Weenink VanessaDr VANESSA WEENINK (National—Banks Peninsula): Thank you Mr Speaker. I'm proud to discuss and share my insights into the Estimates and appropriations for 2024-25. In particular I want to talk about how everything is related to health. In my background as a doctor it's hard for me to not look at the world through this lens.Approximately 80 percent of health outcomes are determined by factors outside of the health system. So while people might not make this direct connection for me our Government's commitment to things like radically improving the availability of housing is going to have a massive impact on health outcomes. So housing is about shelter—it's a basic physiological need and one where if it's not appropriate if it's damp or if it's in a mouldy environment if it's overcrowded that can actually lead to more avoidable hospital admissions and upper respiratory infections and the like and all sorts of ongoing health problems.So in our Budget we've committed $140 million for 1500 new community housing places. So that's going to be provided by community housing providers who will be able to improve access to housing but that's not the only thing we're doing in housing. We're also bringing in a range of changes that will reduce the cost of development. We're going to be going for growth in housing which means that we're going to fundamentally make changes to the way that councils approve and go through their consenting processes and all of the costs that are associated with red tape will be reduced. We need to massively expand all of the options for people including some of the options like build to rent developments mixed model uses and others to expand the choices available.The other things that we're doing that actually are about health in my eyes: education spending. So education is fundamentally linked to health outcomes. Educational achievement is correlated with lower infant mortality also higher rates of immunisation and fewer hospital admissions. So we're going to be investing $1.48 billion in education where we can make sure that the buildings and classrooms that are available for our kids are appropriate. At the moment some of our school stock is actually mouldy and it's probably contributing to the reasons why some of our kids don't want to come to school. Although this is a large investment into making sure that our school stock is appropriate from my perspective we will reap the benefits in the health system as well.So overall if we are looking at the health budget directly we've talked about some of the numbers and that that others have mentioned already. The $16 billion over the next few years is a way of giving certainty to the sector about what the budget levels are going to be so that they're not waiting each cycle to find out is there going to be an increase or a decrease or where it is—there's certainty within the sector. And that's something that's been asked for for a long time. But I think it's really important to note that it's not the size of the budget that matters it's actually what you do with it. And it's actually how you take care of things that matter.Tom Rutherford: It's not all about size.Dr VANESSA WEENINK: Ha ha! That's right.Tom Rutherford: It's about the delivery.Hon Ginny Andersen: Are you heckling your own member?Dr VANESSA WEENINK: The Minister of Health has—yeah I'm being interjected by my own side yes. So the Minister of Health has appointed this week a commissioner for the health sector. This is one of the best pieces of news for people within the sector. We're finally seeing some real action—we will see some real hope within the system. And that's the message that I've received from people on the front line and health leaders has been: Thank goodness it's about time and finally we can see some hope." Because really what has been called for and what has been needed in the health system has been leadership: clear leadership.That was actually one of the key themes that came through the report into the health system that the health reforms were sort of quasi based upon—a report that most of the recommendations in some ways were torn up and thrown away by a Minister of Health who'd been in place for less than five minutes—I mean five months—when he decided that he knew better and it would be better to have instead of a slow transition and a process that should take between five and 10 years to implement they would do it in the space of one year. It was a risky and now we can see pretty terrible implementation. It has resulted in the worst level of low morale that I have ever seen in my 20 years of being a doctor for my health colleagues. They were tired they were burnt out from dealing with a 100-year pandemic and the previous Government did not listen when the New Zealand Medical Association—that I was part of at the time—said that we need reform in the system but now is not the time; now is not the time.Because in order to implement proper decent change in our health system you need to have an engaged health workforce. You need to have a workforce who is ready to participate who's ready to step up to the mark and do what is required. But what's happened is that instead of engaging the workforce those on the front line there has been a massive increase in the managerial overlays. So instead of having 20 district health boards we had one Te Whatu Ora (TWO) plus we had the regions but then we had on top of that districts underneath them. So in real terms you had more than 20 entities—probably about 25. You ended up with thousands of extra people and many of them when I've spoken to them within the system because they cycled through so rapidly most of them didn't know what they were actually there to do. I'd say that over the last few years we would have seen thousands of people go through that change management process. And by the end of it we will have seen one of the worst examples of an implementation process that has ever happened in a health system anywhere. And I would say that even 30 years ago when we had the previous health system reforms with the Crown health enterprises—CHEs—that three-letter acronym is probably going to go down in history as being not so bad as the three-letter acronym of TWO.So as a health leader in the sector at the time—a front-line GP going through that—it was appalling and it was something that we could see the potential outcomes. And we know what is happening now. So from my perspective everything that we are doing within our Budget for 2024 is helping to redress some of the health outcome problems that we have in New Zealand. And like I say 80 percent of what happens in the health system is actually—you can find the cause of that outside of the health system.So some of the things that people also wouldn't think of as being a health improvement function would be tax cuts but actually improving peoples' incomes and the money that they have in their hands is directly related to their health outcomes. So the more money they have the better they will do. Prosperity in a country is directly related to mortality outcomes. So by increasing prosperity in our country by improving growth by working on infrastructure by improving our roads that will lead to better outcomes across the economy we are actually improving the health of our people.So everything that we are doing within Budget 2024 is aimed at improving health outcomes for New Zealanders. It's about caring it's about the way that we do things not about the size of the money that we're putting in. So I'm very proud to be a part of a Government that is actually getting things done that is getting things back on track in this country and I commend this bill to the House."