Bishop ChrisCHRIS BISHOP (National): Thank you Madam Speaker. Well here we go again. Twenty years ago Labour came in in 1999 and they had a great big new reform which was going to make the New Zealand health system the envy of the world. They said the National Government had run down the health system and underinvested blah-blah-blah you've heard it all before. Their great big big bang reform was a structural change to the health system and it's called district health boards. We had 16 district health boards established round the country and we had elections. It was Annette King's—she was the Minister of Health—it was her big reform. We were going to elect locals to the district health boards. Unfortunately we then saddled it with the single transferable vote election system and I took great pride and pleasure in my time as Wellington City district health board resident every—Hon Simon Bridges: I was hoping you were about to tell me you've been on one of the boards.CHRIS BISHOP: No no no. It was not my privilege sadly Simon Bridges. But every DHB election would come around and I would go through the little booklet which gives you 250 words of meaningless nothing. I would always make sure that Sue Kedgley was ranked last in the district health board elections and Helene Ritchie who was at various points a Wellington City councillor—always made sure Helene Richie was ranked number 28. I then tried to find the competent people and I put them at one two and three—people with some sort of accountancy skills and things like that. I didn't get to vote for you sorry Dr Verrall because I'm in the Hutt Valley DHB now obviously. But I tried to vote for competent people and anyone who seemed nuts like an anti-vaxxer or anti-fluoride or anything they went last but the person who always came last was Helene Richie.Anyway I digress away from the bill which is to say we've sort of been here before because 20 years ago the answer was DHBs and yet here we go again. Labour's back in and their big bang reform now they're unshackled from New Zealand First—and I have no time for Winston Peters but it is true to say that the last Labour Government was stopped from doing some dumb stuff by New Zealand First. I mean one thing they stopped them doing was this stupid retrospective property law changes which we're going to consider in the next bill before the House but I don't think they would have agreed to this. But anyway here we are unshackled by any essential governing party—and I don't count the Greens as part of that governing arrangement because as was demonstrated last week in the bipartisan deal done between National and Labour over housing no one cares what the Greens think anymore actually about much at all frankly. No one really has any interest in what they have to say. So they're there but let's face it this is Labour's ideological bill. So we're going to get rid of DHBs and go back to the future.Hon Member: They'll bring them back in about another 15 years.CHRIS BISHOP: Yeah in 30 years' time after the long next National Government's finished its time and Matt Doocey and Harete Hipango and Nicola Willis and Simon Bridges and Maureen Pugh have been long-serving senior Ministers—Hon Member: Government of excellence.CHRIS BISHOP: —a Government of excellence—after Labour finally come back around the mulberry bush they'll probably bring it back again. Who knows? That's the way these things tend to go.But the reason I make that point—it sounds frivolous and I'm being slightly frivolous but it's a serious point which is that the health system endures this constant churn of reform and Dr Verrall who is a Minister knows this all too well. Actually reform is OK as long as it meets the hurdle rate. The reason I say hurdle rate or the threshold rate is that it takes up an inordinate amount of time and money. In relation to these reforms the Government has put forward on the table it's going to cost $478 million. Now let's be generous and say that that's an underestimate and say it's probably double. So let's round up—I don't think it's being unfair—let's say it's the thick end of $1 billion. Now you might say: what's a $1 billion between me and some friends? Well 1 billion bucks is a lot of money. That is a lot of ICU beds. It's a lot of hip operations. It's a lot of GP surgeries. It's a lot of primary care. It's a lot of money in the health system. So you don't just go throwing away a billion dollars—likely—but sadly that is the dead-weight cost of these reforms. That is literally money vaporised. It's productivity and it's efficiency and it's the cost vaporised. That's something we get nothing for.Now the Government would say in the long term the medium to long term we do get more efficiencies and more reforms out of it. But I for one do not accept that is necessarily true. Actually the analysis underlying the reforms says that as well because if you read the cost-benefit analysis this is prepared by the officials no way to evaluate whether these reforms will deliver this outcome. Low to medium certainty. So these are reforms that are not based on a sound foundation.I make the point that I'm not opposed to reform and neither is the National Party—we're not opposed to reforms. In fact I would like to be part of a reforming administration because ultimately I got into Parliament and into politics to improve things and make things better. That often means changing the status quo; that's part and parcel of being here. But I'd simply say in relation to structural reform of a major part of our economy and a major part of our society the threshold rate for change is a high one; you have to be able to make the case. You just know what's going to happen anyone with any experience in the Wellington public sector knows what's going to happen because if I could be a little bit provocative and maybe a little bit pejorative towards the last National Government—and a guy I have a lot of time for Steven Joyce—the Ministry of Business Innovation and Employment (MBIE).Now you know MBIE was brought together the Department of Building and Housing; department—I can't even remember the names—oh the Ministry of Economic Development the old MED—Hon Member: Housing. Building.CHRIS BISHOP: Housing. Building and housing. They brought all the agencies together and lots of grand proclamations about what a great job it would do and it would be more efficient and it would join up Government and all the rest of it. All the things that frankly if you read the bureaucratic documents underlying these reforms you'll find and nine years later has it delivered on its promise? I don't know I think that's probably an open question.I'll tell you what has happened though. Lots of rebranding new buildings new letterheads new email addresses new sector teams lots of whiteboard meetings lots of afternoon and morning teas lots of—Hon Member: Brainstorming.CHRIS BISHOP: —blue-sky thinking sessions. Brainstorming sessions. Lots of that. That's all fine keeps people employed and occupied. But that's actually not why we have MBIE. So I make the point: we're going to get rid of all these DHBs and you could already see it coming through in stories from the health system which is morale. That's the other big thing about change and managing change is that it affects people's morale. So all of a sudden everyone who works in the health system is always looking over their shoulder going What's coming up behind me? What's this next change the Government's doing? Do I have a secure job in the next 12 months? What's my pay going to be like? Who am I going to work for? Who's my boss?"Now again those changes can be justified but that can be worth it but you have to be really sure that at the end of the day in five years' time or 10 years' time you're going to get a health system where morale has been improved and you get efficiencies and get all the outcomes you want out of it. It's not just me saying this. If you read any—or many—theories of business change management and structural reform in the business world all of these problems are well known around morale from restructuring having a big effect around the efficiencies of change and restructured organisations often never really materialising. It's not just me saying this; this is based on theory and evidence from the business world as well.So you can make a case for change but you have to be really sure that we're going to get the benefits and I just simply say—in the final minute of my speech—will these reforms deliver more hip operations or less? It is not clear to me that we will get more operations out of it. Will these reforms mean better primary care in our communities? I do not believe the case has been made that they will. Will it mean more connected health resources for Māori and Pasifika communities and harder to reach communities where there are health inequities and inequalities? I do not believe that that case has been made. It's going to a committee you never quite know we are pretty firm in our opposition to this but we'll wait and see what the evidence shows. But at a time of a global pandemic with very scant evidence for reform the Government's belief in this bill seems frankly heroically optimistic at best and naively incompetent at worst. Sadly I think it is more of the naively incompetent than the heroically optimistic."