Little AndrewHon ANDREW LITTLE (Minister of Health): Can I begin by once again acknowledging the family who are at the centre of this report and now at the centre of this debate. I acknowledge the grief that they have suffered through the loss of a loved family member.Can I also pay tribute to our health workforce—those working in Middlemore Hospital but also those working right across our public health system and who have had one of the most challenging three years and then on top of that one of the most challenging winters that we have seen or that our health system has experienced for many many years. In fact every clinician I talk to says of this winter flu season that it is the worst in living memory.Those were the circumstances in which Middlemore Hospital and the rest of our health system was operating in June this year when this patient presented herself at about 1 a.m. one morning in June. It's interesting to note in the report that even the report author acknowledges his—and I think it is a his"—limitations in preparing the report. He opens the report by saying "I have not received or read any clinical notes. I have not reviewed any policies regarding the triage process or escalation procedures." So that is a matter for the independent reviewer. The independent reviewer is independent and is entitled to access to information; that's how the independent review process works. But this independent reviewer decided to write the report not on the basis of that clinical information but on the basis on whatever information he had.I say for the benefit of the member who has brought this urgency motion the report is also very clear in that they thought that even had this patient been triaged in the way that they ought to have been notwithstanding that the independent reviewer did not have access to triage policies it may not have prevented the outcome. Indeed the reviewer goes on to say of this event that it was "unfortunate" that it was "unpredictable" and that it was "unavoidable" and just as the hospital's own review of the incident concluded it could not be concluded that were circumstances different in terms of the numbers of patients in the emergency department and the number of patients in the hospital the outcome might have been any different.I think it is important to note too that we can look at an isolated event and this report deals with an isolated event and it would be simplistic to draw conclusions without looking at the context. This is a health system that after two years of dealing with COVID—and its resources are somewhat stretched to deal with COVID because you had nursing and other health staff redeployed to run the amazing vaccination programme that vaccinated such a large proportion of our population; they're managing those turning up to hospital with COVID and the extra special care that they needed. And then we're faced with a winter with the borders open and a flu season unlike anything anybody had ever seen before. Those were the circumstances in which these events happened. They are not the only circumstances and the reality is that ours is a health system that has been run down; run down for years—underfunded and under-resourced. The National Party when they were in Government or at least when they're in Opposition still will not take responsibility for the appalling and disgraceful under-investment and under-resourcing of the health system. You know it's interesting how right now this is a Government that in five years has committed $7 billion for the upgrading and rebuild of hospital facilities that we desperately need. You compare that to the nearly $1 billion that was put in in the previous nine years. You compare that to two years—2015 and 2016—when no money was allocated to hospital facilities in this country. And so we are in a desperate catch up mode. In addition to that this is a Government that has in its five years funded an additional 5000 nurse positions in our hospital system because they desperately needed it. The previous Labour Government committed to a Safe Staffing Accord with the New Zealand Nurses Organisation. That led to the Care Capacity Demand Management programme and it was left to the previous National Government to implement it and by the time they ended their term nine years later it was in disarray. Most hospitals had not fully implemented it despite having had nine years to do so and one of the hospitals—from my home town Taranaki Base Hospital—was one of the early starters and by 2017 was one of the laggards in terms of implementation because they were not interested in it. That's what happens when you have a party that just neglects health—a party that just neglects health. This is a Government that has funded our health system to an extent that it has never been funded before; increased funding by nearly 45 percent. Now we know there are challenges in the rest of the health system too: challenges in primary care challenges in aged residential care and we're working on all of those areas. So when the National Party complains about "not enough doctors" they did nothing to increase the number of medical students. I'm very proud to have announced a couple of weeks ago a programme for more medical graduates to train as GPs and to train in the GP context and to lift those numbers and to do that in collaboration with the Royal New Zealand College of General Practitioners. So these are the initiatives that are needed. And then we also know we're a system that has always been dependent on immigration and that's why we have changed our immigration settings to make it easier for health workers to get here. Even during the time that our borders were closed 5000 health workers were able to cross our border to be part of our health system—many of them health care assistants working in aged residential care.But that's not the only place where we need to fill the gaps; we have a lot of gaps in the public health system as well. We now have the Accredited Employer Work Visa; we've had in fact over 500 applications of that now. That follows on from the critical work visa that had been in place during COVID and ended at the end of July. I'm pleased to report to this House that since July 381 nurses ready to work have crossed the border to come and work in our public health system—most of them on the critical work visa because that's what was available at the time—and a growing number now on the Accredited Employer Work Visa. And for those that think that you know you change the immigration setting and the next day thousands of people turn up—that's not how it works. These are people who are applying for a visa that guarantees them residency so they are here for the long term. They are recommitting their lives in coming to New Zealand and so it takes some time for them to close out their affairs where they are shut down their lives and shift it all to New Zealand to start here. And that is what is happening.We have a lot of trained nurses coming here on visitors' visas doing the Competency Assessment Programme and then converting to one of the other visas—it will now be the Accredited Employer Visa—and we're seeing that happening as well. Hundreds of nurses—hundreds of nurses—queuing up getting their visas getting their approval and coming to work in our system; that's what they're doing and that's what they do. Since July 381 crossed the border—that's what they are doing.So I am satisfied that Te Whatu Ora – Health New Zealand is doing everything they can to recruit and to get nurses and other health workers here. Very shortly they'll start up their dedicated immigration desk have immigration officials amongst others working on it and they will manage the process—right from the recruitment ad that goes out overseas to dealing with a contact dealing with the application dealing with the visa application and helping them with their airfares and resettling to New Zealand to fill those gaps. But to not make that change quickly when you have nine years of under-investment nine years of running down the system and two years where you don't invest anything at all in the facilities and our health system—it takes a while to turn that around and we are in major catch-up mode.But here's the extra thing: when the ACT Party talks about "We need more productivity" all they talk about is doctors and nurses. Well the reality is that health care is changing. We saw during COVID and we saw with the vaccination programme the brilliant effort that went in—for a whole bunch of people who know about health care who know about health work and with just a little bit of micro-credentialing a little bit of support and some good leadership we're able to pick up tasks that previously we would have relied on nurses to do. The challenge for the health system of the future is not for doctors and specialists to insist that they do everything not to have nurses doing a whole lot of tasks that other good skilful healthcare workers can do but to actually make sure we have a health system that is about the right health professional doing the right thing for the patient at the right time. That's the magic we have to achieve. So much of the health workforce gets it and they want it and we are going to deliver it.That's why there is a health workforce programme of development under way at the moment. That's what has informed the initiatives that we've started implementing—ones I announced on 1 August and the ones that I've announced since then. Very soon we will start a dialogue with the health workforce on what else it is that they want to see that's going to help us fill those vacancies but most importantly make sure that their working lives are as satisfying as they can be that they are able to work at the top of their scope and exercise the skills that they've got. For those who want more qualifications and more training we will provide them the opportunities to do that and have a health workforce that is relevant to the needs of New Zealand today.One of the other incredible things is the kaiāwhina workforce that was stood up during COVID-19 many of them so keen to continue to work in our health system. Some interests within the health system don't want them. I remember the words of Professor Des Gorman in a presentation he made earlier this year "There is privilege in our health system"—there is privilege in our health system. Part of the challenge is to break that down and say "Actually we've got to distribute these important health tasks for skilful and qualified people. But most importantly if we're going to make the difference and have health services that are easily accessible—accessible to people who have not had or who struggle to get access to health services—having the right people sitting in front of them providing them comfort to be there and the skills then to address the health needs that they've got. That's the direction that we're in. That's the path that we're on. And I'm confident that Te Whatu Ora – Health New Zealand and Te Aka Whai Ora – Māori Health Authority are doing amazing work and will get us there.But I again conclude by paying tribute to the incredible health workforce that we have a health workforce that is dealing with literally—well in any one night—7000-7500 patients staying overnight in our hospital system and thousands more turning up to the emergency department (ED). You know in June at the peak of the COVID and flu and the staff absenteeism over 100000 people—I said 90000 on the radio this morning—turned up to a New Zealand ED in the month of June. Normally it's around 80000—between sort of 70000 and 80000. Over 100000—that's the pressure that the system was under at a time when we are still trying to fill the vacancies still trying to fill the gaps and working very hard to do so. But we were left in that position; our health system has been left in that position because of those long periods of under-investment.And it is important we rebuild our facilities; there are EDs that are in desperate need of attention. You visit Hawke's Bay you visit Hastings hospital and you see the ED there and the folks there tearing their hair out about the environment they have to work in. We have to change that. But we've got hospitals—you know Whangārei hospital—neglected for years by the previous Government. The MP at the time couldn't even persuade his colleagues to invest in upgrading the hospital. Fortunately Whangārei has an MP Dr Emily Henderson who cares about people and their healthcare and has persuaded this Government to make the investment.Now I'm confident that Whangārei is going to have an outstanding world-class hospital thanks to the advocacy of the member for Whangārei; the member for Northland Willow-Jean Prime; and the member for Te Tai Tokerau Kelvin Davis—great advocates for their people in their part of the country. I pay tribute also to the member for Nelson Rachel Boyack who has advocated strongly for the long overdue upgrade of the hospital in that region too—even the former MP for that area Nick Smith was unable and he sat around the Cabinet table to persuade his colleagues to invest in health services.This is a Government that takes health seriously. This is a Government that is investing in health to a level and extent that this country has not seen before—not just in services not just in the workforce not just in the personnel but in the buildings and the facilities as well. And we will continue to do that. The great thing is that we now have the ability to manage the system as a national system and to manage it on a regional basis so hospitals within regions can make sure that where there is a need in one place and there's capacity in another place they can support each other to deliver on that. There's amazing coordination happening across the hospital network to make sure that that happens and to lift the performance of our health system.The independent reviewer's report tells us we have more to do and that we have change to make. I'm confident that with the system that we have in place with the leaders we now have in place and coming in place with the dedication of the workforce that we've got with the initiatives that we have under way and principally those workforce initiatives we will have that world-class health system that every New Zealander will be very proud of. Thank you Mr Speaker."