Ryall Tony: Debate on Crown Entities Public Organisations and State Enterprises — In Committee 
Text is incorporated into the Bound Volume 
Ryall Tony: Debate on Crown Entities Public Organisations and State Enterprises — In Committee 
[Sitting date: 29 June 2010. Volume:664;Page:12250. Text is incorporated into the Bound Volume.] 
Hon TONY RYALL (Minister of Health) 
: 
 I am pleased to have the opportunity to speak in this debate on the MidCentral District Health Board entity. Mrs Kedgley is correct in pointing out that the MidCentral District Health Board has undertaken some of its own work to look at the status of rest home auditing and monitoring in its own region. It is done within the context of a quite serious situation that this Government inherited. It is set out in the report that informed the work of the MidCentral District Health Board which is the quite damning report of the Auditor-General. Mrs Kedgley acknowledges that report even though she is travelling around the country with the people who are damned in it. That report sets out very clearly the failure during the period 2002-08 to correctly monitor performance in our nation’s rest homes. This is very much the theme picked up in the MidCentral District Health Board report. 
The Auditor-General said that despite knowing about a number of shortfalls in the monitoring of rest homes in New Zealand as early as 2004 the previous Government failed to act on the issue of rest home monitoring and auditing. 
Hon Steve Chadwick 
: Who turned down the aged-care inquiry? 
Hon TONY RYALL 
: We do not want inquiries; we want action. That member was an Associate Minister of Health whose governance was panned in the Auditor-General’s report. The Auditor-General’s report was highly critical of the Ministers of Health under the previous Government—and it had three in 3 years—who failed to act on the poor state of monitoring in rest homes. 
As the MidCentral District Health Board report says a number of changes are needed and this Government has acted. The first thing we were very concerned about—and it was a feature of the MidCentral District Health Board report because it talked about the importance of clinical engagement and leadership in a lot of these rest homes—was to deal with the quality of nursing supervision in our nation’s rest homes. One of the first things we did in last year’s Budget was put an extra $18 million into subsidies for aged care specifically to improve nursing supervision and numbers in rest homes. That is a very important investment. We followed that up this year with an additional $16 million increase in subsidies for aged residential care. So there was a 5 percent increase last year and an additional increase of $16 million this year with a real push on nursing quality and supervision in our rest homes. That was something that was picked up by the Auditor-General and by this MidCentral District Health Board work that Mrs Kedgley talked about. 
We have followed that up even further by introducing a spot auditing regime. Many members would be surprised to know that when it came to the mid-year audit the auditors used to ring up the rest home and say: “We’ll be arriving on this date.” Well hello! Does that mean that the auditors would get a true look at what is happening? They might but they might not. We have introduced spot auditing. We do not tell the rest home the date on which the auditors will turn up and that is very important. 
What is more we have said that the people in rest homes their families and those considering going into rest homes need more information about the performance of rest homes. That is why for the first time despite the previous Government being asked to do it this Government has put those audit results online. We have provided an easy colour-coding in order to look at how rest homes are performing against the key quality criteria. 
Craig Foss 
: What does red mean? 
Hon TONY RYALL 
: It starts with blue which means a very good performance through to red which means a poor performance. When a rest home has a poor performance there is a requirement on that rest home to address those concerns. 
As is pointed out in the MidCentral District Health Board report much of this hinges on the designated auditing agency the third party that comes in and audits the rest homes. The Government has been concerned about the auditing process because as Mrs Goodhew pointed out in her discussion paper on aged-care policy in 2007 a lot of these rest home audits were contradictory. They could be done within weeks of each other yet they were contradictory. We have been looking at this audit process with particular scrutiny on the auditing agencies. One of the initiatives of this Government which is in line with the Auditor-General’s report is to bring in third-party accreditation of the auditing agencies. This means that the auditors themselves now have to meet an accredited standard in order to audit rest homes. This action was announced a week or two ago by myself as Minister of Health. It follows a programme of auditing the auditors. Last year we sent the Ministry of Health in to audit— 
Hon Steve Chadwick 
: More bureaucracy. 
Hon TONY RYALL 
: Well do we want to care for the old people in rest homes or not? It is not more bureaucracy because it is actually dealing with the problem where we can have duplicate audits saying completely contradictory things. We are auditing the auditors we have brought in third-party accreditation for the auditing agencies and we are reviewing the auditing process—so much so that the Ministry of Health is now briefing the auditors directly on how they do some of their work. 
All of us have visited rest homes from time to time to visit some of our most vulnerable New Zealanders there. Earlier this year I went with my children Maisie and Llewellyn to visit a rest home in Te Puke. I can tell members that it was very clear that most older New Zealanders in rest homes are receiving very good-quality service. They are being looked after by people who care for them love them and are doing their level best for them. Those front-line workers deserve our support and admiration for what they do. But there is no doubt that there are a number of cases of people not receiving the quality service that they need and that is why this Government has invested in nursing quality and supervision in rest homes. We have brought in accrediting of the auditing agencies we are smoothing the audit process so we do not get these contradictory audits we are reporting the results online and we are engaging with district health boards on how we make sure we get a better service there. The key thing is we can have all the auditing we like but we still have to make sure we get good-quality care for the residents. 
Anybody who has visited a rest home recently would be able to tell us that we have done a pretty good job of staffing our rest homes in the last 18 months. Work has been difficult for many people and turnover has dropped dramatically in the health sector. Last year I visited a rest home on the Kapiti coast and for the first time in years it had had a number of people apply for nursing positions. Previously it had struggled to get even one person to apply but others have now applied as well. We have been able to get good staffing in many of our rest homes around New Zealand. 
However it is very easy to beat up scaremongering stories. We heard one today in the House in question time where it was alleged that the Government had taken away Meals on Wheels in Helensville. The truth of that is that eight people will now be covered by the general service for Meals on Wheels and home support in the Waitemata District Health Board. Those people will still get their Meals on Wheels. They will be getting the same if not better service as a result of that. It is very easy to put out a press statement that says as that one did that starvation was inevitable as a result of those changes but it is very important to know the details. 
In their work on rest homes the good people at MidCentral District Health Board have identified the importance of a number of factors. One is that there are some risks around smaller owner-operated rest homes. They have indicated that there were some risks when there is a large turnover of staff or management in particular. They have identified that when there are complaints that is also a red flag showing further investigation is needed. That is all being adopted into the changes that we are making in rest home supervision. The Government did not inherit a good situation. The Auditor-General not the National Government tabled a report before Christmas that damned the governance of the previous Government. It said that the previous Government knew the state of rest home monitoring was appalling and it did nothing about it. It took this Government led by John Key to start dealing with the issues. From that party opposite we see that it is trying to rewrite the history of its neglect of rest home monitoring and supervision in New Zealand. 
As I travel around the country I can tell members that more and more people have wised-up to the political games that are going around the country on this select committee dealing with rest homes. They know the members whom they are talking to were Ministers in a Government that neglected rest home nursing and supervision neglected monitoring and neglected dealing with the auditing agencies. They are all issues that this Government is dealing with and they are all issues that the MidCentral District Health Board is strongly supportive of.