Clark DavidHon Dr DAVID CLARK (Minister of Health): Thank you Madam Speaker. There was a lot to say about that speech. I don't want to dwell too much upon it other than to note that of course years of neglect and under-investment in our health services will be a theme of my contribution but also a reflection just around the nature of the economy we inherited. That was really being pushed by population growth—huge immigration during the previous Government's tenure—and also from people selling houses to one another. Those were the things that were propping up the economy and that is not a sustainable plan for an economy that we want to see. We want to see a prosperous economy where the benefits are shared across the population where the wellbeing of our citizens is at the core not just GDP but also looking more broadly looking to the environment and looking to social connection looking to education and skills looking to all of those things that make a good society that everyone benefits from.I do want to concentrate my contribution on a few of the issues—the long-term challenges—that we've inherited in health and the investments that are being made in this Budget to tackle those long-term challenges. It is true that the previous Government under-invested in health and independent research suggests that was about $2.3 billion worth of under-investment. And of course you cannot strip $2.3 billion out and not see service levels drop. That's what we've inherited as a Government and we are absolutely committed to investing more.So in our first Budget of course we put a record amount into DHBs—$2.3 billion—and then in our most recent Budget we went higher again at $2.8 billion into our DHBs to make sure we have more doctors and nurses because those workforces had been stretched for far too long under the previous regime and were showing the signs of stress and strain and certainly I had plenty of people come and talk to me in Opposition about the difficult situation they found themselves in in our hospitals. We are investing in those workforces and we're going to make a difference but of course we can't train the workforces overnight; that neglect has a long tail. We have to build up workforces. Some of them take five years to train some of them 10 and 12 but we're getting on with that because we're determined to address the problems that we've inherited to make sure that we are investing in our nurses and doctors.Another area where there's been significant neglect that we have put more money into is cancer treatment. The previous member Paul Goldsmith raised this and tried to claim that no money went into the Budget into Pharmac—after the prior Budget was a record amount. A huge amount went into Pharmac and this most recent Budget put another $10 million in. We know that hundreds of thousands of New Zealanders have benefited in just two Budgets from more access to medicine. And then subsequently we've put yet more money in—another $60 million into Pharmac more recently in recent weeks alongside our cancer action plan—and much of that money will be spent on cancer medicines and I think that is a really good thing.But of course we're looking at the whole spectrum of cancer care. So we've also invested $25 million in the linear accelerators to make sure that the fleet of them is upgraded because they again were not funded or supported under the previous Government and that postcode lottery that we inherited in cancer care is something that we are determined to address to get on. We're not going to crawl over the troubles that led us here—the neglect of the system under the previous Government—but we've inherited that situation and we are determined to make sure that we are investing. So for the first time we will have linear accelerators in Taranaki in the Hawke's Bay in Northland—areas that had not had that level of cancer treatment available to them. People have had to travel—or haven't travelled because they couldn't neglect their families—to go and get that cancer treatment.We've also rolled out more bowel screening and we continue to roll that out so that now hundreds of thousands of New Zealanders can access that bowel screening and that programme has already revealed 320 New Zealanders had bowel cancer detected in the two years the programme has been up and running and many more have had polyps removed that could have developed into cancer. So that programme—the screening and prevention aspects—that we're promoting and funding through the Budget will continue to grow and I'd expect more investment in future Budgets in that area because we are committed to that programme.Another area that I noticed the finance Minister touched on was the huge capital investment that this Government is making. And in the area of our hospitals many people will remember that we inherited hospitals with rot and mould in the walls and in some cases sewage in the walls and that is largely a result of under-investment under the previous Government's watch. Well we have decided to turn that around and in two Budgets—just our first two Budgets—we have put more money into our public hospitals in total than they put in in the whole nine years that previous Government was there for a point of comparison. Not just more money in two Budgets than they put in in nine years but twice as much money in just two Budgets as they put in in the whole nine years they were in office and shame on them because our public health system has been neglected. But we are determined to build it up again so that we have the kinds of facilities we think New Zealanders expect and deserve when they're wrestling with cancer when they're needing the care that they need when they've got other health conditions—whatever it is. When they show up at a hospital they should have access to modern facilities here in New Zealand. We are a First World country.We've better funded our ambulance services. We're paying family carers what they deserve in the Budget and of course I mentioned the cancer care—the range of areas we've invested in. But on top of that in cancer care one of the significant things is meeting our promise of establishing a national cancer agency. We've got an interim director in there who is going to set tumour standards across the country and that will make a significant difference. We've already seen with bowel cancer tumour standards that some DHBs are providing better care than others. It's difficult for DHBs to hear that but it's actually a part of finding the solutions working out where we're doing better and how we support those areas that are not doing so well. We are going to tackle those challenges those long-term challenges that we have inherited. Of course recently I had the privilege of going and launching a couple of new helicopters that were funded out of the additional money we put into helicopter services to ensure a better level of care. The previous Government seems satisfied with single-engine helicopters where people couldn't be treated in the back of the helicopter. The previous Government seemed satisfied with that situation. They were not interested in raising the standards around the country making sure everyone had access to high-quality care no matter where they were. In fact some of them argued that some areas should have access to lower-quality services just because of a parochial interest but we won't say more about that now.There are many more areas where we are cleaning up after the previous Government. The Holidays Act provisioning—I know in the DHBs the work that's going on there. You know that was an issue that they had the whole time they were in office and didn't address and that's meant that New Zealanders had been underpaid for years. We'll hear more about that. We're also going to have to be writing off money associated with the National Oracle Solution—a failed IT system a failed project of the previous Government. All of that money will come through the DHB funding system.So as a Government we are determined to tackle mental health and I want to say a few words about the recent announcements we've made on mental health. In the past couple of weeks we have firstly rolled out the first funding for services that had already been piloted across New Zealand supporting 170000 New Zealanders to get supported at primary care level. It was of course one of the central findings of He Ara Oranga the inquiry into mental health and addiction that we needed a primary care service available to those with mild to moderate distress and those with anxiety or depression and as a Government we are determined to ensure that every New Zealander in distress every New Zealander with anxiety can access the support that they need to wrestle with that mental health challenge.So shortly there'll be a request for proposal going out—it's just gone out in fact—that will call for more projects around the country so that we can expand these services and make sure New Zealanders—no matter who they are no matter where they are in the country—can access primary care support be it through an NGO—$62 million of the $455 million associated with that initiative is for kaupapa Māori services recognising that while most Māori continue to access mainstream services kaupapa Māori are becoming increasingly important. So we're going to grow our kaupapa Māori services so that people can find support where they would normally go in the community to find support: through community development agencies through youth one-stop shops through their GP through kaupapa Māori services and so on. Of course beyond that we've also announced a suicide prevention strategy. Of course there was a gap. That last one ran out in 2016. Again He Ara Oranga said that we needed to get one in place sooner rather than later. That is now in place and there is support for the bereaved associated with funding in the Budget because that has never been supported in the past adequately. Beyond that we've announced the Suicide Prevention Office which will drive accountability across the sector. We've announced a Mental Health Commission and the initial commissioners for the interim period—another promise delivered on. There are so many promises that we've delivered on already in health. A very busy Government and a big mess we are cleaning up.