Street Maryan: Budget Debate 
Text is incorporated into the Bound Volume 
Street Maryan: Budget Debate 
[Sitting date: 30 May 2012. Volume:680;Page:2707. Text is incorporated into the Bound Volume.] 
Hon MARYAN STREET (Labour) 
: 
 We have heard a lot in this Budget debate about the lack of vision in this Budget. I agree with that entirely. It is a zero Budget delivering zero hope zero vision zero excitement and zero initiative for anybody to advance their business and make sure they are keeping up with developments in their industries promoting and developing new products and getting our exports to market. The lack of those things is apparent and has been covered by my colleagues contributing to this debate already. But I want to talk about the lack of truth in the Budget. I want to talk about the lack of whole truth in the Budget and I particularly want to talk about health. We hear repeatedly from the “Sunshine Minister” Tony Ryall about the wonderful work that is being done in the health portfolio. I want just to elaborate on some of the implications for the health portfolio that are apparent in the Budget—or are apparent when you look closely because the thing that is missing in the figures in the health budget is the whole truth. Of course the Minister could add one more dollar to the health vote and put his hand on his heart and say: “Never in the lifetime of any human being has more money been paid into the health budget.” 
Hon Trevor Mallard 
: He wouldn’t do that though would he? 
Hon MARYAN STREET 
: He has been doing that on repeated occasions—“Never has there been such money invested in the health portfolio.” He could put one dollar in and that would be true but it is not the whole truth. I want to focus particularly on some of the implications for district health boards because the Minister says an extra $350 million has gone into the district health boards. Well I would like to put that in context. Although it might be true—and I am not absolutely persuaded yet that $350 million of new money has gone into the district health boards—I want to talk about the things that the Minister is not talking about that he is requiring the district health boards to absorb this time around. It does not matter how much he says is being given to the district health boards; what he is failing to tell the public is how much they are being required to absorb out of their new reprioritised and existing baseline funding.  
For example look at the obligations that the district health boards now have to take up—the KiwiSaver payments previously paid by the Government out of central Crown accounts. The Minister gave district health boards notice a while ago that it would be their obligation to pick up these KiwiSaver employer contributions and that the Government was not having a bar of it any longer. This has been notified to the district health boards and because it has been notified the Minister of course does not feel any obligation to point out the whole truth of the Budget. For example let us have a look at the funding increase to Auckland District Health Board which has been $30.5 million. That is the funding increase above its baseline apparently. Its liability for KiwiSaver in the next year 2012-13 is by its own calculation $4.8 million. So already 16 percent of the new money is to go on to a liability that the Minister is not talking about.  
It gets worse. If we get to Canterbury District Health Board its KiwiSaver liability is $8.6 million. It has been given $20.5 million of additional funding. Forty-two percent then of its funding increase will have to go on the KiwiSaver contribution—42 percent. Here is the Minister saying that more money is being given to the district health boards than ever before that it is going to go on these services and that money is being transferred to provide all sorts of costs but nearly half of that new money at Canterbury District Health Board is going on KiwiSaver alone.  
Worse than that if we have a look at the increase of funding to each of the district health boards we see that the percentage increase across all of the district health boards ranges from a low of 1.33 percent at West Coast District Health Board to a high of 4.5 percent at Counties Manukau District Health Board. The 1.33 percent funding increase at West Coast District Health Board I suggest not only does not keep up with ordinary cost of living adjustments and predictable cost increases but also is going backwards. The district health boards are not better off for this funding. If we have a look at the high one there is a 4.5 percent increase in funding to Counties Manukau District Health Board—one of our largest district health boards. Again even at 4.5 percent it is unlikely to cover predictable cost increases. This is meant to cover the increase in the nurses’ collective agreement. Their collective agreement was modest by any negotiating standards. They negotiated a collective agreement that ran across 41 months effectively because they gave up 5 months’ worth of back-pay. In the first year it is 2.5 percent in the second year it is 2 percent and in the third year it is 1 percent. These are not extravagant numbers yet there is not enough in these percentage increases across the district health boards for them to meet current liabilities let alone do the new things that the Minister is requiring of them.  
So what does this mean? It means that the district health boards are going to have to cut services. They are going to have to cut services and where will they cut? Well they will not be allowed to cut in the hospitals because that for the Minister is too politically sensitive and too obvious so money has to go into funding more elective surgical procedures. For the cost of more elective surgical procedures the district health boards if they are to manage these additional liabilities are going to have to cut services elsewhere. And where will they cut them? They will cut them in the community. They will cut the delivery of services in the primary sector because those services on the ground and in the communities go to the little people who do not squawk loudly. They go to the little people in little bunches of money to provide really essential primary intervention in the communities where there is the best return for the health dollar quite frankly. Those services will go and there will not be the kinds of squawks and loud noises that there would be if there were to be cuts in the secondary sector in hospitals.  
So there are two levels of damage that are happening here. There are two levels of damage. First of all in not telling the whole truth the Minister of Health is disguising the amount of the benefit to district health boards from the funding increases. In fact my figures would suggest that there is not $350 million worth of new money but in fact $276 million worth of funding increase—let us not call it new money because much of it is reprioritised; stolen from elsewhere—going into the district health boards. The second layer of subterfuge is just where the cuts are going to land. They are going to land in the community they are going to land in the primary sector and ironically they are going to land in the area where there is the best cost-effective return for the health dollar. This is less than the truth from the Minister.