Turei Metiria: Questions for Oral Answer — Questions to MinistersText is incorporated into the Bound VolumeTurei Metiria: Questions for Oral Answer — Questions to Ministers[Sitting date: 05 June 2013. Volume:690;Page:10721. Text is incorporated into the Bound Volume.]5.METIRIA TUREI (Co-Leader—Green) to theMinister of Health: How many decile one two and three primary and intermediate schools have their own school nurse funded by the Government?Hon TONY RYALL (Minister of Health): I am advised that there are around 680 decile 1 2 and 3 primary and intermediate schools. District health boards currently employ 280 fulltime-equivalent public health nurses who provide nursing services to all of these schools. These nurses are employed by district health boards not the schools themselves. How the needs of each low-decile school are best met is organised on a local basis and additional services are provided in many cases—for example as part of the rheumatic fever programme in 198 schools. But I have to tell the member that this is not the only good news. There will be 670 social workers—Metiria Turei: I raise a point of order Mr Speaker. Just as questions are required to be succinct so are answers. I think the Minister has talked a lot. I will certainly be making a point of order as to whether he answered my question but he is simply going nowhere with his current answer.Mr SPEAKER: Is the member saying she is satisfied with the answer? We can move to the next supplementary question.Metiria Turei: I raise a point of order Mr Speaker. The Minister has not answered my question.Mr SPEAKER: The Minister was attempting to but it is very difficult for the Minister to address the question when immediately upon answering it the member starts to dispute the answer. I invite the Minister if he so desires to continue his answer.Hon TONY RYALL: As I said district health boards employ 280 fulltime-equivalent public health nurses who provide nursing services to all these schools. This is not the only good news. There are 670 social workers in all low-decile primary schools by the end of next term and I am advised that virtually all schools have a named public health nurse who works with them.Metiria Turei: I raise a point of order Mr Speaker. This question has been put on notice for some hours now—Mr SPEAKER: Order! [Interruption] Order! The Minister has quite adequately addressed the question. The member now has some supplementary questions if she wishes to use them.Metiria Turei: How many decile 1 2 and 3 primary and intermediate schools have a nurse based permanently in their school?Hon TONY RYALL: I do not have information on how many because—[Interruption] What I can tell the member is that—and I do not think that the member was aware of this when the Green Party policy was announced—public health nurses are allocated to every school in New Zealand and those services are provided by the public health nurses to all those schools. Matching those public health nurse services for all those schools are 670 social workers by the end of next term. It is this combination of school nurses and social workers that has proven to be most effective.Metiria Turei: How many decile 1 2 and 3 primary and intermediate schools have a nurse who visits more than once a month?Hon TONY RYALL: Quite a lot actually. While I have been talking around the countryside it has become quite clear that most decile 1 2 and 3 schools will have a very regular visit from their public health nurses. I talked to a couple of schools today who had a visit at least once a week and all these nurses are available on referral by the school.Metiria Turei: I raise a point of order Mr Speaker. My question was very precise. It asked how many decile 1 2 and 3 primary and intermediate schools had a nurse who visits more than once a month—Mr SPEAKER: Order! Can I invite the member at the conclusion of question time to study theHansard.Metiria Turei: If the Green Party’s proposal—[Interruption]Mr SPEAKER: Order! Would the member start again. I cannot hear the question; start again.Metiria Turei: I cannot hear anything either. If the Green Party’s proposal for a dedicated school nurse in every decile 1 2 and 3 primary and intermediate school was already happening as the Minister has said why then is KidsCan having to embark on a major school nurses programme of nearly $2 million to “plug holes” in school health services?Hon TONY RYALL: I have not got the full details of what that member is alleging but what I can say is that we are providing nurses in schools. Virtually every school has a named public health nurse and there is a much better coverage. I saw a report earlier today that said there used to be one public health nurse for 13 schools in Porirua in 2002. What I know is that now all the four or so schools in Cannons Creek are receiving regular nurse visits every week for a significant number of hours. In the Capital and Coast District Health Board area for example some schools are allocated 20 hours a week of public health nurse time. The Green Party was unaware that public health nurses were active in schools.Metiria Turei: If the Green Party’s proposal for a dedicated school nurse in every decile 1 2 and 3 primary and intermediate school was already happening as the Minister said why has the principal of Papakura’s decile 1 Kelvin Road School said in a written email to me that they have had only one visit from a public health nurse last term and only one visit from a public health nurse this term?Hon TONY RYALL: I would have to check the detail of that case but I would say I do not think many people think it makes a lot of sense to have one nurse allocated to a school of only 40 children. That does not make a lot of sense because what will the nurse do all the time with one nurse for 40 children in a school? What this Government does is have 280 public health nurses working every day with schools up and down thiscountry which is a fact that the Green Party seemed to be completely unaware of when it announced its policy on Sunday.Jacinda Ardern: I raise a point of order Mr Speaker. Just for the sake of clarity the Green Party had asked a question on notice about how many of the school nurses in decile 1 to 3 primary schools were funded by the Government. The Minister mentioned that there were many nurses. Clearly he did not have an exact figure. I just wanted to seek clarity as to whether or not it is actually up to the district health board’s discretion—Mr SPEAKER: This is not a point of order. [Interruption] Order! That is not a point of order. The member will resume her seat.Metiria Turei: I seek leave to table an extract from the email to me from the principal of Kelvin Road School who says that—Mr SPEAKER: Leave is sought to table the email from the principal of the school. [Interruption] Order! The House has heard enough. Leave is sought to table that email. Is there any objection? Yes there is.Dr Jian Yang: Has the Minister seen a report that says there are no health services between before-school checks and nurses in secondary schools and a claim that says that there is a gap in school-based health services programmes in primary schools?Hon TONY RYALL: Yes I have seen a report that says there is no national framework for school-based health service programmes in primary schools. This is simply incorrect. It appears that the writers of this report were completely unaware that we have significant numbers of public health services in primary schools delivered by public health nurses especially in low-decile schools. The writers of this report said that there were no health services before before-school checks and before secondary schools. The writers were well and truly behind the eight ball and the report came from the Green Party of Aotearoa.Metiria Turei: If the Green Party’s proposal for a dedicated school nurse in every decile 1 2 and 3 primary and intermediate school was already happening as the Minister has said in his last answer why then has the principal of Hamilton’s decile 3 Rhode Street School written to me to say that his school has had to employ its own nurse with funding diverted from his school’s operation grant because “Many of our tamariki were missing school due to preventable illnesses such as glue ear school sores and head lice.”?Hon TONY RYALL: Of course I would have to check the full circumstances of what the member says but I understand that in the Waikato they employ 36 public health nurses who regularly visit schools. I think that if the member had taken the time to talk to some decile 1 2 and 3 schools she would have found out that public health nurses are regularly visiting those schools. They can take referrals from those schools. They are working actively with those schools with Child Youth and Family and with hospital and general practitioner referrals. It is quite clear from the Green Party policy announced on Sunday that it did not realise that public health nurses visit primary schools regularly.Metiria Turei: If the Green Party’s proposal for a dedicated school nurse service in decile 1 2 and 3 primary and intermediate schools was already happening as the Minister keeps repeating wrongly why then did a principal write to me to say that a public health nurse tried to help where she could but was spread between too many schools and was often seconded by the district health board to deliver other programmes?Hon TONY RYALL: Of course I would have to be able to check the details behind that. But what is absolutely clear is that we have got 280 public health nurses who are regularly visiting and supporting schools. They are also working closely with thefamilies based on the referrals that schools make. This is a valuable service that is already being provided. It is absolutely clear in its discussion document and its policy that the Green Party was completely unaware that the school-based health service is provided by public health nurses up and down the country. It is rather embarrassing for it I would have thought.Metiria Turei: Will the Minister address the reality of the situation and concede that school principals are right when they say that there is a glaring gap of nurses in primary and intermediate schools right now and that the pay-off of a comprehensive service in these schools is improved academic results better school attendance millions of dollars saved from avoidable illness every year and most important better lives for around 120000 New Zealand children—lives that he is not providing for because there is no comprehensive public health service in primary and intermediate schools—[Interruption] I raise a point of order Mr Speaker. I do not expect the Minister to stand up and begin answering the question before I have even finished it. [Interruption]Mr SPEAKER: Order! It would be helpful if the Minister did not rise until the member had finished. But equally it was a very very long question.Hon TONY RYALL: What I would say to that member and in response to that question is that members can ask as many questions as they like but it will not cover the fact that the Green Party was unaware that for example in Gisborne primary schools there in the high-decile areas are visited three times a week and more often when need is there that in Northland—Hon Member: The high decile in Gisborne?Hon TONY RYALL: —rather the low-decile schools in Gisborne—and the low-decile schools in Northland are visited on a weekly basis including 19000 one-on-one consultations between the public health nurse and the school student. Whatever that member says it cannot hide the fact that the Green Party did not know that the public health nurse services were provided in primary and intermediate schools.Mr SPEAKER: Supplementary question Brendan Horan. [Interruption] Order! I have called Brendan Horan.Brendan Horan: Are school nurses able to provide care for every child that is insulin dependent and has type 1 diabetes in decile 1 2 and 3 schools and are these nurses aware of the problems these children and their parents are reporting with CareSens meters and faulty scripts?Hon TONY RYALL: I am sure the school-based public health nurses are aware of the needs that any school wants to draw to their attention but I have to say in respect of that matter of the diabetes switch-over led by Pharmac that actually the vast majority of consumers have made the switch and it is progressing very well.Metiria Turei: I seek leave to table a summary document prepared by my office of extracts of emails from nurses and from principals talking about the issues of having no nurses available—Mr SPEAKER: Order! That is enough of an explanation: a summary document prepared by the member’s office summarising the issues. Is there any objection to that being tabled? There is.Brendan Horan: I seek leave to table correspondence from Mrs Sarah Jane Mills regarding problems experienced by a registered nurse to test her primary school - aged son’s blood sugars using a CareSens meter.Mr SPEAKER: Leave is sought to table that document—Rt Hon Winston Peters: I raise a point of order Mr Speaker.Mr SPEAKER: Are you speaking to that point of order?Rt Hon Winston Peters: I am speaking to the point of order. My point of order is to ask whether this disclosure is being made with the consent of the correspondent.Mr SPEAKER: That is a reasonable point. Could the member Brendan Horan confirm that the disclosure would then be made with the permission of the patient he is talking about?Brendan Horan: Yes I believe it is.Mr SPEAKER: OK leave is—[Interruption] I think that unless the member is sure he would be better not to be tabling the document. That would be my advice.Brendan Horan: I seek leave to table correspondence to me from Helen Lockley of New Plymouth whose diabetic son—Mr SPEAKER: Again the same issue. Is Mrs Lockley aware that you are attempting to do this?Brendan Horan: Yes.Mr SPEAKER: OK. Leave is sought to table that correspondence. Is there any objection? There is.Metiria Turei: I seek leave to table two documents. Both are communications to me the first from the New Zealand Nurses Organisation and the second from the New Zealand Educational Institute supporting a policy of comprehensive health services in decile 1 2 and 3 primary—Mr SPEAKER: Leave is sought to table those two pieces of correspondence. Is there any objection? There is.Chris Hipkins: I raise a point of order Mr Speaker. I waited until the end of the question because I did not want to interrupt the member’s questions but I want to raise with you a recurring issue in the House and that is the inconsistency of the quality of the sound system. During that question we could barely hear Metiria Turei and I could tell that she was speaking quite loudly. We could hear very clearly both the Minister and Brendan Horan and others who were speaking quite quietly. It does seem to be that some of the microphones in the House are very loud and others are not. Sometimes sure the level of interjection impacts on that but clearly there were points when the House was very silent while Metiria Turei was speaking and I could still barely pick up what she was saying.Mr SPEAKER: I will certainly look—Hon Gerry Brownlee: I raise a point of order Mr Speaker. I do not want to prolong things. I would have to agree that it was pretty hard to hear the member. It is probably because of the location of the microphone. With all due respect if it was on the other side of that desk and she was speaking directly to it it would have been in a better position to hear what she was saying. But it was actually quite pleasant.Mr SPEAKER: That is not helpful either. I will—[Interruption] Order! I am ruling on this first. In answer to the point raised by Chris Hipkins I will certainly have another look at the quality of sound. It is not helped by noise coming from any part of the House when members are attempting to ask questions.Brendan Horan: I seek leave to table a series of photographs showing the results of dual testing using the same drop of blood—Mr SPEAKER: No. That is not going to be of any value to the House.