Craig LizDr LIZ CRAIG (Labour): Thank you Madam Chair. It's an absolute pleasure to speak on this year's annual review debate on health and as Louisa Wall mentioned we reviewed as a select committee a range of different entities. So we looked at the Ministry of Health the Health Research Council Pharmac and around half of our district health boards (DHBs). The theme I'd like to touch on today is a similar theme to what Mr Michael Woodhouse spoke about in terms of that sea of red because what I want to do is actually unpack a bit about what is the health system that we've inherited. I think for me it's thinking about those twin legacies of systematic chronic under-investment in our health system over a period of nine years and basically taking a very hands-off approach to that strategic management that planning of things like workforce and also our infrastructure.But before I want to go into that in more detail I just want to touch on again what Michael Woodhouse mentioned about targets because the previous Government very diligently monitored emergency department waiting times. But what they didn't do is actually count the number of people coming into emergency departments with preventable conditions—things like housing-related preventable conditions infectious respiratory diseases and those that could be prevented by early access to primary care—or look at people's access to primary care and housing which are two big things that our Government is focusing on.But coming back to the review of the DHBs what was very very stark was that pretty much all of the DHBs that we reviewed were in deficit and while each of them talked about different reasons for that deficit there were a number of common themes and one of them was just systematic under-investment over the past few years. One DHB said that they'd had their budget capped for three years up to 2017-2018 and while they were happy that that cap had now been removed they said We had to think about the challenge of coping with the $30 million that we didn't receive in those previous years." So for many of our DHBs there's no fat in the system so that if they get an increase in acute demand there's none of those buffers you could accumulate from previous years to be able to cope with that.Others were talking about those increases in acute demand—things like people coming in for ambulatory sensitive conditions those hospital admissions that could be prevented if you went to the GP early. So they were talking about those increases in demand for acute surgery and also mental health. These are things that our Government has been investing in. Last year we put in that huge extra investment so that community service card holders could get low-cost access to their GP when they needed it and we also made sure that children up to and including age 13 went to the doctor for free.While it's too early to really check that in the hospital admission trends to see a reduction at the moment because those investments are just bedding in I think in future years we are going to see the impact because people now don't have to think twice before they go to the doctor if they're on a low income and worrying about the cost. The other thing that we've signalled is that mental health is going to be a very big priority in this year's Wellbeing Budget because that's something as a country we really have to address. One of the other things though that some of the DHBs were talking about struggling with was the workforce because we've really taken our eye off the ball in terms of that strategic planning in terms of how many specialists how many medical staff how many allied health professionals and how many nurse practitioners we need. Many DHBs were saying that they were struggling. One DHB was saying they were having to share their specialists with the neighbouring DHB because they couldn't recruit enough. Another was talking about the challenges of getting GPs into smaller towns. One DHB was citing some of the reasons for this deficit. It was because they were having to pay so much for locums and outsource some services because they just couldn't attract regular staff—so really the whole legacy of that lack of strategic planning.But another one the third thing that really stood out was the impact of the lack of investment in our infrastructure in our hospital buildings. I think the Ministry of Health in their report put it very politely—just reading their quote—that they had quite a "challenging and constrained operating environment" and what that had resulted in was deferred maintenance some buildings being too old and seismic assessments on buildings since the Canterbury earthquakes leading to some that needed to be strengthened. I think the actual media was much more honest in their reporting when they talked about some of the mould and the problems in the walls of Middlemore Hospital and taking your eye off the ball in terms of investment in our assets. So I'm proud to be part of a Government that's going to be investing back. In last year's Budget we put $750 million back into our infrastructure and we're really investing in primary care cheaper doctors visits our health infrastructure and mental health. Thank you."