Parker David: New Zealand Public Health and Disability (Southern DHB) Elections Bill — Third ReadingText is incorporated into the Bound VolumeParker David: New Zealand Public Health and Disability (Southern DHB) Elections Bill — Third Reading[Sitting date: 12 May 2016. Volume:713;Page:11093. Text is incorporated into the Bound Volume.]Hon DAVID PARKER (Labour): I am going to begin by qualifying my knowledge of the health system across Otago-Southland. I was born in Roxburgh hospital which existed then—formed at the time when the power dam was built there. I was raised in Dunedin. I suffered a serious head injury when I was working on Stewart Island in the early 1980s and was flown to Invercargill hospital and from there to Dunedin Hospital. Some people say that is why I joined the Labour Party but I deny that. So I know the importance of Invercargill hospital. I lived for a period in Queenstown in the 1980s. I was the member of Parliament for the Otago electorate in the early 2000s and—Hon Annette King: Best one they’ve ever had.Hon DAVID PARKER: —oh thank you Annette King—I had a lot to do with health services in the three regional hospitals that were in the area that I was the MP for Ōāmaru Queenstown and Dunstan Hospital near Alexandra. While I was there the Labour Government funded the rebuild of the Dunstan Hospital. I lost that seat and since then I have lived at least some of the time in Dunedin.I believe that there are some ironies in this bill. Members do not have to have been here very long to know that Richard Thomson one of the commissioners was removed from his post by the last National Minister of Health when Tony Ryall chose to blame him for the computer rort that had been outed by Richard Thomson as chair who brought it to the attention of the authorities and caused the individual to be prosecuted—that was the Swann fraud. For doing his duty as chair he was removed as chair. None the less the then Minister appointed a chair from out of the region—from South Canterbury from memory—to be the chair of the board—Hon Annette King: Joe Butterfield.Hon DAVID PARKER: —Joe Butterfield—to sort out the finances which got worse. Not only did the Minister appoint the chair but the Minister also appointed Crown monitors. Stuart McLauchlan I think was the Crown monitor who was appointed and that Crown monitor could not sort it out either.I want to explore why it is that the rural population-based funding model which lies behind the funding deficit that led to this appointment and the extension of this appointment is wrong. New Zealand has forever been an outlier in the international statistics on the outcomes for rural people. Somehow we have been miraculously able to deliver health outcomes for rural populations as cheaply for rural areas as we can in city areas despite that not being achievable anywhere else in the world. And that feeds through to the rural adjuster because the rural adjuster assumes that it is not as expensive to service rural populations as in fact it is. Why is that? It turns out that it is because the way in which New Zealand collects statistics for rural populations is different from the rest of the population and the rest of the world—and it is wrong.So how does it work? Well small towns in New Zealand are classified as “urban” despite being serviced by rural hospitals. What that does is understate the cost of servicing rural populations because those rural townships are not included in the statistics for rurality. Instead they appear in the city population statistics and they average down the appearance of the—[Interruption]I have got the other call Mr Assistant Speaker. I raise a point of order Mr Speaker. I apologise if this has not been done properly but my understanding is that the Greens are not taking the other 5-minute call. Therefore I seek leave—The ASSISTANT SPEAKER (Hon Trevor Mallard): Sorry I had not picked up that you were doing both calls. In fact I saw a signal otherwise to your deputy leader earlier. I am not sure of the rules here as to extending calls—I know you can pass off calls but I am not sure you can extend them. I think probably the easiest thing to do—Hon DAVID PARKER: Well can I seek leave—The ASSISTANT SPEAKER (Hon Trevor Mallard): I will because I am not sure of the rules. I seek leave of the House for the Hon David Parker to take a 10-minute call being the 5-minute call that would otherwise be available in the next call to the Labour Party as well as this one that was available to the Greens. Is there any objection to that? There appears to be none.Hon DAVID PARKER: Thank you Mr Assistant Speaker I appreciate the way you handled that.So the cost of rural health is underestimated because our rural populations are included in cities and therefore it slightly averages down and hides the cost of rurality. The second point is that the rural people who live in lifestyle blocks around cities in New Zealand are counted as rural when in actual fact they are generally wealthy people who are getting their services from cities. So that is the second reason why we have mistakes in the rural adjuster in respect of truly rural populations. So the rural adjuster is problematic and the consequences of that are that district health boards that service rural populations are underfunded. And there is nowhere that that problem is greater than in the southern region in Otago-Southland.The second point I would make in terms of the issues that we have in the South is that there are some really important decisions that the commissioners have to take. Population densities are changing across Otago. We have strong population growth in Queenstown-Wanaka we have low population growth in Invercargill and Ōāmaru and it is not that high in Dunedin either—it is a bit higher than in Invercargill and Ōāmaru. The difficulty there is that decisions have to be taken now as to what is the future shape of tertiary hospitals in the South. I think it is obvious that whichever way you cut the numbers even though Queenstown is growing Queenstown is never going to be in the foreseeable future as large as the Dunedin centre of population. That means that the tertiary services in the South in Otago-Southland will still need to be provided from out of Dunedin.The worst of all outcomes is if we start to spread some of those specialist tertiary services to Invercargill Alexandra Queenstown and Dunstan because none of them will be big enough to support quality tertiary services. We would undermine the quality of tertiary services in Dunedin and increasingly those tertiary services would then be serviced from Christchurch which is not in the interests of anyone in the South. So I urge the commissioners to make that decision to give long-term direction to all of the hospitals in the South. Some people say you should count Wanaka and Queenstown together. You should not. That is a poor form of care because having Wanaka people going first to Queenstown means they would be going further away from the tertiary hospital in Dunedin to which they may need to be transferred. So the best route of care goes Wanaka Dunstan and Dunedin for those people who need it.Those decisions have to be taken. If they are not taken the viability of not just Dunedin Hospital is threatened—and there are some terrible things that have happened in Dunedin in recent years. It has lost its teaching status for things like the intensive care unit. I had an eye infection about a year ago—I had to go into the eye clinic—and my doctor sent me down there. The place is—you know I am amazed at the quality of service that they give out of a building that is very run down and shabby. It is under pressure from the number of people who now need eye services both because of improved technology but also because the ageing population means that there are a lot more people in the South needing eye interventions than used to be the case.So I am supportive of the extension of term. I do think that this is not going to be cured unless the rural adjuster is looked at. I also agree with some of the other speakers who say that teaching hospitals probably are not properly compensated either; and that is felt to be most pressing if you are in a small centre where you cannot spread the cost of teaching over as many people—which again reflects the Dunedin problem. Underfunding because of the rural adjuster in particular I think is the main cause of the problems.There will though be a need for an update of some clinical practice in Dunedin. I think that over time for some of the specialist services outside peak times there is going to have to be a slightly different model in Dunedin for the delivery of those services including more cooperation with probably the Canterbury District Health Board in respect of after-hours telephone cover for the registrars who are rostered on out of hours. That is the way in which people in Invercargill Queenstown Alexandra Dunstan and Ōāmaru currently get support and services delivered—through the telephone from specialists as well.So with those comments I support this bill. I do share Clare Curran’s concerns that it is bad that we have unelected representatives but I do not think there is any way of avoiding that. We have got to give these commissioners time to finish the job.