Craig LizDr LIZ CRAIG (Labour): Thank you Mr Chair. It's a privilege to take a call on this year's annual review debate on health. As Louisa Wall mentioned our committee took in-depth reviews on a number of health agencies: the Ministry of Health New Zealand Blood Service Health Quality and Safety Commission and 10 district health boards (DHBs). Sitting and listening to these organisations as they presented I think for me there were three key themes that emerged. I think the first one was just the ubiquity of the deficits and the considerable strain that a lot of those DHBs were under financially the second was this relentless increase in demand for acute services and the third one was the challenges posed by the ageing and inadequate healthcare facilities. I want to talk to just each of those in turn.Looking firstly at the DHBs' financial situation almost all of the DHBs that we listened to were either in deficit for the 2016-17 year or projecting a deficit for the current year. While some of the DHBs talked about plans for how they were going to break even in the next two or three years not all were confident they could actually do that. We heard from one DHB who had to come up with $30 million in savings each year and talking through what they could do they weren't that confident that those savings could be fully made.The other one though on the other side of the equation was the ongoing increases in acute services demand. So what we were hearing was about A & Es being absolutely full and about hospital wards being at capacity and having all of their beds open in summer which anybody working in the hospital wards knows is very unusual; you'd expect a peak demand in winter. But they were seeing this increasing demand right throughout the year.They also a lot of them talked about the increasing demands for mental health services. What that is doing is also impacting on the DHBs' ability to recruit sufficient workforce. One DHB was talking about their mental health staff having trouble recruiting having trouble retaining and having their staff being absolutely exhausted because of trying to keep up with that demand and pressure.One of the DHBs—we had to go back and I had to query it in the transcript—reported 3326 days of psychiatry vacancies so that's actually nine full-time psychiatrists in a single DHB alone. Others were talking about their primary care being at capacity and some of the issues with DHBs not having affordable access to after-hours care. In some of the Auckland DHBs what all these increases in demand were attributed to was just this massive population growth. They were seeing huge numbers of people moving into their areas and their infrastructure and resourcing were struggling to keep up with that. But even some of the DHBs in regional centres where there wasn't a lot of population growth were talking about the increasing demand because we have an ageing population—and also about unaddressed drivers in terms of social determinants.So there were big issues with you know low-quality crowded housing and cold houses and the impact they were having on acute infectious and respiratory diseases. From my own experience working in child health and looking at the reporting on why kids are coming into hospital you know you're seeing things like pneumonia asthma. A lot of those are housing related. So there is a sense of having the impact of an unaddressed housing crisis where we've got some families living in cars in sheds or in crowded boarding houses and then you know those unaddressed factors turning into sick kids coming into A & E and causing excess demand there.The third thing which was sort of also related was just district health boards talking about the challenges posed by inadequate or ageing infrastructure. One DHB in the Auckland region that was facing this increased demand for services just purely because of population growth—they were saying they needed about $500 million to rebuild and to expand some of the wards in one of their hospitals but they also said they needed $110 million to expand their elective surgical unit and another $30 to $40 million for their forensic psychiatry ward just to be able to keep up. Other DHBs not in that situation were also talking about their health infrastructure coming to the end of its life and needing either replacement or total refurbishment. So together we've had chronic under-resourcing coupled with increasing demand and also a lack of strategic planning across asset management and also across workforce planning. And so this current Government has got a lot of challenges in addressing this but we are up to the task and as the Minister said we've got a lot of plans in place to address this. Thank you.