Watts Simon; Little AndrewSIMON WATTS (National—North Shore): Thank you very much Mr Chair. Look I've got five primary questions for Minister Little relating to DHB workforce infrastructure operating deficits and holiday pay. First question: during the annual reviews we consistently talked with DHBs highlighting the lack of workforce so I'd be interested to hear how many fulltime-equivalent vacancies we had across all the DHBs as at 30 June 2020 and of that how many were for nurses. Second question: during the annual reviews we heard consistently around the infrastructure deficit crisis within the health sector. What I'm interested in is what the estimated capital deficit or investment deficit is over the next 10 years as of 30 June 2020 for all DHBs. My third question: in regards to closing that infrastructure deficit we've obviously got the aspect of dealing with growth. So in addition to that what is the outlook in terms of the next 10 years from the end of June 2020 for growth and capital investment? Fourth question: we discussed at length around operating deficits within our DHB environment—basically where costs are exceeding revenue. Can he articulate what the total deficit was across all DHBs for the year ending 30 June 2020 and does he expect that to be bigger or smaller as we come to the end of this financial year? Lastly a large portion of those DHB deficits relate to holiday pay provisions. What I'm interested in from the Minister is what DHBs if any received a qualified audit opinion in 2019/20 because they could not reliably measure their holiday pay liability. A supplementary to that is: in the annual reviews we heard from Waikato DHB that they noted that they were instructed to make balance sheet provisions for holiday pay. To your knowledge were there any DHBs instructed by the Ministry of Health or your officials to make balance sheet provisions for holiday pay? Thank you Minister.Hon ANDREW LITTLE (Minister of Health): Thank you Mr Watts for those questions. I will get through them as quickly as I can. In relation to the workforce issues that the member refers to I'm not quite sure what the number of vacancies on a fulltime-equivalent basis is. What I can say is that this is a Government that in the last couple of years alone has added funding for over 3000 fulltime-equivalent roles within the DHB network alone and we've added on more in previous years to that. We know that there are nurse vacancies. Part of the challenge we've got is workforce development so investing in more training. Creating a new nurse is a multi-year challenge in terms of getting the training the on-job and getting up to spec so that will take some time. One of the benefits of the health reforms and of Health New Zealand is that they will have a dedicated workforce planning and development mandate. That means that they can do the long-term planning engage with the training institutions work up the training programmes and start to really plan and work out that long-term pipeline of health talent and skills that we need. I think part of the problem has been that under the DHB model it has been way too disaggregated and a bit haphazard and a bit ad hoc which explains the shortfall in health skills that we have at the moment.In relation to the infrastructure deficit I thank the member for the question. He might want to talk to some of his colleagues who've been around a little longer particularly those who were in Government because there were two years—I think 2015 and 2016—when there was no money spent by the Government of the day on health infrastructure. You look at the graph and it's just blank in those two years. We have a major catch-up job that we're doing which explains why this Government has allocated close to $5 billion in health infrastructure in the time that it has been in Government. Of course what we're discovering is that you can make that decision but getting the planning and the design and getting construction under way takes a bit of time as well. So there is a programme. I think the four northern DHBs have done a plan—I think their infrastructure deficit just over the next 10 years is something like $10 billion. So this is what we're talking about and when you're rebuilding almost an entire hospital in Dunedin which is a nearly $1.5 billion building project you start to see the scale of the problem that we are fixing—that we are fixing.How to deal with growth as well—the member raises an interesting point and I think one of the challenges we see and one of the things I expect to see out of the health reforms is that stuff that is currently done in hospital—some treatments that are currently done in hospitals—we need to be finding ways to push out into community settings. There are some types of chemotherapy that don't need to be done in a hospital setting—could be pushed out into a properly equipped and staffed community setting. More opportunities to do that so that we focus our hospitals on the serious end of healthcare that's needed and those things that people don't have to travel hours and hours for that can be done close to where they live and to their communities—we want to find opportunities to do that. So I think the member might expect over the next few years to see a slight reorientation of the capital works programme to move away from just the big grand hospital campus renewal stuff to other facilities in a more community-oriented sort of basis.In terms of deficits the total deficit at 30 June 2020 was just over a billion dollars. That did include Holidays Act accrual as well as some COVID spending and indeed there are deficits being recorded for the DHBs at the moment that still incorporate those two elements. It will be bigger this year but the DHBs will be supported in terms of meeting their Holidays Act liabilities and they will also be supported to meet their additional COVID-19 response costs.