Menéndez March Ricardo; Reti Shane; van Velden Brooke; Verrall Ayesha; Dean JacquiRICARDO MENÉNDEZ MARCH (Green): I want to turn my focus to the issue of oral health and I acknowledge that for many of our communities accessing decent dental care services remains out of reach for them because they're inaccessible. Some of the figures that the Minister of Health has provided in written parliamentary questions show that there has been consistent—around 13000—discharges where the primary diagnoses was diseases of oral cavity salivary glands and jaws over the last few years. So my question is around what initiatives the Government is working on to reduce the incidences of these diagnoses and to improve people's oral health and whether Te Whatu Ora's relatively low number of fulltime-equivalents (FTEs) working in the public healthcare system when it comes to dentists and the oral health workforce needs bolstering and whether the Minister is comfortable with the fact that the majority of the provision for oral health services sits within the private sector. There's such a low number of FTEs within that workforce there. So any strategies that the Minister can illuminate on improving people's oral health would be welcomed.Dr SHANE RETI (National): Thank you Madam Chair. During the Estimates we asked about the number of staff at the Māori Health Authority. We were interested in this because the previous Minister of Health struggled to give an adequate answer in my view to multiple written parliamentary questions and yet this is a question we ask of every entity: what is your fulltime-equivalent (FTE) growth like? The first time that we got a really good look at that was when the briefing to the incoming Minister (BIM) came in in February and it was identified that there were 220 since February 2023 that there were 227 fulltime-equivalents. When we asked this question in Estimates the answer we got was 321—that was subsequently corrected in written parliamentary question No. 20630 to 388 FTEs or 400 headcount. That's quite a substantial change; almost a doubling from the BIM in February of 227 through to the projected final headcount of 388. While we talked about those numbers there needs to be some explanation to that and how many of those projected FTEs at establishment are vacant spots. I understand there could be a hundred of those places still vacant. In that same brief it would be useful to know if there's actually a financial officer permanently appointed.I have a number of issues around the Māori Health Authority not an increase in confidence with the recent announcement of new board members. Effectively half the board—remember in legislation there can be up to five to eight members of the Māori Health Authority board—jettisoned and another four brought in. Sharon Shea Dr Sue Crengle Lady Tureiti Moxon and Dr Chris Tooley as far as I can determine have been jettisoned. Thank you for your service. One year—just one year—later and four new people have been brought in. That needs some scrutiny some explanation as well I think. But one year later half the board gone—why is that? I suspect some of those answers are in the Ernst & Young report that the Minister will not release—if she's prepared to put a time frame on that preferably this side of the election then we will know what she knows or what the sector is telling me. So I come to that point that the Ernst & Young report may well address some of these issues and that was received on her desk on 5 May. Some of the things we know that it's likely to go over which are part of the Estimates include the fact that the statement of performance expectations that was tabled in November 2022 did not include the full financial intonation required to meet the Crown Entities Act 2004. So there are financial issues with the Māori Health Authority that I believe that document may well explore and I think it should be in public domain.We asked about why the 20 mobile dental caravans that had been previously promised had never eventuated and we're asking this question again today. It was a very firm commitment in the previous Minister's hands which sits inside this purview. We were assured—in fact the comment was: Just wait. There's still more of the parliamentary term still to come." Well no there's not; there's about another three weeks or another 11 or 12 sitting days maybe and that's it. I just can't see 20 mobile dental caravans on the horizon. So it would be useful to know about that.There are parts of information technology in the Estimates that need some serious scrutiny. If the Minister wants to explain exactly what Hira is supposed to deliver in a concise sort of way—this is a multi-hundred-million-dollar project. I've looked at it many times and I understand the interface that it's trying to have with multiple different providers. I understand that it's to enable patients to get access to their own information. All of that sounds like a flash personal health record to me. Why we are spending hundreds of millions of dollars alludes me somewhat. So it would be illuminating to have the Minister expand on that large part of the IT budget.In the same breath the southern digital transformation—again hundreds of millions of dollars. Exactly what that is doing one presumes it's associated with the Dunedin Hospital build. My understanding is that there were five options and we chose the gold-plated option. I'm happy to be corrected on that but I would also be happy to understand that better—to understand its progress how it is doing with the triple constraint of time scope and cost because for hundreds of millions of dollars in the Budget I think it's reasonable to expect some report back on that. We did look to touch on that in Estimates but it's certainly appropriate to put that on the table here as well tonight. Thank you Madam Chair. BROOKE VAN VELDEN (Deputy Leader—ACT): Thank you Madam Chair. I want to talk about safety. This year we have found that the safety of staff in our hospitals has been appalling. The number of assaults has more than doubled in the past year in our hospitals and I have had conversations with people who work in hospitals who say "Look I don't actually want to get paid more I just want to feel safe when I turn up to work and walk down my hospital wards" and people don't feel like they have the ability to do their jobs and do them adequately because they're fearful of being assaulted or threatened when they're in the hospitals.I'm curious whether there's been any funding allocated in these Estimates or any analysis done on how much money—extra—the Government should be spending or allocating in this Budget towards improving the safety and wellbeing of people in our hospitals.Dr SHANE RETI (National): Thank you Madam Chair. The previous speaker raised the question of the winter preparedness—I say again that the Government's first speaker Tracey McLellan raised the question of the Winter Preparedness Plan and I think that does bear some scrutiny in as much as that its purpose amongst other things is to decompress hospital emergency departments (EDs) and yet what we know is that Greymouth hospital is at 100 percent capacity in their general ward Oamaru Hospital had to close their ED overnight on Monday and send patients to Dunedin and Christchurch—that's right this was the Pegasus clinic last week that had to close which is a primary care clinic and one would imagine some of that overflow went to ED as well.So the Winter Preparedness Plan is supposed to relieve some of the pressure on EDs. I'm not seeing it. I'm not feeling the love from that plan not seeing huge benefits to that yet this is part of what the funding in Budget 2023—not part. It's a substantial amount of about $189 million if I recall correctly and it's supposed to be reducing the capacity and the load on these emergency departments but even here today in these past 48 hours we're not seeing that. Could this possibly be because the Winter Preparedness Plan apart from the Telehealth component is only for the eight hotspot EDs in the eight hotspot areas? So for example the scope extension of pharmacy to minor ailments which I'm supportive of scope extension—I think there's a role for that—but it really needs explanation as to why it's just these eight regions. Because what we have is we have pharmacists from Waikato and from Rotorua saying "What about us? It's not like we're an area that's extremely well served and have a well-healed population and yet we're completely missing from that part of the Winter Preparedness Plan." I think that's a really really good question to raise. I have no explanation as to why this was not ubiquitous across the whole country. I think it probably should have been and so I'd like to see the explanation for that given the substantial sums of money in the Winter Preparedness Plan.To follow on with another point that the first speaker raised around the "strong" evidence for co-pay relief I think that needs some challenging. One study that the small numbers were questioned both by the authors and by the reviewers does not a summer make. I also think that the fact that 145000 people were not able to pick up their prescriptions in the previous financial year I think it was due to cost which is being held out as one of the reasons for this wide-ranging policy. I think there are questions around that. It's been called a small number by a number of commentators. I get that 145000 is some but in the context of all the prescriptions it's not a lot.Secondly when you probe into that—and that data was done by the Health Quality and Safety Commission (HQSC)—and say well how many of those had community services cards or were SuperGold card holders because that that's the alternative policy that we are proposing the reply is "Sorry we can't tell you that we don't have that much granular data." Well that's kind of not useful. That doesn't let us have that contest of ideas. It starts with what's been quoted as a smallish number anyway and so I want to just contest this idea that the evidence is strong.There is some evidence and let's remember the primary outcome of the Otago study in question failed. The primary outcome was actually decreased length of stay. It was a failed outcome. There were some small pockets of pathology that benefit but if you read the report it was a failed primary outcome. It did reduce the number of people that went to hospital. That is fair. So it did achieve that goal and that that's a desirable goal don't get me wrong but let's not presume it was overwhelming or "strong" evidence that the Government has put forward for the co-pay reduction. It's still struggling to map that concept that wealthy people will get the same co-pay relief as those who are most vulnerable. It's just a principle that doesn't make it over the line. It just doesn't get there. I personally don't need to pay for the co-pay and I'm happy to pay for it and I know there are a large number of New Zealanders who feel similar. So I want to contest that this is a strong policy and put up a contest of ideas that in fact it should be for the most vulnerable—those with community services card holders and SuperGold card holders is what I'm proposing and unfortunately the data is not held by HQSC to actually look at what that number of 145000 is.So you know we don't seem to be able to go any further down that path at the moment but I think it's an important point to make. Again if the Minister could explain to come back to my first point why it is only eight regions eight hotspots in New Zealand who are benefiting from the Winter Preparedness Plan—apart from Telehealth; I understand that has extended further. That would be useful. Thank you.Hon Dr AYESHA VERRALL (Minister of Health): Well there you have it: an argument against targeting on the one hand and an argument for targeting on the other—total absence of logic in the last part of that question. We saw the fig leaf being wheeled out didn't we? We saw the fig leaf of "Well I've read the study and one endpoint said this and one endpoint that." and that's the warming us up for the cuts that National are going to make to the very effective and popular policy to make medicine free—to make sure as the member said that we keep people out of hospital. Going back to the first part of his question it was "How do we keep people out of hospital?" Well there's one way. We also have the winter plan and yes many of the initiatives are targeted. There are a wealth of targeted initiatives in our health system and the first year of the winter plan the first time our country has had a comprehensive winter plan that spans across pre-hospital hospital and post-hospital care—that first time yeah we did decide to approach it in a targeted way. We will be reviewing that and see if we cannot make improvements in the future.There have been some very successful parts of the winter plan. I'm told the minor ailments scheme in pharmacies is going exceptionally well. Thousands of visits there lots of people making use of it. Sometimes when people do come to hospital they have been to the pharmacy so they've had the basics already done. The kid with fever has already had their paracetamol and that means that they actually are in need of coming to hospital at that point.I contest the idea that every single output that was measured in the health system is actually the appropriate measure to take with us in perpetuity. It may not be. We are trying to change our health system to reorient its priorities to have a greater emphasis on equity to have a greater emphasis on keeping people well in their communities and that will mean that in trying to get a broad representative set of indicators of performance we will need to make changes. It's quite a complicated thing to pick the appropriate indicators and work on that is ongoing at the moment and the appropriate vehicle for resolving that will be through the Government policy statement process which will be concluded over the coming six months.In terms of questions about dental care I thank that member for that question. I'm very proud to be part of a Government that's taken the step to depoliticise fluoridation and make that an official decision. That is one of the most impactful measures we can have on young people—on all people actually but particularly young peoples' oral health and dental care. The changes we made have the potential to take our fluoridation rate from 50 percent up to 80 percent of people having access to a water supply that is fluoridated. The decisions that underlie that are now taken by the director-general and involve local authorities.In addition part of the child and youth wellbeing strategy involves other aspects of looking after young peoples' oral health. In some poorer communities we are providing families via community health providers toothbrushes toothpaste and education on proper dental hygiene there. Then in addition the really important change was to the emergency grants for dental care which has resulted in a $30 million increase I'm advised in hardship grants that have been paid out.On the matter of consultants in the Ministry of Health there were a lot of consultants in the Ministry of Health as the pandemic wound up. So of the 990 contractors in the Ministry of Health 574 moved to Te Whatu Ora. They were data and digital contractors. So 184 were in COVID vaccination. Clearly they were going to be on a contract and not long-term permanent staff in most cases and 89 were also in other parts of the COVID-19 response.I think the member who asked the question about Te Aka Whai Ora staffing numbers received a letter from the chief executive of Te Whatu Ora—and it was not via written parliamentary questions—an apology for the mistake made there which was an honest mistake—[Bell rung]—about the number of staff reported at select committee. CHAIRPERSON (Hon Jacqui Dean): Does the Minister seek another call?Hon Dr Ayesha Verrall: No Madam Chair."