Reti ShaneDr SHANE RETI (National): Thank you Mr Speaker. We now know why more than more than 36000 people are waiting more than four months to see a specialist. We now know why emergency department (ED) wait times have increased with some people waiting more than 32 hours. We now know why we have a health workforce shortage—4000 nurses 1500 GPs and 1500 specialists.Because Andrew Little ignored the cry for help a year ago when a district health board (DHB) chief executive wrote on behalf of every DHB pleading for help a letter with dire warnings and actions that were needed immediately to avert a health crisis". A year later the chickens have come home to roost.Let's see if Andrew Little takes a general debate call this afternoon 48 hours out from significant health reforms which would be the convention with such a big structural change. Let's see if that happens and if he wants to defend what I'll lay down on the table today. The Minister is trying to say he only found out about this letter a month ago. I do not believe that and I want to challenge that on at least two points.First of all if the Minister didn't know about the letter he should have known about the letter. This letter was on behalf of every single chief executive in the DHB sector—that is the most senior executive group in our hospitals—and they deserved his attention.Secondly very senior people in the Minister's own ministry also received the letter—the ministry he is supposed to have oversight for. It was also sent to the acting Deputy Director-General of Health Workforce New Zealand on 28 July last year. It's a very senior person the Deputy Director-General inside the Ministry of Health.I contend that Andrew Little should have been aware or was aware of this letter from DHBs a year ago and he did nothing. The Minister was warned a year ago and did nothing. His track record in this sort of modus operandi is well known. I'm inclined to remember ICU beds—warned about it did nothing and the dire consequence that came from doing nothing around ICU beds and particularly building new ICU beds particularly in Auckland.The letter sent by 20 DHBs a year ago had multiple warnings. First the health system is buckling with some sites in code red. Directly from the letter: "You will be aware that our hospitals are also experiencing very high levels of occupancy at present and some sites are even in code red where they are deemed to be at extreme levels. This is obviously an unsustainable situation and places even more pressure on our existing workforce. We are very concerned about this situation and for the potential for further deterioration if there are no changes to assist with at least securing the existing workforce from 20 DHBs." Secondly the letter also says "We are also experiencing increased presentations in emergency departments." They even sent graphs of what the occupancy rate looks like inside the EDs showing the increasing trend towards what they call "extreme occupancy" across emergency departments a year ago and here we are today with emergency department times increasing. Point three what the letter also says: "In order to respond to surge the system will have to redirect workforce from areas like planned care." That's code for 36000 people waiting more than four months to see a specialist. What's really poignant is their last summary of that: "This will have long-term impacts on the health and wellbeing of New Zealanders."Point four and here's the immigration bit—here is what 20 DHBs were urgently asking for which resonates with what my colleague Erica Stanford has been talking about for a long time in which we have a petition up at the moment. This is the summary to the letter: "Therefore DHBs seek your immediate attention to (1) ensure our current overseas-trained staff can have a direct and prompt path to residency." That's not two years for registered nurses; that's a direct and prompt path to residency. "And (2) that overseas health professionals are facilitated to enter New Zealand as required to avert a crisis in the health sector."Clearly that has failed. This was a warning a year ago that the Minister had and he did nothing. There's now no money for ED nurses; no money for ED docs. Because what we also know is that instead of building the health workforce the ministry has employed up to 1000 new consultants—not even in the past year; just in the past 10 months is what the written parliamentary question shows. No money for ED nurses no money for ED doctors but plenty for up to 1000 consultants.It's interesting looking at the list of consultants: corporate services 78; data and digital 728; the DG's Office 40; Health Workforce New Zealand 10. I think that kind of sums it up right there. Just 10 in this bloated excessive list of consultants. I rest my case."