Coleman Jonathan: Annual Review Debate — In CommitteeText is incorporated into the Bound VolumeColeman Jonathan: Annual Review Debate — In Committee[Sitting date: 03 May 2016. Volume:713;Page:10666. Text is incorporated into the Bound Volume.]Hon Dr JONATHAN COLEMAN (Minister of Health): To resume from where we were 2 weeks ago—look if you look at the wider picture in health over the last 7 years this Government has put an extra $4 billion into the health sector. We have been very much focused on delivering increased access to services at the same time that globally most other Governments in the Western World have actually been decreasing their public service spending and their health services have been massively under pressure. So if you look at the achievements of this Government in health not only have we kept spending at about 6 percent of GDP which is higher than that in Australia but we have also been very focused on delivering those services that really matter to the people of New Zealand. If you look at first specialist assessments they have increased by 26 percent over that time. They have gone up from 430000 to 540000 per year. At the same time we are delivering an extra 50000 surgeries per year. When we came into Government there were 118000 elective surgeries performed each year; we are now doing 168000 per year. At the election we pledged that we would continue to raise that by an average of 4000 per year and actually we have exceeded that target.Very recently we announced the first ever results of what happens to a referral when it goes from a general practitioner through to the hospital. There has been a lot of debate around this area over time and no Government has ever traced that path. The only evidence we have was back in 2006 when Pete Hodgson the Minister of Health estimated that about 25 percent of patients were returned to their GP and at that time that would have been 65000. We have looked at the figures and the first lot of preliminary data released last week shows that 87 percent of patients who have been referred by their GP to hospital services are getting an appointment. There are about 5 percent who do not meet the threshold and there are 8 percent who have to be held for further information to be sought. If you look at this area of unmet need no Government has ever been able to deliver every operation and every appointment that every person in New Zealand could benefit from but the only answer in the end is to do more and more. That is exactly what we have done. In the area of doctors and nurses we have now got 5500 more doctors and nurses working in the New Zealand health system than 8 years ago. That is a considerable uplift in the number of personnel.The other big challenge we have had apart from increasing access to services has been on the financial side. When we came into Government district health boards were spending about $150 million more than they received in revenue each year. So they were in massive deficit and the whole place was sliding out of control. Through a progressive approach we have brought those deficits back to about $50 million and we are determined to continue to reduce those. If you take Southern District Health Board—where we have a commissioner in place—out of the equation those deficits are even lower. So the fiscal discipline does really matter and the point I would make is that if you look at that whole picture of access to services and the change in the financial picture it has been only a National Government that has been able to increase access to services as well as manage the finances. That is very important because we are never going to have an unending pool of finance for the health system. No one is ever going to say: “Stop sending dollars.” It just will not happen. But what we do need to do is make the very best use of the finance that we do have in the health system.We have taken a very focused approach as well. For the last 7 years we have had health targets for the sector and that has given very clear direction to the system. If you look at the approach in emergency departments when we came into Government there were ambulances queuing in the carpark at my local hospital North Shore Hospital. That does not happen any more because we set this target of 95 percent being in and out of the emergency department within 6 hours. We have actually been very successful in reaching that target. We are no longer also sending people to Australia for cancer care. When we came into Government 700 people had been sent to Australia for cancer care. We are also providing the elective surgery that people in this country need. The other thing we have done is for the first time we have launched a comprehensive New Zealand health strategy that lays out the plan for the health system for the next 5 to 10 years and beyond.Actually what we need in terms of the health system is a change in approach whereby we are focusing more on the community. We are focusing on prevention and earlier intervention because actually it does not really help the patients if the only point of intervention is once they get to hospital. We want to deal with things much much earlier. We want to keep people well and in the community and we want to deliver care closer to home and all that has to be enabled with the best use of technology in the long term.If you look at the investment approach in justice which my colleague Amy Adams was talking about earlier today this Government is very conscious that what we do in these different social sector portfolios is all linked. In health if we want to keep kids out of hospital we have got to have well-insulated homes. That is 270000 homes that have been insulated under the course of this Government. If children are getting their immunisations if they are staying out of hospital and staying well they are actually going to do much better in the education system. If they come through the education system successfully with the skills that you need to actually function in a modern economy they are actually going to have far better long-term social outcomes. If you look at the statistics for people who end up in the justice system they have fallen off the wagon at some point along the way.So all these things are interlinked and what we do know from the political point of view is that the health system is one of those things that the public really does care about. This Government has been very committed to making sure that health has been the largest beneficiary of new money at each Budget and I am sure that will continue to be what happens into the future because in the end we know that well beyond the political arena health is one of those things—in fact it is the most important thing—that counts for New Zealanders and we are determined to deliver on that.