6. District Health Boards—Disability Support Services FundingDr DAVID CLARK (Labour—Dunedin North) to the Associate Minister of HealthDistrict Health Boards—Disability Support Services FundingDr DAVID CLARK (Labour—Dunedin North): To the Associate Minister has she seen a letter dated 5 May from five district health boards (DHBs) to the Ministry of Health entitled—[Interruption]Mr SPEAKER: Order! There is just a little too much chatter and interjection. I am going to invite the member to start that question again.Dr DAVID CLARK (Labour—Dunedin North): Thank you. To the Associate Minister—Hon Gerry Brownlee: Of what?Dr DAVID CLARK: —has she—health Gerry. It is on the Order Paper.Mr SPEAKER: Order! [Interruption] Order! I now understand why there was interjection. It is important when the member rises to announce the question that he does so fully so that the House does know.6. Dr DAVID CLARK (Labour—Dunedin North) to the Associate Minister of Health: Has she received a letter dated 5 May from five district health boards to the Ministry of Health entitled Critical under-resourcing in Regional Intellectual Disability Secure Care"; if not would she be surprised to find it contains a warning that the Ministry of Health's "failure to ensure adequate capacity within the sector is such that there is now a serious and in some areas imminent risk of harm to those individuals unable to access the appropriate care as well as to service providers and their staff"?Hon NICKY WAGNER (Associate Minister of Health): No I have not received a letter but I understand that the office of the Ministry of Health received a copy earlier this week. However I am advised by the Ministry of Health that it has been able to manage growing pressure through regional responses and individual solutions. A new national service is presently being developed for high-risk and high-needs individuals needing a secure and individualised placement and a long-term solution will be finalised in due course.Dr David Clark: What action has she taken to reassure the DHBs regarding their concern that "It is apparent that the current level of resourcing is not sufficient to enable the provisions within the IDCC&R Act to be fulfilled in accordance with the underlying purposes of the Act" and just how satisfied were those DHBs with her response?Mr SPEAKER: There are two supplementary questions there. The Hon Nicky Wagner can address one or both.Hon NICKY WAGNER: DHBs are always entitled to raise any concerns. However I have been advised that currently the ministry has access to up to 66 beds across the country. I am advised by the chief adviser of ID(CC&R) that to date the number of beds has been sufficient to meet demand at this time. However there is always pressure in this area and we are constantly monitoring capacity. As I said a long-term solution is being formulated.Dr David Clark: I raise a point of order Mr Speaker. I listened very carefully. I asked what action the Minister had taken.Mr SPEAKER: And I would be inclined to have helped the member except he broke the first rule—that a supplementary question should have one question. That one had two questions. As I listened to the questions and the answer I think that on this occasion I can conclude that the Minister addressed the second question probably not the first. If the member wants to sharpen up his supplementary questions I can try to help him.Dr David Clark: I raise a point of order Mr Speaker. The second question was dependent on the action in the first so—Mr SPEAKER: No the member is not listening. The member should not have a second question in the supplementary question. I let him do it but then I advise members when they do that not to then complain if they do not get the answer they want.Dr David Clark: Does she agree with Dr Jeremy Skipworth clinical director at Auckland's Regional Forensic Psychiatric Services at Waitematā DHB that the lack of access to step-down beds "creates a major gap in the continuum of care" and that "The risks in this process have been exposed by a number of serious incidents at the point of transition"?Hon NICKY WAGNER: As I have said before I have been advised by the chief adviser of ID(CC&R) that it is managing capacity with individualised solutions and 66 beds across the country. To date they have been able to meet demand but we are concerned about future pressures and we are working on a strategy to go forward.Dr David Clark: I raise a point of order Mr Speaker. I listened carefully and I did not ask a second question that time. I asked if she agreed with the particular bit of advice which was about the exposure through serious—Mr SPEAKER: Order! I have a way forward. I am going to allow the member on this occasion to ask the question again but in future would he carefully look at Standing Order 380(1) and how he should then in future compose questions so that they are easily understood by the House and by the Minister. On this occasion I will let the member have one more go with that question.Dr David Clark: Does she agree with Dr Jeremy Skipworth clinical director at Auckland's Regional Forensic Psychiatric Services at the Waitamatā DHB that the lack of access to step-down beds "creates a major gap in the continuum of care" and that "The risks in this process have been exposed by a number of serious incidents at the point of transition"?Hon NICKY WAGNER: Every DHB manages its patients differently. But what I have been told by the chief adviser of ID(CC&R) to date is that the number of beds across the country is meeting demand although it is looking to pressure for the future and a new strategy.Dr David Clark: Does she agree with Steve Bain acting general manager of mental health and addiction at Southern DHB that "their ward environment is not purpose-built and increasingly unsuitable given the changing patient mix contributing to increased difficulty managing patient aggression on the ward"?Hon NICKY WAGNER: All DHBs have a different way of managing their patients. It is interesting that Southern DHB is getting a new hospital in Dunedin. We know that there is pressure over these areas and we know that the 66 beds across the country can manage that demand to date. However we are concerned and monitoring demand and looking to a new strategy to manage that.Dr David Clark: Does she agree with Dr Peri Renison the chief of psychiatry at Canterbury DHB that "it appears we are in the midst of a national system failure"?Hon NICKY WAGNER: I do not think there is a national system failure. I have been advised by the ministry that it continues to meet regularly with each of its district health boards to ensure that the issues relating to the resource constraints are managed effectively. The ministry is currently doing work on its budgets for 2017-18 and the regional intellectual disability secure services are included in this work."