Scott Lynda: Estimates Debate —  
Scott Lynda: Estimates Debate —  
[Volume:610;Page:7193] 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 The Government spends 6.25 percent of gross domestic product (GDP) on Vote Health and total health expenditure is 8 percent of GDP when one takes into account public private and accident compensation spending. 
We heard from Steve Chadwick about the superb job she thinks Labour is doing in health. I do not think that many people around the country would agree with her. If she asked the general public they would say that there are serious problems in New Zealand’s health system. With the 21 district health boards the Government seems to be pouring money down a black hole. We heard in the Budget speech that Michael Cullen wanted a deficit of $80 million for the 2002-03 year. I shall talk about hospital deficits because they do matter. The deficit was about $237 million last year and this year will it be $80 million? No it will be nowhere near what Michael Cullen wanted. The deficit will be $180-$200 million. Once again district health boards have failed to perform in this regard. We have 21 district health boards—in a country with a population the size of Melbourne. Why do we talk about hospitals deficits knowing that most people switch off when we start talking about them? Because it matters and it matters because of what happens to an area when a hospital is in deficit. 
We saw Graeme Edmond resign as chief executive officer of the Auckland District Health Board. He was an exceptionally good chief executive officer. I remember talking with Graeme when he got Auckland Hospital and Health Services out of the red and into the black. He was really ecstatic about that. The whole dynamic of a hospital system changes when one is looking forward to what can be done that is positive instead of looking at the cuts that have to be continually made. But instead of looking at the progress made under the Health Funding Authority with its four regional offices this Government continued to look back at 1993. Because of the Government’s ideology it could not see what was in front of its nose—that the Health Funding Authority was doing an exceptionally good job. The funder/provider split did not just happen in New Zealand; it was implemented in many parts of the world and there were good economic reasons for that. In 1998-99 going into 2000 the Health Funding Authority was doing an exceptionally good job and it is such a shame that this Government could not see that. 
Graeme Edmond resigned because he had had enough of this Government. He had had enough of seeing the Auckland District Health Board continually having to deal with a massive deficit and having to look continually at making cuts to surgery and cuts to what it could deliver. The Government has done that by putting up the points one needs to get surgery. That has happened all around the country so people have to be sicker or more disabled to get service. It has also been done in different clinical areas—in orthopaedics in gynaecology in ophthalmology. Cataracts hip and knee replacements have been affected and hernia operations have been crossed off the list altogether. That is why those deficits matter. 
Also the boards cannot afford new equipment. Do members remember the linear accelerator that women with breast cancer need so urgently that we heard this Government rave on so much about and how it was going to fix the problem? It has not done that at all—we still have a lot of old equipment. The district health boards cannot afford to invest in it so women go to Australia for Australian private care and to get their radiology because we cannot deliver. Because the studies have shown it women in New Zealand know that if they wait more than 8 weeks for radiotherapy—post-lumpectomy or post-mastectomy—there is a marked increase in local recurrence. One would think that the Ministry of Health would know that and would be pushing very hard to get the equipment needed. 
Judith Collins 
: It is paid enough. 
Dr LYNDA SCOTT 
: It is paid enough but the ministry said that waiting 12 weeks was fine. The studies have shown that it is not and the Government should be doing everything it can to deliver timely treatment for women with breast cancer. Sending people to Australia was a short-term solution that has now dragged on for 3 more years. 
I know that up in Auckland John Childs would have liked to see a public-private partnership on the North Shore that would be able to deliver better services—where people could work in both systems earn more money stay within the sector and within New Zealand. We would actually retain our staff not lose them. But no this Government’s ideology is against that. Although the Minister says that public-private partnerships are all right she then appoints board chairs who are philosophically opposed to them. 
Hon Annette King 
: Name one. 
Dr LYNDA SCOTT 
: Waitemata District Health Board for a start. Waitemata cancelled the birth-care contract said it had the capacity and is now saying that it will have to build another 10 beds because it cancelled that contract. That is a good example of how one builds the public sector and forgets about what one can use in the private sector. We do not have the equipment. Hospital deficits mean that one cannot invest in new procedures—like drug-alluting stents for cardiac patients whose coronary arteries are beginning to occlude. I will tell members what these drug-alluting stents are about because they are more expensive but more effective. They are little things that are put in to open up the arteries so they do not clog up. They save people from having heart attacks or needing coronary artery bypass grafting. But this country cannot afford that. 
Then there are the drugs. We cannot afford things like Gabapentin. People blame Pharmac but Pharmac’s budget went down from $520 million in 2001 to $516 million last year. No wonder people in this country cannot get access to new medicines! No wonder they cannot get access to the medicines they need to keep them well! Gabapentin is a medicine used to treat pain. I have used it myself for people with amputations. One tries everything else first but it gives very good pain relief and people cannot get it. The Otago District Health Board is about to cancel all people on Gabapentin. That is absolutely cruel but this Government has not increased the amount of money that Pharmac gets to fund new drugs so one cannot blame Pharmac. The Government has not even approved the budget for this year. Those are the problems with hospital deficits. 
The Government says it is going to put all the money into primary health organisations. Once again it is being driven by ideology only. Instead of building on independent practitioner associations which most doctors in this country thought were doing a very good job we get primary health organisations. Instead of funding on patient need and ability to pay—no matter where one lives in New Zealand or what one’s race is—the Government decided it had to have politically correct primary health organisations which are funded on location. It was going to force doctors into them because if doctors did not join they would get no access to new money. Does the public know about that? It knows nothing about enrolment. When one asks what the 10 big problems facing primary health organisations are enrolment process is No. 2 because the public does not understand what is going on. New Zealanders shop around for their doctors. They might live in one area but work in another. If they get sick they go to the local accident and medical clinic. What happens is that all the money that was supposed to go to their primary location goes somewhere else. 
Doctors are having a nightmare with primary health organisations. The system was never trialled. It is based on location which has to be 50 percent Maori/Pacific Island or highly deprived. What about the other 50 percent? Why give them cheaper visits when only two primary health organisations have been set up in the South Island and poor people and people with high health needs in the South Island are not getting anything? That is just unacceptable.