edithatogo/nz-hansard-corpus huggingface dataset:
Reti ShaneDr SHANE RETI (National): Thank you Madam Chair. I rise to speak to Supplementary Order Paper 161 in my name and on behalf of the National Party. This Supplementary Order Paper seeks to change the title of the bill to describe what it functionally does which by its own description is to centralise healthcare.I now want to talk about centralising healthcare in this manner. We have significant concerns with centralising healthcare as this bill and these reforms do. Quite simply it is command and control by a socialist Labour Government not happy with centralising polytechnics and ruining that sector and not happy with centralising three waters and ruining local government; now they want to centralise healthcare and will ruin that—all underpinned by a theme of Wellington knows best." Well guess what! They don't know best. Local people know what is best for them. Ask yourself this: do these reforms increase or decrease elected democracy? By removing elected district health board (DHB) members these reforms and this Government arrogantly dismisses the rule of democracy and the voice of elected people. By removing elected officials and saying they never really made a contribution disrespects what the Parliamentary Library tells me are the nearly 1001 people over 20 years who have been voted in by communities. I want to thank all of those elected people who put themselves forward and made a contribution; it was valued.In 2001 the British Medical Journal described the reforms that brought about DHBs and the Labour Government that did it as working to achieve the goals of "a system promoted as allowing greater community voice in health sector decision-making" and "putting the public back into the public health system". What these reforms do is put bureaucracy back into the health system. What these reforms do is take the public out of the public health system. Decentralisation of healthcare by this bill will put layers and layers of bureaucracy between patients and the Minister: a national commissioner four regional commissioners four to five district locality commissioners 80 localities and then providers and then patients—more money more bureaucracy and worse outcomes. Centralising healthcare in the middle of a pandemic when New Zealanders are dying every single day is a reform that will fail that deserves to fail and will see this Government out of office.The question I'd then pose: how does the Minister explain the removal of the democratically elected local people and is democracy enhanced or diminished by this bill? Thank you."
Salesa JennyClauses 1 and 2 CHAIRPERSON (Hon Jenny Salesa): Members we come now to our final debate. This is the debate on clauses 1 and 2 the title and commencement debate. The question is that clauses 1 and 2 stand part.
Chhour Karen; Little AndrewKAREN CHHOUR (ACT) (remote): Thank you Madam Chair. Just a quick question around privacy with information: as we've seen this has been an issue in the past when it came to vaccinations with Māori and Māori information being wanted when it comes to finding out who needed to be vaccinated. I'm just wondering how will people's health information be held under these two authorities and will there be a choice of where Māori hold their information or will that just be shared automatically?Hon ANDREW LITTLE (Minister of Health): I thank Ms Chhour for her question. I think she can expect that patient information will be held by health organisations who gather that information from the patient because that clearly will have been imparted by the patient and the patient would expect that health provider to hold it.Information will not be passed on to any other health provider unless that has been consented to by the patient. So if there is a referral ordinarily a patient would be asked to and required to give their consent to pass that on. That said we know that from every patient transaction there is relevant data that is useful in the aggregate as we think about health planning and the incidence of infections and non-communicable diseases and all the rest of it. So we do need a system that can gather data on an anonymous basis so that anonymised aggregate data can be provided to appropriate agencies as they do the health planning and the long-term planning for the sort of health services that might be needed and the long-term aggregate data too that will assist in locality planning and more localised service provision. To the extent that the member is seeking reassurance about the safety and security of personal information information will be held only by health providers that have been authorised by the patient to hold it.
van Velden BrookeBROOKE VAN VELDEN (Deputy Leader—ACT): Thank you Madam Chair. I had a question that related to Part 4 clause 93 and it's about the director-general requiring information from health entities. It says that (1) For the purpose of monitoring the performance of any health entity or the health sector in general the Director-General may in writing—(a) request from a health entity information in relation to any matter; and (b) specify a time frame by which the health entity must comply with the request." It also says that "(3) The Director-General must not request under this section any personal health information of any identifiable person." I think that's important but I also wanted to give the Minister a chance to explain to people or provide a bit more context because I know a lot of New Zealanders do worry about the privacy of their information. They worry about their names their details and their health records being put on registers and somehow this information not necessarily being leaked but being deposited in an area that it was never expected to. We do note that with the Waikato DHB is an example where there was a privacy breach but I also think of a range of other different registers and I know that a lot of New Zealanders do have an issue with Governments holding their own data and whether or not they feel like that data should be shared. So is there in any other part of the health sector or in any processes or requirements in place within the entities themselves the ability to hold and store this information or processes to help with the transfer of information to the Director-General of Health where that information about that person won't be personally identifiable because I know that this is an issue that has cropped up time and time again with people who don't trust Government departments—people who do have vulnerable health conditions not wanting that to be public in any way. So if the Minister could shed a little light on how this process would actually work in effect. Thank you."
Little AndrewHon ANDREW LITTLE (Minister of Health): Thank you Madam Chair and I thank Chris Penk. For a minute there I thought he was going to say that they were going to vote for the bill but that's too much to hope for. I want to correct the member too. I know he refers to the Regulations Review Committee. It is known around are here as the all-powerful Regulations Review Committee" because we all bow to it. It's very important a very authoritative committee and one that I thoroughly enjoyed serving on for a period of time. No it is important and it's important that it's chaired by somebody with considerable capability as indeed that member reflects as he sits in his chair—it must be late at night! The member has invited a general response as opposed to a detailed response although I'm tempted to give a detailed response. I think that the member makes good points as usual and he makes the point about the extent that regional arrangements are provided for. And that reflects I think an expectation that Health New Zealand and in fact the Māori Health Authority because they've now said this have a regional element to their structure. And the regional division if you like will be quite important. They're going to make commissioning decisions and so it would be appropriate for the sake of transparency and accountability that there is some clear regulation about that so the member can expect to see something in that respect in due course.Although there will be a regional level of organisation the member is right. The whole purpose of the legislation is to try to get rid of the postcode lottery that we've got—I suppose what I would say is the unnecessary and unjustified variation in terms of health services. But of course the other part and locality planning will drive this is we do want some tailoring of services as communities ask for it and want it and need it. So there will be some variation but that will be variation that is justified and warranted. I accept the member's point about when it comes to information being provided it is to be as specific as possible about that. Again that's in the interests of transparency. The dispute resolution provision there relates to disputes between Health New Zealand and the Māori Health Authority to the extent that dispute resolution will need to be regulated. Again that's for the sake of various parties so they know what the rules of engagement are in the event that there is a dispute that can't be resolved in a more informal sort of way but my expectation is that that will be possible. But I thank the member for his contribution."
Little AndrewHon ANDREW LITTLE (Minister of Health): Thank you Madam Chair. Just responding to Ms van Velden's latest question I'm not going to go through an account of everybody's liquor stores to try and gauge exactly what levy might apply. I just simply make the point that the levy provisions in the bill are in fact a direct copy of the existing alcohol levy provisions in the current legislation. They are to raise funds for appropriate health promotion because of the harm that the misuse of alcohol causes—and there is a misuse of alcohol consumption and we have to be able to address it as a major public health issue. I say no more than that.I'll do this in reverse order now that I've started with the most recent question asked and respond to Dr Shane Reti who asked in relation to clause 97(1)(h) about the regulations that can be made and specifically in relation to an entitlement card. Again this is an existing provision that has just been carried over from legislation and put into this bill. I would say that this is simply futureproofing the health system in case we want to introduce a method of recording information for people that we can record that information that way and that information is stored on a card as the basis for people to get access to whatever it is—a service or medications or what have you. So it's just being sure that there is statutory authority to be able to use that technology and use information and store it in that particular way.Then turning to Mr Watts' questions about clause 95(2) and (1)—in that order. I get the member's point that given the amount of land that hospitals occupy—and their use is going to change over time. I get that. But I think the important thing is he is probably right that this is sort of a historical throwback. It's never really been amended to change from an organisation with a turnover of anywhere between $400 million and maybe $1 billion to an organisation that will have a turnover of closer to $18 billion to $20 billion and a workforce of about 82000. It's well worth considering in the five-year review that is provided for in the legislation here. But I think the underlying premise was that land that is held by the Crown for health services and used for health services—you want to make sure that it continues to be available for that purpose even if for a period of time it might be used for some slightly different purpose and to raise some revenue as an alternative.I should add as I understand it the Minister's powers in this regard can be delegated—most likely delegated to the director-general who would then further delegate it to an appropriate senior official. It's possibly even capable of being delegated to Health New Zealand. But it's an old fashioned protection—if I could use that term in that way—that perhaps when the legislation comes up for review in five years this is something that could be looked at then.
van Velden BrookeBROOKE VAN VELDEN (Deputy Leader—ACT): Thank you Madam Chair. I just wanted to quickly pick up on an area where I feel like the Minister may be able to be enlightening towards New Zealanders and in particular younger New Zealanders who might be finding that once they turn 18 they're able to go off to the liquor store and purchase alcohol.In Part 4 under Subpart 3 Secondary legislation" at clause 96 it talks about levies for alcohol-related purposes so that the ministry is able to recover some of the costs it incurs in the health system by people drinking. Now I know a lot of New Zealanders do enjoy a good drink on a Friday night or a Saturday night but the Schedules 5 and 6 apply here and it actually goes into a little bit of detail on how much levy on every drink that a New Zealander might consume is actually taken in for the purposes of taking up some of the costs that's incurred on the health sector.So I just wondered whether the Minister is able to be informative for some of the people who may not realise that when they're buying something there's a levy taken but also maybe just give a little bit of an example of what sort of alcoholic beverages fall between the maybe 1.15 percent to 2.5 percent versus the 6 percent to the 9 percent or between 9 percent or 14 percent. Thank you."
Little AndrewHon ANDREW LITTLE (Minister of Health): The reason this provision is drafted this way is to make sure that the members of the Hauora Māori Advisory Committee represent iwi Māori. Now we're not going to have a representative of each iwi on it—it's going to be a workable number—but in the way that we set up an interim group or a working group in the way my Associate Minister the Hon Peeni Henare and I did when we had Tā Mason Durie advising us he pulled together a group that advised us on the initial appointments to the interim Māori Health Authority. They sought a mandate from most iwi—not all iwi—but that was a model that largely appeared to work and the engagement that Peeni Henare had with the Māori community was that that's what they would like to see in the future.We need the Hauora Māori Advisory Committee to have the confidence of Māori—iwi Māori and urban Māori—and that's why that is structured in that way. They know there are six places for iwi Māori. I'm confident that iwi Māori are capable of working it out amongst themselves who the make-up of that group with be and likewise the urban Māori organisations that are required to appoint too.The role of the Hauora Māori Advisory Committee is to advise me in exercising the powers I have in relation to the Māori Health Authority. That's a further kind of assurance to Te Ao Māori but also consistent with the Crown's obligations under the Treaty and our commitment to partnership is that we work to ensure that the Māori Health Authority—which has such a critical role to play in the health reforms—maintains the confidence of Māori and these systems structured this way are designed to achieve just that.
van Velden BrookeBROOKE VAN VELDEN (Deputy Leader—ACT): Thank you Madam Chair. I just had a query on an area that nobody seems to have picked up on before and that is about the Hauora Māori Advisory Committee under clause 84. I just had queries about how this operates in practice when it talks in new clause 84A about the Hauora Māori Advisory Committee comprises eight members appointed either by the Minister on the nomination of all the iwi-Māori partnership boards; or … by the Minister if and to the extent that a nomination is not made;". So I can understand how you'd end up in a situation where you would want to have the ability as the Minister to self-select because you don't want positions not to be filled but at the same time the requirement that a nomination is made to be a member of the Hauora Māori Advisory Committee by all of the iwi-Māori partnership boards seems like quite a high threshold. So I'm just curious as to why it's so specific that it needs all of the iwi-Māori partnership boards to be favourable to a particular person rather than some or maybe a selection process based on people nominating names in general. Also: how that kind of works when it comes to the fact that the Hauora Māori Advisory Committee does quite a few things but in particular it can advise the Minister when it comes to maybe deselecting somebody to be on the Māori Health Authority. One area that I'm interested in is maybe a potential conflict of interest where you have the iwi- Māori partnership boards needing to work with the Māori Health Authority to come together to create locality plans but the people that are on the Māori Health Authority could in some way be deselected by the iwi-Māori partnership boards telling the Minister that maybe they should be advised to replace the person on the Māori Health Authority. I just wondered if I have that correct in my reading and whether the threshold for the nominations is too high given that it needs all of the iwi-Māori partnership boards to agree."
O'Connor Simon; Halbert Shanan; Little AndrewSIMON O'CONNOR (National—Tāmaki): I'd like to thank the Minister for his contribution. Can he or his officials give me one example of a country in the world over 25 years which has replicated the Pharmac model? SHANAN HALBERT (Labour—Northcote): I move That the question be now put.SIMON O'CONNOR (National—Tāmaki): Sorry to leap back to my feet. It is actually quite a genuine question. I think Pharmac is amazing but having chaired the Health Committee one of the things that has struck me over that time and particularly—actually it's probably over 27 years or so now. Pharmac does many many things well but it's become somewhat of a sacred cow in this country and I am I hope rightly and genuinely asking Minister what other country in the world has replicated the Pharmac model?Hon ANDREW LITTLE (Minister of Health): Just beginning with Mr O'Connor's point: probably no one but then no other country is quite like New Zealand and there's a multiplicity of different systems. There are countries operating on a State basis and provincial basis and at a State basis and provincial basis there are some procurement agencies that operate on that basis where the health system is very much kind of subnational based but the other thing is that other countries have complex arrangements when it comes to public and private insurance. So we know that many European countries rely heavily on private insurance or mandated private insurance to meet the cost in whole or in part of pharmaceuticals. When Pharmac agrees to fund a drug they agree to fund it 100 percent. The cost to the consumer is the prescription charge of $5 each time up to an annual value of $100. But that's what sets New Zealand apart from pretty much every other country—that when we agree to fund a pharmaceutical then we agree to fund it 100 percent. In most other countries it's at best a partial funding.I just want to mention one other point too and that was in relation to consumer engagement—really addressing the point that Mr Watts made. There is a specific requirement in terms of clause 53 where there needs to be a code of consumer and whānau engagement in the health sector. So there is a statutory impetus to make sure that there is consumer engagement.
Woodhouse MichaelHon MICHAEL WOODHOUSE (National): Thank you Madam Chair. I want to continue that discussion about Pharmac because today is an important day in terms of that organisation.I also want to put on record that I think Pharmac as a model is a very effective one but we've known for years that three things Pharmac needed: it needed more money it needed to make decisions in a more timely manner and it needed to be more transparent about those decisions. Dr Reti and I have made these points very clear to the chair of the Pharmac Board in annual reviews over the last few years—the Hon Steve Maharey—and we got those assurances back. But today's report I think makes it very clear that there is a great deal of work to do.We are a little bit on the road regarding funding with Budget 2022 although I want to point out—and this is one of the opportunities I think Health New Zealand really has. I'll use this as an example: a couple of years ago there was a very strong push for devices to be purchased for type 1 diabetics to effectively keep them out of hospital. It was turned down and it was turned down because it was very very narrow grounds for cost benefit and yet the real benefit was going to be on the DHBs. This is the one thing I think that's good about this bill because I don't think we're heading down the right road in terms of the restructure but actually if Pharmac takes more cognisance of a broader range of benefits than just its own cost benefit I think that'd be a good thing.When the Minister responded to the report this morning he said Well we've got this health reform and it's going to be in place in a month and so that'll give us a good chance to"—I think he used the word "reassess". We've got a unique opportunity right now to build in a statutory framework to make Pharmac more responsive more transparent and more broad in its approach to cost benefit.My question to the Minister is in the time he's had available—because he's had the report for a lot longer than we have—what thought did he put into making amendments to Part 3 that will actually make those recommendations a statutory requirement in the law? We've got time because they're pretty straightforward I think. Has he given that thought and if not why not? If he decided not to make any changes right now are we missing an opportunity?"
Little AndrewHon ANDREW LITTLE (Minister of Health): Just by way of some just general remarks in relation to this provision members will recognise some of the entities referred to here. This simply recognises the continuation of these particular entities. But it's in this area too that we also have some other particular provisions—and I'm just looking specifically—in relation to the new public health agency and specifically the expert advisory committee on public health that is provided for.Part of the reforms is to beef up our public health offering and to make sure that we have good—which is not a criticism of any leadership we've had in our public health services to date. But this makes it clear as part of the structure that we will have a discrete public health agency with an external advisory committee who will be advising in that particular service. Also in this regard—or in fact not in that regard at all. But yeah I do want to draw particular attention to that. Otherwise the other organisations here: Pharmac Health Quality and Safety Commission New Zealand Blood and Organ Service—they're all provided for here. They all must continue. They are service providers and therefore they are health entities for the purposes of the legislation.
McKelvie IanPart 3 Other roles CHAIRPERSON (Ian McKelvie): Members we now come to Part 3. This is the debate on clauses 60 to 86 Other roles" as well as Schedule 1A relating to organisations for the purposes of sections 84A(1) and 84B(1) and Schedule 4 which has provisions applying to mortality review committees. The question is that Part 3 stand part."
Little AndrewHon ANDREW LITTLE (Minister of Health): I raise a point of order Mr Chairperson. I seek leave to correct a statement I made earlier this evening as we've been discussing this bill.Hon Michael Woodhouse: Was that in the committee?Hon ANDREW LITTLE: In committee. Earlier this evening Michael Woodhouse made a contribution in relation to the provision in the bill relating to amending the immigration provisions in particular a condition attached to visas for those who are working in the health system. My response was to the effect that I thought that any problem with a health worker on a working visa employed by Health New Zealand who might want to go to other parts of the country with Health New Zealand—that would be managed as an HR matter. I said tangentially that under the new arrangements with the new work visas a health worker employed or at least under a working visa on the two-year pathway to residency as now provided for would as a condition of the visa be required to stick with their employer. I have been advised tonight that that is not correct and that a health worker working here under a two-year visa on a pathway to residency once they are here is free to work in the role in which they are employed regardless of who that employer is. I just wanted to be very clear about that.
van Velden BrookeBROOKE VAN VELDEN (Deputy Leader—ACT): Thank you Mr Chair. I'd just like to pick up on a few comments that have been made around the Chamber in particular talking to Melissa Lee's point about ethnic communities.I think it is really important that in New Zealand we are not just Māori and everything else. Everything else isn't just white. We aren't the 1950s any more. We have actually moved on and we are a society of about 260 different ethnicities. I do have a point to be made there that the Minister says Well there is relevant ability for different ethnicities to be considered in parts of the legislation because they are New Zealanders and different parts of the health strategy refer to different population groups and the needs of different New Zealanders."Well if it's all right for Asian members of our society why is it different for the Pasifika and the Māori people that have been singled out in this legislation?"
Lee MelissaMELISSA LEE (National): Thank you and my apologies to my colleague behind me Simon Watts. As somebody who doesn't actually normally sit on the Pae Ora Legislation Committee or speak on this and is actually getting some attention I'm sure your turn will come Mr Simon Watts. Very quick question to the Minister in response to the answer he's actually given me. I'll try and make it very succinct and short. When the Minister actually says that the commitment is actually there to make sure that the new entity will provide for all communities that doesn't actually tell me that there has been work done by your officials or yourself to actually project and be ready when this entity is actually launched and that the services will be available for those communities. I'm trying to find out if in fact there was work done to project to the future as soon as the new entity is actually ready: what kind of services will there be what percentage of the population may potentially use it and what kind of language services are required for those services? To tell me that there are current new and good examples in the Waitemata District Health Board and that you can't necessarily transplant it into a new one. Yes I probably agree with him but the thing is that that doesn't actually mean that there's been some thought put into a population that is really really massively growing and growing really really fast and I'm concerned that their needs—the ethnic communities' needs—are not going to be met by this new entity.
Lee MelissaMELISSA LEE (National): Thank you Mr Chair. I'd like to ask the Minister a couple of questions in relation to the ethnic communities. As someone who hasn't actually participated in this debate from the beginning I was just sitting in my chair listening to the contribution that other members have actually been making and I thought Where are the questions about the ethnic communities?" I know that there are provisions actually made for Māori and Pasifika communities but there's nothing in there about ethnic communities particularly the Asian communities because I come from that sector. If you look at the Auckland region for example the Asian population in Auckland is about 30 percent and it is actually a very fast-growing population. And for many of them one of the biggest problems that they have when they're engaging with the health system is that one they have language issues and two they feel that the New Zealand health system doesn't actually understand their needs. They have medical professionals—whether it's doctors or nurses or midwives or whatever—who actually do not understand. They have different terminologies for example in Korean. If you have pain in certain areas—I mean the elderly people talk about the wind or the sourness in their bones and you know they say that like that in their own language. And often the translation services are actually not effective enough I don't think. I'm trying to find out if the Minister has put specific provisions for this new entity to provide for the needs of the ethnic communities in New Zealand and what kind of provision he has actually made particularly—different ethnic communities have different health needs. They have specific—what would you call it—susceptibility to certain diseases and I'm wondering what the Minister's projection is in terms of what the attendance rate will be to these health entities by the ethnic communities preventing them from going back home to their home countries to get services because they feel that those countries actually provide better healthcare than New Zealand currently does."
van Velden BrookeBROOKE VAN VELDEN (Deputy Leader—ACT): Thank you Mr Chair. I was just hoping that the Minister might be able to provide a little bit of clarity on the structure of the healthcare system as it pertains to Health New Zealand.When I'm looking through subpart 2 and it talks about the establishment of Health New Zealand the objectives the functions how it all works with the Iwi Māori Partnership Boards and the Māori Health Authority there's an element that I'm not sure is missing or is just intentionally not part of the legislation. And that is when you go on to the Future of health website it talks about there being four new regional divisions within Health New Zealand and I wondered whether these four divisions within Health New Zealand that are regional should be prescribed in the legislation and if there is a reason why they're not prescribed in the legislation at all.Has there been a decision made that these four regional divisions no longer exist or do they still fit within the Māori Health Authority and Health New Zealand then the regional divisions and then the localities? And if they do exist as four regional divisions where are they and who is in charge of them? How do they fit within Health New Zealand?
Little AndrewHon ANDREW LITTLE (Minister of Health): I think it's appropriate to just dispose of that question now. I again thank the member for it. I think the member's right. I mean one thing we don't want Parliament to do is to start setting up the financial management regime for Health New Zealand. But I think he can be assured that there will be appropriate delegations throughout the health system the Health New Zealand organisation and there will be a level of capital expenditure that will be left to local management. It will be whatever the name is given to whoever heads up an individual hospital.And indeed what I would expect to see—which I think again when I look at some district health boards (DHBs) they have struggled with this—is managers at different levels having appropriate delegations. And I am aware of one reasonably large DHB where reasonably senior managers responsible for reasonably significant operations had no budget delegations given to them. They just spent as they thought was appropriate to do their job without any budget within which to operate. So it's that kind of discipline if it hasn't been there before we need to get quickly back into those organisations.In terms of costings I can say to the member that the localities won't be a cost centre. The locality planning process will be kind of coordinated at the regional level within Health NZ and is really a basis on which to evaluate health need and informs the basis of the for want of a better phrase funding to third parties. So funding to your primary care or your primary health organisations if they're there or your aged residential care or all those others who get public funding to provide particular services. The locality planning process is kind of an information-gathering and a planning process for which the regional division of Health NZ will then follow with funding and commissioning decisions. Obviously the way Health NZ will operate is to make sure that the funding of services across New Zealand has a consistency in terms of formula but is about addressing need. And so they will have to kind of weigh that balance out.So to the extent the member thought there was cost centres around localities there won't be. The locality planning process is a planning process from which funding decisions will subsequently be made.
Woodhouse MichaelHon MICHAEL WOODHOUSE (National): Thank you Mr Chair. I do appreciate Minister Little's reply; it was helpful. I would make one observation and ask a question. Firstly he was absolutely right: the Capital Investment Committee and the health infrastructure board are there but they're there for the really big stuff. It's there for the rebuild of Dunedin Hospital Whangārei Hospital probably Hutt soon and other major capital expenditure. It's not really there for the lower-level asset management that goes on in each district health board (DHB) every week. I think there's probably a task to understand the level of delegation of a lower level of asset management and replacement. That kind of segues into the question that I have on this which was: the Minister referred to cost centres. Now in accounting parlance there's a difference between a cost centre and a profit centre and I just want to know whether the—we'll call them the localities using the new nomenclature. Will those localities actually be—I don't want to call them profit centres" because profit's the wrong word but will they be allocated funding within which they need to stay and so will they have the responsibility for managing within effectively an appropriation if you like from Health New Zealand to a locality whether it's a former DHB or something else? And what would happen and how quickly will there be an intervention if one of those localities then fails in its endeavour under clause 16 to live within its means?"
Reti ShaneDr SHANE RETI (National): Thank you Mr Chair. I want to pick up on a previous point. Rawiri and myself will stand on different sides of the Māori Health Authority that's quite clear. But in conversations we've both expressed concerns about whether the Māori Health Authority is being set up to fail. And the discussions tonight around Schedule 3 the Iwi-Māori partnership boards" are something that needs some explanation back to those entities—initially as iwi Māori relationships actually. What happened was they came into select committee named and written in the schedule. I was called by a number of them as the select committee process was finishing and they were actually proud to be named in the legislation. They said "Shane we're named. We've got real pride here. Our name appears in the legislation in the House. Tell us what happens as we come out of select committee." Within 24 hours of coming out of select committee I'd been contacted by the chair of one of the iwi-Māori partnership boards saying "Shane are we still there? Are we still in the legislation?" And my answer to him was "No you're not. You've got a red line through you actually. You've been deleted. Or in fact if you look at the text you've been 'vacated'". And they were hugely disappointed. What do I say to them? They now have to apply. They've been vacated. What do I say to them? How else could they draw the conclusion that they also had been thrown under the bus that they don't exist in a form that either they'd been promised or that they hoped to be that they've just been nonchalantly deleted and as I say what the text describes as "vacated" and they now need to apply. So I'd like the Minister to help me with an explanation so that I can explain to them what's happened. Thank you Mr Chair."
Grigg NicolaNICOLA GRIGG (National—Selwyn): Thank you Mr Chair. I'd also like to refer to clause 10 of Part 2 of this bill. To the Minister I don't know how aware you are of the state of health services in Christchurch. If you think back to all of the earthquakes that our city and our region suffered since September 2010 and indeed February 2011 it has left our health sector very very short on infrastructure and resource. And while the Canterbury District Health Board (CDHB) has built a new wing of Christchurch Hospital it has had a very delayed opening and a very delayed capacity because of the very fact that the CDHB could not resource it with people. So in reference to the overview of the Minister's role in determining the following health strategies including the New Zealand Health Strategy I would ask the Minister to consider the inclusion of Dr Shane Reti's Supplementary Order Paper 158 which would include a health workforce development strategy.In Christchurch at the moment surgeries are being deferred from Christchurch Hospital. The hospital is at 112 percent capacity. The DHB estimates that there is anywhere between 170 and 200 staff either off sick or off isolating. Ten minutes up the road St George's private hospital is likely to lose the remaining dozen or so maternity beds. Now I understand that the story that is not reported in the media is this is actually due to the fact that they cannot staff these beds with midwives. CDHB has been promising for some time to build a maternity wing somewhere near Christchurch Women's Hospital. I had a letter from the CEO just recently confirming it would be available by 2023. Thus far I haven't seen any indication any property has been bought any tenders have gone out; there don't seem to me to be any plans for the build of this facility. I hope I am proven wrong. Ashburton Hospital is only able to cater for very very uncomplicated births. So that leaves the eyes of Canterbury and parents of Canterbury looking at my own electorate Selwyn.Simon O'Connor: What a great electorate.NICOLA GRIGG: Thank you. In a very novel business proposition the Selwyn District Council has acted as a developer and has built a health centre that includes about a dozen maternity beds that it's now leasing out to the CDHB. As I referred in my submission earlier we've also had the closure of the Ellesmere Hospital and the Darfield Hospital. Again we know that that is primarily due to the fact that there is not the workforce available. So in the Minister's ruminations over the New Zealand Health Strategy I would ask that he consider the inclusion of a health workforce development strategy with some urgency. All the issues that we face in Canterbury are absolutely and utterly due to the short-staffing of the facilities and resources available. I would also like to know if there is to be an inclusion of a workforce strategy how will that possibly dovetail in with a rural health strategy? Because where we see the shortages in the urban centres they are absolutely exacerbated in rural areas. So I thank the Minister for his consideration.
Waititi RawiriRAWIRI WAITITI (Co-Leader—Te Paati Māori): Point of order Madam Chair. I tried to vote but I couldn't unmute myself. CHAIRPERSON (Hon Jenny Salesa): Would you like to share your vote with us now Rawiri Waititi?RAWIRI WAITITI: Yes it's two votes in favour.ASSISTANT SPEAKER (Hon Jenny Salesa): Two votes in favour. Can I ask the Clerk to recount the votes please? May I seek leave to correct that vote to add the Māori Party's two votes in favour? No objection. Can I ask the Clerk to please recount the vote and add two votes in favour. The Ayes are 77. The Noes are 42. Motion agreed to.
Woodhouse Michael; Salesa JennyHon MICHAEL WOODHOUSE (National): Point of order. Madam Chair there is a convention that when a motion is put there are no other speech words. That convention was breached. We didn't take a point of order at that time—we were likely to have been defeated—but we will be wanting the rules of the committee to be followed more closely in future motions.CHAIRPERSON (Hon Jenny Salesa): It is also up to the Chair to decide when to put the call and I had actually put through the call and it was actually agreed to.Hon MICHAEL WOODHOUSE (National): Speaking to that Madam Chair that is absolutely true but the House has Standing Orders and Speaker's rulings for a reason and we would expect that on procedural matters relating to motions they are followed.CHAIRPERSON (Hon Jenny Salesa): It is not always the case that when someone seeks the call that a question is put and then it's actually you know that we continue to debate. It is actually up to whoever the Chair is whether or not the question is put.
Craig LizDr LIZ CRAIG (Labour): Thank you Madam Chair. I move That the question be now put.
Kerekere ElizabethDr ELIZABETH KEREKERE (Green): Kia ora. I'd like to point to two Supplementary Order Papers (SOPs) in my name Supplementary Order Paper 164 and Supplementary Order Paper 166. We wanted to perhaps change some of the wording where we talk about engaging with Māori. If a core part of the health system is to eliminate the huge disparities for health for Māori then we're suggesting that there should be more partnering with Māori and less engaging—just being much more specific about Māori being part of the solutions. In the same way rural people must be part of the solutions for rural issues so must Māori be part of this. Of course I'm not denying at all the establishment of a Māori Health Authority—that is well under way.I wanted to pick up on the point that the Minister had made about the law interpreting terms like tino rangatiratanga because I think this is quite important. We suggest in SOP 164 that the words decision-making authority" be changed to "tino rangatiratanga". I just wanted to point out that that is a term that was in Te Tiriti o Waitangi. It was 50 years ago this year that a protest—a peaceful protest—was held a petition was put to this House to make te reo Māori be taught in schools because of decades and decades of Māori being beaten up being hurt for speaking Māori—so 50 years ago. The Māori Language Act came into place in 1987. That recognised te reo as an official language of Aotearoa and it founded Te Taura Whiri i te Reo Māori the Māori Language Commission.It seems to me long past time that core and common Māori words don't have proper interpretation in our law aren't included in our legislation. Some words are and then some words are not. So because Te Taura Whiri i te Reo Māori is available we have many Māori language experts that could support the Government including inside this House—incredible people with expertise in te reo that could help with that.The second thing I wanted to point out—and I want to acknowledge the Human Rights Commission. In particular this SOP 166 is to reflect something they had added in their submission which we supported which was the introduction of and I quote "respecting and upholding human rights including the right to healthcare and health protection as set out in the International Covenant on Economic Social and Cultural Rights." It just acknowledges that in this country we acknowledge that we sign up to a number of United Nations instruments and that when we are restructuring our entire health system acknowledging the one that identifies a person's right to health. Kia ora."
McAnulty Kieran; Salesa Jenny; Woodhouse Michael; O'Connor SimonKIERAN McANULTY (Chief Whip—Labour): I move That the question be now put.CHAIRPERSON (Hon Jenny Salesa): The question is that the motion be agreed to. All those in favour will say Aye to the contrary No—KIERAN McANULTY (Chief Whip—Labour): Madam Chair point of order. Can we just clarify? I'm just putting that the question be now put and I was just confused by—Hon Gerry Brownlee: We can't hear you. Take your mask off.KIERAN McANULTY: Apologies. I'd moved that the question be now put but what you said was that the motion be agreed to. So I just wanted to clarify because there didn't seem to be any response. So—Hon MICHAEL WOODHOUSE (National): Speaking to that point of order. Two things Madam Chair. Firstly it's customary when the Minister has addressed an issue that the debate not end. I didn't take a point of order then but I will just point that out. Secondly your question was perfectly put. Nobody on the other side said yes to it so clearly the Noes must have it.CHAIRPERSON (Hon Jenny Salesa): No one said yes and actually no one said no so let me—Hon Gerry Brownlee: I said no. I know when I say no.CHAIRPERSON (Hon Jenny Salesa): I'm sorry the Hon Gerry Brownlee?Hon Gerry Brownlee: I just said I know when I say no." Madam Chair. I'm sure if you go back—SIMON O'CONNOR (National—Tāmaki): Point of order. Thank you Madam Chair. It is just to seek your ruling on the first part of the Hon Michael Woodhouse's notion that after a Minister speaks there has been a tradition or a convention in this House that further calls could be had. It would be useful if you're going to continue to put the vote to indicate to the committee if that convention is going to change.CHAIRPERSON (Hon Jenny Salesa): Well actually what had happened here is I had put the motion to the committee. You're right in pointing out that there were some Noes but I actually didn't hear one Aye so I will give another call if someone wants to take a call."
Reti ShaneDr SHANE RETI (National): Thank you Madam Chair. I'd like to first address the comments that the Minister of Health has made that the Supplementary Order Paper (SOP) in my name can't legislate health outcomes—that can't be correct. We're looking to insert into clause 7—in that very same clause clause 7(d)(3)—the health sector should provide choice of quality services to Māori and other population[s] ... including by—harnessing clinical leadership innovation technology and lived experience to continuously improve services access to services and health outcomes;". That's almost verbatim what my SOP says so I'm afraid his commentary that you can't legislate for health outcomes is neither persuasive nor interesting. I think the second part where he talks about listening to key stakeholders—that's also tenuous. I've just texted the royal GP network who are astounded—pleased but astounded—that this is now an SOP flip-flop from the Government. So I would suggest that key stakeholders haven't actually been involved.I want to talk to SOP 159—an SOP on behalf of the National Party—an insertion into clause 7 Part 1 which seeks to recognise that the only democratic utility in health is health need. It can only ever be health need. To choose anything else including a Treaty response as the foundational principle to our health system is to actually invite inequities and unfairness that daren't be imagined. If Māori allow anything other than health need to be at the core of our health system then they'll be doomed to a fate that chooses a Treaty response today but the depths of one's pockets tomorrow and one's value to society the next day. Do not be swayed by strangers bearing gifts. Meningitis doesn't care about a Treaty response. Meningitis is agnostic to party colours age colour gender or race. It is simply an urgent health need that trumps all else.This SOP 159 acknowledges the other principles set out in paragraphs (a) to (e) but affirms the primacy of health need above all other principles. I absolutely acknowledge—and myself and my team will bring every skill we've ever learnt to address—the inequities that Māori have in the health domain. They are true; they are real. But they best sit under the principle of health need under which it turns out Māori have the highest health need for nearly every single metric you want to choose. Ethical issues of distributive justice talk about how scarce resources should be ethically distributed. In this context all paths lead to health need. I encourage the Labour Party to support this SOP 159 and I challenge the Labour Party to vote down a health system that is not funded on health need. Thank you Madam Chair."