van Velden Brooke; Little AndrewBROOKE VAN VELDEN (Deputy Leader—ACT): Thank you Madam Chair. I have a few questions for the Minister today on a range of topics within the Estimates debate. I firstly wanted to discuss mental health in particular the acute mental health services. I noted that in this Budget additional funding of about $100 million was provided for over four years particularly for acute services and we have heard in the Estimates during the Health Committee that this funding was mainly about treating people with acute needs in community places and to provide more beds for people who recover in the community following an acute episode. We also heard that this was to aim to treat around 1300 people. My question to the Minister is: we know how many people are aimed to be helped through this funding but how many more fulltime-equivalent mental health specialists are expected to be needed or contracted through this funding to provide those services? How many people are expected to be employed above what the current rate is? My second question is regarding the locality planning and we see that $4.8 million has been allocated for this year and $27.6 for next year and I understand that the Minister expects around 60 to 100 localities to be planned for under Pae Ora legislation. Is the Minister any clearer about the expected number of localities that will be in place once locality plans have been made? And with the funding is there any variation on how much funding will be used based on how many localities are ended up or will all of that funding be allocated no matter how many localities will actually be discussed? My third question relates to the Māori Health Authority and I see that we've got $163 million set aside to provide hauora Māori health services. My question is: what is the estimated number of people that the Minister expects will be able to use these services? How many services do we expect to see be established through this fund and how many people do we expect to use these services? And also how many people do we expect to be employed who will be able to provide these services under the $163 million that's been set aside? My fourth question then revolves around Pharmac and I see that we had quite an increase to the Budget about how much money would be set aside in the Pharmac budget. But I wondered whether the Minister had any estimate on how many new drugs would be procured versus how many drugs that are already funded would be expanded. Does the Minister have any estimate on any new drugs that would be funded versus an expansion of drugs that are already funded?And then my last question is: with the staffing numbers for the Māori Health Authority Health New Zealand and the Ministry of Health is he aware of any increase in the number of staff following the establishment of the Māori Health Authority Health New Zealand and the Ministry of Health as a package together or is it the same number of staff that we had under the district health board model? Thank you Madam Chair.Hon ANDREW LITTLE (Minister of Health): Thank you Madam Chair and I thank the member for her extensive array of questions covering a number of issues. I'll do my best to respond to all of them. So in relation to the additional $100 million of mental health spend I should add too that it also includes $10 million for workforce development. There's some for acute services and meeting that acute need particularly in child and adolescent mental health services which we know is under significant strain at the moment. That's about getting additional professionals. In that respect I should also add though we know there are a number of positions that are funded at the moment but not filled so part of the recruitment effort that Te Whatu Ora - Health New Zealand is going through is to fill those existing vacancies but also to beef up some of those services. I can't put a specific number on it and there still needs to be some evaluative work on exactly what is required in that respect. So there's a combination of recruiting into existing funded positions so that won't be an additional cost plus some additional positions that will be needed to expand capacity for child and adolescent mental health care.There are other aspects to the $100 million too. There's money going into eating disorders—we know we have to step up our capacity there—and then additional funding for more community places for those who have been as I think the member acknowledged in her period when she was posing these questions for those who've been through an acute episode but who need a safe place to continue their recovery in the community. We need more of those places so there's money set aside for that.In terms of localities the member may have misheard me perhaps. She referred to 60 to 100 localities. I actually said 60 to 80; my expectation was 60 to 80 localities. I don't have any greater clarity on the numbers. I can say however that in addition to the nine prototypes that were announced early this year an additional three are now almost ready to go as I understand it but I cannot give the committee any clearer numbers in terms of expectation on that.The member asked if there would be a variation in the funding used in relation to them and therefore whether the total amount would be spent regardless of the number of localities. It may well differ from one locality to the next about how they go about setting themselves up. I expect a locality that covers a smaller geographic area won't require necessarily the intensity of input from whoever is going to lead that network than one that covers a bigger area but the reason why we announced the original nine as prototypes is because we are still feeling our way in terms of putting some of these processes together. I was in Nelson on Friday; the level of enthusiasm by certainly primary healthcare givers about wanting to be engaged in developing those processes and developing the collaboration that they identify they need and want to be part of at a more community level that enthusiasm is very high. So I have great confidence about that. The member asked about the Māori Health Authority Te Aka Whai Ora and an estimate of the number of people who will use their services. There will be ongoing engagement between Te Whatu Ora - Health New Zealand and Te Aka Whai Ora - Māori Health Authority. In terms of funding kaupapa Māori health services other specific Māori health services some of that will be in money directly allocated for Te Aka Whai Ora and others will come through Te Whatu Ora - Health New Zealand as they make decisions about who is best placed to commission particular services. And that will be kind of worked its way through over the next couple of years. On that basis it's therefore not possible to say of the services commissioned by the Māori Health Authority how many will use them. There's a certain number of services at the moment that have been commissioned before previously by the district health boards (DHBs). I expect Te Aka Whai Ora - Māori Health Authority will pick those up and will commission those directly. But I expect also there will be additional services that they will pick up with money provided through Te Whatu Ora - Health New Zealand. It's therefore not possible also to answer the member's other question which was how many will be employed because it will depend on what particular services are commissioned and over what time.In relation to Pharmac—I appreciate I'm running short of time in this particular slot. Again I know Pharmac is working with others through additional either indications for existing treatments that they fund or procuring new treatments. They are working very closely I know with the Cancer Control Agency on all of those things new indications and whole new treatments. So again even at this point it's not possible to say exactly what the number will be. I imagine that will become clearer in the next sort of two to three months. I met with Pharmac yesterday to ask for progress on how that is going. They said they're kind of at the final stages of making some decisions about that so we'll kind of see how that goes in that respect.And then finally the member just asked whether there's going to be any increase in the establishment of staff as I understood the member. Through all those entities the Ministry of Health Te Whatu Ora - Health New Zealand Te Aka Whai Ora - Māori Health Authority and any of the other and then Te Whatu Ora - Health New Zealand on the basis that they've got all these former DHB staff. Apart from additional capacity or capability that this Budget is expected to fund I'm not expecting there to be a dramatic increase. The Ministry of Health has some additional funding by way of a tagged contingency. As they go through their review and work out exactly how it is they need to staff up and what the skills mix is that they need having transferred a number of functions into Te Whatu Ora and Te Aka Whai Ora it remains to be seen exactly what their final staff complement will look like but it will be a smaller ministry than it was a year ago. In terms of the other entities I'm not expecting in terms of establishment numbers significantly bigger numbers. There are a lot of vacancies in front-line operational roles as we know throughout the hospital network that are vacancies of positions that are already funded and then there will be any additional positions that will be funded through additional allocations this year as I said particularly in the mental health area where we have to grow our capacity in some of those more acute services. So I know that doesn't provide any numbers for the member but it does give an indication about where modest additional numbers might appear. But we do have a large health workforce. The public health workforce numbers 80000-plus and so I'm not expecting a dramatic increase in that given the number of vacancies that we are carrying even just at the moment.