Reports — Inquiry into Improving Child Health Outcomes and Preventing Child Abuse with a Focus from Preconception Until Three Years of Age (Volumes 1 and 2)Text is incorporated into the Bound VolumeReports — Inquiry into Improving Child Health Outcomes and Preventing Child Abuse with a Focus from Preconception Until Three Years of Age (Volumes 1 and 2)[Sitting date: 10 December 2013. Volume:695;Page:15457. Text is incorporated into the Bound Volume.]ReportsInquiry into Improving Child Health Outcomes and Preventing Child Abuse with a Focus from Preconception Until Three Years of Age (Volumes 1 and 2)Dr PAUL HUTCHISON (Chairperson of the Health Committee): I moveThat the House take note of the report of the Health Committee on the Inquiry into improving child health outcomes and preventing child abuse with a focus from preconception until three years of age. Thank you Mr Assistant Speaker and also the Business Committee for agreeing to this historic debate on our report. The timing of the debate—just before Christmas which celebrates the birth of arguably the world’s greatest child advocate reformer and philosopher—is more than fitting. It is almost immaculate.May I acknowledge and thank all my colleagues from parties across the political spectrum who have worked hard to achieve a consensus over a range of extremely challenging issues from reproductive health to optimal maternity care and from the socio-economic determinants of health and poverty and political leadership to an all-of-Government approach to improve nutrition and prevent the impending burden of long-term chronic diseases. I have really appreciated the thoughtfulness and contributions of Kevin Hague Annette King and many others who though we are miles apart on many political issues see improving children’s health especially in the very early years as a no-brainer. Some might say that our recommendations could have elements of nanny State but I would argue that from a libertarian perspective it behoves every parent aswell as the Government to do everything they possibly can to ensure all children have the chance to achieve their full potential but as adults to be expected to exercise individual responsibility. May I sincerely thank all the submitters and expert witnesses who so willingly and passionately assisted us with this inquiry as well as the Prime Minister the Minister of Health Tony Ryall and my colleagues in the National caucus who agreed to initiate the inquiry in the first place.We asked the Government to put more focus on and investment into the very early years—preconception to 3 years—because the evidence is overwhelming from science education health justice and economics that very early high-quality care and nurturing in a child’s life gives the greatest chance of that child achieving their full potential and leading a long and productive life. This is an investment approach from the work of Nobel laureate economist James Heckman: the rate of return for the dollar spent on a child is far higher the earlier the investment is made. He said: “The longer society waits to intervene in the life cycle of a disadvantaged child the more costly it is to remediate disadvantage.”This is a proactive preventive whole-of-Government approach that insists on a scientific evidence base and it complements the very important work the Government is doing on the Children’s Action Plan for vulnerable children as well as in early childhood education. We produced a graph demonstrating that a large proportion of Vote Health is spent in the last few years of life. An immediate reaction was: does this mean we would be taking away from the elderly? The reverse is the fact which is that by getting things right from the start of life the quality years of life are extended.The reality of how best to improve the effects of child poverty and the socio-economic determinants of health has different political approaches. As Professor David Fergusson cautioned the committee poverty is relative. Pouring money into a dysfunctional family materially rich or poor may give no benefit unless the interventions are evidence-based are made as early as possible and are associated with the right incentives and reciprocal responsibility.Our report has 12 major recommendations and 130 detailed practical recommendations across a spectrum of areas. We are calling on the Government to take this package very seriously to take it in its entirety and to not just pick up the easy issues.About half a century ago outcomes for New Zealand children were near the top of the world’s. Sadly this has eroded substantially. I cannot think of any New Zealander who would not agree that improving children’s outcomes as well as the economy should be right up on the political agenda in election 2014. Our childhood investment approach is a win for children a win for adults a win for the economy and a win for New Zealand. Thank you.Hon ANNETTE KING (Labour—Rongotai): Can I also begin by thanking the Business Committee for agreeing to this historic debate but also historic report because in my time in Parliament I have not seen a report that has had the agreement of all parties that sat on an inquiry. It has come about by us coming together with a lot of consensus concern and common sense—both economic common sense and social common sense. I think it has come about because we accept that here in New Zealand we really have reached a crisis point when it comes to the future of our very young children. It is timely also that we have our leaders over in South Africa attending the funeral of Nelson Mandela. One of the things that he said in very recent years was this: “We cannot waste our precious children. Not another one not another day. It is long past time for us to act on their behalf.” What I think this report is doing is saying it is time for us across this Parliament to act on behalf of the very youngest and most vulnerable in our society.I want to thank Dr Paul Hutchison as chair of this inquiry for leading in a very able way. I have found him to be a very compassionate man and he will be leaving a legacy for future Governments with this report. I can tell Dr Hutchison that I look forward to implementing it after the election next year. I also commend the members of the committee. You know the stories of politicians that all we do is bicker and fight can be dispelled by the work that went into this inquiry. It is about improving child health outcomes with a focus as Dr Hutchison said on preconception through to 3 years of age. It came about after many many submissions many discussions and a lot of expert advice.The result of all that work is a report based on the best scientific evidence available both here in New Zealand and internationally. In fact I believe that Professor Sir Peter Gluckman would be very proud of the work that we have done because this is an evidence-based inquiry and report. What it recommends is that the Government—any Government—in the future put more focus on and investment into children from preconception through to 3 years of age. As it states it is a policy that is backed by science by equity and by ethics as well as by good sound economic sense.The evidence is very strong that we ought to be investing into these very early years. It is fundamentally important to a child’s health outcomes. We also know there can be great gains and cost saving if we as a country are prepared to invest into effective evidence-based early intervention.Dr Hutchison mentioned James Heckman. He is a man who has done a lot of groundbreaking work on the quality of early childhood development which has proved that there are great economic gains by investment into those very early years. I like this quote from him. He said: “The real question is how to use the available funds wisely. The best… policy prescription: invest in the very young and improve basic learning and socialization skills.”There are 12 major recommendations and we cannot go into them all today. But I would like to just mention quickly two very important ones: the need for leadership and an integrated children’s action plan. This recommendation in the report says that the Prime Minister ought to accept the formal role of developing and implementing a whole-of-Government inter-agency action plan. It would also include monitoring outcomes and annual or biannual reporting of progress and the report said that there was a need to have a cross-party approach on the key recommendations. That I have to say was one of the things that was in our children’s policy at the last election: a Minister for Children a Ministry for Children and a priority on an action plan. This has been accepted in this report and I look forward to your seeing it in our policy again at the next election.The last thing I would like to say is on the recommendation to address the social and economic determinants of health and well-being. It is very important to address the disadvantage that many of our children in New Zealand face. Thank you for this opportunity to support a very good inquiry.Dr JIAN YANG (National): It is a great privilege to speak on the report about the inquiry into improving child health outcomes and preventing child abuse with a focus from preconception to 3 years of age. I would first like to commend Dr Paul Hutchison chair of the Health Committee for his outstanding leadership in the conduct of this inquiry. Dr Hutchison demonstrated his extensive knowledge of the New Zealand health system and his unfailing commitment to the inquiry. Without his leadership knowledge and commitment we would not have been able to produce such a high-quality and far-reaching report.This is the very first inquiry that I have participated in as an MP. I have learnt a lot. There were four doctors on the committee initially including Dr Paul Hutchison DrJackie Blue Dr Cam Calder and myself Dr Jian Yang. Dr Paul Hutchison used to say that I was the real doctor but the fact is that the other three doctors are genuine medical doctors; I am not. I have a PhD but know little about the New Zealand health system and medical issues. I have experienced a steep learning curve. This inquiry has helped me tremendously.I also learnt a lot about our democratic system. We had a large number of submissions and hearings from governmental departments institutions NGOs and individual citizens. I would also like to emphasise that the inquiry adopted a science-based approach.The inquiry makes 12 major recommendations and 130 detailed recommendations. Some major recommendations are to research the cost-effectiveness of early intervention programmes from preconception to 3 years to set a national health target for all women to have an antenatal assessment within the first 10 weeks of pregnancy to make sexual education mandatory in all schools and to increase access to long-acting contraceptives. The Government is currently considering the recommendations of the report. The response will be announced next year.The inquiry and its recommendations build on the work the Government is already doing. Young New Zealanders are getting a better start in life. A record 90 percent of 8-month-olds are fully immunised—a huge increase on only 67 percent of 2-year-olds under the previous Government in 2007. We remain on track to have 95 percent of 8-month-olds immunised by 2017. Ninety-five percent of children under 6 have access to free doctors visits day and night 7 days a week. We have insulated 235000 homes helping people to live warmer drier healthier lives and over 40000 children are participating in the Rheumatic Fever Prevention Programme. Budget 2013 is investing $24 million into rheumatic fever prevention.A further amount of $21.3 million is being invested to boost well child services. This will deliver an extra 54000 visits to around 18000 mothers who need this additional support. This means on average three additional well child visits up to the first 2 months of a baby’s life. Budget 2012 provided $1 million over 4 years for financial assistance for beneficiaries to access long-acting reversible contraception. We have also delivered 1300 more fulltime-equivalent doctors and 3000 more nurses.There is always more to do and we will continue to invest in our health services as part of our commitment to deliver better public services. Five years on we are proud to be delivering better sooner more convenient health care for New Zealand families. As a Chinese immigrant I tend to see New Zealand as paradise. We can work together and make our country an even better place for our children. Thank you.SUE MORONEY (Labour): It is indeed an honour to rise and speak in this debate on the excellent report from the Health Committee into improving child health outcomes. I particularly want to congratulate Dr Paul Hutchison on spearheading this very comprehensive approach and leading a multiparty approach to dealing with the issue that we should all be very concerned about in this country: improving child health outcomes. I want to recognise and acknowledge all the members of the select committee. I was not on the select committee but certainly through our Labour team of Annette King Iain Lees-Galloway and Louisa Wall I was able to have input into this report through the very good consultation that they undertook with Labour colleagues on the issue.It will be no surprise to anyone in this debating chamber that the part of this report that I want to spend a few minutes talking about is in fact the part that talks about paid parental leave because I do believe that this is an important factor for New Zealand children. Certainly the will of this Parliament and the will of the New Zealand public is that we make progress on extending paid parental leave. I want to acknowledge—and Ithink that this report from the Health Committee probably has something to do with it—the approach that I had yesterday from the National Party. It offered to extend the report-back date of my bill the Parental Leave and Employment Protection (Rate of Parental Leave Payment) Regulations Bill and to extend paid parental leave to 6 months to enable discussions to take place about how we might move forward on that issue. I think that really is in the spirit in which this health report was brought together as well—that we can work in a multiparty way to make progress on issues that are of importance to children and their families. So I welcome that.I note that this report also looked into the issue of paid parental leave and did not quite come out with the recommendation around extending paid parental leave to 6 or 12 months. But it certainly did acknowledge that it had many submissions asking for exactly that. I think it is important for that to be acknowledged in the report. The recommendation of the report is in fact that the Government considers the possibility of providing more support for vulnerable women in the post-natal period to allow more opportunity for mothers to bond with their babies.I applaud the select committee for that because I think that that was right and proper. In the section of this report called “Social economic determinant of health and wellbeing”—and I think that that is the right place the exact right place to discuss paid parental leave—it chose to focus on the parents who are most vulnerable. It also correctly identified—and this is an issue that is close to my heart as well—that under our current paid parental leave laws some of the most vulnerable families miss out on eligibility. Those in seasonal and temporary employment are often the most vulnerable families and our current paid parental leave laws do not extend coverage for paid parental leave to those families. I certainly want to work with the Government to make progress on that issue alongside working with the Government on making progress on extending paid parental leave to 6 months.I note that there was a submission from the Ministry of Health and advice from the Ministry of Health about breastfeeding and whether extending paid parental leave had anything at all to do with extending exclusive breastfeeding rates. I am not surprised to see that the Ministry of Health does not see a link because it has told another select committee that I am sitting on exactly the same thing. However how does the Ministry of Health explain the figures that it has not even bothered to gather itself? It relies on the figures that have been gathered by Plunket. Plunket is of course an organisation with a very fine reputation and I am very happy to rely on its data—the Ministry of Health does also. But the figures show that since the year 2000 the 3-month exclusive breastfeeding rate has been increasing by roughly 1 percent per year. Then suddenly in the year 2003 it leaps by 3.2 percent—three times more the increase in breastfeeding rates in the year 2003.Iain Lees-Galloway: What happened in 2003?SUE MORONEY: Ask ourselves: what happened just prior to 2003? The Labour Government introduced paid parental leave at 12 weeks. That is what happened in 2002. Of course the exclusive breastfeeding rate increased by three times the amount in the following year. I ask the Ministry of Health whether that is not evidence enough. But I will leave that for a debate on another day because I do believe that what the Health Committee has done is absolutely moving in the right direction. I would be a little more challenging of the Ministry of Health on its assertion that breastfeeding rates are not affected by extending paid parental leave to 6 months. But again I reserve my right to discuss that at length on another occasion. Thank you.KEVIN HAGUE (Green): It is my pleasure—my genuine pleasure—to take a call in this debate on the report of the Health Committee. I want to begin by thanking our officials from the Ministry of Health all of those who made submissions—there weresome extremely good submissions and there were some not so good—and also those who gave us advice. I think particularly about those advisers and officials whom we went back to time and again to get it right. This was a long inquiry and I believe the report that has emerged has been a comprehensive one.There is something about children that perhaps has enabled the extraordinary cross-party approach that we have been able to take in this report. I think it may be because when we consider children up to the age of 3 and think about all of the things that might go wrong in their lives to that point nothing is ever the fault of those children. So whichever political party whichever political philosophy we come from we are able to agree on the need for us to do things that will make the lives of those children better and we were able to do so.One of the abstractions I guess that we made in this report was a recognition that in order to make the lives of those children better we could not focus solely on services targeting those particular children; we actually also needed to look at almost a life course approach recognising that the circumstances and the lives of the adults in the lives of those children have a profound effect on those kids. We also recognised and it is woven right through this report that the impact of the wider environment—the social environment the economic environment the physical environment—that those kids live in actually has a profound effect also.We had an interesting approach to building this report each of the members of the Health Committee taking particular chapters. The particular ones that I put effort into were around sexual and reproductive health and around nutrition and obesity-related disease. I am certainly proud of those chapters as I am of the whole report. It seems extraordinary to me that we have for example allowed until this point a situation where we know what best-practice sexuality education looks like in schools and yet we have not insisted that all schools implement that best-practice education. I think we are now ready to move on.In relation to obesity and obesity prevention I think one of the things that we learnt going through this inquiry was something that we remark on in the report which was that there is no silver bullet—not one that we are aware of anyway. There is no intervention for which there is comprehensive evidence of success. I draw on the comments Dr Hutchison made in his opening contribution in this debate around what Heckman’s analysis tells us about the importance of early intervention in the life of a child in order to have the greatest impact. What that says to us is that when we become aware of an issue the sooner we can intervene in that the better. What that compels us to in so many of these issues is an understanding that we will not have perfect evidence but that the urgency of the issue compels us to act in the absence of perfect evidence and to gather the evidence as we move on so we implement great evaluation frameworks around the things that we do.I want to finish by commenting on the extraordinary step of this debate in the House. I thank the Business Committee—the extraordinary consensus of the committee. I thank in particular as others have done our chair of the Health Committee Dr Paul Hutchison because his commitment has enabled an extraordinary result as we have seen by the universally positive responses of the news media of the specialists and of the Children’s Commissioner to our report. This is a great report. I look forward to the Government implementing it.SCOTT SIMPSON (National—Coromandel): It is a great pleasure and a privilege to rise in support of Dr Hutchison’s motion to debate this report of the Health Committee. So many people who watch the proceedings of this place often criticise members in it for their partisanship for their lack of detailed analysis of issues of the day for their pettiness and sometimes for the shallowness of the debate that takes placehere. So as a new member with no particular expertise in health matters to find myself sitting on the Health Committee and participating in this very full inquiry came as something of a very pleasant surprise to me. As a new member I found that a select committee process can work to achieve a significant historic and very very important outcome for the future of our nation not just for the young people but for the whole nation. It is a rare and special privilege indeed.Without having any particular health experience other than as an occasional user of the system I found some of the information that was presented to me to be overwhelming in its compelling nature and to be so logical and sensible as to be undeniable in terms of its capacity to be accepted introduced and acted upon. The work of Nobel laureate James Heckman was particularly compelling. The evidence is overwhelming that investment made in the very early years of life is an investment made in the whole of life. That is not only a benefit to individuals but an absolute benefit to us as a society and a nation. Dr Hutchison is completely correct when he says that that does not mean there need be any less focus or spending on the health needs of those who are at the other end of the life cycle.This report has been exceptionally well received as Kevin Hague indicated in his contribution to this debate. The fact that it has been so well accepted and acknowledged by all parties in the House and indeed the media the public and health professionals around the nation is I think an absolute credit to Dr Hutchison and his contribution to leading this work. Without his vigour and enthusiasm for this project I do not think that we would now be debating this matter in the House.No child deserves a bad start in life. It is often said that a child of one is a child of all and then it is also said that investing in children pays a dividend in good and productive citizens. These are mantras that are often touted around the place without any careful analysis of what goes behind them in terms of actually achieving a practical outcome and turning mere slogans into something meaningful and beneficial to individuals and society. So to have us here in this Parliament of New Zealand today debating a unanimously agreed report of the Health Committee on such an important topic is indeed a historic and momentous occasion.This report has been very long in its gestation. Public submissions closed in May 2012. The report is far-reaching. In fact there are actually two versions of the report. There is the full report and then there is sort of a “report light”. I commend that those who want to take a view of it without getting into the real nitty-gritty of it read the “report light”. It is very compelling. It is an easy read. It is absolutely logical and coherent and it makes an overwhelmingly compelling case for the 12 major recommendations and the 130 more detailed recommendations that the committee has presented.It is an absolute privilege to have sat on this committee during the course of this inquiry. I just wish that more of our fellow country folk could see the work that was done on that committee. They would understand that actually the work of this Parliament occurs in weird and wonderful ways often in ways that do not meet with public approval but that in this case we can all as members of Parliament be enormously proud of the work that this committee has prepared. I commend the motion to the House.BARBARA STEWART (NZ First): I am very pleased to rise on behalf of New Zealand First to speak to this report. First I have to congratulate all of the members of the Health Committee on the substantial report that we wrote under the excellent leadership and chairmanship of Dr Paul Hutchison who I must say spent many hours ensuring that the committee was on track encouraging the committee to review the submissions and keep to the topic and ensuring that the recommendations that we weremaking were as realistic as they possibly could be and as perfect as they possibly could be. So thank you Dr Hutchison for your patience in that area.Also we have to give thanks to the select committee staff for their tireless work on this massive project. Thank you to the submitters the advisers and the many others who willingly and passionately gave of their time to ensure that the recommendations were achievable and realistic.It has been great to see a Health Committee report acclaimed by so many organisations and so many people including in editorials and various publications. The fact that there was general consensus within the committee shows that we wanted the best for New Zealand children regardless of our political affiliations.This report should provide a signpost for many years to come. We know that it is very important to invest in the early years and of course there have been very few reports written for this age group. The goal must be to ensure that every child has the opportunity to reach their full potential. A good start in life should pay dividends when school age is reached and further on. I am reminded of the words of my former late colleague the Hon Brian Donnelly who used to say on a regular basis that the quality of the children we leave for the future determines the quality of that future and this is an instance where it is absolutely accurate.One of the areas that I am very passionate about is oral health and I will always stand up for that area. I know that poor oral health affects learning self-esteem development and overall well-being. Dental decay is one disease that is chronic here in New Zealand but fortunately it is one of the most preventable in all age groups. Nothing is sadder than seeing the struggle that children have when they go to school and are trying to learn to read with no teeth. It is difficult to participate in classroom activities. Communication is very very difficult. It generally results in a degree of isolation from their peers and no child should have that. The eleven recommendations that we made in the oral health section are achievable without a huge financial input by the Government.One issue that divides the community is the issue of the fluoridation of water. We have traversed that in this particular report and have come up with some recommendations that hopefully the Government will ensure come into being.The ongoing monitoring of preschoolers who miss scheduled dental appointments is really necessary as this hard-to-reach group cannot be allowed to continue to slip through the cracks. Some administrative factors such as defining dental neglect so that it can be managed accordingly and further defining ethnicity in the category of “other” for children are absolutely essential to identify any groups that are at risk. In this section we attempted to ensure that the recommendations once implemented would significantly reduce the risk factors associated with children’s oral health and dental caries. Our dental therapists do a massive job often in difficult circumstances and we hope that this section assures them that Parliament is keen to support the hard work that they do.I look forward to the Government’s response to the recommendations.PAUL FOSTER-BELL (National): It is a pleasure to take a call in this debate on the Health Committee’s report on theInquiry into improving child health outcomes and preventing child abuse with a focus from preconception until three years of age (Volumes 1 and 2). In continuing with the bipartisan theme of this debate and in the seasonal spirit of goodwill that seems to be emanating from the House at the moment I want to acknowledge all members of the Health Committee—not only the National ones and the excellent chair of the Health Committee Dr Paul Hutchison but also the Opposition members and cross bench members who served on the committee. In particular can I pay tribute to the former committee member Dr Jackie Blue who I alsosucceeded as a list MP and whose place on the committee I took up in May. I know she made a significant contribution to this report before I arrived and I would like to thank her for her service.This is a substantive and highly substantial inquiry with a hefty series of hard-hitting recommendations. The committee believes if implemented it will have a real impact on improving health outcomes and lowering abuse rates which tragically remain far too high in this country.Given the time constraints of this debate I want to single out one or two areas in which I believe there is particular importance. We report in the inquiry that immunisation is the most effective evidence-based way to prevent the spread of infectious diseases that previously caused severe morbidity and mortality rates. The committee had already undertaken considerable work in this area.A report was published in 2011 on how to improve completion rates of childhood immunisation so it has been very satisfying to see that immunisation completion rates for New Zealand children increased from a totally unacceptable 67 percent of 2-year-olds in 2007 to over 93 percent in 2013. The Minister of Heath the Hon Tony Ryall is to be congratulated on setting these high targets and on his unequivocal and unrelenting support for district health boards to deliver this essential prophylactic against serious life-threatening misery-creating and often very expensive communicable diseases.Twelve district health boards have reported that their Māori completion rates are now even higher than those for non-Māori. This is a historic achievement and one that other countries with disadvantaged indigenous communities could do well to emulate. The hardworking teams of professionals often using innovative methods to access hard-to-reach children deserve our gratitude for delivering on this essential target.Although the target of 90 percent of 8-month-olds completing their primary course of immunisation by 2014 is already met and a higher target of 95 percent of 8-month-olds by 2017 has been set there are still many children who are not immunised and to achieve this higher target New Zealand will need to make a strong commitment to children’s immunisation. We have done well but we cannot relax and we cannot sit on our laurels yet.This inquiry makes a number of recommendations for further actions in this area. We recommend to the Government that it requires the enrolment of children in general practitioner health services before discharge from the post-natal ward to ensure that they continue to engage with primary care and also Well Child services. We have suggested the continued implementation of the Ministry of Health’s action plan to enrol engage promote and monitor to achieve these higher immunisation targets. We recommend further improvements to local monitoring and engagement among health professionals and we support more choice for young people by allowing youth health services to advise on and manage vaccinations especially for rubella and human papilloma virus. We also back the implementation of the advice of the Immunisation Advisory Centre regarding hard-to-reach children and populations. We believe that these combined with some of the other recommendations in the field of immunisation will underpin a truly first class set of outcomes in this area and enable New Zealand to become a world leader in preventing the spread of infectious diseases so that we can ensure that the lives of the youngest members of our society are not blighted by such diseases.I would like to add my thanks to the thanks of other members to the officials and the advisers and in particular I thank our Health Committee staff Arwel Charlotte and Tina-Marie who assisted with the drafting of this report. I believe that this report’s recommendations from maternal and infant nutrition through to early childhoodeducation from oral health to alcohol and tobacco are very worthwhile. I commend it to all members and wish you Mr Assistant Speaker a very merry Christmas.IAIN LEES-GALLOWAY (Labour—Palmerston North): The opening paragraph of the Health Committee’sInquiry into improving child health outcomes and preventing child abuse with a focus from preconception until three years of age states: “The major recommendations of this inquiry ask the Government to put more focus on and investment into the pre-conception period to three years of age and take a proactive health-promotion disease-prevention approach (based on scientific evidence) to improving children’s outcomes and diminishing child abuse.” That is the central theme of this report a report that has received support from across the House. In the spirit of bipartisanship that is on display today I want to gently—gently—point out that to achieve the aims stated in that first paragraph will require a significant change in policy from that which has been currently implemented by the National-led Government. I want to look at the current health targets and relate them to the aims of a proactive health-promotion disease-prevention approach to health.First of all we have shorter stays in emergency departments. That is a target focused on what you do after a child becomes ill or they are injured. It is not focused on preventing illness or injury. Improved access to elective surgery actually does not affect children all that much but again it is what you do after someone becomes unwell. Shorter waits for cancer treatment are again not about preventing cancer from happening but about how we respond how our health system is reactive to illness. There is increased immunisation and this is the one place where the Government can pat itself on the back. I notice that this is the one thing that the National Party members hang on to for dear life because it is the one place that they can be proud of. But I would point out that what is interesting is that in the fight against rheumatic fever one of the big objectives for the Government is to find a vaccine for rheumatic fever. That sounds to me like it is trying to find a vaccine for poverty. What we should be doing is preventing rheumatic fever by ensuring that our children grow up in warm dry homes and have good nutrition. The target for better help for smokers to quit again is what you do after someone becomes a smoker; you then try and help them quit. Having more heart and diabetes checks is not about preventing cardiovascular disease or preventing diabetes but measuring it finding it and then trying to do something about it. These targets reflect a health system that is reactive not proactive.It is fantastic that this evidence-based report that has support from all parties in Parliament promotes a proactive disease-prevention approach to our health system one which is quite different from what we have at the moment. Chapter 5 of this report refers to the social and economic determinants of health and well-being. Recommendation 18 says “We recommend to the Government that it continue to actively consider the recommendations inSolutions to Child Poverty in New Zealand: evidence for action and at least establish an overall action plan for reducing child poverty or Better Public Service targets …” for child poverty. As has been well debated in the House over the last week and the preceding weeks there is no target for this Government to reduce child poverty. There is no target for reducing child poverty and I am pleased that this report clearly recommends that we need a target for child poverty reduction.Finally I want to refer to chapter 5 which is about improving nutrition and reducing obesity and related non-communicable diseases. It says again that a health promotion approach directed through communities is what we need. We need a primary disease-prevention approach. It is sad that programmes like Healthy Eating - Healthy Action were cut by this Government because those are precisely the programmes that this report recommends. This is great report. It will be a report that future Governments referto and I look forward to its being fully implemented whatever Government is in place in the future.SIMON O’CONNOR (National—Tāmaki): Mr Speaker—Hon Simon Bridges: It’ll be a National Government.SIMON O’CONNOR: Indeed it will be a National Government and it is a National member - led inquiry from which these results have come about. But I think there has been a great collegial atmosphere in the House today and it is a pleasure to rise and to speak to this report. Importantly I speak as a non-member of the Health Committee but I will come to that.I do want to acknowledge as colleagues across the House have done Dr Paul Hutchison who has the gravitas the energy the passion and the vision to have led this inquiry. Listening to colleagues speaking I can see the support he has gained and garnered from members across the House—from Labour the Greens and New Zealand First—to make sure that this report is tabled before Christmas. As everyone has noted this report is something that is not only time-critical in its nature—it is a report an inquiry about pre-conception to 3 years of age—but in an area that we as MPs across the House want to address quickly and thoroughly across a wide range of areas. So I also take an opportunity to thank Dr Paul Hutchison for the work he has put in. We are all conscious here that his time by choice is coming to a close next year but what a legacy to leave New Zealand and our children.I mentioned at the start that I speak as non-member on this committee. I sit instead on the Transport and Industrial Relations Committee and the Education and Science Committee but I find it quite appropriate to stand up because to me as an MP outside of this committee this report this inquiry has stood out. From the moment it was tabled until it reached my desk it was something I was interested to pick up and read through not only the light version I say to my honourable colleague from Coromandel but the full version as well. It is the result of enormous hard work and it has been a pleasure to sit in the House during this debate to hear all members speak about their particular areas of passion.I think that what I have heard underlying those speeches is the absolute importance of human life the absolute value of human life from pre-conception to 3 years of age and the need to put in place all that we can to help young men and women and our children our tamariki to live a good and full life a life that we respect a life that we celebrate and a life that we in a community draw together. I have always been struck in my years studying philosophy that one of the things I was taught and learnt was that from the very beginning we are born into community. We are never born alone be it a son to a mother a daughter to a mother and so on. We are born into community. [Interruption] Some of my colleagues I think are trying to emphasise health—they want to get away to lunch. But what I am trying to emphasise here is the real and important place of community. I think this report from Dr Hutchison and others on the Health Committee is emphasising that real importance of community our young people in it and all the elements of support that are needed.So again I note that my colleagues across the House in particular are keen to celebrate health by having lunch. I think they want me to sit down but I want to end where I began by acknowledging Dr Paul Hutchison for his leadership his chairpersonship of the Health Committee. To all members of the committee I say well done—kudos. We look forward to a Christmas break and to coming back in the new year to put these recommendations into action.LOUISA WALL (Labour—Manurewa): Kia ora Mr Assistant Speaker. Thank you very much for the opportunity to contribute to this discussion about a Health Committee inquiry that will leave a huge legacy for our Parliament. I want toacknowledge the leadership of Dr Paul Hutchison in being the champion for children. I think that this inquiry report provides a template for whoever is the Government in the future to actually address what the heart of this inquiry was about. It was about improving child health outcomes and it was about preventing child abuse.What I want to highlight are some extracts from the report. One of the clear findings was that parents should be as healthy as possible prior to conception. I mean I think there is general agreement that in New Zealand we have a bit of a problem around conception. We have a bit of a problem about young people particularly engaging in sexual activity and not being in the right state to then be parents of the 64000 children who are born in our country every year. So one of the questions for me and for all of us was about who is giving birth to our children and where they are being born.I do also want to highlight that in parallel to our inquiry the Māori Affairs Committee has been doing an inquiry into the determinants of well-being for Māori children so I look forward to the recommendations in that report. To quote from the report: “Great effort must be made to ensure that Māori and Pasifika people have access to services and that those services are culturally centred.” I think actually that is one of the biggest challenges that we have.I would like to highlight two areas in particular. One is around sexual and reproductive health. The context I talked about earlier is really important because more than 40 percent of pregnancies in New Zealand are unplanned. So we do need a huge emphasis on sexual and reproductive health and well-being education for our children and it should be a priority. What this report does is say that we have to create young people who are aware and who are resilient. They go through biological processes that mean that they will engage in sexual activities. I think that it is in the best interests of all of us that our children and young people are doing that in a safe context where they have the tools to make decisions and also the tools to be able to grow up supported. So that is one of the areas I particularly wanted to highlight.The second area is around the national health target that says that for 90 percent of all pregnancies mothers should be booked in for antenatal assessment by 10 weeks’ gestation. I want to focus on where that recommendation came from because it was very specific. It came from an external review of maternity care from the Counties Manukau District Health Board led by Professor Ron Paterson. Why did the Counties Manukau District Health Board have this independent review? Well it had the independent review because between 2007 and 2010 2804 New Zealand babies died before reaching 28 days of age post-birth. In the Counties Manukau District Health Board that figure was 469 babies or 17 percent of the burden in that particular district health board.Why is it relevant? We have just under 9000 babies born in South Auckland every year and of those 50 percent are born to Māori and Pacific mothers. If we look at that 90 percent target what will that target actually achieve? It will mean that mothers have access to lead maternity carers and midwives so that we can assess mums we can help them prepare for baby and we can monitor their diet exercise and whatever else but firstly we will be able to help prevent these perinatal mortality statistics. Currently in the Counties Manukau District Health Board only 16 percent of mothers are receiving the treatment that they are entitled to.We need to ensure that we can identify the mothers who are at risk and that we can support them but overwhelmingly the biggest challenge that we have as a country is the distribution of our midwives. We may have 13.5 percent of the births but we have only 5.5 percent of the midwives. We are over 200 midwives short so I believe that this particular recommendation can make the biggest difference. Again I want to commend Dr Hutchison for his leadership. Thank you.LOUISE UPSTON (National—Taupō): I am very pleased to be the final speaker on this debate on the Health Committee inquiry. As my colleagues from across the House have done I want to commend my National Party colleague Dr Paul Hutchison for leading this very significant piece of work. Like my parliamentary colleagues in the House today I do recognise that this will be a legacy piece of work. The Government will of course be officially responding but I think it is a very comprehensive piece of work that has looked at the most critical years of a child’s life. We in this House all know that every single baby and child of New Zealand is precious and we need to do whatever we can to protect them and make sure that they have the best opportunities as they grow up.I think one of the things that has been successful in the work we are doing in Government now is to continue and increase the investment in health overall. If you look at other countries with the economic conditions some have struggled to kind of keep up their investment. So I think it is important that we continue to do that and to make sure that that spending is focused on exactly the areas that count.My colleague Louisa Wall talked about the fact that many of our pregnancies are not planned. If we think about parenthood I consider it to be the most important job on the planet and so many of our young New Zealanders are not planning that particular role. So I think that children who are born into those families need more support than they get currently. This was a common theme that came up when I was a member of the Māori Affairs Committee in its work on the inquiry into the determinants of well-being for Māori children. There are a number of recommendations in the report that look at the whole concept of contraception and of education—about making sure that unwanted pregnancies can be prevented in the first place and that we support those with planned pregnancies.It was interesting that my colleague Louisa Wall referred to the recommendations in the report specifically around that early pregnancy intervention because that is what I also wanted to highlight from Counties Manukau. If you look at an example from New Zealand in Counties Manukau less than 16 percent of pregnancies had had an antenatal check before 8 weeks. If you look at the equivalent in Sweden it is 90 percent. So you are kind of getting a double hit because some of those women who are presenting in Counties Manukau will be of Pacific Island descent and unfortunately the statistic there is that 86 percent of those are overweight or obese. So before that baby is even born there are additional risks presenting from a health perspective for things like gestational diabetes which then presents a lifelong challenge. The more opportunity we have to intervene early the more we should look at that.The fantastic thing about those early antenatal checks is that through a range of different agencies and groups working with mums and families other potential risks are then able to be identified. With programmes like Whānau Ora and some of the other work that we are doing inter-agency we are able to make sure that the services are wrapped round that mum and family before baby arrives. I think that is one of the most important things we can do. It very much mirrors the work that Paula Bennett is doing in the vulnerable children space. It actually joins up with a lot of the Government’s work at the moment and looks more specifically at some of these areas. In that antenatal area for example getting more of our mums presenting earlier in their pregnancies is one very simple thing that this report highlights would make a significant difference.I am very clear and I want to quote the Prime Minister in closing this debate today when he said: “The basis of a country is not its Government but its families.” I thinkthat is a very true note. I want to close my address today by wishing every New Zealand child and family and my parliamentary colleagues the best of the season’s greetings.Motion agreed to.