Russell DeborahDr DEBORAH RUSSELL (Labour—New Lynn): As chair of the Pae Ora Legislation Committee I'd like to report on some of the submissions that we received in the process of hearing the Pae Ora (Healthy Futures) Bill. We received 4665 submissions of which 178 were from groups rather than from individuals. On a straight numerical basis most of the submissions were opposed to the bill but the great majority of those submissions opposed to the bill came from individuals and they were single-issue submissions—I'll refer to those later on. But professional bodies; medics; lobby groups; population groups; the Asian the Māori the Pasifika groups; the rainbow groups; the disability groups; and so on expressed support for the bill. There was overwhelming support for the bill from professional groups from medical groups and from the workers in the health system. They see the need for change and they know that the time for change has come and they support this bill. Members opposing this bill opposite have worried about what a locality is and said We don't know what it is". I invite them to raise that in the committee stage but the Minister Andrew Little has already been quite clear about what a locality is—it's a place- and people-based approach for improving the health of populations. There are three characteristics: it's a partnership with mana whenua it supports locally led solutions that take a holistic approach to wellbeing and the locality approach joins up care across communities. It is a very localised approach rather than a top-down approach.I want to just read some of what people said about the bill some of the submissions that came in. General Practice New Zealand said "GPNZ is supportive of the overall reform direction that the legislation is designed to enable. We endorse the principles set out in the Bill specifically the requirement to give effect to Te Tiriti o Waitangi. The Te Tiriti section clarifies that the whole health system and not just the Māori Health Authority will be responsible and accountable for health equity and upholding the principles of Te Tiriti. We support the new structures and the intent to achieve a consistent and unified health system". That's from General Practice New Zealand.The National Council of Women said "NCWNZ welcomes and strongly supports the purpose of this Bill to fundamentally change the structure and accountability of the publicly funded health system" and they "particularly welcome the establishment of the Māori Health Authority".The National Hauora Coalition drawing on their decades of experiences of running a Māori primary health organisation say "The NHC supports the intention behind the Bill to create a fairer more equitable health system that is effective for Māori and honours te Tiriti o Waitangi." They sought a stronger Te Tiriti clause in the legislation and they emphatically supported the establishment of a Māori Health Authority.The Health and Disability Commissioner said "I acknowledge the Government's ambitious reform efforts and endorse the vision of an equitable and cohesive public health and disability system which gives effect to the principles of Te Tiriti o Waitangi and is designed in partnership with the people it serves." The New Zealand Health Group said "We want to be part of the story that stops the decline in Māori and Pasifika health and for those living with disabilities or injuries for our current and future generations." Then it goes on to say "The Pae Ora (Healthy Futures) Bill lays the foundation for the transformation of our health system to better achieve equity by reducing health disparities among [the] population groups in Aotearoa and particularly for Māori Pasifika and those living with disabilities [and] injuries."New Zealand Rural General Practice Network (RPNG) said "[The] RPNG is supportive of the overall reform direction that the legislation is designed to enable. We support the new structures and the intent to achieve a consistent and unified health system. This support includes the requirement to give greater effect to Te Tiriti o Waitangi. We endorse the intent that the whole health system and not just the Māori Health Authority will be responsible and accountable for health equity and upholding the principles of Te Tiriti."The support for this bill was overwhelming from people who know what they're talking about within the health system. Now of course there were many areas where people asked us to go further and particularly it was with respect to health strategies. The bill already has a New Zealand health strategy a Māori health strategy a Pacific health strategy and a health of disabled people strategy. We were also asked to put in place strategies for Asian peoples for women for rainbow people for mental health and addiction services for rural communities for refugee communities for rare diseases for children infants and a strategy for medicines. So those were a lot of strategies we were asked to put in place as part of the legislation.Now we've already heard from Mr Matt Doocey his concern about whether or not there is something in place for mental health services and then saying that mental health was overlooked in the bill. But I request Mr Doocey to look at clause 7(1)(e)(iii) of the bill where the health system principles specifically say that it should promote health and wellbeing by "working to improve mental and physical health and diagnose and treat mental and physical health problems equitably". It's sitting there in the bill already. We have as a committee endorsed the inclusion of a women's health strategy in the legislation. That seemed to be something that was really important to do in the legislation itself. But just because a strategy is not in the legislation does not mean it cannot be elsewhere in the system and Health New Zealand will be able to develop its strategies for all those other groups as needed—as needed—and they certainly are needed but that will certainly be part of the work that Health New Zealand and the Māori Health Authority are enabled to do.The people who were opposed to the bill were overwhelmingly opposed on a couple of grounds. I'm going to read just the one submission but there were huge numbers of submissions that said basically this and this person has said "No public mandate has been sought for segregating our health system. I support health services based on clinical need not race." Indeed. Indeed we should support health systems based on clinical need. A report on Radio New Zealand from earlier this year talking about research that was conducted at the University of Otago says that Māori are more likely to get cancer will get it younger are diagnosed later have poorer access to treatment and are much more likely to die from cancer than non-Māori because of inequity in the health system. People told us that in order to have equal access to the health system we should have access that is not based on the colour of one's skin. Indeed it should not be but that has been the case for far too many years now that Māori have simply not had equitable access to our health system and neither have Pasifika peoples. This bill sets about changing that.As the Minister said it is not just a matter of need. And this goes back to the mandate. Was there a mandate? Yes. Health reform and it was firmly on the table. Ensuring that we better meet our Treaty obligations was firmly on the table. Part of the ethos of this Government is to ensure that we are continually talking with our treaty partners with our Māori Treaty partners that we are continually revising and re-understanding and reorganising the way we do treaty in this country. That the Treaty is a conversation that constitution is a verb not a noun. We are continually working to ensure that we are doing governance as Treaty partners—and that is part of what is happening was the establishment of the Māori Health Authority. We are working to make the Treaty a real part of the constitution and I am proud to be part of that.Finally I wish to conclude with some thanks to the people who worked so very hard on this bill. My thanks to the officials in the Department of the Prime Minister and Cabinet who helped to get us through this bill and worked so hard on it and to our clerks in the select committee who helped us to run a very effective and efficient process. I would also like to give my thanks to the committee members especially my deputy chair Tāmati Coffey but also to all the members of the committee. It was a very efficient and effective process. We disagreed strongly about issues but everyone worked hard to make sure that the process went very smoothly and I'm very grateful for that. I am very grateful to the submitters who put in submissions and helped us to improve this bill immeasurably. And finally I wish to acknowledge the extraordinary work done by the Minister of Health and by the Associate Minister for Māori health and for the people who have been involved in this legislation. This is transformative change and I thank the Ministers for bringing it to the House."