O'Connor Damien: New Zealand Public Health and Disability Amendment Bill — Second Reading 
O'Connor Damien: New Zealand Public Health and Disability Amendment Bill — Second Reading 
[Volume:667;Page:14380] 
Hon DAMIEN O’CONNOR (Labour) 
: 
 It is indeed an honour to speak on the New Zealand Public Health and Disability Amendment Bill. With the sad departure of our colleague and friend the Hon Luamanuvao Winnie Laban I am now on the Health Committee so it is good to be thrown in at the deep end I guess. Be warned I say to members an old cynic is coming to the Health Committee. I have been around for a wee while and I smile when I read some of the notes on the bill and hear some of the speeches because I can remember Jenny Shipley as the Minister of Health making statements on the efficiency of having many Crown health enterprises and competition in health. Even in Christchurch two Crown health enterprises were set up on the basis that the competition would deliver efficiency better outputs and more money to the front line. At the same time the National Government brought in charging for hospital beds so that if someone ended up in hospital that person paid about $100 per night. That was abhorrent and it contributed to the defeat of the National Government and its silly ways in 1999. 
Hon Maurice Williamson 
: 9 years later! 
Hon DAMIEN O’CONNOR 
: It was 9 long years of that National Government— Mr Williamson is dead right. He can remember all those things because at that time the policy said that if we had many many competitors and participants and a split of funders and providers plus everyone else and if we had them all fighting and scrapping then we would see efficiency. Well when Labour came into Government we realised that that simply was not working. We put billions of dollars into the health system and we brought some alignment. 
Hon Lianne Dalziel 
: And we put up nurses’ pay. 
Hon DAMIEN O’CONNOR 
: We put up nurses’ pay. We had a huge amount to do to retain people in this country. We realised that there had to be better alignment and that there had to be strategic thinking in health. This bill talks along those lines but I have not seen strategic thinking coming from National or from many of the champions of business that National members go on about and use as exemplars in terms of business management. Well I welcome any move towards strategic thinking but unfortunately Tony Ryall has moved away from that. In respect of strategic thinking we said that primary health care is the smartest way to spend money in this country. I know there are members opposite who understand health and who know this is true. Getting in at the front line early on reducing the cost of seeing general practitioners and getting medical help when needed reduces the cost over time. 
But since National came into power we have seen an absolute determination to focus on measurements not on long-term strategic goals in public health mental health or areas where money spent can reduce our long-term costs. What has the Minister done? He has measured hip replacements—and the odd knee but knee operations are a bit more complex. The measurement of the success of the health system has been on elective surgery once again. That is destined to fail because it is short term populist and political. 
Michael Woodhouse 
: Shorter waiting times. No! How terrible! 
Hon DAMIEN O’CONNOR 
: The member opposite says that elective surgery waiting times are really important as is the number of people waiting for hip surgery and we know that those things improve the quality of life for all of those people. But although those people might wait 1 month less for a hip replacement they now understand full well the wisdom of investing in primary health care for their grandchildren and making sure that their sons daughters and grandchildren can take their children to the doctor when they need to. They understand the wisdom of that investment but that is not where the Government has gone. 
I have looked through the notes on the bill and I applaud some of the things that have happened. If we end up in the area of procurement with a model like Pharmac then I will commend the Government. Pharmac is a highly successful model but I have fears about it. John Key was talking with the Americans about free-trade deals and all the rest of it and he came back to this country and said the issue of Pharmac and pharmaceuticals might have to be opened up again. He said that having coming back from the US on one of his earlier trips. I do not know what has caused a change of mind since then or whether it was due to the collective wisdom of many of the people in his caucus who know that Pharmac is brilliant but we do not want to muck around with a model that is successful. 
Hon Maurice Williamson 
: Only the visionary person who first set up Pharmac. 
Hon DAMIEN O’CONNOR 
: Even Maurice Williamson understands that right wing though he is and erratic though he is. 
Hon Maurice Williamson 
: Who was the visionary who set up Pharmac? 
Hon DAMIEN O’CONNOR 
: Mr Williamson understands and I commend the Minister for understanding that Pharmac is brilliant. Please do not play around with it. But he knows full well that his Prime Minister— 
Hon Lianne Dalziel 
: They’ve already undermined it with Herceptin. 
Hon DAMIEN O’CONNOR 
: Well that is right. There was an intervention but we will not go there; let us just move on. 
The best thing I can see in this bill is the move to national procurement and some centralised purchasing of the core materials and goods that are necessary for all district health boards. That is likely to save us a whole lot of money and give us some strength when we negotiate with many providers of highly technical things in health who often have the whip hand. We no longer accept the word of the general practitioner or the specialist. People now go online and find out what is available throughout the world so we are forced—and there is nothing wrong with it—to try to provide the very best we can for New Zealanders up and down this country in terms of apparatus equipment and health care. That is the way it should be. There is a price associated with it and health is a bottomless pit—we know that. There will be demands so the question is where we draw the line and for what reasons. The problem at the moment is that the National Government is drawing the line and making measurements in relation to elective surgery: waiting times for elective surgery outputs or throughputs or what do they call them now? They have probably changed the terms. I get confused myself; I think we might have changed the terminology once or twice ourselves I have to confess. But the bottom line is that outputs from the health system are measured and they are now focused on elective surgery. We are trying to measure and improve the overall health of society. 
The US is often held up by National as being a wonderful place with the best of management and systems. 
Chris Tremain 
: When was the last time we did that? 
Hon DAMIEN O’CONNOR 
: Well the member opposite probably has not been around long enough to hear some of the speeches in this House about the wonderful management in the US. 
Hon Maurice Williamson 
: Give us one National MP who has held up the United States as wonderful. 
Hon DAMIEN O’CONNOR 
: Mr Williamson knows— 
Hon Maurice Williamson 
: Give us one example of any National MP who has held up the United States—just one. 
Hon DAMIEN O’CONNOR 
: Mr Lockwood Smith the Speaker has done that. I do not like to speak of the Speaker in his absence but I know that he has been to the United States and thinks that there are some wonderful examples of management there right through Government and industry. I am not trying to discredit that view; it may or may not be true. But the US spends almost twice as much as we do on health and its overall health status is no better than ours. 
We should guard jealously our hands-on system of management and consultation with the community allowing the community to make judgments on important issues for their region in terms of health care. Unfortunately this bill takes away the obligation to consult with local communities. My community down on the West Coast is totally different from that of South Auckland. I would not like to be making judgments on the priorities for health care in South Auckland because I do not know what they should be whereas that community does. This bill takes away from the district health board which is mandated to care for people in its region and provide all their health care the obligation to consult the community. I am scared that people sitting on their chuffs here in Wellington under the Minister’s direction will make decisions on what is the best health-care for South Auckland North Auckland or Northland. It is not the right way to do it. 
So although the consolidation of procurement may be a good thing consolidation in some areas of health care decision-making is not all good. Although we support the bill in general terms we do not think the savings the Minister claims will be made will eventuate. We hope that improvements are made as I say in the area of procurement but we will be monitoring this very very closely to make sure the district health boards are indeed answerable to their communities.