Little Andrew; McKelvie IanHon ANDREW LITTLE (Minister of Health): Thank you Mr Chair. If I just respond as I can to the most recent contributions.So to Dr Shane Reti and perhaps to Nicola Grigg as well who put the case for a workforce strategy—I do refer those members to clause 14 of the bill which was amended by the Pae Ora Legislation Committee and I'll refer them to subclause (1)(fa) and (fb) which spells out as part of the functions of Health New Zealand in subparagraph (fa) undertake health workforce planning; and (fb) collaborate with relevant entities to improve the capability and capacity of the health workforce;". So that is a statutory function of Health NZ and there's a further obligation for them to cooperate with the Māori Health Authority on that. Because this is a Government that likes to back up its words with resources and action the members will be aware from the Budget two weeks ago that we have put additional resources into workforce development for the Māori workforce for the Pacific workforce and for the health workforce generally just in the way we have done with the mental health workforce that had been left pretty run down for nine years in a row by the previous Government.It's interesting that Mr Doocey should talk about epiphanies. I think the biggest epiphany is the National Party realising in Opposition that we actually have mental services. Having neglected them for so long they now are in a dire state. It is this Government in the last five years that has actually taken the action to really boost them by adding more than 900 people to the front line of those mental health services and starting to make a real difference. But I'll come back to Mr Doocey's points in a minute because as always he's got things wrong.I just want to say in terms of the state of the workforce the members are right: there are some real challenges for the health workforce at the moment not helped by the fact that the health workforce was also the victim of underfunding for many years by the previous Government. Indeed you've got things like nurses. Nurses' remuneration went backwards in real terms under the previous Government. They simply did not give pay increases to nurses that matched the rate of inflation. We've turned that around. Even before the pay equity claim if and when that ever gets resolved with the Nurses Organisation we've increased pay by 20 percent in the first four years that we've been in Government. But through the pay equity settlement when that does come on stream that is a significant change in remuneration for nurses. A nurse with seven years' experience on a basic salary a full-time salary of $95000 and with the benefit of doing overtime and what have you it will push it well over $100000—that's the sort of stuff to do because we know that for nurses they've been undervalued and therefore underpaid for so long. But many of the challenges we have with the workforce is because there is a worldwide shortage of health workers whether it's at the senior medical officer end whether it's nurses or whether it's healthcare assistants. We've done a lot of work to support health entities both public and private to make sure that they can recruit offshore but also investing and developing our own workforce. So this year we put 1700 New Zealand graduate nurses into our health system just from last year's production from the tertiary system and we will continue to invest in that and grow places.The member did raise an interesting point about overseas-qualified medical officers struggling to get supervised places for their postgraduate year 1 and 2 and I know the member is genuinely concerned about this as we all are. One of the challenges we've got is again with the vacancies we have in the health system arranging supervision. We've got to have enough senior medical officers who are prepared to provide that supervision to allow that to happen. I can say to the member that I am aware both the ministry and people on behalf of the DHBs have been working with the Medical Council and others to talk about ways in which that supervision can be provided that isn't in the traditional form but can get those qualified graduates who are driving Ubers and what have you into a health system where they are desperately needed. The other aspect of that is that some of those graduates because they've got family here they're very clear about where they want to go and it's not necessarily where all the vacancies are. So look these are challenges but the member will be aware that is what goes with workforce management much less with workforce planning. But the member will see from clause 14 in the bill that there is a statutory obligation on those entities to do workforce planning and the capability development that goes with it. I'm satisfied that those provisions close off the things that he would want in his Supplementary Order Paper (SOP).To address Mr Doocey's ongoing claims with his SOP for a mental health strategy the health strategies that are referred to in there are population strategies. These are populations that typically have been underserved by the health system previously. We know Māori and Pacific and actually the disabled community—if you look at the responses they get many of them struggle to get the health services they need. Many of them actually are very clear that their issues are not just about health services; it's about the full range of services which is why as part of the reforms we're establishing a separate ministry for disabled people—it's a working title at the moment. But when it comes to a mental health strategy that is a requirement of the health entities. I refer the member to clause 7(1)(e)(iii) where it refers to "(e) the health sector should protect and promote people's health and wellbeing including by— … (iii) working to improve mental and physical health and diagnose and treat mental and physical health problems equitably;"—that is to say that we don't treat mental health services or the needs of those with mental health issues as somehow inferior or secondary to those with physical health challenges. That has been the culture of our health system. It's been the culture of the previous Government. That's why this Government has worked so hard to address the challenges we have in our mental health system. That's why we've added more than 900 people to the front line of mental health services providing talk therapies and other assistance to those with mild to moderate mental health issues. It's why we put another $100 million into mental health services for specialist and acute services in the Budget two weeks ago where we can start to address those shortages in those services where we can start to beef up the services available for those with eating disorders and where we can start to provide places in the community for those who having been through an acute episode and who would best recover in the community will have places to do so. That is our commitment to mental health services.So far the only plan that the National Party has for mental health services is to appoint a Minister for mental health services which tells you that the National Party is only interested in window dressing. They haven't spelt out a single plan or a single thing they would do for mental health services assuming that is different to what we would do. They are the party of window dressing when it comes to these sorts of things. Their track record in Government is to run down health services and to neglect mental health services. So I stand by what this Government has been doing and is doing the commitments that we're making and I'm confident that the statutory commitments that are provided for in this bill means that our health services will be well looked after.Nicola Grigg talked about workforce development. She seems to want me to start doing the work of those who will be responsible for putting together the women's health strategy and others; I'm not going to do that. There is a statutory requirement to have a women's health strategy that will include maternity services.What we won't do is we won't allow a repeat of what has happened in Canterbury before and that is to have in that case a DHB that overspent its budget significantly year after year after year. If the member's worried about what has happened to Canterbury health services she should ask "What is the DHB doing?" They not only spent what they were asked to spend and appropriated to spend they spent a heap more besides and still they struggled to get the health services. This Government has been committed to Canterbury health services. It's why we've approved additional buildings and why we're backing the Canterbury District Health Board in its current form to continue to provide services.The staffing shortages that are evident throughout are staffing shortages that not only are we experiencing across the country but the rest of the world is experiencing too. We hold our head up high in terms of the investments we're making and the efforts that we're making to fill the gaps that are there at the moment.CHAIRPERSON (Ian McKelvie): I call Brooke van Velden and in doing so I just put Rawiri Waititi on notice that I haven't forgotten him."