Street Maryan: Appropriation (2012/13 Estimates) Bill — Third Reading Imprest Supply Debate 
Text is incorporated into the Bound Volume 
Street Maryan: Appropriation (2012/13 Estimates) Bill — Third Reading Imprest Supply Debate 
[Sitting date: 21 August 2012. Volume:683;Page:4577. Text is incorporated into the Bound Volume.] 
Hon MARYAN STREET (Labour) 
: 
 I rise to speak in this debate on the Appropriation (2012/13 Estimates) Bill on that part of the Budget that takes some 19 percent of Government expenditure and that is health. The total health budget is something in the order of $14.1 billion so nearly 20 percent—19 percent—of the total Government appropriation. If one were to believe Tony Ryall one would think that all health services are performing better than ever before: there are no difficulties here move right along there is nothing to see except those occasional statistics that the Minister wishes to shine a very fine spotlight upon. Those are the things where targets have been met because of the blood sweat and tears of our professional health staff working in district health boards who because they have been funded to do so but sometimes not have worked extremely hard to meet the targets—the short-term measurable targets—that the Minister has set them. 
The truth however of the health landscape out there is one of cost cuts of chaos and of impending chaos. The expression “death by a thousand cuts” takes on a new meaning under this Minister of Health. There is a whole new meaning to that expression when we realise that the funding in the health sector is $230 million down on what is needed simply to keep up with cost pressure never mind catering for a larger ageing population or an impending diabetes epidemic. Never mind those things—simply looking at cost increases the Government is $230 million down on what is necessary in that area. So the district health boards are not even being funded to break even. They cannot cover their costs. They cannot meet the increasing demand of an increased population and an ageing population. 
In the health budget only $358 million was new money. The district health boards in particular are being asked to do more with less. They are being asked for example to absorb all of the KiwiSaver liability that they have not been previously asked to cover. There was no additional appropriation for the covering of the KiwiSaver liability. That used to be taken care of centrally by Government which is no longer to be the case. So what we have now is some of our district health boards spending huge proportions of their new funding in covering new liabilities—not funding that was given to them or tagged for that purpose but funding that they have to give out because the Government has withdrawn from liabilities it covered previously. 
Let us take for example Canterbury—our most smitten of district health boards our most desperate district health board trying to recover from its devastating earthquakes and at the same time meet the Minister’s short-term measurable targets. Canterbury District Health Board has a projected liability for KiwiSaver of $8.6 million. That is about 42 percent of the new funding it has been given. So nearly half of its new funding which is meant to be delivering all these things the Minister requires is having to be spent on KiwiSaver contributions. There is no recognition of that. The KiwiSaver contributions are critically important to the economic welfare and future of this country. If we are ever going to deepen our domestic capital markets KiwiSaver and New Zealand superannuation are the mechanisms to do it for us. However the Government is not taking any responsibility for that and so Canterbury District Health Board is having to take up 42 percent of its new funding to cover that liability. Even a little wee district health board like the West Coast District Health Board is having to spend 34 percent—one-third—of its new funding on its KiwiSaver liability. 
Listening to the Minister of Health as I say one would think that all was well in the health garden. Well it is not rosy in that health garden. I would like to stress for just a moment a number of the things that have been cut by this Government. Let us take just a few down-to-earth practical examples. The Dannevirke out-patients clinic was cut. Counties Manukau District Health Board has had to cut funding which included two Maori health programmes and Auckland University’s evaluations of the board’s 5-year $10 million scheme to reduce the incidence of type 2 diabetes. These efforts out in the community are being cut because the Minister is requiring district health boards to turn on more elective surgery procedures so he can go and award certificates to those poor district health boards that have tried desperately hard without the funding to do what the Minister requires. 
As an example of this I would like to quote from the  
Nelson Mail 
. Just recently the Nelson Marlborough District Health Board showed that it had performed 6209 operations—150 more than during the last financial year. Yet the district health board’s surgical services manager Dorothy McKeown said that its elective teams had done a terrific job to surpass the elective target—which they have and I take my hat off to them—while at the same time ensuring that no one was waiting longer than 6 months but she said: “We were required to support this with extra resources that were not budgeted for.” 
So what gets cut? What gets cut? Well the Government has cut numbers of things. It does not matter whether we look back a couple of years or we concentrate on today. The abandoned school food guidelines for example were an absolutely no-cost item that this Government chose to cut when it came in because it was something that the Labour Government had put in place. They were food nutrition guidelines to secondary schools to school tuck shops encouraging them to sell only healthy food. What has that done? Well quite frankly it has done nothing to improve our obesity problem and the tendency towards type 2 diabetes that that problem will produce over time. 
The Government has cut front-line public health programmes: some $12 million from tobacco control $8 million from sexual health promotion and prevention programmes $1 million from public health alcohol and drug services $4 million from mental health workforce development and on it goes. This Government is cutting health at every turn and in fact replacing what should be long-term health goals with short-term measurable outputs that the Minister can then trumpet. Those are the things that he is funding and he is not acknowledging what the experts are saying which is that in order to reduce our health liabilities and the cost of health in the future we need to be putting more into prevention. 
There is a report that has gone to the Ministry of Health because it wanted to find out how to deal with diabetes care and management given that the Government has cut the “Get Checked” Diabetes Aotearoa programme. When we have this epidemic coming down the tracks at us why would a Government stop the “Get Checked” Diabetes Aotearoa programme? The report says that there was a recurring theme amongst those who were consulted that prevention and early intervention were not being funded as a priority by this Government or even included as a specific target. For all that the Minister trumpets successes in the health portfolio he is really jeopardising the future health of New Zealanders.