O'Connor Greg; Uffindell SamHealthCHAIRPERSON (Greg O'Connor): The Minister of Health is now available for one hour from now to respond to members' questions.SAM UFFINDELL (Chairperson of the Health Committee): Thank you Mr Chair. So we conducted our annual review into Health New Zealand and we looked at everything Health New Zealand does and we do note that it has expanded considerably with the 20 district health boards (DHBs) being disestablished. Health New Zealand now leads the day-to-day running of New Zealand's publicly funded health system. It is the largest Crown entity in terms of staff numbers with almost 85000 employees. We conducted an annual review over nine hours and 25 minutes and I'd like to thank all those members in the House and Health New Zealand officials who participated in that process. It was a very valuable process for us.Some of the things to note were that Health New Zealand reported a deficit of over a billion dollars but it is noted that there were a couple of major issues for that. There was a substantial pay-equity settlement for nursing and a $284 million write-down of COVID-19 inventory that was transferred to Health New Zealand. The Auditor-General did note some concerns around the control environment financial information and supporting systems and performance information and recommended that a clear performance framework and performance story be generated. The primary concern for the Auditor-General was that there was no clear story about the performance of Health New Zealand of the health system in New Zealand and of Health New Zealand's contribution to that and no overarching framework linking inputs to outputs and outcomes. And in the absence of such a framework it was their opinion that it's difficult to evaluate Health New Zealand's performance and more broadly the overall health system's performance.But we did note some other key challenges and I'll take my time to address those. We noted the Auditor-General observed that Health New Zealand only achieved 34 out of its 87 service performance targets and a deterioration for most health system indicators. We note that emergency departments elective surgery patient inflow indicators CT scans and MRI scan wait times have increased during the year under review. We are concerned with these metrics going backwards and we want them to be improving when we sit down in a year's time to go through them.We do note that health systems globally are struggling. This isn't just unique to New Zealand. There is a big inflationary impact as well. There is concerns around the data and information and Health New Zealand are very clear around the concerns here especially with the disestablishment of the 20 DHBs and the formation coming all under Health New Zealand. There are 6000 digital applications creating an incredibly complex IT landscape and a lack of standardisation making it difficult to aggregate data. There are cyber-security concerns but we want to acknowledge the improvements that Health New Zealand have made in this space after the Waikato DHB attack. There are now 169 permanent staff.We have significant concerns in the workforce area. There are a number of gaps and of particular concern were the mental health and emergency department gaps—very challenging situations there. We have nursing shortages and there are acute shortages there as well as GP shortages. Of concern is that two-thirds of GPs are going to be retiring in New Zealand over the next decade and we expect Health New Zealand to be doing all it can to be ready to tackle those problems. Health New Zealand noted that recruiting international talent is absolutely crucial to making sure we address workforce shortages and there was some commentary around the nursing council making sure that foreign accredited nurses are able to come in here and work in New Zealand.That is very important as is the importance of primary care and community. Community care plays a key role in bookending the hospital and specialist care system. There are still some significant pay-parity issues to be dealt with and significant concerns in the mental health and addiction services. There is a shortage of facilities available—these are more acute in certain areas—and we have a shortage of key workforce staff.There are also issues around immunisation rates which have been declining since 2017 exacerbated by COVID but are particularly harmful to Māori and Pasifika. There are a number of recommendations that we hope Health New Zealand will continue to work hard on in the year ahead. Thank you Mr Chair.