Verrall Ayesha; Willis Nicola; Pugh MaureenHon Dr AYESHA VERRALL (Labour): Madam Chair thank you very much. I note the comments earlier in this debate about increases to Vote Health and also note that there has been substantial commentary and research showing that those increases to Vote Health do not meet reasonable assessments of what cost pressures in the health system are. So I'd be interested to hear from the Minister of Finance if there's been any other advice to the contrary on that. But of course every year our population grows up inflation in the health system goes up and more is required to do the same.Then I want to talk specifically about the population health primary and community care appropriation within Vote Health. That is $9 billion under this Budget an increase of approximately $400 million from the year before an increase proportionate to all the other health appropriations. What characterises that appropriation is that the vast majority of it is for services in the community that are largely provided by other providers—they're largely contracted out. The most important one to most people is the contracts that Government have with general practitioners are funded out of there. What I want to ask the Minister is: if the uplift overall in this appropriation is sufficient why is it that general practitioners are in the unusual situation of having to increase their fees this year? And in fact Health New Zealand has provided an allowance this year for general practitioners because they only have a 4 percent uplift in their contract which is insufficient to keep up with their costs. Health New Zealand has taken the unusual step of allowing them to increase their fees by up to 7.7 percent and that puts additional costs on people.Hon Shane Jones: Relevance. Relevance.Hon Dr AYESHA VERRALL: It's going to hit them in their hip pocket. And I think it is relevant to a Minister who promised there'd be no cuts to front-line services when general practitioners are taking the unusual step of writing to their patients around the city and saying that this is a consequence of this Government's Budget. How does it add up?Hon NICOLA WILLIS (Minister of Finance): As I have said previously in this House the cost pressure funding approach that we took in this Budget was twofold. One we set a figure from Budget '24 for the upcoming financial year that was informed by both the top down funding model that factored in demographic inflation and other expectations and a bottom-up planning and budgeting by Health New Zealand as part of developing the 2024 New Zealand Health Plan. The number we finalised was exactly the same number that we campaigned on and that the Labour Party campaigned on. So I do find it difficult when that member Hon Dr Ayesha Verrall dances on the head of the pin and pretends that somehow there would be free money trees if she were in Government when actually she campaigned on exactly the same number.As the member understands there are always challenges in the health system and our job is of course to ensure there are additional resources. That's why we've taken the extra step of making pre-allocations from future year Budgets to give the health system assurance that there will be more funding for demographic increases in the future that there will be more funding for cost pressures in the future and that they should plan on that basis.But as my colleague David Seymour has said we would be fooling ourselves if we said that all that was required was more money. In fact what is also needed is to ensure that we are supporting our front-line workforce to be the productive people that they wish to be and not to be settling them with flawed reforms like that member did when she was the Minister of Health because that did not help at all.What I would finally say to the member is this: it is lovely to have her embracing the public private partnership which is the GP model. And I would remind colleagues across the House of this: we often hear that ideological cry that the private sector should not be involved in the delivery and provision of what are public goods.Hon Chris Bishop: What about GPs?Hon NICOLA WILLIS: I have in the GP model an outstanding example of why private enterprise has a very crucial role to play in our communities and to play in service delivery. And we in this Government want to work alongside GPs to ensure that they can deliver more of the services that are needed to prevent New Zealanders turning up in hospital and in the emergency room and we are thinking very laterally about how to achieve that.CHAIRPERSON (Maureen Pugh): Members the Minister's time in the chair has come to an end. We now have the Minister for Children. The Minister is available until the dinner break.