King Annette: Financial Review Debate — In Committee 
King Annette: Financial Review Debate — In Committee 
[Volume:624;Page:19412] 
Hon ANNETTE KING (Minister of Health) 
: 
 I thank members for their contributions to and comments on the financial review which as I said in my opening remarks was a very positive one for the Ministry of Health. In fact the ministry received a very good report card from the Audit Office. Those who take the time to read the review will know that there are very many good things outlined in that report. I thank the members of the Health Committee for the report they have given to the Committee of the Whole House. 
I will deal with some of the issues raised by Judy Turner. In the first instance she raised the issue of child health. I share her concerns about child health particularly in the area of dental health and about our ability to provide a network of dental health services to children and adolescents in New Zealand. Members will be aware that two major reviews of the way we will provide it have been done. In the next 3 months I will announce the total repackaging of the way in which we provide those services including the capital investment that is needed. One of the great tragedies however is in our ability to provide that service because we have such a shortage of dental therapists. 
Darren Hughes 
: And why is that? 
Hon ANNETTE KING 
: My colleague may well ask why we are unable to provide that service. For over 80 years Governments provided training for school dental nurses followed latterly by dental therapists. They were trained in three places in New Zealand: Christchurch Wellington and Auckland. In my day about 80 people were trained in each of those schools per year. In the 1990s every school was closed—no school was left open by the end of the 1990s. How did we think we would train a workforce to do dental and oral health in New Zealand if we did not have a workforce to do it? I have no idea what went behind that thinking. 
The first new training course was opened in 2001 in Dunedin. It is a degree course for dental therapy. The second course opened in 2002 at the Auckland University of Technology and it also is a 3-year degree course in dental therapy. It takes 3 years to train people. We got our first graduates from Otago last year. We got our first graduates from Auckland 2 weeks ago. We need 40 graduates per year just to replace what we have now. 
When I hear National Opposition members making comments about the Government’s inability to provide dental health services to children it makes me sick because we cannot provide the service without the workforce. We will have 40 graduates per year by next year. It has taken determination by this Government to put that in place. Otherwise we would not have had that workforce and we would continue to be unable to provide it. I know the concerns of both Barbara Stewart and Judy Turner. They have raised them many times and I know they are genuine in their concerns. This is a good opportunity for me to set out once again why we have the problem. That is not an excuse; it is the problem. We will overcome it and I believe that we will overcome it by next year when we will see children once again being recalled after no more than a year. 
Over the last 5 years we have seen a huge investment in mental health. We undertook to implement the Mental Health Commission’s blueprint for services and we have seen almost a doubling of funding in that area. Judy Turner raised the issue of a drop in access. I need to inform her—I do not know whether the select committee was told this—of one of the problems. From July 2004 we required service providers to provide us with data on diagnosis but in fact we did not collect all the data. The data is incomplete which is one of the reasons why we do not have full data on access. Organisations are required to provide the data by March this year so we will see the genuine level of access then. One of the problems is that we do not record what services are provided by non-governmental organisations and as members will know non-governmental organisations are increasingly becoming the providers of services outside the acute care services provided within hospitals. So being able to capture the data as to what is being provided by those organisations is really important. 
I am pleased—and I know that Judy Turner will be—to see the huge improvements that have been made in child mental health. It is not good enough but I invite members to look at what we started from. If members go back and look at the figures provided on page 7 of the report they will see that in June 1998 we were funding 24 inpatient beds for children. Now we are funding 56. We had 322 fulltime-equivalent clinical staff. We now have 739. In 1998 we had no day residential or respite care packages for children. We now have 113. So there has been improvement. We still need more. 
Barbara Stewart raised the issue of aged care. The Government shares many of the concerns she raised. I am pleased to tell her that my Associate Minister Pete Hodgson is involved with a working group on long-term sustainability for aged care because it is an issue we will face into the future. Most of us here are baby boomers. We are going to live a long time and want a lot of services particularly services for older New Zealanders. Ensuring that we have that long-term sustainability is really important. That work will I think be very significant. Also the member asked when the 3 percent will be passed on to aged-care providers. It will be passed on as soon as they sign their contract. The Government has approved the money. It is there for the providers. They have to sign the contract. I hope that that happens soon. 
Finally the National member Paul Hutchison took a second call and raised a number of issues including the issue of deficits. It is interesting that we rarely hear about deficits today. That is because we no longer run what is called the “second chequebook” which was a hallmark of the 1990s. Boards were able to run up deficits and then the Minister of Health with the Minister of Finance would sign off a cheque to cover the deficit. Now there is only one funding stream. Boards are required to live within the funding they receive. When we look at the deficits across this $10 billion sector—most of which goes to the district health boards—we see that the deficit for the last financial year was around $80 million. I remember that around 1997-98 it was over $200 million on much less money. Paul Hutchison said that the sector was worth around $6 billion. It was probably worth about $5.5 billion at that stage and the deficit was over $200 million. 
He also asked about Auckland. Most of his speech went back to the 1980s. He did not talk about what a National Government would do but he went back to Helen Clark and the 1980s. He talked about the Auckland District Health Board and its deficit. I would like the member to reflect on why it has a deficit. If he had asked the chairman of the board I am sure he would have been told that the major reason why Auckland has a deficit is the shoddy decision made prior to the 1999 election to build the Auckland Hospital. The deficit almost reflects the underfunding of that project because there was no business case. The project was signed off in Jenny Shipley’s office just before the election. 
Steve Chadwick 
: They were told that. 
Hon ANNETTE KING 
: I am told that the select committee was told that. There was no business case there were no real costings and when the building was done the project was well over the proposed cost. [ 
Interruption 
] That is the absolute truth. I say to Bill English who is very ashamed of this that he should speak to the chair and the members of the Auckland District Health Board who will tell him never again to build a hospital with that shoddy approach. National did the same thing in Wellington. It promised a new hospital for Wellington a few minutes before the election at $150 million. There were no real costings it was never able to be built for that sum and once again we have had to fix up the health mistakes of the past. We are prepared to do it whether or not it is the workforce or buildings. Those are just a few of National’s mistakes. It failed then and it would fail if it ever got another chance. 
Report noted.