4. Question No. 4—HealthDr CARLOS CHEUNG (National—Mt Roskill) to the Minister of HealthQuestion No. 4—Health4. Dr CARLOS CHEUNG (National—Mt Roskill) to the Minister of Health: What steps has the Government taken to improve the performance of Health New Zealand and to deliver better health outcomes for New Zealanders?Hon Dr SHANE RETI (Minister of Health): Yesterday I announced the appointment of a commissioner to Health New Zealand due to deteriorating performance issues. The issues at Health New Zealand stem from the botched health reforms undertaking over the last two years. This includes Health New Zealand currently overspending at the rate of approximately $130 million a month. This is unsustainable despite our Government's record investment in health of $16.68 billion in this year's Budget. This is a significant intervention which we have not taken lightly but nothing matters more to this Government than ensuring that our health system delivers better outcomes for all New Zealanders.Dr Carlos Cheung: What structural and cultural matters have been raised with the Minister regarding Health New Zealand that have led to his decision to appoint a commissioner?Hon Dr SHANE RETI: The issues at Health New Zealand stem from the mismanaged health reforms which resulted in an overly centralised operating model limited oversight of financial and non-financial performance and fragmented administrative data systems which were unable to identify risks until it was too late. Deciding to break up the district health boards and to reform the health system in the middle of a pandemic was always destined to be challenging and the situation we're in right now is proof of that. The move to appoint a commissioner comes following concerns raised by numerous bodies such as the Office of the Auditor-General the Ministerial Advisory Committee for Health Reform Implementation the Crown observer we appointed and the new commissioner himself. We are not afraid to take this action.Dr Carlos Cheung: What will be the focus of the commissioner?Hon Dr SHANE RETI: I have made it clear in my letter of expectation to the commissioner that he is to work to ensure there's no interruption to delivery of services during this period of recovery and that Government targets and objectives are prioritised. We have appointed the commissioner to reduce the distance between the front line and decision making streamline unnecessary back-office management and administration and have a single point of accountability that is laser-focused on patient outcomes for New Zealanders. The commissioner will focus on de-bureaucratisation putting patient outcomes first and ensuring that local staff are involved in decision making. This is how we will drive better health outcomes for all New Zealanders.Hon Dr Ayesha Verrall: Which is correct: the Minister's statement yesterday on Checkpoint that overspend on back-office staff is the cause of Te Whatu Ora's deficits or Margie Apa's statement today that rapid changes in the nursing workforce caused the deficit?Hon Dr SHANE RETI: What is correct is that an increase in back-office staff from 2018 to the current time of 2500 has contributed to the current financial position.Hon Dr Ayesha Verrall: Is he seriously saying that a six-year period's change in back-office staff suddenly impacted the Te Whatu Ora's books in March of this year?Hon Dr SHANE RETI: I'm seriously saying that six years of that Government and two years of a botched reform is seriously affecting where we are now.Dr Carlos Cheung: How will the decision to employ a commissioner affect front-line staff?Hon Dr SHANE RETI: Disconnecting from the front line meant that Health New Zealand was challenged to align its resources with front-line needs. There was inadequate visibility of what was happening at the front line. So a significant part of what we're doing here is reconnecting with the doctors nurses allied health and other parts of the health workforce. They know best what resources they need what workforce they need and how to best flex up and flex down to meet acute need. The commissioner has already taken steps to move decision making closer to the front line and local communities. This move will help to guide better outcomes for patients and empower local staff with decision-making authority.