Reti Shane; Salesa JennyDr SHANE RETI (National): Talofa Madam Speaker. It's a pleasure to speak to this Budget a Budget that is clearly going backwards. I will turn my attentions to the health space particularly and I have three broad concerns with this Budget in health. First of all clearly not enough spending on the health workforce I'll give more detail around that. Secondly dumb spending—and I'd put to you the health reforms is dumb spending. And thirdly an inability to deliver any health benefits with a poor track record that portends poorly that anything will actually be delivered in this Budget.But before I drill into those I want to talk about what's not there before we critique what is there. The campaign 2020 promised to deliver 20 mobile dental clinics at $39.7 million. It was a promise in the first year of being elected. Didn't happen last Budget. Well maybe it was in this Budget we were all thinking. Didn't happen in this Budget either. And when the Minister's asked on Q+A where's the 20 new mobile dental clinics? His weak response was Well there's still a bit of a parliamentary term to come." Yeah well winter's coming as well and there's still a lot of stuff to come and we're not seeing anything from this Government. So zero—zero—mobile dental clinics from a promise within the first-year campaign 2020. Zero.That's what's not here. What is here that's a problem? Well the big signal was $1.8 billion for health. Health will always be grateful for funding don't get me wrong health will always be grateful. But what's not being said here is that $1.8 billion is simply to manage cost pressures. If you look at table 3.3 on the Budget Economic and Fiscal Update it very clearly shows $1.796 billion for cost pressures and $266 million for new initiatives. The new stuff is only $266 million. The bulk of it is just shuffling the deck chairs. There are no new deck chairs that matter. It is just shuffling the deck chairs.And how do we find ourselves that the cost pressures are that sort of figure? Well maybe we'll start with roughly $530 million of consolidated debt—probably the highest consolidated DHB deficit ever. And how do we get to that? Well there was a number of reasons for that. First of all the Government took their eyes off the annual plans that hold the DHBs to their fiscal accountability. There's a number of Official Information Act (OIA) documents what's called "tranche 4" documents particularly that the Treasury sends to the Ministry of Health saying "We are disappointed in the negotiations you have reached with the DHBs" fundamentally saying "You are not holding them to account." So $1.8 billion this big figure in health that we're being told is the new health spend is actually mismanagement by this Labour Government and we are paying for that. That is the shuffling of the existing deck chairs.I want to talk to the $1.3 billion for health infrastructure—Nelson and Whangārei are highlighted. I want to talk about the upgrade at Whangārei Hospital and I want to ask the Minister this: did the Capital Investment Committee reject and turn down a Northland DHB business case for $917 million and tell them they had to cut $200 million off it down to $515 million which will be the equivalent of 128 beds? If this is such a wonderful infrastructure Budget can the Minister come down to this House and deny that his capital investment committee told the Whangārei people to take $200 million off their capital build their promised new hospital upgrade and to reduce the beds by 128? I challenge him to come down and address that. The Nelson Hospital well and likely will require some attention but this is a $1.3 billion health infrastructure build in this Budget and I would suggest that there is no ability for this Government to deliver that. I'd say that in a context of several things. First of all if we go to the investor confidence ratings in the most recent investor confidence ratings from the Treasury the Ministry of Health was given a "D" for their ability to manage projects. How are we supposed to expect that $1.3 billion is going to be adequately managed when they currently have one of the worst ratings a "D"?Secondly we've had recent news around seismic concerns news that I would contend the Government has known about for quite a while. We have Hutt Valley with a New Building Standard (NBS) of 15 percent evacuating their Heretaunga building. And the questions I'd like to ask in fact I have asked and I have the answers: Written Parliamentary Question (WPQ) 15618 where I asked whether the Hutt Valley District Health Board Finance Risk and Audit Committee had reported or made recommendations to the board in the past two years around seismic risk at Hutt Hospital. "No." OK. Does the Hutt Valley Risk Register record the seismic risk to Hutt Valley Hospital? WPQ 15683. "No." How can that be? How can the DHB be allowed to not record a risk that suddenly appears out of the blue a significant risk that requires evacuation of patients how can they be allowed to not put it on a risk register? Capital Coast had to put their ER which was 15 percent NBS on their risk register. Why was the head of Heretaunga block not on the Hutt Valley risk register? And when we look at when the information came to hand at Hutt Valley what we find in WPQ 15677 is that on 15 February a detailed seismic assessment summary by Aurecon was presented to health officials. The evacuation occurred in May. What happened between February and May over several months when the knowledge was known and why was it so late before actions were taken?There are other hospitals other facilities around the sector who are saying "Crikey if Hutt Valley evacuates at 15 percent NBS—we're at that level or lower—what does it mean for us?" Taranaki thankfully is being rebuilt and I think that's a project that clearly needs to proceed. But as we can see in other WPQs looking at the greatest seismic risk there are a number of clinical-facing facilities that are at or equal to the NBS that evacuated Hutt Valley Hospital. And I would put some in exactly the same seismic risk category because you can say "Well look in Northland you don't have the same seismic risk." Some of the top 10 seismic buildings under concern actually do sit along fault lines and so I think the ministry needs to take some accountability for that as opposed to a WPQ where fundamentally Andrew Little threw the DHB under the bus and said "It's not our responsibility it's not an MOH responsibility; it's a DHB responsibility." I don't buy that. They submitted their risk registers every quarter is my understanding. You must have seen or you should have seen—you need to own that.What the Budget also raises concerns around is this Government's ability to manage assets. And we need to imagine that Health New Zealand will be one of the biggest asset managers. What's a concern then is part 3.5 and this looks at how Health New Zealand will be seen—I'm reading here—"as a high-quality asset manager for the health estate as measured by the Asset Management Maturity index for the health portfolio." Now the index goes from one to 100 and you would think with these sort of assets you would want Health New Zealand to be at least up in the 75/80 percent to show that they understand and are looking after New Zealand's assets. Imagine our surprise then in Budget 2022 when the standard they've set—the standard Health New Zealand has set—in that range of 0 to 100 is 40 to 60 percent. That's the standard they've set that's what they're hoping to achieve: that some of the time they'll underperform be under the 50 percent; and a small proportion of the time they'll overperform; 40 to 60 percent is the Budget standard.And what's also revealing is there's an assessment of performance here that says "The extent to which actual benefits meet the expected benefits from those capital investments as set out in the relevant business case"—now you'd expect to get darn near close to 100 percent of the benefits of your assets as you put them into a business case. But you know what the standard is for this particular reporting measure? Eighty percent. Budget 2022 says 80 percent of the time the assets have to align with what you said would happen in the business case. How can that be acceptable?I now turn to part 3.5: "Capital Investment in Health New Zealand" a really interesting entry. Here's dumb spending: $31.5 million for capital investment in Health New Zealand and the health restructuring. And what really interested me was under the performance reporting is this statement: "An exemption has been sought under … the Public Finance Act 1999 as the performance information for the appropriation or category is not likely to be informative in the light of the nature of the transaction or causal event giving rise to the expenses." So they've sought an exemption of over $31.5 million of Health New Zealand assets because they can't imagine how they can report an end-of-year performance report on that. How can that be? How can there be such mismanagement of health assets that you will blatantly put into health Budget 2022 that you cannot imagine any sort of end-of-year performance reporting on that $31.5 million and so you've sought an exemption under the Public Finance Act.This is just an example of all the issues we have and that New Zealanders will have with this Budget. There is not enough health workforce. You can have the best policies in the world but if you don't have the health workforce to deliver it it will fail. A lot of the spending is dumb. The health reform spending is dumb and we have absolutely no faith that with a Government that sets an ambition of 40 to 60 percent on the assets and only 80 percent of the business case they could ever hope to achieve what they think they are.ASSISTANT SPEAKER (Hon Jenny Salesa): Talofa lava I call on Barbara Edmonds."