SuperGold Health Check Bill — First ReadingText is incorporated into the Bound VolumeSuperGold Health Check Bill — First Reading[Sitting date: 24 June 2015. Volume:706;Page:4749. Text is incorporated into the Bound Volume.]SuperGold Health Check BillFirst ReadingRt Hon WINSTON PETERS (Leader—NZ First): I move That the SuperGold Health Check Bill be now read a first time. I nominate the Health Committee to consider the bill. This as you will realise is a seriously non-controversial measure that should have the support of every sane and reasonable person in this House. We are proposing the SuperGold Health Check Bill as a common-sense cost-saving policy and preventative measure. Giving three free GP visits with the SuperGold card every year makes more than economic sense. It will save lives and precious health dollars. Globally according to Deloitte life expectancy is expected to increase from an estimated 72.6 years in 2012 to 73.7 years by 2017 bringing the number of people over the age of 65 to around 560 million worldwide. That is more than the 10 percent of the total global population and in Western Europe the proportion in 2017 will hit 20 percent. In Japan it will be 27 percent and what it will be here according to Statistics New Zealand is 16 percent but of course that is seriously dependent upon the wisdom or lack of it in terms of immigration policy.Bearing in mind that Deloitte also warned that pressure to reduce healthcare costs remains and is escalating due to Government debt and constraints on tax revenue and ageing populations a policy that makes medical social and financial benefit makes common sense. Today the price for a hospital bed per day in New Zealand is about $1243. That is a lot of money when the average price for a stay in hospital and the cost to the taxpayer is in the vicinity of $10000. This policy will cost about $69 million per annum based on the number of SuperGold card holders we have now. But it will be cost-neutral only if 1 or 2 percent of the SuperGold card holders use the three free visits and are kept out of hospital. Simply put keeping SuperGold card holders out of hospital will help to contain health spending.Grey Power has welcomed the policy applauding it in terms of the cost and suggesting it will be an incentive to get people to the doctor. Grey Power says there are many cases of elderly people putting off going to the doctor or declining to pick up prescriptions because of the cost. Just recently in the Sunday Star-Times it was reported that a huge premium rise is driving older people to drop private health cover just when they need it the most and pushing the burden on to the taxpayer. This is because the excesses are now between $2000 and $4000 per annum and if you bear in mind what these people get annually plus rates and every other cost this is not what they can afford. Bearing this in mind we want people out of hospital. The economics of preventive medicine simply put makes sense. That is what this bill is about.Even the Conservative Cameron Government in the United Kingdom has a National Health Service health check for people turning 65. The National Health Service points out that as we get older we are more likely to develop conditions that are rare in younger people—and this is under a Conservative Party Government in Britain. If it understands the need then why would we not? Economic modelling has estimated a saving for the National Health Services in the UK around £57 million over 4 years rising to £176 million over a 15-year period. I wish to table this at the end of this speech. But the lesson from the UK is that everyone benefits and there is a real benefit for the health budget.The great thing about this of course is that it will kick in in the 2016 Budget not now. For the individual New Zealander who takes up the three free GP visits the benefits will be huge in all respects: social emotional physical and mental well-being. A fair society is not a mean society. It must not be so mean that we ignore measures that will prevent seniors from sitting at home too worried about cost of a GP visit. We want to avoid the consequences that would arise. As we get older we become more susceptible to age-related issues. God knows over there I can see many examples already. A winter cough can easily lead to pneumonia—Hon Member: Don’t say that about Ron Mark.Rt Hon WINSTON PETERS: Well Ron is one of the fittest guys in this House. Hospital beds start to fill in winter as the elderly get hit by winter ills so any sort of preventative care makes economic sense. For families and friends the checks will reduce the pressure for them to act as drivers helpers and carers when older relations and acquaintances have secondary health problems. The dissenting commentary against the SuperGold Health Check Bill is from groups who want—and this is sinister—more public health dollars targeted towards the older and the poorer. Groups advocating means testing for three free GP visits go against the gain of hugely successful SuperGold card in this country. Bear in mind that we are talking about people who have paid some of the highest taxes—66c in the dollar—of any age group in this country’s entire history. The SuperGold card was introduced by New Zealand First in 2007 so that all New Zealanders turning 65 are recognised for a lifetime of contributing to society. Making it universal is simpler than hiring an expensive army of bureaucrats to regulate it—and do not forget; it was all about putting old bottoms on empty seats and removing the increased carbon footprint. Where better to place three free GP visits for over 65s than in the SuperGold card?We recall advocating free medicine or free doctors checks for children under 6 years of age. It was opposed back then but now is so supported by some enlightened members of the National Party that they want to deliver it next year to all primary school children. We have always said that there is much to be proud of when others adopt your ideas. Another sound reason for the Government to support this bill is economics. Finance Minister Bill English is constantly telling us he has to nip and tuck and cut everywhere to save dollars. So right here amidst his health-funding headache is an instant remedy. The Government support should be coming from Peter Dunne because back in 2008 he promised a free annual warrant of fitness check for seniors. New Zealand First is hopeful that National and United Future and the Māori Party for very very good reasons because of affordability will support this legislation. I know that some members here may have been told by caucus what they should do but frankly if they let the bill go to a select committee we would know what the rest of the country thought. As I know the Māori Party has always spoken out about looking after seniors. A simple scheme to keep them out of hospital must seem appealing. The Māori Party is dedicated it says to improving the lives of whānau and these checks will certainly do that.A general practitioner visit is so much easier to organise for the families in this country than the comings and goings required when a relative is in hospital. It is not just the $10000 per hospital visit; it is all the cost of relations in some cases because hospitals are so far away from many of our provincial populations which is in itself an enormous cost. We believe that the Labour Party and the Greens have got the picture and clearly will support this legislation and we are grateful for that. We believe that seniors who have worked and paid taxes for decades and have contributed to building the country to whom we owe respect and dignity should be honoured in this respect and it will not cost us anything. It will save us money. One sure way to make this happen is to provide the health care they need. Looking after our seniors is a lesson we can take from many countries especially those in Asia who elevate their senior citizens to a high status so that everyone is respected and is understanding of their needs.We commend this bill to the House. It makes economic social and medical sense and it is a way of putting a preventative health measure in place and to do it now. Thank you very much. I seek leave to table the NHS Health Check implementation review and action plan July 2013 from Public Health England.The ASSISTANT SPEAKER (Hon Trevor Mallard): I think I had better ask the member the question that the Speaker asks as to whether this is a document that has been downloaded from the internet.Rt Hon WINSTON PETERS: I have to confess it was given to me by my staff and I have got no idea how they acquired it but I do think given how far it is away it is very relevant.The ASSISTANT SPEAKER (Hon Trevor Mallard): On that basis I will put the question. Is there any objection to that document being tabled? There is no objection. It can be tabled.Document by leave laid on the Table of the House.The ASSISTANT SPEAKER (Hon Trevor Mallard): The question is—Simon O’Connor: Mr Speaker—The ASSISTANT SPEAKER (Hon Trevor Mallard): Simon O’Connor. I thought we were going to have a very short debate.SIMON O’CONNOR (National—Tāmaki): It could have been. You never know. It was a great phrase: “Timeo Danaos et dona ferentes”—I am not quite sure what the declension is in terms of the New Zealand First Party—beware Greeks bearing gifts. We have just heard from the other side that this is a no-brainer it will save money and it is easy. Well the National Party’s position is quite clear as is my own. We will not be supporting this bill and there are a number of good reasons not to do so. But as we start the debate around this bill there is always that usual suggestion of “Look let’s just take it through the first reading and let’s just put it to the select committee and have a discussion.”I am certainly one of the people who do not necessarily believe in just sending things to select committees for the sake of it. I think we can exercise some judgment prudently and early on in order to engage with this particular first reading of the SuperGold Health Check Bill. Any attempt to try to improve the health of Kiwis is worth engaging in is worth discussing but just because—[Interruption] They are yelling that we have to send it to a select committee. They forget that we have discussions before we come to anything like this and that we actually have a debate at the first reading to decide whether a bill is worthy of going forward. As I said at the start there is not really much need for this to go forward.The primary reason we do not support this bill—and those who understand health will understand this—is that ultimately this issue is about targeting and putting money and support into the most necessary places. Those of us engaged in health care—be it as the chair of the Health Committee or in my work previously—know that there is not unlimited cash for every desire and that we have to have priorities. We have also got to have some prudence around some of the arguments.One argument that the right honourable gentleman put forward is that people are getting older and therefore as ages increase we have to make sure that people do not go to GPs and to hospital. It does not really make a lot of sense because actually as people are ageing it does not really matter when they engage with the GP they will still ultimately for a lot of people end up in hospital or in residential care and the like. So it is not ultimately a saving further down the track. What we see as the main provisions of this bill—[Interruption] I have to say one thing I notice—the Opposition members are in excellent voice and will not need to go and see an ear nose and throat doctor. I am sure that through your vocal cord exercises here you are doing very very well.This particular bill the SuperGold Health Check Bill argues for three free GP visits. What we know already is that generally speaking those over 65 are not struggling to go to the GP certainly not in the same way that our younger people are. What we know already is that 95 percent of those over 65 are able to get to a GP at least once a year. [Interruption] Of course Opposition members are not terribly happy to hear that statistic so we should repeat it again. We would not want them to be hard of hearing. Of course if the Opposition members are hard of hearing I am pleased to tell them that the SuperGold card enhanced by the National Government enables them to go to the likes of an audiologist. If they also need some ophthalmological help I think that they can with the enhanced SuperGold card from the National Government get some ophthalmological help as well. I am not sure they do brain transplants—that is probably a bit too involved.The statistics are very clear that 95 percent of those over 65 years of age are able to access and are accessing a GP. In fact 80 percent—80 percent—of those over 65 years of age access a GP three times a year. So really you have got to ask what the problem is here. I know that in my own electorate this is not an issue. My electorate is relatively diverse. You go from the heights of Ōrākei down to the likes of Glen Innes. Not being a constituent MP the honourable member would not understand this—sorry; he has just become one. That is right! He has just become one so I am sure the member is going to tell me that he has all these people knocking his door down. Well actually I know from my own electorate that this is not an issue. Be it from Glen Innes or from Ōrākei they not demanding this. In fact what they are asking for is more focus on young people. Of course they might talk about Northland seeing that my family is from up that way—but in Northland they do not talk about this. In fact they are asking where the local MP is. Look the Government already has a wide range of support—Hon Member: They’re still looking for him.SIMON O’CONNOR: Still looking for him—that is right. What they are looking for is obviously support for the elderly and I think it is important to tell the House that there is already something called the Very Low Cost Access Scheme. That is around co-payments that people make and I know colleagues of mine will speak to that. We already have the high use health card and the community services card. Again those who are most in need regardless of age have access to this. Then there is the pharmacy subsidy card which is quite well used in my electorate which means that if you have over 20 prescription items in a year—that is about $100—your prescriptions become free after that.So the two primary messages I am trying to put across here are that first and foremost our elderly those over 65 are already accessing primary care and for those who are struggling there is a multiple array of support services already in place. I think it is also very helpful to note that the Government continues to be committed to the area of health. During the Budget speeches you would have heard about the extra elective surgeries that we are having a 47 percent increase there. We have recently announced a $47 million increase for dementia care. I know this is only a small part of health care for the aged but we understand the importance of that.We are also working on other technologies to make say getting your pharmaceutical scripts easier through the e-Prescription System. It is something really simple. When our aged or anyone goes to their GP the prescription goes straight to the pharmacist. Patients do not have to take a piece of paper. It is automatically being checked. It is better for the pharmacist better for the doctor and most important better for the patient. So ultimately this bill does not need to be implemented. The services are already being provided to the over-65s.I would suggest that this bill is a classic case of bribing people with their own money. I notice that the honourable member the Rt Hon Winston Peters talked about the high taxes in times past. If I recall correctly that member was in those Governments that had those very high taxes. In fact I think that the member may have been in a Government with my predecessor Muldoon when the Government was having the high taxes and so forth. The services are already there for those retiring. They are receiving good support be it though superannuation through governmental supports already for health care and importantly through the SuperGold card.One of the things that the right honourable member will be absolutely thrilled about is that often when I go into the retirement villages and residential care services in my electorate people will mention the SuperGold card and they are very very pleased that the Rt Hon Winston Peters introduced it which is great—it is always a positive way to start the conversation. What is excellent is that by the time I finish chatting with them they are thanking the National Government for turning the SuperGold card into something absolutely fantastic. So I think it is important to acknowledge the honourable member for starting the journey—the first step on the ladder. National proudly has taken it a lot lot further and we pay substantial moneys now—and rightly so—into the SuperGold card which is helping across a wide array of areas.So fundamentally this desire to extend it for this particular reason is really just political posturing if you will. As we said at the start this is not something that is well needed. The member himself costed this at about $69 million. I was going to say it was something between $64 million and $100 million a year. Is that really the costings that we need? Again I do not think we do. We have to be prudent with the health spend. It is the largest ever—just shy of $16 billion now under this Government—but every dollar counts. In fact we heard that very clearly today from the Minister when we were discussing the estimates—we need to be prudent with every dollar. So targeting up to $100 million towards those over 65 to go to their GPs when they are already going to their GPs or are in residential care or villages and are accessing primary health care is not a prudent spend particularly when you contrast it with what every medical professional—GP or specialist—will tell you which is that we need to target our young people.The Health Committee before me did a fantastic piece of work on the period of time from pre-conception to 3 years old—that is where the most efficacious use of our health care spending is and where we need to focus. It is one of the reasons why we as a Government were happy to have free health care for under-sixes and why most recently we are moving towards having free health care for those under 13. That is where the efficacious spend is and not in better health outcomes because importantly they are the ones not engaging with primary health care in the way that they should.So I want to conclude by reiterating the National Party’s desire not to vote for this bill. We acknowledge the great intention of the member in bringing this here—for political reasons or otherwise. Sometimes a SuperGold card can help you get cheaper tyres hearing checks and so forth but a SuperGold card cannot prevent someone from coming up with ideas that are a bit shoddy.Hon RUTH DYSON (Labour—Port Hills): Well that is 10 minutes of our lives that we will never get back. What a tragic waste of space—absolute waste of space—from the patronising heights of Orākei telling us that older people do not need better support to go to a doctor. Thank you very much for that contribution Mr Simon O’Connor. I am so pleased it is on the public record and I will enjoy knocking on the doors of SuperGold card holders in your electorate and making sure that they have heard your contribution to this debate. I want to commend the Rt Hon Winston Peters for bringing this bill back to the House. I think it is a very good bill and I am delighted to be supporting it.The member Simon O’Connor who tragically is the chair of the Health Committee still I think said that National would do anything to improve the health of New Zealanders—any proposal would have good discussion. Three minutes into his speech the first speaker from National said that he was going to vote against this bill. One of those statements is not true and perhaps neither of them is true but you cannot give a good idea any consideration unless it goes from this House to a select committee and that is where it should have gone. The member also made I think it was a sort of Ian McKelvie - type of contribution. Remember Ian McKelvie a couple of weeks ago said that he was wondering whether there was any difference between people-trafficking and sheep rustling? Ian McKelvie said that in the House. Mr O’Connor said: “It doesn’t really matter when old people go to the doctor. You know if it’s early on in their illness or later on they will end up in hospital anyway.” It was an extraordinary comment. It is on the public record. It is in Hansard. It will be another one that I think will need to be distributed.Why do we not get some facts on the table to consider in this bill? It costs about $30 to $35 for a person who is over 65 to go to the doctor—that is the average across New Zealand. Over half of over-65-year-olds in New Zealand are totally dependent on New Zealand superannuation and if you go up to the next 20 percent 80 percent of their income is from superannuation. We can be very proud of our level of superannuation compared with many countries but it does not leave a lot left over. It does not leave a lot left in your pocket every week and if you have had something big break down—whether it is a fridge a washing machine or a car or the roof is leaking and you need some big expenditure—that would chew away at your savings pretty fast. If you have been on a low fixed income for your entire life and then you go on to superannuation then going to the doctor might just be that expense you cannot afford. We know that if frail people are sick and do not get treatment they end up in hospital and who wins from that? Who wins from a person with a preventable illness not being treated and ending up in hospital? I cannot see any winners out of that.Simon O’Connor clearly can see a winner out of having someone who is 75 who has contributed all their life to the good of our community in one way or another who cannot afford to go to the doctor ending up in hospital. He said: “That doesn’t matter. They would have ended up in hospital at some stage anyway.” Three doctors visits a year for an over-65-year-old is about the equivalent of a quarter of one hair straightener at the Ministry of Business Innovation and Employment. For every pensioner who has three doctors visits a year it is about a quarter of a hair straightener. I think that for every person who gets early treatment and who ends up not getting worse not being sick not being hospitalised or just not being really unwell actually—that is bad for them even if it does not cost us money—it is a good investment.I would not often say this to the Rt Hon Winston Peters with regard to his view on people for superannuation but I think he could have gone further in this bill. I would like to see him go further. Access to primary health care should be something that this House should strive for so that people who get unwell get access to a doctor or a nurse as early as possible. If it is money that is the barrier then we should ask what the priority is for spending of this Government and this Parliament. I think older people should be quite high on the list. They do not have an opportunity to make additional money often. They are dependent on what is compared with all of us in this House a low fixed income. This bill would have given them better quality of life and reduced our health expenditure. With just 1 percent of uptake of these people not going into hospital it would have been financially neutral. I urge the Government members to think again support old people and support this bill’s referral to the select committee.BARBARA KURIGER (National—Taranaki - King Country): The intention of this member’s bill that we are speaking on tonight would be to provide three free doctors visits for people over 65 which in itself is commendable but it is very unnecessary and very expensive. Over the next 10 years one of the challenges facing the public health service will be the increase in the population of people aged over 80 years.The member Ruth Dyson stood up earlier and said that the esteemed chair of the Health Committee had said that these people do not need to be supported. What the chair of our select committee actually said was that these people are being supported anyway because under this Government those over 65 who struggle to pay to go to the doctor are already supported and as he also said that is the group that is less likely to be deterred from going to the doctor. We need to be more supportive of our younger people.Let me tell you that given that 80 percent of the people who are over 65 now are actually going to the doctor at least three times a year it is unlikely to significantly increase the number of GP visitations or to decrease the number of hospitalisations. So when we think in the context that over the next 10 years we will be worried about the costs associated with the number of people over 80 years old imagine how much that measure is going to increase the cost to the system. I think that despite the fact that you can retire at 65 some people who are well over 65 are actually quite fit and healthy.On Monday I did a volunteers day out in the electorate with a number of different groups. For part of that day I did Meals on Wheels. The couple who so kindly offered to take me out and around to do Meals on Wheels were celebrating on that very same day their 58th wedding anniversary and here they were actually out delivering Meals on Wheels and they were going to a Lions meeting that night. I cannot thank enough the elderly people in our community who get out and volunteer and care for each other. That actually in itself gives them company and keeps them fit and healthy. I also had another man in my electorate who is 80. He says to me that he used to drive the elderly people to their medical appointments. Now he is actually driving his peers and it is an honour for him to be able to get out and do that.For those who struggle to visit a GP there is a wide range of support available and that includes high-user health and community services cards and it includes a pharmacy subsidy card. This policy as our select committee chair said is likely to cost between $64 million and $100 million. But that actually does not include administration costs it does not include after-hours GP visits and it does not include prescriptions. Even the New Zealand Medical Association chair Dr Mark Peterson said the policy is unnecessary and difficult to justify and he went on to say: “we need to target increased funding to those who really need it those people who can’t afford to go to the doctor otherwise.” As we said before 80 percent of those people are going to the doctor anyway.In terms of health care I think this Government is doing pretty well and I think we are supporting those people. We have also put an extra $76.1 million in the next 4 years to go into palliative and hospice care. We have increased spending on aged residential care and it is really commendable I think the work that has been done in this area. Also the number of hours of home support that are going in now has been lifted from 9.3 million up to 10.9 million in 2014-15. So that is prevention that is an example of communities looking after themselves and it is actually about people taking care of each other with support from our Government and helping each other lead a long healthy sustainable life. Thank you.KEVIN HAGUE (Green): The Green Party will be supporting this bill at its first reading. We believe that the kind of conversation that is just beginning perhaps in the House tonight would be advanced best by select committee discussion where we can actually listen to some evidence as well as argument.Health care should be a fundamental right for all New Zealanders. There should be no access barriers certainly not financial ones. Services should be universally available. Services should be preventive in focus. Services should be integrated. They are pretty good goals are they not? Those goals are not necessarily the Green Party’s goals; we did not invent them. They are actually the goals of the New Zealand public health system as set out by the Savage Government in the 1930s. The Savage Government set out in its establishment of the New Zealand public health system to actually make primary care—doctors’ visits as we would say now—free for all people who needed them.But it was blocked in doing so by the New Zealand chapter of the British Medical Association in fact. What we have seen over the years is a steady increase in what is called the co-payments—the amount of money that a patient has to pay when they go to see that doctor. With the capitation formula that we now have the district health boards are in a position to impose a cap on that but the cap tends to be still set at a pretty high level. Even those practices that are called very low-cost access practices which are located in parts of the country that have a very large proportion of their population on very low incomes still have a co-payment for patients of $15 a visit. The evidence is that even $15 per visit which is about the cheapest that you will find if you are over the age of 6 currently—even at that level that is prohibitive for many people seeking health care.That is a problem. It is a problem because our New Zealand Health Strategy and the health strategies that I am sure every party in this House would actually support are ones that attempt to prevent people from becoming ill in the first place and if they do become ill that seek to treat them in community settings close to where they live. So if you have that as your strategic intent but then the State places a financial barrier to accessing those primary care services it is a case of cutting off one’s nose to spite one’s face. It is a problem that we seem to have all too often in the health sector.Most of the people who are lying in the beds in our medical and surgical wards in hospitals are older people. If it is possible to actually stop them getting there by treating their problems in the community that would be a very good thing with health benefits and cost savings thereby distributing funds to other causes. Having said that it is certainly true that in the New Zealand Health Survey people over the age of 65 were numerically and proportionately the group that was least likely to miss out on primary care because of costs. However because of the number of older people and their frequency of requirement of primary care that is still a very substantial number.So our preference of course would be to return to a system in which primary care was completely free but failing the funds for that—and I rather suspect that the Government’s priority on new motorways for example means that probably we cannot possibly afford that—we actually need to prioritise how we best spend the money that is available to us. Making primary care more available to New Zealanders is a very sensible and wise use of health care dollars. It is an open question as to whether the universal age group - based subsidisation is the best way to do that as this bill provides or whether it is more targeted assistance based on socio-economic status. But that is the discussion that we need to have at the select committee and therefore we strongly support the bill at this stage and look forward to the Government perhaps changing its mind taking a more rational approach to this bill and one that is more conducive to discussion and debate.Dr SHANE RETI (National—Whangarei): It is a pleasure to speak on this bill. We support the intention of improved access to health care for older people but this bill is not the right tool to do that. It suffers from a lack of understanding of how medical services are provided. It is broad and unfocused and because of that it is also fiscally unsustainable and I will give examples of all of this. Firstly let us imagine the deployment of this bill with free doctors visits and three free health checks. What is a doctor’s visit? Well you know that is kind of a hard problem. In fact academics and others have pondered over that for many years. What is a doctor’s visit? Is a blood pressure check a doctor’s visit? Is a repeat prescription a doctor’s visit? When does a doctor’s visit start? Is it when you enter the building? Is it when you check in with reception? Is it when clinical notes are first entered in the computer? You see all this matters because as we know through years of medical audit we need to be able to reliably map service to funding—the details matter.But here in four pages despite others spending many years trying to figure it out it seems like we have an answer. The answer is in the interpretation clause clause 4: a doctor’s visit means to a doctor who is a general practitioner. What a disservice to the largest medical workforce in New Zealand our nursing workforce. Under this bill this lazy definition nurses are incapable of undertaking a health check and I would hotly contest that—lazy drafting. And what of nurse practitioners who run clinics in remote regions—Te Hāpua or Te Kao? Amongst some of the high-risk populations that this bill seeks to reach they would miss out under this bill’s poorly drafted words. A health check—what is that exactly? Is a phone call a health check? Is a blood test a health check? You know it would have been so easy to add a bit more detail and carry the intent of the bill by adding one word: preventive. OK—got it. There are a whole lot of descriptions around what preventive health checks are but no no. It is lazy drafting and it just adds further confusion to an increasingly confused bill.It gets even worse. The bill espouses the aim of “ignoring a minor ailment that could [get worse]”. What is a minor ailment? Because you know the doctor’s code in what is called recoding and systematized nomenclature of medicine—there is no code for minor ailments. It just does not exist. It is a lazy interpretation and lazy drafting. Even if we accept this let us look at two scenarios. An older person thinks they have a minor ailment. They visit a GP and in fact nothing is wrong. Do they then have to pay? Conceivably this could increase the costs to older people. Let us take the other extreme. What about the person who has a major illness who visits under this scheme? Will they be excluded because they do not have a minor ailment? It is poor drafting lazy drafting and exactly the people whom we want to target are not targeted. Therein lies the confusion.If we start at the front of the bill the confusion actually starts in the general policy statement where it reads: “[The bill will have] far-reaching benefits in terms of social emotional physical and psychological wellbeing”. Does the member not think that older Māori might be a target population; if so why does this part of the bill completely miss out one of the fundamentals of Māori health which is spiritual well-being? It is completely eliminated in this description—not interested. Under the most common framework for Māori health te whare tapa whā spiritual health is one of the sides. It is lazy drafting. It misses the target and that is important to this bill—targeting; exactly that. This is a major problem. There is no targeting. Everyone gets three visits despite the fact that 90 percent of New Zealanders report they are in good very good or excellent health and for those over 75 80 percent report good very good or excellent health. There are other targeted tools—very low-cost access high-user health cards prescription subsidy cards.We know the sector would struggle with this bill. As my colleague Barbara Kuriger said the New Zealand Medical Association chair Dr Mark Peterson said that the policy is unnecessary. It is short on detail short on facts and unsustainable. It is short on everything. It is more of a haiku than a bill. It is just short and I cannot commend it at all. Thank you.DAVID SHEARER (Labour—Mt Albert): I welcome that speech by Shane Reti for three reasons. Firstly it did not make any sense at all and that was absolutely obvious to anybody who is watching this debate; secondly it shows the National Party members for who they are: heartless and unable to understand the benefits that can be contributed to our society from making sure that our older people are well looked after; and thirdly older people vote—90 percent of them vote. If they are watching tonight they will be saying to the National Party: “That’s the last time I vote for them—those heartless illogical people opposing this bill.”The SuperGold card has been one of the real triumphs of the last 10 years. I have to say that most of the credit has gone to the man with the golden card Winston Peters—but remember it was actually done and agreed to under a Labour Government. I have to say that now belatedly we want to take a little bit of the credit for it. Quite frankly the SuperGold card has made an enormous amount of difference to New Zealanders and older New Zealanders right across the board. I do not mean just the fact that they can be helped out by getting on to a bus or whatever else needs to be done when they do it. The fact is that—and so many people say this to me—they are getting out. That is the most important thing. They are getting out there in the community taking their trip across to Waiheke Island. I know that Bill English does not like the fact that they are charging up all this money but actually the money is so insignificant compared with the benefits to those people getting out of their homes getting real value out of that SuperGold card and being able to get out there and prolong their lives and be healthier as a result.This bill is simply extending the value that is already there which is to provide free doctors visits three times a year. I mean three times a year? Is this Government really opposing their visiting a doctor three times a year so that they can get checked up and so they can get to know what the problem is before it gets complicated into something that will hospitalise them? In hospital as the previous speaker Shane Reti knows that is going to cost them—how much does it cost in hospital fees for one night?Louisa Wall: $1400.DAVID SHEARER: It is $1400 compared with going along to see a doctor which might cost $50. This is actually a saving in health services not a cost. So I do not understand for one minute what the logic is in opposing this bill. Firstly the bill makes good common sense; secondly frankly it means that these people who are some of the most vulnerable in society get to be seen; and thirdly ultimately it will save money.It makes absolutely no sense to oppose it. But I am absolutely delighted that the Government is opposing this bill because anybody who is watching this on television tonight will say: “What a heartless out-of-touch arrogant Government this is.” This is from a group of people who vote in every single election. That will be felt at the ballot box. It will be felt by this Government and they will see this Government for what it is—not standing up for the elderly in society. Those people have contributed and those people have paid their taxes all throughout their lives. They are being denied the opportunity of getting along to a doctor three times a year to get a check-up to save us—us taxpayers and everybody out there watching as well—more money as a result of their being able to go along and get that ailment or whatever it is seen to early rather than having it get complicated and their having to go into hospital at $1000 a night. This is illogical. The National Party should be backing this bill just as the Labour Party is backing New Zealand First.SCOTT SIMPSON (National—Coromandel): That was one of the member David Shearer’s better speeches. In fact all that was missing was—Tim Macindoe: The best.SCOTT SIMPSON: It was his best. It may have been his best speech. If he had given speeches with as much vigour passion and commitment when he was the leader of the Labour Party he would not have needed to hold up the two dead fish and we know where that led him.I am speaking in this debate as a member of the Health Committee. I had the privilege of being on that select committee in the last Parliament. I do not come from a medical background but one of the things that you learn as part of our select committee process is that you learn a lot about subjects that you did not know much about when you came into this place. The select committee process gives a great learning experience to a whole range of members. I listened with great and careful intent to the contribution of my colleague and friend Dr Shane Reti who was speaking only a few minutes ago. When Dr Reti speaks he speaks from the experience base of having been a long-serving dedicated professional GP in practice on the ground who knows how GPs work. I think that he made a very valuable contribution in his speech this evening when he asked the very basic question as to how you do actually define what a doctors visit is.He made a very good point because this bill in its current drafting does not really make that clear. This is a bill that simply provides that if you are a valid SuperGold card holder and if you are enrolled as a patient of a primary health-care organisation then you will be entitled to three free doctors visits per year. But the bill does not go on to define in any way what that might entail and how it might be. For instance would it be simply a blood pressure check at the premises of a GP conducted by a practitioner nurse? I think those are good questions. Dr Reti made I think a very good point that the bill in terms of its drafting is lazy and that it is a lazy piece of waffly legislation. He talked about how he thought that some more care could have been given to its drafting in order to target an approach like thisbetter. I am not one who is cynical enough to believe that the member sponsoring and introducing this bill is doing so for purely political motives—that he is doing so simply as a grab for votes from those older senior New Zealanders who feel that they have the need to go and see a GP. The statistics are actually very compelling: most older New Zealanders are not the ones who have difficulty going to a GP. In fact the statistics are very clear that they go to a GP very regularly and do not have a problem in that area.In the last Parliament the Health Committee did a very good piece of work under the chairmanship of Dr Paul Hutchison—another medical practitioner of long standing and high professional regard. The committee put together a very detailed report. We did an inquiry and it was called Inquiry into improving child health outcomes and preventing child abuse with a focus from preconception until three years of age. Why I refer to this is because the evidence that we gleaned as a result of that inquiry was absolutely overwhelmingly compelling. In terms of where we spend our health dollar as a society and as a nation it was estimated in that report that we spend at the moment probably well over half of the total Vote Health on the last 2 years of life. But the report advocated for a bigger spend in the period from preconception through to the age of 3 simply because there is much less need for care in your senior years if we get that part right. I want to quote just one thing from the report. It said: “The evidence is very strong; the first few years of life from pre-conception are fundamentally important for a broad range of child health outcomes and for the achievements of children as adolescents and adults.”I think that one of the faults of this bill is that it is not science based it is not targeted and it does not do what it proposes to do. As I say I am not cynically motivated so I do not think that the mover and the sponsor of this bill is doing so for the wrong reasons; I think that he is probably attempting to do it for the right reasons. But it simply does not achieve what he sets out to do and therefore I cannot bring myself to support this bill. It needs a lot more work. It is a lazy bill and I cannot support it.LOUISA WALL (Labour—Manurewa): Kia ora Mr Assistant Speaker. Thank you very much for the opportunity to contribute to this debate. As a member of the Health Committee I firstly want to take the opportunity to congratulate the Rt Hon Winston Peters on his bill and also to acknowledge Barbara Stewart one of my colleagues on the Health Committee who was the original proponent of this piece of legislation.I want to read a quote. It says: “Our vision is for a society where people can age positively where older people are highly valued and where they are recognised as an integral part of families and communities. New Zealand will be a positive place in which to age when older people can say that they live in a society that values them acknowledges their contributions and encourages their participation.” This is from Older New Zealanders: Healthy independent connected and respected. It is from the Office for Senior Citizens it is dated October 2013 and it is part of New Zealand’s Positive Ageing Strategy. One of the interesting components of the strategy is that it is actually about health. So if you go to that particular document what it says in its first bullet point is actually about support to stay well. There are 55000 New Zealanders who are over 65; this Government and this strategy commit to supporting over-65s to stay well.But when you actually look at how it defines how older people are supported to stay well there is a big focus on the high-use health card and one of my colleagues across the House mentioned that earlier. In fact only 14300 of those 55000 65-plus benefit from the high-use health card. That is only 2.6 percent of the New Zealanders who would qualify under this piece of legislation for a visit to a doctor. I concur with all of my colleagues on this side of the House who have contributed today. If older people have an opportunity to go to the doctor—which actually is about a wellness focus. It is about prevention and we heard a lot of that focus in the Health Committee today given we had the Minister of Health talk to us about the Healthy Families New Zealand initiative.So this Government has got a huge commitment in primary health working with communities and preventing their need for secondary and tertiary intervention and it seems that this is a policy idea that actually has some merit. I would have thought that as a reasonable House we would actually send this piece of legislation to a select committee where we can have the discussion and the debate that we have had tonight. Actually finding all the holes in this piece of legislation picking on drafting issues is not constructive. We in this House all have a vested interest to ensure that everybody—and particularly our older people—has three GP visits every year if it means it prevents them from going to hospital. So a $35 cost which is a hospital visit actually pays for 45 older people to have a GP visit as opposed to a 1-night stay in hospital. It costs us $1400 for an older person to stay in hospital for 1 night. If you have pneumonia the average stay is 10 days. If these three visits can prevent an older person over 65 from getting pneumonia and going to hospital for 10 days I would have thought that this House would want to debate the merits of this particular policy proposal.So what I am saddened to say is that this is actually about the money and fundamentally it is about priorities. Just because it was not the Government’s idea why is the Government not actually allowing us to have the debate to do what we did through the inquiry that focused on the needs of young people? Yes I am a bit sad because I think this is a member’s bill that warranted serious consideration by this House. If it could prevent older New Zealanders going to hospital and actually contribute to an efficient and effective health system which we are all committed to achieving then this is a sad day. Thank you.MARAMA FOX (Co-Leader—Māori Party): I rise tonight to support—yes that is right you heard me correctly: to support—the SuperGold Health Check Bill.Hon Members: Kia ora.MARAMA FOX: Thank you. You might find that I am often correct—something you may need to learn.The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! I think the member advising me about needing to learn that is probably not the proper thing—MARAMA FOX: My apologies. The members of the New Zealand First Party might find that I am often correct. Yes it may be some surprise that I am supporting this given the events that unfolded in question time today. But you need to understand e te Mana Whakawā that there is no festering turd of resentment here in the Māori Party. In fact despite the baseless accusations against my co-leader I am happy to support Koro Winitana and his well-herded followers and we will not be dissuaded from supporting this proposed legislation. Why? Because this legislation is aimed at alleviating the hardships that our people face.I do have a few concerns though. I wonder given the aim of the bill to support the needs of our elderly folk our most senior members of our country whether there might be some conflict of interest from the member who is proposing the bill. But far it be from me—The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! The member will resume her seat. There are two warnings now. That was an inappropriate comment and the member will withdraw it. The second warning is that the member is reading her speech and she must stop.MARAMA FOX: Fair call Mr Assistant Speaker. I withdraw. I will no longer read the speech but I might refer to it every now and again. I do withdraw those comments about the member who is proposing the bill. There should be no aspersions cast that there is any feathering of nests here—or Zimmer frames.The ASSISTANT SPEAKER (Hon Trevor Mallard): The member will resume her seat again. In her withdrawal she did more than say “I withdraw.”; she repeated—she repeated—the point. Although the member might find it funny I think defiance of the Speaker when asked to withdraw is not something that leads to happiness for members—I have some experience.MARAMA FOX: Thank you Mr Assistant Speaker. I will try to keep it under control.I do want to support the bill though in all seriousness because it is aimed at alleviating the hardships of our people—and our Māori people specifically do suffer in this country from actually living 8 years less on average than non-Māori. It would be hard for New Zealand First to add to this given that it does not appreciate race-based policies. However it is a suggestion that I think should be taken up—that in fact if Māori live 8 years less then maybe the benefits of this legislation should be supported to take effect at 60 the way they used to be and not at 65 as it is now.We have moved into a time when it is more a case of economy versus society. If it is for the fact of money that we are making this decision we need to think again. We need to move away from the economy and back to society. Our older people are well respected. If they were not here to give us guidance and advice we would be less worthy of that in this country. We would be failing to uphold the richness of their numerous years. I think that we would like to support the legislation to ensure that they live long and healthy lives and to improve the state of Māori. That is why we stand as the Māori Party to support this legislation.You will know or perhaps you may not Mr Assistant Speaker that in the East Coast region there is much disparity but we get most of our support on the marae from our old people. I know when I go up the coast and up to Wairarapa that those numbers are dwindling quickly. There is great hardship on our older people especially at this time of year and that only needs to be witnessed—[Interruption] You would know that actually if you—[Interruption] The members might understand that I am speaking in support of this bill so their yelling out is not helping. I would think that if we concentrate on keeping our elderly people alive and offer that support to the marae and to their communities then we will be the richer for it in this country. Therefore we support this bill.Rt Hon WINSTON PETERS (Leader—NZ First): I want to thank those members from the Labour Party the Green Party and the Māori Party who have backed the SuperGold Health Check Bill with their senior members and former Ministers who understand the common sense behind it. National led off with laymen and laywomen backbenchers. National rubbished free doctors visits for primary school children in the past. Of course Mr O’Connor forgot to say that it was New Zealand First’s idea and he claimed that it was National’s policy. Then having rubbished the SuperGold card in the past according to Mr O’Connor MP for Tāmaki it was National’s policy he claimed tonight. It must be personally debilitating and gutting to be forced to stand up in this House and make those claims when they know that they are demonstrably and palpably just false. Mr Reti the third National speaker the person who has got a qualification as a medical doctor the MP for Whangarei got up and said that in the UK the Conservative Party and Prime Minister David Cameron do not know what they are talking about. That is what he said in essence. And then he said that Te Hāpua and Te Kao the two most northern settlements in my electorate of Northland would miss out. How he could not say. He then posed as an antipodean Blackstone or an expert in draft statute law. He questioned the bill’s drafting. Why? He could not say. And then he said that the bill left out Māori spiritual health. He wants a free visit to a tohunga. He is so out of date that he wants a free visit to a tohunga.National gives $42 million per year to Skycity and yet says we cannot afford this bill. National gives $40 million and massive power discounts to Rio Tinto and yet says we cannot afford this bill. National gives $800 million to the South Canterbury Finance bailout and then says we cannot afford this bill. Mr Reti’s question—and how electrifying it was—asked: “How do you define a doctor’s visit?”. He himself could not say. But the most senior Minister in the National Government Chris Finlayson regarded this debate from his colleagues as a substitute for Mogadon and spent most of the time asleep. I hope it was a pleasant sleep at the time. Where was the Minister for Senior Citizens? Well that Minister could not be seen for dust and small pebbles. No they put up their political cannon fodder like lambs to the slaughter. If that is the best that the—Simon O’Connor: What is it about sheep and you lot? You’re obsessed.Rt Hon WINSTON PETERS: No no. It is not sheep to the Arabian slaughter but lambs to the political slaughter. Mr O’Connor that was a disgraceful performance. The reality is that Conservative Parties around the world know that this works. If you are going to make a complaint without having any substitute wording that will not wash any more. We are required to be professional in what we do. This legislation has precedent—precedent in the foundation source of the National Party in this country. How sad it is that the British Conservative Party might remember Disraeli and people like that but this new modern brand of National Party has no philosophical basis at all. That is why National opposed the people who we know used to be so loyal to them. Here comes the warning. This is a fatal night for those backbench members. There will come a time soon when they will realise that they should have stood up for themselves and their constituents not for the hopeless political organisers at the top of the ninth floor of the Beehive.A party vote was called for on the question That the SuperGold Health Check Bill be now read a first time.Ayes 60New Zealand Labour 32; Green Party 14; New Zealand First 12; Māori Party 2.Noes 61New Zealand National 59; ACT New Zealand 1; United Future 1.Motion not agreed to.Rt Hon WINSTON PETERS (Leader—NZ First): I raise a point of order Mr Speaker. Because I thought I had misheard what the National Party whip had given for another party we did not go for a personal vote. But this is so close that I believe we should have a personal vote and I am moving that.Mr DEPUTY SPEAKER: There is no reason to hold a personal vote. The member must in calling for a personal vote have good reason to believe that members are absent and so the vote is invalid.Rt Hon WINSTON PETERS (Leader—NZ First): I raise a point of order Mr Speaker. I realise what you have just said. But when a vote is that close—Hon Member: Not close.Rt Hon WINSTON PETERS: No no. When it is that close with respect there have been times in the past and it goes back a long time when people have given their votes and they have not been here. I have got an example where one night three people did not make it here into this House but they were counted and then it was found that they were not here. I think with a vote that close on an issue so critical we should have a personal vote and that is what I seek to move.Ron Mark: Speaking to the point of order—Mr DEPUTY SPEAKER: No I do not require any assistance in respect of this matter. I have given my ruling on it and nothing the right honourable member has said has caused me to change my mind from that call.RON MARK (NZ First): I raise a point of order Mr Speaker.Mr DEPUTY SPEAKER: Well I hope the member is not going to challenge on some frivolous basis but I will hear his point of order.RON MARK: I do hope that you do not rule this as frivolous. It is not intended to be at all. But in your deliberation you said that where the party believes that a member is absent—Standing Order 144 clearly states: “A personal vote may be held following a party vote” which has been called for “if a member requests one” which the member has “and the Speaker considers that the decision on the party vote is so close that a personal vote may make a material difference to the result.” It makes no mention of us having to believe that someone is not present in the House or may not be here. The vote could not be closer. It is a vote of 60 to 61 and we are exercising our right under Standing Order 144 in asking for a personal vote.Mr DEPUTY SPEAKER: Thank you. The member has made his point.Hon MICHAEL WOODHOUSE (Minister of Immigration): Mr Deputy Speaker in support of your decision I want to draw the House’s attention to McGee’s Parliamentary Practice in New Zealand page 208 which goes directly to this matter. “The Speaker has emphasised that closeness on a party vote result cannot by itself be enough to justify holding a personal vote. Depending on party standings in the House every party vote might be close.” It goes on to describe a number of scenarios where—perhaps due to confusion—there may be a reason; closeness is definitely not one of them.Ron Mark: Speaking to the point of order Mr Deputy Speaker.Mr DEPUTY SPEAKER: No I am not going to take any further comments or further points of order in respect of this matter. I know the matter has been controversial I know it has been well canvassed and I recognise that in a—Rt Hon Winston Peters:I raise a point of order Mr Speaker.Mr DEPUTY SPEAKER: No I am not accepting a point of order. [Interruption] I am still giving a ruling. The member will be seated. I was still speaking when he stood and sought a point of order. He should sit down now.Rt Hon Winston Peters: No. I raise a point of order Mr Speaker. This is a new point of order and I am entitled to put it.Mr DEPUTY SPEAKER: No the member will be seated. The member will recall that he started speaking—making this point of order—while I was still speaking. I have not finished yet. He should stay in his seat. [Interruption] The Speaker’s word is paramount. The National Party whip has cast the vote. There is no reason why there should be any doubt whatsoever and if the member wants to restate his point of order—that it is 60-61 it could not be closer—he may well make his point. But in this Parliament—the member should be seated while I am speaking. I have shown the member as the elder in this House due regard so I would expect him to show the person seated in the Chair due regard. The member will recall that in this House especially under MMP votes have often been close and I am not going to call a personal vote on the basis of closeness. If the member has a new point of order he may well put it.Rt Hon WINSTON PETERS (Leader—NZ First): I raise a point of order Mr Speaker. Thank you very much. If you are going to take the advice of the National Minister by reciting McGee—Hon Todd McClay: What’s the point of order?Rt Hon WINSTON PETERS: The point of order is that the—Ron Mark: Silence.Rt Hon WINSTON PETERS: The point of order is—first of all you will hear this point of order in silence. But the real issue is this: the Standing Order is clear. If it was not you would go to McGee but he is not the authority where the Standing Order is so precise as my colleague Ron Mark said. Now that any lawyer will tell you is a fact. So therefore to have heard that argument and give it credence simply is not the way this House should be conducting its affairs.Mr DEPUTY SPEAKER: Exactly right and I will be the judge of how the House is going to be conducting its affairs. The fact that the Hon Michael Woodhouse happened to agree with the ruling that I had already made did not sway my mind one way or the other.