Woodhouse Michael; Hipkins ChrisHon MICHAEL WOODHOUSE (National): Thank you Madam Chair. This would be described I think as the Hotel California" contribution to the health Estimates debate. I've checked out but I never really left!The reason I am contributing actually is that Matt Doocey isn't able to ask the questions that he has around mental health. So I am going to kick off in that regard. I certainly appreciate the candour with which the Minister has approached his new portfolio and the fresh eyes that he's brought to it. And it's in that spirit that I want him to perhaps give a view on how effectively we have spent the mental health funding that was appropriated in Budget 2019 because it started with a big number—$1.9 billion—but that included some pay equity settlements and the normal cost increases. My kindest estimate was around $780 million or $800 million and then we've got a number of $455 million over four years for what was described as front-line mental health services. The problem is that at the end of April only $20 million of that had even been committed much less spent.Now admittedly it was only going to be $48.1 million in the 2019-20 year but it still suggests to Matt Doocey—and it's a view that Dr Reti and I share—that this is much slower to get out of the blocks than was anticipated. I would really appreciate almost a commentary rather than a specific answer to that question on whether the Minister having come in and had a look at that is satisfied that we're making sufficient progress to give effect to the recommendations of the Paterson report which is so fundamental to improving the mental health and wellbeing of New Zealanders.I'll just finish on this point: Dr Gluckman made comments at the Epidemic Response Committee around PTSD in the wake of COVID that potentially up to 10 percent of people who have suffered job loss or other loss as a consequence of the COVID lockdown could suffer PTSD. So not only were we seeing this bow wave of mental health need; that wave could well get bigger and obviously we share the Government's desire to make sure that we can manage the effects of COVID on mental health and mental health more generally. I would like to hear from the Minister on whether or not he feels we're going far enough fast enough.Hon CHRIS HIPKINS (Minister of Health): I thank the member and I will make a reasonably general contribution. It's an area which I have been looking at. Of course if the member asks me in any of my portfolios whether we are making fast enough progress my default answer to that question will always be no because the machinery of Government never works fast enough for my liking. In every aspect of my ministerial work I want to see faster progress and mental health is certainly one of those where there's a crying need. Can we make faster progress? Yes. Are we making faster progress since the lockdown ended? Yes we are. Can we move even faster? Yes I believe we can and I'll be leaning very heavily on that.A couple of issues at play here: the member will be aware that the funding profile of that $400 million - plus that he talks about increases as the years go on and it was a relatively small investment in the first year. One of the reasons for that is around building capability particularly building up the workforce capability and there has been significant progress in committing the funding since the lockdown ended. Things did slow down during the lockdown period and it did push time frames out by a couple of months but I am now satisfied that that first-year funding is now by and large committed and that actually a significant proportion of the second-year funding has also been committed as we go into the second year of that funding allocation.I don't have updated numbers on expenditure against commitments but I'm certainly happy to get those to the member. But my overall conclusion is: are we moving fast enough? No. Can we do more? Yes.Hon MICHAEL WOODHOUSE (National): I thank the Minister the Hon Chris Hipkins. Just by way of follow-up we were quite exercised in the Estimates discussion around this in the context of the quality of the information that was being provided through because when Mr Doocey asked the Minister around data around the 40 sites that had been selected for those front-line mental health services as sort of the vanguard for the improvements members on this side of the House were very disappointed at the lack of detail of the answers—didn't know where they were didn't know how many staff were reemployed didn't know how many referrals had been received and didn't know when they had started receiving patients. This goes to a concern that I have about the quality of the information that's being provided or even collected. So there's a specific question around mental health but also around health data and health targets more generally. Now the Government it would seem to me at least has been reasonably lukewarm on the previous national health targets that were introduced by the Clark Government in 2007 and committed to their continued collection and then their replacement. Now that was a commitment made shortly after coming into Government. It hasn't been achieved and we haven't seen any data on any health throughput published on the Ministry of Health website since September 2019—that's 10 months ago. So that's the second leg of my question around data.The third leg is on financial performance. Now I now see today when I look at the DHB combined financial performance data for the nine months ended March 2020 it's now on the website—some nearly five months from when that period ended. That's been the pattern: four to five months it's taken to get financial performance data online. So I'd like the Minister just to address the question of collection of data on mental health national health targets and where we're going with that and his confidence and comfort level with the degree to which the financial performance data is being recorded and reported in a timely manner.Hon CHRIS HIPKINS (Minister of Health): Yeah I think those are all fair questions from the member. With regard to data it is something that I've been looking very closely at. As you can imagine as a new Minister one of the first things you want to do with a portfolio is actually get the data so that you can understand what you're dealing with. So many of those questions that he has just asked are questions that I have asked over the last three weeks as well.It's well canvassed I think previously that the new Government coming in three years ago didn't agree with all of the focus on the Better Public Services targets of the previous Government although they have continued to be reported against in the meantime. So that data is still on the website. My understanding is that the most recent data released for that is imminent. Of the most recent up-to-date data on that I know I've read something about that in the last couple of weeks. I can't remember the exact date but I do understand it's imminent in terms of the latest release of that data.I have also recently signed out a report to the Ministry of Health to prepare a report for the Cabinet on what a broader set of measures will look like. I have asked for some more information on some of those and I will be aiming to progress that as quickly as I can. If I can do that before the election then I'll aim to do that. I do think it would be useful to have a broader set of performance measures for the system not just around financial but actually around what the system is actually delivering in terms of wellbeing and health and wellbeing outcomes. So we've done some work—and that work was starting before I became the Minister and I'm trying to speed it up a bit now—to actually get that better set of outcomes out there because I think transparency is an important thing.In terms of DHB performance I've been scrutinising that very closely. I'm sure the member's going to have lots of questions about DHB financial performance—I can see he's got a list of dauntingly large highlights on his page there. My overall impression there is there's been a significant increase in personnel costs across the DHBs and I'm trying to get underneath that and understand a bit more about what's driving that. Some DHBs will be faster to return to a break even or even a surplus position than others. I am currently in the process of going through with the Ministry of Health a letter to each DHB setting out the Government's expectations around their pathway back into surplus because their current financial performance simply isn't good enough. As I said some may take a couple of years and some may be much more quick as a result of the additional investment we'll be making but I'm taking some time—I was aiming to sign them out by last week; I have not done that yet. The reason for that is I'm going through each DHB individually to understand a bit more about their individual financial performance what's got them to the position that they're at and what it's going to take to get them out of it.Hon MICHAEL WOODHOUSE (National): Good luck answering that question. It's one thing I think the Minister and I have in common which is that degree of interest in the detail. My ministerial staff when I had that privilege described me as annoyingly interested—Hon Shane Jones: Like my good self.Hon MICHAEL WOODHOUSE: —and I think that was—ha ha! Hasn't lost his sense of humour.I want to just elaborate firstly in respect of targets. I don't actually mind what those targets are or if they are changed. Well I do mind what they are but I think if there's change that's fine. The Simpson report which the Minister will be considering with his Cabinet colleagues at the moment did talk about population targets. I think that's an entirely appropriate alternative to the output-based targets that the previous two Governments had. But the important thing is that we have a very clear expectation about what good looks like in the sector and I don't believe we have that right now. There's a sense of drift and it certainly is manifesting itself in the financial performance which I want to draw on. The nine-month performance shows a combined deficit of $375 million which is $61 million more than the previous year—19 percent unfavourable. Now in that previous year it was $264 million and even that was $56 million or 27 percent more than the previous corresponding period.We have a sector that is now spiralling out of control financially. The previous Minister kept blaming us the previous Government. That's fine—it's not true but that was his answer to just about everything. I would like to hear from the Minister now that he has had his feet under the desk for a couple of weeks what he believes is possible because the answer he's just given around the two years back to financial sustainability and break even has been talked about since I started in the health sector in 1995. So I've been hearing this for 25 years and it ain't happening. In fact it's getting worse. That is despite increases in Vote Health that have been above what was previously allocated. Get all political if we like but the expectation was that deficits would go down not up and they're going dramatically the other way even when you take out the one-off costs for things like Holidays Act and—what was the IT system?Dr Shane Reti: National Oracle Solution.Hon MICHAEL WOODHOUSE: National Oracle Solution. So we have a problem here. My first question is: does the Government actually have a reasonable expectation for DHBs to break even and if so how? Secondly is it appropriate for those great clinicians and health administrators in the Canterbury DHB to forecast a $180 million deficit this year? Thirdly will he commit to this information being made available in a more timely manner? Because we're talking about data that's now four months old. We're at the end of the financial year. Can he give the committee a sense of whether or not the projected $643 million which was the March projection for full-year financials—we won't be able to go to the exact numbers but was it achieved? Can we expect bad news? Better news? What's happening now? Because that's essentially the role of the committee to assess those financial estimates.Hon CHRIS HIPKINS (Minister of Health): The member perhaps won't be surprised but will probably be disappointed to learn that the numbers are worse for the latest quarter than were projected. Of course— Hon Michael Woodhouse: I'm not surprised actually.Hon CHRIS HIPKINS: —they'll be—yeah he's not at all surprised. So not surprised but hopefully disappointed like we are. I am as I said getting underneath those numbers and trying to understand what's driving them. Personnel costs have been a big contributor to that. One of the issues that I'm trying to understand a bit more is the safe staffing model implementation which was going to result in an increase in the number of nurses employed by DHBs. It would appear that it's resulted in significantly more nurses being employed by DHBs than were first modelled and so I'm trying to again get underneath that and understand that.In the case of some DHBs—and the member mentioned Canterbury. Depreciation of course does play a significant role around Canterbury's costs because they have a very very significant level of capital investment there. Whilst the Government is centrally funding the capital charge the depreciation component of that still sits with the Canterbury DHB.There is an intractable dilemma in health. The member mentioned you know his challenge back to the 1990s and that is that the more money we spend on health the more we need to spend on health. That will be the dilemma for every Government from now into for ever. The more you spend on people the healthier you keep them the more they ultimately end up costing. So there's always going to be that challenge in the health system and any Minister of Health is going to grapple with that. I don't think our Government's any different to the previous Government in that regard.But I do think the final point the member makes around transparency is an important one. As I've indicated I'm going through those numbers at the moment DHB by DHB. I will be sending a letter to each of those DHBs in the next week or two setting out my expectations. I have no hesitation in making that information public and being transparent about that. I'd like to get it to them first so that they've got a week or two to think about it before I make it public but then actually I do think it is important that it's made public.CHAIRPERSON (Hon Ruth Dyson): Before I call the member could I just ask colleagues in the Chamber to show a little more respect for the members who are seeking the call because it's really hard to hear them when other members who have quite loud voices use them."