van Velden Brooke; Little AndrewBROOKE VAN VELDEN (Deputy Leader—ACT): Thank you Madam Chair. I have questions regarding mental health and in particular the Government's response to the mental health crisis that is facing New Zealand. Two years ago the Government committed an extra $1.9 billion for mental health over a five-year period—$235 million was allocated to building new mental health and addiction facilities—but we know that only five new beds have been delivered. So my question is: how many new mental health and addiction facilities are in the process of being built and how long will it take for them to be built?We also know that more funding or more money being put aside for mental health doesn't necessarily guarantee improvements in people's care. I would like to know from the Minister from the extra $1.9 billion that's been set aside how much of this is being analysed as to its cost effectiveness? Do we have any details on whether the mental health service wait time has been decreased because $1.9 billion will be set aside? Do we know whether there'll be increased access to new services because this money has been set aside? Has there been a decrease in suicide attempts because of this money being set aside? What actions will the Government actually take to make sure that we have more accountability and transparency in where this money is going and whether it's being spent when we're being promised that it's being set aside to help solve our mental health crisis?My last point I'd make is that the Mental Health and Wellbeing Commission released its first report Mā Te Rongo Ake and it looked into the response to He Ara Oranga which was from the mental health inquiry. It listed that out of 36 of that inquiry's findings on a scale of one to six—one being the lowest; six being the highest—that the Government's response has only got a one or two out of 23 of those recommendations. I would like to know whether that is the transformational mental health delivery that we were promised or whether it's a lack of that delivery. Thank you.Hon ANDREW LITTLE (Minister of Health): I thank the member again for her question. Just taking her points seriatim: she talked about the $235 million for facilities and then says that only five extra beds have been delivered. So let me just disabuse her of one thing that the $235 million allocated to either completely rebuilding or upgrading five facilities that work has been commissioned the planning and design is under way but no construction has taken place.So the five additional beds relates to the work that DHBs do from one year to the next to add capacity or in some cases to reduce capacity. So if the member looks at the data over the last few years she will see that actually bed capacity for mental health wards and mental health facilities fluctuates from one year to the next. Where we're trying to get to with the new facilities is facilities that offer much greater flexibility because there is fluctuating demand. You want to have facilities where there is enough space to do the kind of projected business-as-usual demand but when there are spikes that there are spaces that are flexible enough to be able to convert into therapeutic spaces where people can be located. But that is where we're going with those upgrades.The member raises a very good question about the time it takes for capital works in the health system and this is a matter of considerable frustration for Ministers as it is indeed for patients their families and many others. But this is the system we've got at the moment. If you look at the last significant mental health facility that was built it was commissioned in 2016 and it opened for business last year—no in fact I think it was 2015. So it was a five-year period. Myself and the Minister of Finance are driving work with the Ministry of Health at the moment to accelerate the time it takes to get capital projects that have been committed to to actually get them built. I'm confident we will get there. So we're working very hard to get those facilities built because the need is there. Some of the facilities that are being replaced are kind of contrary to good therapeutic principles. So we need to get those changes as quickly as possible.The member expressed concern about whether there is enough analysis going on to effectively the efficacy of the spend. I can say when you look at what has been spent of the $1.1 billion that is the Ministry of Health's responsibility—that includes the $235 million capital spend. When you look at for example the money committed for the Access and Choice programme—so that's the additional services provided for those with mild to moderate mental health issues—we've added 520 fulltime-equivalent roles across our health system. In May they delivered 20000 sessions to more than 10000 people. So those are additional services. They were services that were not available and not being delivered before; they are being delivered now.Without the benefit of a systematic review what I can say is the feedback from all quarters is those services are making a big difference. There will be a review because there always is of effectiveness of spend. That will no doubt look at the impact of new services. Whether it's possible to say that those new services have had an impact on for example attempted suicides I'm certainly not qualified to say that and that might be a matter that might be reviewed at some point in the future. But in terms of actions for accountability I would have to say that the $1.9 billion appropriation is probably the most examined and scrutinised appropriation in Health that there has been for a long long time. So there is a considerable degree of accountability being demonstrated about that. That is good; it ought to be scrutinised. We have had longstanding major problems in our mental health services and I am very proud to be part of a Government that has really taken the bull by the horns actually stepped up to really take seriously the need to make significant change to our mental health services. It's a pity that it couldn't have been done before but this Government is doing it now. These things take time but there are good things happening and positive changes happening.