Little AndrewHon ANDREW LITTLE (Minister of Health): Thank you Madam Chair. I thank the member Dr Shane Reti for his questions which canvassed a number of issues so I will respond to them as indeed he has asked them and in that order. First of all in terms of the financial position of DHBs the member asked what the collective position is forecast to be by the end of the financial year. I think the member is right: one of the challenges for the DHBs for a significant period of time has been living within their means and sticking to their budgets. In fairness to them they've been struggling with growing populations and a comparatively suppressed level of funding. It is true to say however that at least in this financial year by comparison their financial performance has been better than in the last financial year and indeed in the year before that. But at this stage the forecast for the consolidated deficit across all DHBs will be somewhere between $350 million and $500 million. Now it could indeed be a little more than that and I don't disaggregate the accrued liability for holiday pay. That amount alone is quite significant and it may well be that when the work is completed on auditing what the shortfall is which goes back many many years that liability alone could in in the order of $1 billion. But that work isn't completed yet. On the second question the member asked about health workforce and pay equity what I can say to the member is agreements have been reached with the Public Service Association (PSA) and the Nurses Organisation for DHB nurses. That was due to go out for a vote to nurses. The Nurses Organisation withheld the agreement to go out to ratification and they are now deciding whether that goes to their members for a decision about whether the members contest it in the Employment Relations Authority on the grounds that the terms of settlement reached are in breach of the pay equity legislation or whether they actually proceed to a ratification vote. In terms of other pay equity settlements the pay equity settlement done for the admin and clerical workforce which also concluded at the end of last year is due to go to a vote to the PSA members at some point. I'm not quite sure what the timetable for that is now. They have indicated that as a consequence of the position the nurses have taken on their pay equity agreement they may take a pause for a while. We are currently in negotiations with representatives with DHB midwives—that's the Midwifery Employee Representation and Advisory Services—for a pay equity agreement for midwives but that is under negotiation and there are foreshadowed pay equity negotiations for the allied health workforce. Their collective bargaining is in process at the moment. An issue there is the process for the pay equity claim they've got but the pay equity part is yet to be negotiated. The member raised a question about back-pay agreements. I am confident and satisfied from the documentation that I have seen going back to 2018 with the New Zealand Nurses Organisation that there is no agreement on back-pay for nurses. There was an expressed intention in 2018 by both parties and the language was that the parties intended that the pay equity negotiations would be complete by the end of 2019 and that that would have been the basis of an implementation date. Of course it was a good intention but the job was way harder than people thought so that intention was not realised. I'm satisfied as I say from the documentation I've seen that there is no final agreement—no agreement at all—on back-pay but nevertheless the Nurses Organisation has taken a position. The third question in the set of questions the member asked is in relation to the aged residential care workforce. The member characterised it as the workforce or the sector I think breaking in front of our eyes. I know there were some pretty dramatic language used by one of their representatives on the radio yesterday that the sector was collapsing. I reject that. It is a sector under pressure like all parts of the health sector because of staff absenteeism because of COVID and a range of other issues. It is a sector under pressure but it is a sector where people every day are turning up to work and providing the care that is needed. The member is correct that once the pay equity agreements are finalised and concluded and implemented there will be a gap a reasonably significant gap in pay rates between those in the DHB sector—or the public hospital sector as we will call it—and the funded sector: aged residential care primary care and others. There are negotiations at the moment with the employers in the primary and community care sector and they will start to address those issues but the reality is that there is difficulty in our collective agreement negotiations framework in the health sector—particularly for the funded sector—where the employer and the employee parties meet but the funder isn't there. We actually need to find a model where we can bring all relevant parties together to talk together about some of these big issues and I'm doing some work at the moment with the ministry and others to work out a model that we can have to do that. I have to say talking to employer representatives in the sector that they are very keen to find a model that means they can have a better discussion so that we can more effectively address these issues. In terms of any plan for pay parity I think what I would say to the member is that I am acutely aware that we do need to see progress in terms of closing that gap but we have to find a way to do that that is going to be effective for all parties. In terms of the fourth question the member raised which was about Pharmac and whether Pharmac will continue cancer treatments for children in hospital my expectation is that they will. They've done a review about the funding of cancer medicines for children as a consequence of a ruling by another body but I can tell you that this Government remains totally committed to the existing regime of cancer treatments for children and that they are free in our public hospitals. Finally the member asked about the Te Aho o Te Kahu report that came out last week on cancer treatments. I don't share the member's dramatic view of that report. I don't think it was damning; I think it gave us clarity about what the gap is at least between New Zealand and Australia. It was a piece of work of the sort that we expect the Cancer Control Agency to be doing—that's why we set it up in the first place—so we can get good information on cancer treatments cancer diagnosis cancer screening and the performance of cancer services across the country. So this report gives us good information about what the gap is between the New Zealand treatments and Australian treatments and what we might reasonably expect. I think that report would be very useful to inform both the Government and Pharmac in its future decisions about what we can and should be doing. I see it in that light and I'm very keen to pick up the report and work with the other Government agencies to make sure that we see that through.