Clark DavidHon Dr DAVID CLARK (Minister of Health): I suspect there are going to be more questions to answer as we go through and I'll look forward to the contributions of other members but I think it's timely to address a few of the issues that have been raised to date. The Hon Tim Macindoe asks really questions around the consultation that took place leading up to the decision—Hon Tim Macindoe: And process.Hon Dr DAVID CLARK: —how the process ran and I think it's helpful just to explain some of that.The concerns had been raised with me over a long period of time. The prior board chair Sally Webb performed incredibly professionally in my view in raising her concerns whilst continuing to try to ensure that the board functioned as well as it might to address the challenges that they were facing. You know I think—without sounding too political here—they've been in a very constrained funding environment and I've been certainly critical of the previous Government's funding of our health system. That coupled with fraud and other difficulties in their senior team really left the district health board (DHB) in a very difficult position and I think we need to acknowledge that.My dissatisfaction with the board is well known but it would be churlish not to acknowledge that they inherited a very challenging situation and that was the situation they were dealing with. I also had concerns expressed to me from senior clinicians at the hospital about the governance and their lack of confidence that the decisions could be made that needed to be made into the future. Of course as Minister I had appointed a Crown monitor into the DHB to give me a direct sight into how their financial planning was going and what their future projections were for financial performance.Whilst the health system has been in my view underfunded quite significantly—an independent economic agency estimated a $2.4 billion funding shortfall under the previous Government and that certainly has put a lot of stress and strain on the health workforce—this particular board seemed to be in a position where it was unable to wrestle with that stretched and strained environment in a way that they could project a confident future. Part of the solution certainly lies in ensuring that we are funding the health boards better. In this Budget we've put $2.8 billion in as a Government—a record $2.8 billion—to ensure that health boards are better funded but of course re-funding and developing workforces will take time. Nobody pretends that one or two Budgets will address all of the problems created by a decade of underfunding in our health system.So those concerns have been raised with me. There was then a consultation process as is set down under the Health Act whereby I consulted with the board members themselves on my intention to dissolve the board. Those board members came back to me nearly universally offering their resignations deeming that this was indeed the right step to take to appoint commissioners to come in to wrestle with these challenges. Two board members chose not to offer their resignations but they did choose to then send a very similar letter outlining similar concerns and also recognising some of the contributions that had been made during their time on the board as did the board members who tendered their resignations. So there was a fairly widespread acceptance that this change needed to happen.The member Jamie Strange raised the issue around whether this is limited to one election. Indeed it is. By postponing this coming election that is all we're doing. We're taking one election cycle out and then thereafter the situation returns to normal as it does with the other DHBs every election cycle. There is a law which dictates they must go through an election process. That law kicks in as usual again in 2022 and democracy is restored to the DHB appointment process—of course albeit that under the current situation the Minister himself or herself is able to appoint several members to the board to provide leadership on that board as well.The engagement that was had with those board members revealed to me also—and this goes to a point raised by the member Jamie Strange—their concern that they had not been able to recruit a chief executive. I'm very pleased that the new commissioner has been able to quickly recruit a chief executive because stability at the senior leadership level is incredibly important in situations where things become a little fragile to give the assurance to the staff that the situation is managed to compile a plan to ensure that we are planning into the future for that DHB that the clinical care is delivered there now that the high quality of clinical care is delivered into the future and that necessary change is made over time as new models of care are deemed important to introduce as new equipment comes in that the changes in models of care are updated that those leadership decisions are taken and that the financial situation is managed.DHBs: we have put a record investment in as a Government this time around $2.8 billion into the DHBs in this Budget and we are putting record amounts into capital—we've put $2.45 billion in in our first two Budgets. To give that some context for capital works into our public health system that $2.45 billion in our first two Budgets for capital is more than twice as much as the prior Government put in over nine years. It's more than twice as much as they put in over nine years. We're serious about fixing up our public health system and making sure we have high-quality buildings for our clinicians to operate in for our patients to get the care they need in modern healthcare environments. So we're getting on with that work.That inability to attract the leadership needed as that change happens as new buildings inevitably will come or changes or improvements on to the Waikato campus—I mean the mental health facility there is one that's been there for a long time and does in the future need to be upgraded. I visited it myself. I can see that like many of our mental health units around the country we need to update them. We need to make sure that they are places where people are going to get well and I was delighted to be able to announce in Tai Rāwhiti recently that we're going to do something there.Now to come back though to the engagement with the board their indication to me was that they needed that stability at the governance level to recruit the CE. I do also want to put on record—as the members the Hon Tim Macindoe and Jamie Strange have both done—my congratulations to Derek Wright for the work that he did as the interim chief executive really coming into a very difficult situation and providing confidence to the clinical leaders through that situation and really giving of himself to ensure that that leadership was sustained there. So I do want to put on record my thanks to him.Following on from that was of course the consultation with the members themselves. They provided the feedback to me and then I finalised my decision as is dictated under the terms of the Act. In appointing the commissioner Karen Poutasi I was delighted that a person of her calibre was willing to take that role on. As a former director-general she has the mana in the sector and the experience to lead that important work and she has subsequently herself appointed three deputy commissioners: Dr Andrew Connolly a surgeon out of Auckland out of Counties Manukau very esteemed and well known across the sector for his contributions at a governance level and a former chair of the Medical Council of New Zealand; Chad Paraone a data expert also with Māori and cultural expertise who will bring his skills to some of the challenges in terms of how models of care are developed and how we measure success over time; and Professor Margaret Wilson herself with a strong legal background and of course a former parliamentarian from this House and a former Speaker of this House—again somebody well respected in the Waikato region as a local who can bring that local representation as well as expertise in health and legal areas with some experience too on the board previously.So I'm confident that we're taking the right step here but no one underestimates the challenge that lies ahead for this group of commissioners. The financial situation and the clinical situation and the challenges they're facing are worth highlighting. The challenge in working with primary health organisations and primary care arrangements that have been unsatisfactory to many over a long period of time—there are relationships that need to be built. There are clinical models that will need to change over time but I'm very confident that the actual people providing the care there are incredibly proficient professional and will continue to do a professional job and they can now have the confidence that there's a structure that sits there to support them to do the job they get up every day to do to go along and care for the people that come through the emergency door or come in for operations be they elective planned care of different types or be they emergency.Our acute operations this year are up quite significantly across the public health system. We know more care is being provided in the community as well and the DHB of course has the oversight of all of those interactions—into primary care as well—to ensure that our health system is providing the right care at the right time to the right people. So it's important we don't just think of the hospital but we also think of the wider healthcare system: those primary care networks how they interact with the hospitals how we make sure that the money is being spent on the taxpayers' behalf for the best possible outcomes for the best future for the people of Waikato who need and deserve as high a quality of care as anyone else in this country.