King Annette: Questions for Oral Answer — Questions to Ministers Questions to MembersText is incorporated into the Bound VolumeKing Annette: Questions for Oral Answer — Questions to Ministers Questions to Members[Sitting date: 25 September 2013. Volume:693;Page:13684. Text is incorporated into the Bound Volume.]4.Hon ANNETTE KING (Labour—Rongotai) to theMinister of Health: Has the increase in health funding for 2013/14 been sufficient to stop cuts in health services and staffing?Hon TONY RYALL (Minister of Health): The increase in available health funding for this year and for the next 4 years averaging around $400 million a year has actually been sufficient to improve not reduce front-line services and staffing like the 2700 more nurses and 1300 more doctors employed in our public hospitals. The Government is however very aware that there are always pressures on providers such as on some general practices offering low-cost doctors visits to some in our most vulnerable communities. Consequently although we have already increased the very low-cost access scheme subsidy to these practices by $11 million over the last 5 years—that is by 33 percent—it is clear that some are finding it difficult to remain viable and later on this afternoon the Government will be announcing an increase of a further $16 million over 4 years or an 8 percent increase to help these practices out.Hon Annette King: If district health boards have sufficient funding why hasWaitematā District Health Board now confirmed it is cutting mental health charge nurses in mental health units by 50 percent why has it told staff that it intends to slash the numbers of mental health administrators by 14 and why is it removing cars from public health and community nurses because of “continuing cost pressures coupled with lower funding growth” ?Hon TONY RYALL: My understanding is that theWaitematā District Health Board is continuing to invest more money in its mental health services and that wouldcertainly meet with the fact that we put an extra $31 million into theWaitematā District Health Board in this year’s Budget.Hon Annette King: If the funding is sufficient why is theWaitematā District Health Board proposing to cut 10 doctors from the emergency department not for clinical or quality reasons but to save money; and does this not make a mockery of his letter of expectation to district health boards where he said they need to “improve clinical staff retention”?Hon TONY RYALL: This is sort of what we have come to expect from this member because—Hon Annette King: I raise a point of order Mr Speaker. It was a straight question. There is no need to have the beginning of his answer.Mr SPEAKER: And I agree. Would the Minister just answer the question.Hon TONY RYALL: My understanding is there is a consultation that will see that staffing mix at theWaitematā emergency department change to reflect the staffing mix at Auckland - Counties Manukau. But I cannot believe that the Opposition would ask a question about the North Shore’sWaitematā District Health Board emergency department when under its watch old people waited for 3 days on hospital trolleys under bright florescent lights and they do not do that any more.Mr SPEAKER: Order! That answer is quite sufficient.Chris Auchinvole: What progress is being made to improve health services on the West Coast?Hon TONY RYALL: I am pleased to advise the member that later this afternoon the Government will announce that it has given the green light for a brand new West Coast hospital to be built at Greymouth at an estimated cost of around $60 million. This new development will replace Grey Base Hospital with new wards an emergency department and new operating theatres. It will also include an integrated family health centre that will co-locate general practice on the Grey Base Hospital site. The Grey Base Hospital’s facilities have significant seismic issues so this announcement is important for the 32000 people who live on the West Coast and it gives them confidence in the future of their health services. Site work is expected to begin late next year with the new hospital and facilities to be completed by the end of 2016. Even in the most difficult of economic times this Government has found $60 million for that member’s electorate’s hospital.Hon Annette King: In light of that answer can he guarantee that with the building of the new Greymouth base hospital Reefton Hospital will not be closed and patients shifted to Greymouth?Hon TONY RYALL: What I can tell that member is—Hon Annette King: Answer the question.Hon TONY RYALL: Well I give this assurance to the people of Greymouth. We are putting $60 million in and once more I can say that there will be a further announcement this afternoon on a further investment on the West Coast and I say to the member “Wait for that”.Hon Annette King: Is he aware that the—Hon Christopher Finlayson: Give up old girl.Hon Annette King: I beg your pardon Attorney-General? Did you hear that Mr Speaker?Mr SPEAKER: That type of interjection is totally unhelpful to the order of this House. Would the honourable member start—[Interruption] Order! Would the honourable member start her question again. [Interruption]Hon Annette King: He just did it again Mr Speaker.Mr SPEAKER: I did not catch where that interjection came from but—[Interruption] Order! We are getting to the stage now where unfortunately I am going to be asking members who constantly interject to leave. That is a warning I am giving to all members on both sides of this House. I ask the Hon Annette King to continue with her line of questioning.Hon Annette King: Is he aware that the emergency department at Waitakere Hospital is being discussed at a closed board session today; if so will he guarantee that the emergency services at this hospital will not be compromised by a lack of funding and staffing?Hon TONY RYALL: TheWaitematā District Health Board’s budget has increased by $30 million this year. There are 268 more nurses and 114 more doctors. What I can say regarding this Government’s record with the Waitakere emergency department is that we have improved that service beyond whatever existed under the previous Labour Government which is opposite. We now have 24-hour emergency department services at Waitakere Hospital far more than that party opposite ever delivered to those people.Hon Annette King: Did he raise the amount of fundingWaitemata District Health Board received when he phoned the chair and the chief executive officer to pressure them after being questioned about proposed cuts in Parliament 2 weeks ago and did they tell him that under his watch the additional funding this board has received in 2013-2014 is half what it received in 2007-2008 which might account for its current financial situation? He might like to have a look at this graph which shows that the level of increased funding he is crowing about is now halved.Hon TONY RYALL: I just have to say that I am glad the member has admitted finally that this Government increases health funding because she constantly paints the picture that we have reduced health funding. We have increased it year on year by an average of $500 million. I can tell this to the people ofWaitematā: because of our investment in a 24-hour emergency department at Waitakere and tens of millions of dollars in a new emergency department at North Shore they are getting faster and better emergency department care than was ever offered when that member was the Minister of Health.Hon Annette King: I seek leave to table a copy of the Minister of Health’s letter of expectation which is not readily available saying that he wants district health boards to improve their staff retention.Mr SPEAKER: Leave is sought to table an expectation letter from the Minister. Is there any objection? There is objection.Hon Annette King: I seek leave to table a copy of the consultation document fromWaitemata District Health Board on mental health services of 26 August this year which states that cost pressures and lower funding growth are the reason for cuts.Mr SPEAKER: Is that document freely available?Hon Annette King: No it is not available Mr Speaker.Mr SPEAKER: Leave is sought to table the consultation document. Is there any objection? There is objection.Hon Annette King: I seek leave to table a graph of additional funding per year atWaitemata District Health Board—Mr SPEAKER: Order! Is that the graph the member was using?Hon Annette King: It is. Here is the—Mr SPEAKER: I am not prepared to put that leave. [Interruption] Order!Hon Annette King: I raise a point of order Mr Speaker. Can I please know why you would not let me table a graph that comes from district annual plans?Mr SPEAKER: I am happy to catch up with the member and deal with her later. It is a Speaker’s ruling. If the member is seeking leave to table a graph that has been prepared for a political point it is not—[Interruption]Grant Robertson: I raise a point of order Mr Speaker. The graph in question comes from theWaitemata District Health Board planning department and from its annual planning process so it has not been prepared for any purpose other than for theWaitemata District Health Board and I think you should put the leave.Mr SPEAKER: I have already ruled that I am not putting the leave.Hon Annette King: I raise a point of order Mr Speaker.Mr SPEAKER: A fresh point of order?Hon Annette King: No I want to table another document. I seek leave to table an email sent to John KeyCampbell Live and myself from a constituent from North Shore about the lack of proper care at North Shore Hospital because doctors and nurses have said—Mr SPEAKER: Leave is sought to table that particular email. Is there objection? There is objection.Grant Robertson: I raise a point of order Mr Speaker. I do think we need some clarity from you around what the basis of the ruling is. I accept that there may be a Speaker’s ruling that we are not aware of but it would be good to know because there will be other occasions we want to table documents like this.Mr SPEAKER: There will be and I suggest the member look at a page full of Speaker’s rulings 148.Hon David Parker: I raise a point of order Mr Speaker. A page full of rulings will have about half a dozen different reasons. I think what my colleague was asking was for the reason—Mr SPEAKER: Order! The member now is disputing my ruling which will lead to disorder. There are a number of rulings there. I am suggesting he read them all which would help him.Chris Hipkins: I raise a point of order Mr Speaker.Mr SPEAKER: Order! I am on my feet. Is this a fresh point of order? Because any attempt to dispute a ruling that has been made—Chris Hipkins: It is seeking clarity from you.Mr SPEAKER: Is it is any way disputing a ruling I have made?Chris Hipkins: No it is not disputing; it is seeking some clarity.Mr SPEAKER: I will hear from Chris Hipkins.Chris Hipkins: Thank you. I am relatively familiar with the issue of the tabling of documents because you will be aware that it was raised by the Standing Orders Committee of the last Parliament and significant changes were made to reduce the scope for the tabling of documents. But the critical issue there was that the Standing Orders Committee did not want to in any way curtail a member’s right to seek leave; it wanted to provided further clarity as to what was legitimately to be tabled. Information that is not publicly available is a legitimate thing for a member to seek to table and the Standing Orders Committee was very careful not to overly restrict what sort of format that might be in. So I just want to get some clarity. Annette King indicated that the document she sought to table was not publicly available or may not be available to members. The principle behind the tabling of documents is that it is in order to provide members with information that they might not have readily available to them and it seems to me that without hearing a proper description of the document and without actually putting it to the House we cannot judge whether the House would like to have that information.Mr SPEAKER: I thank the member for his point. The issue I think that may be of confusion to me is the authenticity of the document. If it has been prepared by the member for the point of making a political point then I will not be prepared to put the leave. If the member rises and says that it has not been prepared by the member and is of an authentic source the easiest way forward—[Interruption] Order! The easiest way forward once I am convinced of that is that I will put the leave. I am asking the Hon Annette King for clarification.Hon Annette King: The data is sourced from theWaitematā District Health Board’s annual plans for 2008 2009—Mr SPEAKER: Order! I did not ask where the data came from; I asked for the authenticity of the graph. Is it a graph that the member has prepared herself?Hon Annette King: Yes but—Mr SPEAKER: That is all I need to know thank—Hon Annette King: I raise a point of order Mr Speaker. It is a point of clarification. Could you please explain to the House—[Interruption] Well I am entitled to ask for a point of order—[Interruption]Mr SPEAKER: Order!Hon Annette King: —in silence.Mr SPEAKER: Would the member please continue with her point of order.Hon Annette King: Could you please explain to the House when sources of information that come from an independent source are a political item?Mr SPEAKER: Order! What we are talking about here is the tabling of a document that the member herself has prepared. I invited the shadow Leader of the House to have a look at Speakers’ Rulings and he should do so. If it has been prepared simply for the point of making a political point by the member regardless of where the data has come from I am not prepared to put that leave and that is the end of the matter. If any member wants to question it further I will have no choice but to ask that member to leave the Chamber. I call question No. 5 Dr Russel Norman. [Interruption] Order! I have called Dr Russel Norman. [Interruption] Would Chris Hipkins stand withdraw and apologise for that remark.Chris Hipkins: I withdraw and apologise.