Simmonds Penny; Little AndrewPENNY SIMMONDS (National—Invercargill): Thank you Mr Chairman. In the review process we heard of concerns around the equity of care for disabled persons our elderly and mothers and babies and I have five questions for the Minister relating to these concerns.Firstly does the Minister consider the daily payment rates for disability respite carers of $76 a day for 24-hour care equating to $3.16 per hour as appropriate?Secondly how many day centres for people with disabilities were closed by disability service providers throughout New Zealand in the 2019/2020 financial year?Is the Minister aware of the 15 percent gap identified by the Disabled Persons Assembly (New Zealand) between the funding of day services to disability service providers and the cost of provision of services for people with disabilities by the service providers?In the 2019/2020 financial year what was the range in points scored across the DHBs which enabled a hip-joint replacement and does he consider it appropriate for a score of 50 points in the Canterbury DHB area enabling hip-joint replacement surgery while a person in Invercargill must reach a score of 70 points?And finally does the Minister believe there is any correlation between length of stay in hospital after birth and mother or baby's readmission within the first 1000 days of a baby's life?Hon ANDREW LITTLE (Minister of Health): In relation to the daily payment rate and whether or not it is appropriate I think we all want to make sure that the support given to caregivers whether they're family or not is appropriate and is fair and I might say is consistent across funding streams. And that is a big piece of policy work that needs to take place.In relation to how many day centres for disabled have been closed in the year under review I cannot answer that question. I do not know.In relation to the 15 percent gap between funding of day services and the cost of services I appreciate the member providing that figure to me. I think that and the previous earlier question about the daily payment cover the point that the Health and Disability System Review didn't sort of get to but which we have committed to which is we actually need to unpick disability support services and funding arrangements and remove it from the health focus because it is not just a health focus there are other social supports that are relevant to them. And we need to have and explore a regime the Government's regime that I think is respectful of the full breadth and all dimensions of the needs of the disabled community and that kind of covers off the points that the member has been raising.I'm glad the member has drawn attention to the points system in different DHBs—for example in relation to hip-joint replacement—because it wasn't something that was addressed by the previous Government. It is one of the postcode lottery issues that infects our current health system. And it is precisely because of that sort of thing that a unified coherent consistent health system under a Health NZ with a nationwide mandate can actually start to seriously address—we can actually put in place some common standards of diagnosis and treatment across all hospitals regardless of where you are. And actually we can manage patients' treatment through a hospital network not going to say Well if you can't get it at that hospital that's part of some DHB you're going to struggle to get it somewhere else." ACC actually provides an interesting model because they are a funder of healthcare they can pick and choose where across the public health system they can get procedures done and they do that. Well you know if it's good enough for somebody who's suffered an injury by accident and they've got a financial backer who can pick and choose where they get their treatment so it's faster than somebody who is getting treatment that is not by reason of injury by accident actually Health NZ can provide an answer to that problem.Finally the correlation between the length of stay in hospital of a new mum and readmission I don't know the research on that—and I'm sure my colleague Dr Ayesha Verrall who covers this area would be fully familiar with the statistics in it. But it wouldn't surprise me if the point that the member is making is correct."