why will the commissioners not say so because the community knows it—and a very good example of this is the situation with Compass Group. Last year the Southern District Health Board was given the choice—no choice—to accept Compass as the contractor to provide food inside our hospitals across our region and for Meals on Wheels and look how that has turned out. Half of the people receiving Dunedin Meals on Wheels have ditched Compass. Relatives are bringing food into the hospital because the meals are so bad. Staff are expressing serious concerns about the nutritional values and about the fact that they have to serve the food that they have to care for patients who are receiving this food. This is frozen food that is being trucked in from Auckland.This is a company that paid $2 million—just $2 million—in tax last year in New Zealand. Instead it makes loans to its UK parent company and those loans have gone up six times in the last 4 years to $33 million in the last year—Mr DEPUTY SPEAKER: Come back to the bill.CLARE CURRAN: It is called tax avoidance and it is amoral. But the big question is—which relates to this bill because it is about the decisions that the district health board has been forced to make to save money—how did Compass Group get to be the preferred provider? Did the Government do any due diligence on Compass Group New Zealand’s tax affairs before insisting that the district health board sign a 15-year contract to deliver hospital food—a 15-year contract? Who signs a 15-year contract? Especially under these circumstances with a community that was so opposed but we were being told “Oh no”—Mr DEPUTY SPEAKER: Come back to the bill.CLARE CURRAN: —there would be $6.5 million in savings over X number of years—15 years I think it is. How is that going to pan out given that most of the district health boards around the country refused to take Compass Group on because they could see what a problem it was? This is a huge issue in Otago and Southland. It is an absolute disgrace that patients who are sick and vulnerable are being forced to eat slops—and yes I will use that word because that is what is happening. Four hundred people lined up outside Dunedin Hospital last Friday—Mr DEPUTY SPEAKER: The member should come back to the bill. She has been given—[Interruption] Do not interrupt. Do not interrupt. Sit down. The member needs to tailor her debate to the bill. The member has been given a lot of latitude to cover the ground that she wanted to; she has done that and now it is appropriate for her to move on.CLARE CURRAN: Thank you Mr Deputy Speaker. As you can see I feel very strongly about this matter.Mr DEPUTY SPEAKER: That is not the point. You have got a bill to address.CLARE CURRAN: Compass Group was taken on by the district health board—a contract was signed—to save money and this is the pressure that our district health board is being put under. The communities in Otago and Southland are absolutely opposed to this contractor—[Bell rung]—and have expressed their views on this contract which was put in place to save money because of the pressures that our district health board is under.Shortly after that contract was signed the district health board was dismissed because it could not manage the financial situation that it was in. Four hundred people stood outside our district health board in Dunedin Hospital on Friday to protest. The commissioners have spent a quarter of a million dollars in a listening exercise saying that they want to go out and listen to the community—well 400 of them stood directly outside Dunedin Hospital last Friday telling the district health board that they did not like this contract; that they wanted Compass Group sacked that they wanted to reinstate hospital food being prepared in our good hospital kitchens in Dunedin Hospital and Invercargill hospital and that the staff want it the staff are concerned the staff are being gagged from speaking out about these issues—Mr DEPUTY SPEAKER: Order! The member is still talking about this particular aspect which she has covered. There is plenty more in the bill and if she wants to make a contribution and not have her call terminated she should get back to the bill.CLARE CURRAN: Thank you Mr Deputy Speaker. The bottom line for this bill lies with Jonathan Coleman. He is the Minister; he is directly accountable. This bill says he is directly accountable for the fate of the Southern District Health Board. He is directly accountable he has got 3 years to sort out this problem and he could start with an acknowledgment that the Southern District Health Board is underfunded. He could start with coming to our region talking to people understanding how deeply concerned people are in the Southern District Health Board region and ensuring that there is a sustainable plan in place and that the district health board will not end up being underfunded.Mr DEPUTY SPEAKER: The member’s time has expired.JACQUI DEAN (National—Waitaki): It is not about the food—it is not about the food. There are far more important issues around the Southern District Health Board than a beat-up around hospital food which is being used by the Opposition to try to score points—as simple as that. I am not going to waste my precious time raving about something that is materially not important to the performance of the district health board. It is ironic however that the commissioners are appointed by the Minister of Health to bring the Southern District Health Board into shape for its patients and all the Opposition can do is talk about the food. I would suggest that it has got its priorities in completely the wrong place.I would also challenge the figures proposed by the member opposite Clare Curran as a fabrication because the experience of people going to Dunedin Hospital and Southland Hospital in Invercargill is materially different from that which is described by the politically motivated opposite who are whipping people up into a frenzy. The reality is that people do not go to hospital to eat the food. People go to hospital to get treatment. Here is the good news. Here is the progress that is being made by the Southern District Health Board—I am going to go through some of these good figures. The Southern District Health Board has made great progress on the new faster cancer treatment target and that is that it has achieved 77 percent up 10 percent in the last quarter. That is progress; that is what matters. Does food matter or does faster cancer treatment matter? I know which one I would vote for: for better clinical services each and every time and that is what the commissioners are focused on. That is what the commissioners should be focused on.The elective surgery targets were exceeded by 7 percent in the last quarter. That is the kind of target that I focus on: outcomes for patients not politically motivated protests out in the rain of Dunedin about something that is basically immaterial—and I dispute the facts as presented by the other side. The target for shorter stays in emergency departments was exceeded by 5 percent on the previous quarter and also further work and improvements are being made in immunisation coverage. I would say that those are the targets that matter; those are the issues that matter.The New Zealand Public Health and Disability (Southern DHB) Elections Bill extends the time in office of the commissioners of the district health board. They have a large amount of work to do. This bill will enable them to get on and do it for the benefit not just of Dunedin Hospital—or indeed Invercargill hospital—but also of the rural hospitals and the rural healthcare that I care about so much in the Waitaki electorate. Thank you Mr Deputy Speaker.KEVIN HAGUE (Green): Thank you very much—[Interruption]Mr SPEAKER: Oh look you two old—Kevin Hague has the call.KEVIN HAGUE: Thank you very much Mr Deputy Speaker—I will reset. The Green Party supported Jonathan Coleman’s appointment of commissioners to replace the board members of the Southern District Health Board and we did so with a heavy heart. It is not something that we readily do and our reasons for doing so—for actually suspending the democratic representation of the people of the Southern District Health Board area—were different from the reasons that the Minister of Health had for appointing commissioners.Our reasons were primarily twofold. We said that the members of that district health board had failed in their basic responsibility to represent the interests of the people who lived in that district. We said for example that that district health board was facing unreasonable financial requirements from the Minister and that that board had failed to stand up for the interests of people living in that district.The Southern District Health Board came about through the amalgamation—the forced amalgamation—of two districts Otago and Southland. One of the things we know about the population-based funding formula is that although it tends to work fairly well for district health boards that are of a middling size it does not work so well for district health boards with very rural catchments because of the diseconomies of scale that they face. At the other end of the scale it does not work well for district health boards providing tertiary-level services because actually they have an inherently higher cost structure in needing to be able to provide those more advanced services. The Southern District Health Board is an amalgam of both of those kinds of district health boards so of course it was under extraordinary financial pressure and the district health board failed to stand up to the Minister with his repeated requirements around breaking even. That was one reason.We had another particular reason because of an issue that we had raised repeatedly and that was the dispute between South Island district health boards and an organisation called South Link Health over funds that had been retained by South Link Health. The Southern District Health Board had the responsibility to try to get those funds back—whatever the more elegant word is for that—and again the Minister had gone to the district health board and said: “I don’t want you to take court action.” So even though the district health board had clear evidence that South Link Health had retained funds inappropriately and it had legal opinions saying that potentially fraud had occurred it took no action because the Minister said that he did not want it. Again we said at the time that the Southern District Health Board should have stood up to the Minister and done what was right for the people of that district.I did not say at the time—but I could have done—that actually the district health board’s decision to contract with Compass Group for food was also a disastrous decision made under pressure from the Minister. We were very clear that the decision to actually make the food somewhere else was not in the interests of the health of the patients of that district was not in the interests of the economy of the Otago and Southland regions and was potentially disastrous in the case of some kind of natural disaster where actually having a local service would have been appropriate in general. You know it does not make sense to contract out a service that you actually need to use every day all the time like a hospital kitchen.Those were our reasons for supporting the appointment of commissioners. Since then under the watch of the commissioners there has been more money that has gone into the district health board with the Minister finally recognising—not enough yet—that the district health board was underfunded. The district health board has now given up under the watch of the commissioners on regaining that funding from South Link Health and we have seen both patients and community appalled and angry about the slop—and I agree with Clare Curran’s word—that is being served up to the patients in Dunedin and Invercargill hospitals. So there is some progress there but also some things that have not improved and we have also seen some things that have got worse.The Health Committee’s report talks about this issue of transparency and the Minister says that the commissioners have agreed to improve transparency by allowing the public into the advisory committee meetings. Well that is not really what the people of Otago and Southland are calling for when they say they demand transparency. We heard from various submitters—and in particular from Te Rūnanga o Ngāi Tahu—about the fact that the district health board’s statutory duty to honour the Treaty of Waitangi had effectively been suspended by the appointment of commissioners and by the way they had gone about their task. We have heard from the Minister today that there is good news: what is going to happen now is that the commissioners have agreed to work with the rūnanga to work out the appointment of representatives of Kai Tahu on to the advisory committees. Well again that falls short of the requirement that is actually in the law. So yes the commissioners appear to be doing some very good work but also some things seem to have got worse.It is evident to the Green Party and it should be evident to everybody in this House that the people of Otago and Southland want their democratic right back. They want the right to be able to appoint their representatives on to the district health board. The Green Party will be voting to support that right. We will be opposing the bill at this reading and at subsequent readings. In refusing to agree to that demand from the people of Otago and Southland the Minister and the Government is actually answering a question: to whom should the district health board be accountable? They are answering that question with the wrong answer because they are making the primary accountability to the Government and not to the people of that district. That is the wrong answer.Continuity of the work that the commissioners have begun is important and it could have been achieved if the Government had picked up the suggestion by Dr John Chambers that the commissioners be appointed by the Minister under the powers that he has to the appointed positions on the board. That could have been done while retaining the democratic rights of the people of the southern region. That would have been the right thing to do.RIA BOND (NZ First): It is a great privilege to stand here today on behalf of New Zealand First to speak to the New Zealand Public Health and Disability (Southern DHB) Elections Bill. This is a bill that is very dear to my heart. It is also very dear to the community that I reside in having grown up there from the age of 14 and actually two of my children were born at Southland Hospital. I just want to touch on a few points that previous speakers have spoken about today.I do want to say that the number of submitters was quite small. We heard from them and read their submissions. I think it is fair to say I can echo what the Hon Annette King said in her call about the issues that were worked through throughout the Health Committee process to ensure that all parties had their say throughout that committee process. I also want to touch on what Mr Hague said about the fact that Māori representation or the voice of Māori was actually forgotten about by the Minister of Health. I am quite pleased now that Ngāi Tahu will be the voice of Māori to ensure that we do not get forgotten about in this bill.I also want to address a statement made earlier by Jacqui Dean when she said it was not about the food. Well actually it does not take a saint to understand that when you are in hospital and you have had surgery you need a good square diet—good food—to actually recover. If you are not getting fed good food that has nutritional value you are going to stay in hospital as a patient for longer. So I do not support that statement at all. I also want to make a point about the number of elective surgeries which has been mentioned. Down in Southland where I come from where my family has grown up and in the community that I know best I can say that I have had people come into my office to show me that they have been kicked off the elective surgery list. I have had to write letters to the Minister of Health to ask him to reconsider the treatment for those constituents.We have all heard the Government members say so many times that this bill is about cost cutting and it is about efficiency. But I believe that this bill means so much more. I believe there is a bigger problem than this and it is the fact that our community has a right to have a say. We deserve to have our voices heard when it is to do with local health-care and how that is managed. Southlanders have had to ask themselves what their priority is—where does their priority lie? What do they believe in? Is it important that they actually get to have a say over what health-care services are dispensable or are being made dispensable in Southland?Under the guise of fiscal responsibility this National-led Government has decided it wants to suspend Southerners’ rights to vote for our health-care representatives. The Minister believes that he knows best. He appointed his commissioner and thinks that she knows best. Well Minister Coleman I can tell you now that Southlanders think that actually they know best how to vote for the people in their community to ensure that they have the right to lobby those members on the board at such time when they need to. In Southland we recognise that there is a deficit problem with our district health board. New Zealand First strongly believes in holding the district health board fiscally accountable for the choices that they have made. But New Zealand First does not believe in railroading the democratic processes simply to fulfil a cost-cutting exercise.Elections are often thought of as the heart of the political process. That is how the Minister got into Parliament and that is how New Zealand First got into Parliament too. In New Zealand democracy gives people the ability to be the owners of their own destiny. Think for a moment about some of the recent examples of New Zealanders standing up and sending a message. The Northland by-election is a good example.So many constituents have been in contact with me. In fact over the last week I have been to one public protest in Otago where—it has been echoed already—there were over 400 people attending. That was because they were not satisfied with the food that they were receiving in the hospital or out in the community through the Meals on Wheels scheme. I have also been to one public meeting in Invercargill where the deputy mayor came to talk about the fact that we have a problem with this Compass Group contract and we deserve the right to have our say to show our disapproval. We are certainly planning on more meetings.The food that is being served to our patients at the Southland District Health Board hospitals is an issue. I know Mr Deputy Speaker that earlier you said to the previous speaker to bring it in.Mr DEPUTY SPEAKER: Bring it in.RIA BOND: Thanks. But the issue is that the district health board has been forced to deal with a deficit. In that it has actually been forced to take on a contract and it has to watch its bottom line so that contract is part of that process. I asked the district health board members when they appeared before us in the select committee whether they would be prepared to actually put an independent food auditor in to spot-check the food to make sure that it had a nutritional value and that just fell on deaf ears. That was actually really sad.I will come back to an area that I am quite interested in—and people in Invercargill are too—which is that the ability for the people of Invercargill to be stripped of our rights to vote for our elected district health board as this all comes before the House is an indictment. In Southland it means that we cannot have the voice to fight for our rights; to voice against our absolute horror about the slop that is being served to our people. We do not get the right to actually hold our board responsible and we absolutely lose the right to hold the Minister of Health responsible too. We will lose that right until such a time as the Minister sees fit to return to the people of Southland the right to vote for our district health board members. We heard that that could be in 2019. I have heard Annette King mention that she surely does hope that that occurs. New Zealand First is quite hesitant to actually completely absolutely trust that that will occur given that recently in this House another bill was put forward to actually extend a time for the Canterbury area to not have its democratic vote.Before I heard too from previous members that Southlanders do deserve the right to vote and actually so do Otago people. In Otago especially they deserve to have their input into the rebuild—or the overdue renovations—of Dunedin Hospital. They deserve to say what services they want for their community. When the Minister appointed the commissioner to run the Southern District Health Board he was quoted in the Otago Daily Times in June saying: “The plan is really for the commissioners to stay on as appointed members of that board and new elected members to come on at the local body election.” I still do not understand why this cannot be the solution. I am asking why there was such a big U-turn Minister Coleman. Why cannot Southlanders vote for the remaining board members and then everyone actually gets what they want which is really at the end of the day to have their say to ensure that the community is not lost in that. Stripping the votes from Southlanders by this National-led Government is placing all the decision-making powers in an unelected few and that really concerns us.This is the same Government that oversaw the merger of the Southland and Otago district health boards in 2010. It further streamlined a centralised agenda and it actually burdened our district health board because we have the largest geographic area in New Zealand. That National-led Government watched from the sidelines for years as the district health board struggled without giving any timely assistance. That Government has gone to great lengths to blame the former board management while it quickly undertook a review of the population-based funding formula. For me if that is not a concession that it has starved our district health board of adequate funding then I do not know what is. We know from Cabinet papers that the rural adjuster calculation did not adequately fund the Southern District Health Board and that the district health board missed out on the correct funding for many years.When the district health board members appeared before the Health Committee I asked how much money they thought that it had actually missed out on that has continued to add to its deficit. Have a guess what they replied? They could not tell me. They could not give me a figure; they could not do that. I asked how responsible that was of that commissioner and his subcommittee members now today—not the previous board who could have told us but the commissioner that we have in place now.More than 40 percent of the Southern District Health Board population lives outside the urban centres and this increases the cost of the delivering of services. With such a big region to service it is no wonder it struggles to meet its service needs and its financial needs also.In closing I want to issue a challenge to the Labour Party members tonight. If they support the Real Meals Coalition for a call to stop the Compass Group contract why are they supporting this bill that will strip Southlanders and Otago people of their democratic right to vote? Thank you. New Zealand First opposes this bill.SARAH DOWIE (National—Invercargill): Thank you very much Mr Deputy Speaker for this short call on the second reading of this bill the New Zealand Public Health and Disability (Southern DHB) Elections Bill. I am actually very positive and very happy and very pleased to be taking this call because this is an opportunity for the good people of the Waitaki and this is an opportunity for the good people of Clutha for the good people of Southland and of Otago to get quality sustainable health-care provided throughout our district. That opportunity should not be sniffed at and I am actually very very excited about it.The Southern District Health Board’s issues have been well documented for a number of years. In fact for the last 13 or 14 years it has posted deficits. Despite the Opposition trying to rewrite history about that we are now the Government that is getting to the bottom of these issues and making sure that the commissioner team will provide our people with a sustainable and quality health-care system moving forward. The penultimate of these deficits was forecast this year at $42 million—despite the fact that the Southern District Health Board did receive extra funding of $134 million—and that is unacceptable. Although the Opposition wants to rewrite history we are sticking to the facts.When I first took office as the MP for Invercargill in 2014 my constituency inquiries with regard to district health board issues tracked at about 11 percent. And if you look at all of the Government departments that MPs deal with—the wide-ranging issues that relate to central government—that is quite significant. That is considerable. And it is certainly not a reflection on front-line staff—the good kind doctors and nurses who are providing quality health-care on the front line—but it is to do more with system failures and administrative failures and that the district health board could not provide clear sustainable management of its services. So something had to be done and the Minister of Health obviously intervened and put a commissioner team in place—a commissioner team with skills—which would come in and look at the system and look to provide that sustainable health-care moving forward.Despite Ms Curran’s analysis of the In Your Shoes workshops I was happy to attend them in March in Invercargill; a series of workshops that the commissioners put together to hear from patients and from staff as to the failings of the district health board. I can tell you that as I sat there listening to the patients and talking to the staff there was a clear form of relief in that room—a strong sense of relief that these people were finally being listened to and that the commissioners were taking on board what those failings were and had a clear plan to rectify the systems that needed to be rectified and provide quality health-care in the Southern District Health Board region. I want to pay tribute to Mr Tim Keogh who facilitated those workshops. They were very well run and it was fabulous to see people engaging and committed to that process.Look the ocean liner is starting to turn the commissioner team needs more time and there certainly is in my region a sense of optimism about where the district health board can go and where it can end up. I want to end by sharing a constituent issue. I spoke to a nurse who works at the district health board and she said to me that in respect of the direction the commissioners are taking the district health board in this is the first time that she has felt optimistic in 10 years. I think that is really good. That is wonderful for our people and I cannot wait to see the result and see quality health-care being provided to all of the wonderful people of the Southern District Health Board region.Mr DEPUTY SPEAKER: Metiria Turei—a 5-minute call.METIRIA TUREI (Co-Leader—Green): The Green Party supported the appointment of the commissioners because we wanted to make sure that those responsible for the health services in the southern region were responsive to the community. It was clear the previous board was not. It was responsive to the desires of the Minister of Health and that led to a very large number of very serious problems for the southern community. We are now in the situation where it is possible for the communities of the south to have elected representatives on the Southern District Health Board who will represent them—genuinely represent them—and their concerns and we should be welcoming that opportunity. It is important that we have local democracy and that is why we are opposing this bill because this bill will take from the communities of the south their right to have local democracy and to have their representatives on the board.This is no reflection on the current commissioners. I have met with Cathy Grant and Richard Thomson. I have a great deal of respect for the work that they have been doing to this point.The benefit of the Green Party proposition that we keep elections for the district health board is that the communities of the south can have the best of both. This is a potential win-win for the communities of the south. I live in Dunedin. This is a community that I represent and work with. We can have elections for our representatives on the board who are responsive and accountable to us and we can have the expertise and the experience of the current commissioners who can be appointed to that board as well to help maintain the good work that has been done and to manage the transition from the commissioners to a fully elected district health board.This is a win-win proposition that the Greens are putting forward for the communities of the south and it is amazing to me that the National Government wants to remove from the table that win-win for the south. But maybe it is not such a surprise because of course we know that National at every point it has been able to has removed from local communities their right to local democracy. We have seen that happen repeatedly in Canterbury for example. There is no way that any community in this country can trust National when National says it is going to restore local democracy because at every point it has had the opportunity to do that it has chosen not to and this is yet another example.I want to echo the comment by Ria Bond actually that one of the reasons why people in the south deserve to have the chance to elect their representatives is that there are serious issues. Currently two issues are major issues in the south. One is the food—well you cannot really call it food. Let us just be—no it is not food. The slop that is provided by Compass Group under the ministerial direction that this contract continues—that is a major issue for all of the communities in the south. The people of the south want to have advocates for their position on the district health board and they deserve to.The second issue that is currently significant in the south is the mental health services and mental health funding cuts. We have seen the Stop the Cuts to Southern Mental Health organisation activists be very clear that they want to retain the best possible mental health services particularly in Dunedin and elsewhere. Those people too deserve to have their representatives on the district health board to advocate for their needs.This National Government is stripping from those communities—from the patients in the hospital and those with mental health issues and their families in Dunedin—the right to have their advocates on the district health board being accountable to them and arguing for their needs for no reason except that National wants to keep control and remove local democracy from the south. The Green Party opposes this legislation.JENNY SALESA (Labour—Manukau East): This bill proposes to exempt the Southern District Health Board from the 26 district health board elections and this is not a bill that should be passed without rigorous scrutiny because it suspends the democratic rights of the community for a whole electoral term. The usual rules supporting openness and transparency that would apply to decisions of the district health board do not apply to a commissioner. I have got to say even though the Labour Party actually supports this bill I would like to draw attention to a few points.First in the Ministry of Health’s briefing paper to the Health Committee on key aspects of the bill it made note of the proposals to extend the Southern District Health Board commissioner’s term in order to provide sufficient time to develop oversee and implement a financially sustainable plan for quality health services for the southern district. Well there is a short answer to that precariousness of the Southern District Health Board financial situation: give it sufficient money in order to enable it to run a decent health service. Figures that were released earlier this year showed that the Southern District Health Board has long been starved of essential funds. The Government must ensure adequate funding to ensure that the region’s health needs are not put at risk. It must develop a plan with genuine deliverables and sensible resourcing that is robust and available to the public.The pickle that the Southern District Health Board has found itself in is this Government’s responsibility. The Government’s failure to develop a credible path to financial stability over 7 years deserves condemnation. Going back to the Ministry of Health’s paper to the Health Committee I presume that “quality services” referred to in that paper indicates a commitment to high-quality services. I wonder whether this ambition for high-quality services extends to nourishing food to support patients’ recovery and their long-term health. In February of this year on this commissioner’s watch Compass Group won a 15-year contract to supply food to the Dunedin Hospital—a money-saving move presumably purporting to support the financial stability with many of the meals served to the patients at that hospital being prepared in Auckland and Tauranga frozen and then being trucked down to Dunedin and Invercargill reheated and then served to the patients. This includes meals that are served to the elderly folks on Meals on Wheels in the region; nourishing food that was previously prepared in-house by local workers and based on local ingredients is no more.Secondly the Health Committee expressed concerns in its report because Ngāi Tahu feels that its access to decision making has diminished under the new governance arrangements. This is an important issue and it was the subject of many submissions to the select committee. Although it may not be appropriate to insert particular directions in this bill the committee has strongly urged the commissioner to engage with Ngāi Tahu to ensure that Māori continue to contribute to the district health board decision-making and that the principles of the Treaty of Waitangi are indeed adhered to. I endorse this strong comment and urge the ongoing situation to be monitored to ensure that mana whenua rights are upheld.Thirdly some submitters on this bill felt that the commissioner’s decisions were being made behind closed doors and they sought to increase transparency of the commissioner’s activities and decisions. Thank you.TODD BARCLAY (National—Clutha-Southland): It is a privilege to speak in support of this bill. Before I start I want to acknowledge the Minister of Health Jonathan Coleman; the commissioner who has been appointedKathy Grant and her team; and the Health Committee for facilitating this bill through the select committee process.I think—just listening to all the contributions that have been made so far by the Labour Party the Green Party and New Zealand First—that if the biggest single issue in health in Southland and Otago is the quality of the food then it really shows how out of touch those parties are with their constituents down there. I have been meeting with constituents from across my electorate—from across Gore Balclutha Winton Queenstown Te Ānau and Lawrence—and the state of the food has not come up at all. What they are focused on are the optimistic opportunities that they see with the commissioner and her team coming into place to reform and reconfigure how health care is delivered across Otago and Southland.There are systemic financial issues that have been facing the district health board which were actually brought about by the poor mismanagement of the health portfolio under the Labour Government over a decade ago. That is why we are here. That is why the Minister of Health Dr Jonathan Coleman had to put in a commissioner to reform health care in Southland and Otago. We want faster more effective and more efficient patient care we want a more sustainable financial organisation and we want to reconfigure the systemic failures across the district health board and across the facilities.There are hundreds of highly effective highly passionate doctors nurses and care specialists across the district who are putting a lot of faith in the abilities of the commissioner and her team to be able to reform the health system in Otago and Southland. I know that the commissioner and her team are getting out and about. They are holding “walking in your shoes” sessions with staff and “walking in their shoes” sessions with members of the public and I am holding a number of constituent clinics as well.What is broadly coming through quite clearly is a sense of optimism in that this Government has decided to take a stance and make a change to reform how health care is delivered there.Clare Curran’s comments around the food are I think out of touch; so are Ria Bond’s. I do not think they are an accurate representation of the views of the people of Southland and Otago around health. I think it is actually quite misleading and it is not fair on our district. We have got an opportunity to be able to restructure and reform and I want to acknowledge the commissioners. I meet with them or talk to them regularly and they are listening to people. They are passionate about what they are doing and I think as they start forming a plan we will start to see more information coming through and that will be starting to be communicated with the community. Each step of the way there is community consultation so for the Greens to say that we need to do a complete about-face disband the commissioners and have local elections this year—it would just put at risk and would totally destroy all of the hard work and effort that have already gone into reforming the Southern District Health Board.In closing I just want to reiterate my support of this bill and the support of the Minister the commissioner and all the doctors nurses and specialists across the region who are doing their best to reform health care for the better for Otago and Southland.PEENI HENARE (Labour—Tāmaki Makaurau): Tēnā koe Mr Assistant Speaker. I find it ironic that a former lobbyist for the tobacco industry gets up and preaches to this House about health. The member Todd Barclay seems to think that food is not important in the recovery of those who need the valuable services of a hospital.Carmel Sepuloni: But Rothmans is.PEENI HENARE: Ha ha! Furthermore as my people the Māori people see rising rates of diabetes and rising rates of obesity I wonder then does that member truly think that food is not related to health?I believe that in this country democracy in communities is a right and not a privilege. I believe that this particular bill will suspend those democratic rights that belong to the communities of the deep south. This House has spoken about the voices of the people. It is important that those voices are heard. We understand the need for good financial management—we understand that. We want to see our district health boards receive the money and manage the money accordingly so that the communities those district health boards look after get the vital services that they need. That is very important and we want to see that in the Southern District Health Board. However it is with some apprehension that we support this bill knowing that it will suspend the democratic rights of the people in the deep south. We believe that their voices are important in the ongoing conversation of their health needs moving forward.This House has spoken about the submissions made by Ngāi Tahu. Members have also spoken about the submissions made by Te Pūtahitanga o Te Waipounamu. I mentioned at the beginning of my speech the critical needs of the Māori communities and it is important that groups like Ngāi Tahu and groups like Te Pūtahitanga o Te Waipounamu find a voice to advocate for their people’s needs in such important health management structures. Therefore although we look at this bill and see that there is some pressure to be applied on to the commissioner to make sure that they do find a voice we on this side of the House will be making sure that indeed that is what happens and that it is not simply a box-ticking exercise—one where we call a meeting people come in we have a 1½ hour discussion we have a cup of tea and the box is ticked. Conversations in that meeting stop right at the end as the cup of tea is being poured. It is important that voices like Te Rūnanga o Ngāi Tahu and Te Pūtahitanga o Te Waipounamu are heard on the district health board.I feel it timely to remind the House just how critical a hospital is to a community. The issues facing Dunedin Hospital have been well recorded. This side of the House led by the members Dr David Clark and Clare Curran has pushed hard to make sure that this Government realises that—to make sure that Dunedin Hospital is not just something that is planned on paper but is actually seen by the people of Dunedin and to make sure that the people of Dunedin can receive the services that they so desperately need and in my opinion deserve.We notice that despite regular engagements by the commissioner with our external stakeholders there are still some concerns about transparency. This goes back to making sure that the voices of the people are heard in the management of health services in the southern district. It is important that transparency is there so that the debate that is currently flying across the House with regard to the quality of food contracted for by the commissioner appointed to serve the people in the deep south is clear and transparent to the people of Southland to make sure that they know the processes that took place and make sure that they are informed about the decisions made and the services that they receive. Although we understand that there will be pressure placed on the commissioner to make sure that those transparency measures are in place we on this side of the House will be making sure that that is indeed what happens.Whatever happens from here on out with regard to the suspension of the democratic rights of those people we want to make sure—and we will be keeping a very keen eye on this particular process to make sure—that come 2019 those democratic rights are fully restored. Not partly restored but fully restored so that come 2019 the Southern District Health Board will be in a strong position to continue to deliver services to the people of the deep south.To me this is about doing what is right. It is about doing what is right by the community. It is about doing what is right by those who need the critical services to make sure that our elderly to make sure that the young and to make sure that the vulnerable get the services that they so desperately need. It is important too to make sure that the district health boards across the country maintain the confidence of the New Zealand public and that can happen only when transparency is there and in place. It can happen only when the voices of the people are heard. It can happen only with strong fiscal management. It can happen only when democracy will be returned to the people of the deep south.It is not just about the deep south. We on this side of the House hear regular concerns from across the country about the critical health services that people feel they are not getting and it is important that this particular bill the New Zealand Public Health and Disability (Southern DHB) Elections Bill maintains that integrity so that the New Zealand public can have faith in the services that are available to them.We on this side of the House have faith in the processes in this particular House and it is with some surprise that we hear some of the challenges made towards the Labour Party with one recently being made by the member from New Zealand First. So it is important that throughout the entire process—I understand that the Health Committee entered into strong robust debate about this particular bill which has made us arrive at the point where we on this side of the House will be supporting it. But let me remind this House in conclusion that we will be making sure that democracy will be restored to the people of the deep south. We will be keeping a keen eye on this Minister and on the bill to make sure that the people in the deep south get what they deserve. Kia ora.Dr SHANE RETI (National—Whangarei): It is a pleasure to take a short call—the last call—on this bill. I think it is important and appropriate that the commissioner and her team stay in place beyond this year’s local body elections—12 months after their appointment—which is what the New Zealand Public Health and Disability (Southern DHB) Elections Bill provides for. I say that for several reasons: first of all it takes time for a new board including a commissioner to grapple with the complexities of health let alone a district health board that is challenged. Over the three boards that I was lucky enough to be involved with I made the observation that it takes about 18 months for a new board member to grapple with really complex terms like “case weights” “DRGs” and “inter-district flow”—they are really complex. At about 18 months in they grasped it and the board members were really able to make good progress.I think the second point is that the commissioners have set a target—a deficit target—of $35.9 million compared with what was projected at $42 million and they should be given time to meet their target under their own strategic direction. The third reason why I think this bill is a good bill is that it is very challenging for staff when there is a short turn-round of board members at a district health board. We had that in 2000-01 when the transitional district health boards were appointed—they were appointed for 1 year. What happened was that the whole organisation sort of went into watch-and-wait mode instead of act-and-move. So I think it is appropriate to have continuity there.I also think there is a precedent. In my own region the Kaipara District Council was challenged in 2012 and we placed a group of commissioners there and the local body elections were in 2013—again like this 1 year later. In fact we rolled them over. We have just reappointed them through to the current local body elections and it has been effective. So there is a real precedent for this sort of thing.I think finally there has been a lot of comment around public involvement or lack of involvement in the current positioning of the board and I understand that the commissioner is re-establishing the advisory committees—the hospital advisory committee the aged and disability support advisory committee and combining that with the community and public health and advisory committee. I also understand that the commissioner and an iwi representative will be part of those committees. So I think there is ongoing public engagement in the new board and the new board structure and I commend and encourage the board for the work it is doing and that it will do. I think this bill is correct and I commend it to the House.A party vote was called for on the question That the New Zealand Public Health and Disability (Southern DHB) Elections Bill be now read a second time.Ayes 95New Zealand National 59; New Zealand Labour 32; Māori Party 2; ACT New Zealand 1; United Future 1.Noes 26Green Party 14; New Zealand First 12.Bill read a second time.