Ryall Tony: Budget DebateText is incorporated into the Bound VolumeRyall Tony: Budget Debate[Sitting date: 04 June 2013. Volume:690;Page:10659. Text is incorporated into the Bound Volume.]Hon TONY RYALL (Minister of Health): It is a great opportunity for me to talk about the great way that the health budget this year is dealing with the changing needs of our population thanks to the stronger financial management that the National Government has brought to the public health service. Health is again the biggest recipient of increased funding in the Budget. The total health budget this next year will be $14.65 billion including capital. When you contrast that with only 5 years ago it was $11.8 billion. So this Government has continued to invest in protecting and growing the public health service in the last 5 years. In tight world financial times when so many countries are reducing their public health spending or freezing it we are continuing to protect and grow our public health budget. In fact the OECD found that New Zealand had the third-biggest increase in public health investment of any country in the OECD in the latest available figures that it has produced. Vote Health in this Budget gets an average of around $400 million available for each year over the next 4 years to meet pressures and initiatives. That includes $350 million in new money and around $50 million in savings. It gets a lot better because we are able to use that money to invest in the changing needs of our population.Let us just have a look at some of those changing needs. We have been able to take money that we had set aside for district health board deficits and risks and because of our strong financial management we have been able to take that money—about $35 million—and put it into a heart disease and diabetes initiative. This heart disease and diabetes initiative is a very very significant boost in funding that we have announced in this year’s Budget. Why is it important? It is important because heart disease remains a leading killer of New Zealanders and similarly so many of the risk factors associated with heart disease are also associated with diabetes. We know that diabetes is a major challenge for New Zealand but what is an even more important challenge is the prevalence of pre-diabetes and what we can do as a country to deal with pre-diabetes. So in our $35.5 million funding boost for diabetes and heart disease in this Budget we are including $16 million to further increase the number of New Zealanders getting heart and diabetes checks. These heart and diabetes checks are an important preventive health target. They are important because they tell people of an age that they have gotrisk factors that may lead to them having heart disease or a heart attack or maybe having diabetes or being pre-diabetes. Once people know that they have got these risk factors once they know that they may be pre-diabetes they can then make the lifestyle changes that they need to make in order to better control their disease risk factors. So we are doing that.Secondly we are going to double the number of Green Prescriptions that doctors and nurses can give their patients. Green Prescriptions are a reference for a patient to go to a provider who can help them with more physical exercise or better nutrition. We know there are very very significant health benefits if people are more active so that is why we are going to double the number of Green Prescriptions over the next 4 years. It is a really significant investment of over $7 million. For those who have got diabetes—remember this is very much about preventing people getting diabetes; a very strong focus on pre-diabetes and prevention—we have got a number of local diabetes care improvement programmes. We are going to significantly increase that funding by about a third over the next few years in order to expand those local diabetes care programmes to provide more diabetes nursing and more podiatry services. That is dealing with heart disease and diabetes but so many of these people who have got heart disease and diabetes also have other diseases—they call them co-morbidities in health. We want to support those people to get better care from their general practitioners so we are putting $13 million into expanding the Care Plus programme which is a general practice - based programme that provides additional support to patients with long-term conditions. So you can see this is a Budget about the changing needs of our population.Similarly with aged care we know that we are ageing and we know that our country is getting a greater prevalence of dementia. The prevalence of dementia is growing at 4 to 5 percent a year. It is going to be a very very major challenge for New Zealand so in this year’s Budget we have got a very very significant investment of $70 million extra over 4 years for aged care and diabetes and a $20 million boost for home support because we think we should be supporting our older folks to stay longer in their homes if they want to and that is a $20 million boost to help those people do that. Similarly there is going to be a $12 million boost to dementia bed subsidies. What we know is that we are going to need a lot more residential facilities for people who are demented. As I said it is growing at a rate of 4 to 5 percent a year so what this will do is say to rest home providers: “We need more dementia beds. Switch on the investment signal.” This is the third year we have had a pretty significant increase in dementia bed subsidies and we are getting more of those beds.We are also going to put $2 million into dementia awareness because over the next 10 years dementia is going to affect everybody in terms of their friends families or someone whom they know who will be suffering from dementia. It is not a disease that people should be frightened of. They should be aware of the supports that are out there so we are investing $2 million to provide more dementia awareness programmes and to assist our general practitioners and our general practice teams with how they can identify dementia particularly with early detection because that can better help manage those people’s positions. Over $1 billion extra is going into training for our health care workers and there is also a $33 million increase for rest home bed subsidies across the board. We increase those subsidies every year and this is a very significant increase of $33.2 million. So that is focused on our ageing population but also on this increasing prevalence of dementia—150000 New Zealanders are projected to have dementia by 2045-50. So that is a very very very significant investment there.At the same time this Government continues to invest very strongly in preventive health and we are almost doubling our rheumatic fever programme. Members will recall that rheumatic fever became a national priority in 2001 and then that Governmentdid nothing. It made it a priority and then it did nothing other than more people got rheumatic fever. So our Government came into power and we have invested in two Budgets in a rheumatic fever programme aimed at reducing rheumatic fever in our most at-risk communities. What we know is—and even the Green Party which did not really want to admit this but in its leader’s speech on Sunday it actually talked about the fact—that where we have run this throat-swabbing in parts of the Hutt Valley we have not had one case of rheumatic fever while we have been running that programme. So we are running this programme right across the high-prevalence areas—Porirua the Bay of Plenty Rotorua the East Coast South Auckland west Auckland—and it is making a very very big difference.But of course what happens when school is not in? That is why we are investing in this Budget $11.25 million in developing sore throat drop-in clinics. One of the key messages is that one of the reasons why mums do not take their kids with a sore throat to some doctors is the time they have got to wait to be seen because mums are leading busy lives. So what we are going to fund are these sore throat drop-in clinics particularly in Porirua South Auckland and parts of west and central Auckland where parents will know that if their kid has got a sore throat and they need to be seen they can turn up at these drop-in clinics. There is no charge they can be seen straight away and they can have the throat swab taken and know whether their kid needs to get some antibiotics to deal with streptococcus A. It is a really sensible initiative. It is backed up by the $100 million investment on expanding the home insulation programme. This is a Government that acts across the life course and puts a huge investment into prevention. You know almost a quarter of a million homes were insulated under the first 4 years of our insulation programme. Another $100 million is going in particularly targeted at those high-risk homes.So this is another Budget of another year of record investment in health targeted at the areas that matter most to patients: making sure we have got a strong investment in prevention making sure that we are dealing with the changing needs of our population and making sure that our hospitals continue to provide the quality services that New Zealanders want. That is backed up by our 2000 extra nurses and our 1000 extra doctors working on the front line of New Zealand’s health services. This Government came to power with the challenge of repairing the damage of a decade of neglect wasteful spending and clinical disengagement. In the last 4½ years this John Key Government has delivered more operations faster more preventive care across the whole range of services and a health system that New Zealanders can be proud of.