Reti ShaneDr SHANE RETI (Deputy Leader—National): The clear signal in Vote Health 2021 is that Labour no longer cares about older people. They have turned their eyes away from older people and towards the mirrors on their wall. Labour doesn't care about older people.It is the Budget where older people pay for the ideology of this Labour Government to centralise everything in Wellington. It is the Budget where older people are fobbed off so that the Minister and his increasing band of expensive consultants can decide from Wellington what is good for older people and good for New Zealanders. It is the Budget that hides more than it helps; it hinders more than it hastens. It is the Budget that takes from older people. Labour doesn't care about older people.Let's be clear on exactly what is taken from older people in Budget 2021: $200 million of healthcare the annual free GP check has been taken dissolved and removed—a broken promise with older people simply dismissed by this Government. They have every right to be angry.What is even worse is that the draft document papers show cynical discussions how this Labour Government can pull $200 million out of health but pay off a paltry $8 million towards an aged-care commissioner to keep older people happy. They will see through the smoke and mirrors.The business case to David Clark for the free annual health check is fascinating as the Labour Government makes the case for why it is so important. The benefits of the annual over-65 health check are: reduced mortality Labour doesn't care about older people; reduced health costs for out-patient and in-patient care Labour doesn't care about older people; reduced emergency department—ED—visits Labour doesn't care about older people. And while we are talking about emergency visits please explain to me why in the month of January from the hours of 1 a.m. to 7 a.m. 156 people over the age of 80 were discharged from DHBs—that is not just in an emergency department; they were in in-patient status in a bed and 156 sent home at 1 a.m. in the morning. Oh and what is even worse: three of them were over the age of 100. Explain that to me; that surely is unexplainable. The final benefit: improved mental and social wellbeing. That is another benefit that is being cut. Labour doesn't care about older people.So $200 million is what older people have given up in this Budget. What have they got in return? More hip replacements? Nope. More knee replacements? Nope. Half of the cost of this Government's restructuring has been borne by older people in the experiment for three new statutory entities three new health systems and layers and layers of bureaucracy. That is what older people are paying for.Andrew Little knew that when he was taking money away from older people it was a bad decision—a very bad decision—because he was even afraid to take it to Cabinet. Written parliamentary question (WPQ) No. 202—SPEAKER: Order! Order! The member's not allowed to say that.Dr SHANE RETI: Oh OK. Then if I can just talk to WPQ No. 20233: What communications has"—this is to Andrew Little—"he taken to Cabinet if any around cancelling the free over 65s seniors annual health check and eye screening … ?" "I have not taken any papers to Cabinet around cancelling the free over 65s seniors annual health check."Is the $486 million a good business decision? Well let's check the business case. Oh wait! There isn't a business case—$486 million on health restructuring and no business case. Andrew Little wrote back to me saying that no he had not been provided with a business case for the restructuring. So I thought maybe Grant Robertson might throw further light on this. "A formal business case is not part of the review case" is what Grant Robertson writes to me.So if older people are giving up $200 million for half of the health restructuring—that $486 million—where else is the rest of the money coming from? Well some of the Associate Ministers were clearly told "We're already taking money away from older people and out of core health to pay for this so don't even make a Budget bid. Don't even ask." WPQ No. 20585 from an Associate Minister of Health—I got this last week—"What communications with the Ministry of Health or Minister if any describes Budget 2021 bids that the Minister made … ?" "I did not submit any separate bids" from an Associate Minister of Health. Wow. No health bids into Budget 2021 from an Associate Minister of Health. What does that say?I can tell you where the rest of the money to pay for this experiment is coming from: it will come from cutting costs delaying programmes and repurposing existing programmes. I know that because that is exactly what the Minister told me. WPQ No. 20827: "Did he send or sign a letter to the Minister of Finance between Dec 3 and Dec 11 2020 inclusive indicating 'To live within a smaller funding envelope will require choices to be made about whether to progress these initiatives how they might be phased and whether they can be scaled or I look at what existing programmes may be able to be repurposed'?" The answer to that was "Yes or reprioritised"—as we heard today; another word for cutting costs.So what programmes in Budget 2021 were phased scaled and repurposed to pay for this experiment? The Pharmac budget is $200 million. In campaign 2020 we had three revenue streams for Pharmac: the first was $200 million for cancer the second was $20 million for rare disorders and the third was to index Pharmac funding to the increase in Vote Health that goes up every year. What we know is that it has gone up about 10 percent this year on a $1 billion Pharmac fund—that's $100 million. We would have been looking at around about $320 million in our hands this year; understandably still not the $700 million that is required for unfunded medicines but at least 50 percent more than what this Government was putting in Budget 2021.What else was scaled? Who else is paying for this experiment? Well DHB funding has been scaled back by $305 million from last Budget—$980 million is what the operational expenditure for cost pressures for DHB was last Budget; $675 million this year. How will the lights stay on when operational funding has been cut to DHBs?Dental care was cancelled. An absolutely clear broken promise when the Prime Minister stood on the campaign trail nine months or so ago and said "We promise 20 mobile dental clinics in 2021 and to increase the emergency dental benefit"—nothing in this Budget.We already have a health Minister who is struggling to stand up to Grant Robertson with his health bids. And we know that because we asked the health Minister whether he made a bid or had he had any correspondence suggesting that Budget 2021 might have 20 free mobile dental clinics. The answer to that was: "I indicated which of the manifesto commitments I believe should be progressed alongside the work on the health and disability system reforms which included an initiative around additional mobile dental clinics." Andrew Little seemed to have understood the importance of the mobile dental clinics but couldn't get it over the line with Grant Robertson. Dental care was cancelled. As I say there are no teeth in this Budget.I think what we are also concerned about is what else has been removed from the 2021 Budget. I think that a real concern is where we are seeing cost cuttings around rationalising specialist services at provincial hospitals. Now I actually asked Andrew Little this question on 8 April. It was my second question in this House supplementary No. 4. I asked him: "Has he read any briefings around rationalising specialist services at provincial hospitals … ?" He said: "No." Then imagine my surprise this week when in reply to my WPQ No. 20767 he replies—my question was: "Has he read any briefings around rationalising specialist services at provincial hospitals to manage funding down pressures and if so what?" And he replied: "I received a briefing on 3 December 2020." Quite different to what he indicated to me on 8 April in the House. He knew specialist services would be cut to fund this experiment—this experiment in centralising health from Wellington—but told me "No."If I can just conclude how else could we spend that $486 million that is to go to restructuring? Well a few weeks ago there was an anomaly in cancer drugs for children who currently receive Pharmac-subsidised drugs in hospitals. The Ministry of Health has realised there is a policy anomaly and are considering whether newly diagnosed children with cancer should still be able to receive those medicines in public hospitals. I would strongly suggest that they could. A tiny tiny part of this $486 million would cover that.We could completely eliminate the waiting list for cochlear implants—not just double what we're currently doing; completely eliminate it. We could fund more than half of the total cost of unfunded Pharmac medicines. It turns out that we could do nearly 30000 hip replacements with $486 million that is being put aside. That would likely clear the waiting list so well that we would be doing normal hips—30000 hips could be done instead of the $486 million.In conclusion there will be no more Pharmac funding there is no closing or clearing of the cochlear waiting list and there are no more hips to be done because in this Budget the Government takes from older people they take from DHBs they take from Pharmac they take from dental health and finally New Zealanders are also taken to the cleaners in this Budget. This is a poor Budget. I cannot commend it. Thank you."