Hodgson Pete: New Zealand Public Health and Disability Amendment Bill — First Reading 
Hodgson Pete: New Zealand Public Health and Disability Amendment Bill — First Reading 
[Volume:663;Page:11033] 
Hon PETE HODGSON (Labour—Dunedin North) 
: 
 The New Zealand Public Health and Disability Amendment Bill is a rather small piece of legislation. It has some good bits in it I think. It is confused in other respects and there are one or two pieces that are frankly alarming. It is small and the proof of its size I suspect is that all of the speakers from the Government side have pretty much spoken about things other than what is in the legislation. I hope to depart from that. 
We had in the speech from the Minister of Health the Hon Tony Ryall a great deal of mythology about what the previous Labour Government had done for health and that mythology was repeated— 
Michael Woodhouse 
: Another rewriting of history. 
Hon PETE HODGSON 
: Another rewriting of history; indeed it was as the member who has just interrupted me has said—by Dr Paul Hutchison. That was not so however in the case of Rahui Katene who did not bother to rewrite the mythology of Labour’s involvement in health but decided that this bill was a warm endorsement of Whanau Ora—a bow that was drawn a little long in my view. Then we had Nicky Wagner from the National Party who decided that we needed to learn just once more the history of the splitting of the atom. So those members were involved in talking about anything except the legislation although Michael Woodhouse did talk about it a little I must acknowledge. That is because the legislation does not contain a lot. 
The bill does contain some measures and I want to dwell on a couple of them. The first is that I want to pick up on the word “quality” as other members have and say a couple of things to the Minister and to the National Government. The legislation repeals EpiQual the predecessor of the Quality Improvement Committee. Section 17 of the parent Act the New Zealand Public Health and Disability Act is repealed by clause 6 of the bill and that committee is replaced by a new commission the Health Quality and Safety Commission. It also has the word “quality” in its name but its functions are different from those of the committee. Although Kevin Hague thought they were quite different from those of the committee I think they are only slightly different. We will see whether that is so. The point I would like to make is that the EpiQual the predecessor of the Quality Improvement Committee was put into the public health and disability legislation just after the turn of the millennium when it was first introduced by the previous Labour Government. The EpiQual part of the Act in my view did not work very well. What is more I reckon that I have worked out why that was the case. I fear that the Government might be about to repeat the mistake that was made then. 
Here is my story. EpiQual did not work well precisely because its findings its results and its work were not driven down through the existing accountability structures. That is to say EpiQual sat off to one side of the district health board system. It sat off as a quango on its own and therefore quality sat off in a quango on its own almost absolving the district health boards from taking a more headstrong view on issues of quality. I do not want to overstate that because of course many district health boards were and are very quality-focused. But it was not until the Quality Improvement Committee got going which Kevin Hague was on and Pat— 
Dr Paul Hutchison 
: Snedden. 
Hon PETE HODGSON 
: —Snedden chaired and which had some very significant champions driving quality that we had some progress. Again the reason for the progress was that those quality programmes were driven through the existing accountability channels. 
Now if the current Government has left the Quality Improvement Committee or some variant of that committee—some son or daughter of that committee—in place that is fine and dandy. But if it has not then by repealing section 17 and replacing EpiQual with another stand-alone entity—this time called a commission not a committee—we run the risk of repeating history which will not be pretty. At the moment we are getting runs on the board with regard to quality. The Minister in his opening remarks decided to try to monetise the value of quality. That is fair enough; people do these things. There will be no gains unless the current accountabilities are used to drive the quality agenda down through to hospitals and to other district health board functions. 
That is not all I want to say about the repeal of section 17 of the parent Act because one of the things that that section states is that the committee must specifically deal with morbidity and mortality issues concerning the perinatal infant and child and adolescent sectors. Those mortality and morbidity studies which are now a permanent feature of our health and disability system are themselves big drivers of quality. If we can identify why we have for example an increase in sudden infant death syndrome or why we have an outbreak of alcohol-related deaths in youths we can improve the quality of our health system. That part of section 17 is gone. I do not know whether it is gone on purpose and certainly section 18 says mortality review committees can be appointed by the Minister. But the section requiring that has gone and it is not being replaced by the new sections. I am drawing that to the House’s attention because I think that might be a mistake. 
The thing I will concentrate on next is the issue of procurement. I just say there is money to be made from procurement and money has been made there. Money has been made first of all through Pharmac and it is serious money. Tribute goes to the National Government back in 1993 for setting up Pharmac. It was a good move and Pharmac has survived successive Governments and will survive successive Governments—at least until the United States starts talking to us about a free-trade agreement. But there is no reason to stop there. When Annette King was the Minister we decided that we would go for joint procurement across a range of things—for example insurance. There is no reason to stop there. We could go on to telecommunications or to all manner of things. Some of those things have huge gross profit margins in the system. To give one example prosthetic companies make a lot of money; it is in essence a racket. The racket can be dealt to if we end up with a bit more monopsony behaviour by the system and district health boards all decide to buy one form or only three or four forms of hip prostheses instead of buying 30 of them. 
So I think that part of the legislation which is amended by clause 9 of the bill in front of us will receive quite a lot of support from members around the House. I do not expect however it will make a lot of difference by itself. There is a lesson there because there are very many instances of situations where the current legislation has been treated with “ignore” by people within the health sector and the Minister will have to have not only this legal avenue available to him but also a great deal of determination to push it through. I can remember saying at length to district health boards that progress on that issue would need to be made or funding would be cut. In fact I took 0.5 percent off them at one point in order to get their attention and gave it back to them only when they had started to procure a little more sensibly. 
The thing that really concerns me is that clause 9 inserts new section 33B. That is a new section which states that the Minister may give directions to all district health boards—not about procurement and not about existing services as the Act currently states but about effectiveness and efficiency. On the face of it that is not a bad thing—who will argue against effectiveness and efficiency—except that the Minister is largely untrammelled by the legislation as introduced and therefore is in a position where he can force should he choose to do so more or less anything on to district health boards. I have two comments about that. The first is he should bring it on. If the Minister is going to get gung-ho about requiring this and that he will find there will be a political backlash. The second is that at some point the Minister if he overplays his hand under that new section will start to abrogate the democratic parts—district health board elections and all that—of the original parent Act. You see we do have a hybrid system: it is part elected part appointed; part local responsibility part central responsibility. The Minister has decided—and it is a very strange thing for a centre-right Government to do—that he will give himself command-and-control powers. That is what they are; they are broad indeed. The Minister can smile; those powers are very broad. I just say to the Minister that further unpleasantries in this regard are eagerly awaited.