Clark DavidDr DAVID CLARK (Labour—Dunedin North): I move That the House take note of a matter of urgent public importance. This is the story of a Minister who does not care about his sector it is the story of a ministry that is demoralised and struggling with senior leadership issues and it is a story about a sector that is growing incredibly frustrated as its efforts to provide healthcare to New Zealanders who deserve it are frustrated time and time and time again by a Government that cannot lead on one of New Zealand's most important issues.I want to set a little bit of context at the start. We know that this is a sector that has been underfunded by the Government to the tune of $2.3 billion. The health sector has been struggling in a funding-constrained environment because this Minister and his predecessors have run a policy of underfunding year in year out. That $2.3 billion is not a number plucked from the air; that is a number put together by independent research group Infometrics using Treasury data to ascertain how much more funding would have been needed each year under this Government to deliver the same level of services. If you cut the amount of funding for delivering existing services they get cut especially when you take $2.3 billion out of the sector.In this Budget $200 million was needed just to keep district health boards (DHBs) standing still to deliver the same level of services as they delivered last year. And what did we find out? We found out that $650 million was needed but that there was a shortfall in funding in this Budget of $200 million. The Government allocated only $439 million to DHBs—a shortfall of $200 million in this Budget alone.In that situation with a tight budget the ministry let those people know that they would have to make do but it let them know that only at the last minute. Normally what happens is that the prior December or thereabouts the DHBs get an indication of how much money they might expect in the Budget so that they can do planning. If they are having to make cuts as they are under this Government they have to work out how they set their priorities. That is only fair in a funding-constrained environment. But what we had here is a Government that sat on the figures a Minister who had no leadership and a ministry that was then unable to communicate with the DHBs that they would be receiving a cut.On Budget day those DHBs found out that their budget was going to be cut in real terms by $200 million and with that cut they had to make do. When they sat down the next day and tried to work out how they were going to make ends meet with their effective funding cut they then had to work out what they were going to cut and what they would continue—with short notice because they had not had an indication in the previous year as is best practice. So they proceeded to try to work out what they would cut and what they would proceed with. Given that the next financial year was looming closely many of them—the more diligent DHBs—will have got on with their planning and may even have started negotiations for service deliveries and service cuts for the coming year.When it worked out that there was something wrong the ministry rang the DHBs and said: If you have extra money in this Budget—we know it's tight; if you've got a little bit extra in your pot we'll let you keep it. You'll be able to hang on to that money. Even though the Budget documents are printed—you know they're printed they're out there—we'll let you keep that money." Two weeks later—2 weeks later—the Director-General of Health and his offsider rang around the DHBs again and said: "Look we're sorry we're going to have to claw that money back. We know you're underfunded already. We know we promised you on Budget day that you'd get X funding but I'm sorry we're going to have to take some of that back because there has been a blunder. There has been a blunder at the ministry."The Minister had seen the figures; he signed them off. He is responsible to this Parliament for those figures and yet there was a mistake—and it is not the first time and the Minister knows it. It was not so long ago that the ministry tried to get $18 million extra out for a blunder in the spending around the redevelopment of the head office. This is not the first time and the Minister knows it so he is trying to cover it up. He is sitting over there with that fixed grimace on his face and well he might because the story does not end there. We know the DHBs were underfunded we know they were told they could keep the little bit extra that they got in the Budget and we know it was then taken off them but the story does not finish there. When they were called into Wellington the chairs and the chief executives of the DHBs to meet with the ministry—and the Minister admitted today in response to questions in the House that he was not aware of this so once again we see that he is not across his portfolio—they considered whether they would put forward a vote of no confidence in the director-general. It has happened once too often.This is a sector that is distressing of the leadership in the Ministry of Health—that important sector that delivers the healthcare that New Zealanders need. And let us not forget that we believe on this side of the House in the Labour Party that all New Zealanders should have affordable access to quality healthcare. But those people who are providing it out in the communities those people at the coalface are being let down by the senior leadership in the ministry and the lack of leadership—the lack of leadership—from this particular Minister.What is going on out there in DHB land as they cut the services? Well we know from the Government's own figures that over 500000 New Zealanders last year could not get to a GP for reasons of cost. That is what is happening with these cuts that happen year after year after year—the funding that gets restricted in real terms. I will come back to how that equation is done because the Minister keeps liking to say—he would put his hand on his heart and say that every year more money has gone into the health budget. But I think everybody in this House knows that $1 more each year would be more funding in the health budget and everybody in this House knows that GP fees go up by more than $1 a year. One dollar a year doth not a swallow a summer or something like that make—I think you get the point. One dollar more really is not going to cut it when we have got an ageing population more complex health needs and a system that needs more money just to deliver the same services each year.Those ongoing cuts have got a real cost and the ministry's failure of leadership and the Minister's failure to secure adequate funding for healthcare in New Zealand mean that those health professionals who want to deliver those quality services have their hands tied behind their backs year in year out.The Minister over there is not aware that the DHBs are considering asking for the resignation of his director-general. He said to the media just the other day "No I haven't received a resignation and nor would I want one either. He's doing a fine job;"—says the Minister—"a fine job." He is the only one in the health sector—that shows just how out of touch he is.I have spoken at several conferences in the last few weeks that have made the point up the front on political panels that they have a wide range of political parties there in front of them but there is one that is missing. Just yesterday in front of an audience of a hundred people there was one major party missing. It was the National Party. Last week at the Rotorua GP conference there was one major party missing. There were hundreds of GPs there and they were furious but once again the Minister did not front. The Minister is not fronting up to the issues in the health sector. He is hiding he is running for cover and that is not acceptable because this is such a significant issue for New Zealanders. When they cannot afford to go to their GPs when half a million Kiwis cannot afford to go to their GPs when Kiwis cannot afford the oral care they need when Kiwis cannot afford to pick up their scripts at the pharmacist it is simply not good enough.The Government's own figures tell us another thing. They tell us that 60000 New Zealanders last year were referred back to their GPs by a hospital even after they had been referred to a specialist because the hospital said they did not meet their threshold: "I'm sorry we don't have enough money to give you the care that your GP says you need. You can't even visit the specialist. We're going to send you back to your GP; come back again if your situation gets worse. If you're so much in pain that you can't move when it gets to the point that you can't work then we'll look at it again if you get another letter from your GP to come back to us." That is all part of what is going on. It is part of a bigger picture because every year it gets harder for New Zealanders to get the healthcare services that they used to get. Every year it gets harder for people to get the cataract surgeries knee surgeries and hip surgeries that they need because this Government is not funding adequately to deliver the same level of services each year as the year before.That is what that Infometrics report points to. It says that with an ageing and growing population if you want to deliver the same level of services to each member of the population as you did before you would need to put in $2.3 billion over that 9-year period. But that has not gone in and so services have dropped and that is the story that is demoralising the health sector as it struggles to deliver excellent care. Anyone who goes and visits a hospital or a GP will generally have a positive experience because those health professionals are doing a mighty fine job—despite the Government rather than because of the Government—and I want to take my hat off to them for making the most of a very difficult situation under this National Government's watch.I should also mention that Labour has clearly pledged that it will meet the health costs in the sector going forward and will return that $2.3 billion over time. We believe in delivering affordable healthcare that is of a world-class quality to New Zealanders even if that Government across the Chamber does not.We have now a situation where the Director-General of Health is lacking confidence from senior sector members. We have a situation where the Minister says he has not received a resignation but the director-general says he has given one. What has happened there? One of those people clearly has got the situation wrong—I do not want to say but somebody needs to tell the truth out there as to what is going on.We also know that that money is being clawed back—that money in the Budget was wrongly allocated. That is a major Budget blunder. That is really basic stuff Minister. That is the kind of mistake that should never happen in this House. Those numbers are checked and double-checked; they certainly would be by a diligent Minister who cared about what was going on in the sector and who was worried about those DHBs that were missing out.I want to go through—if I can find the little bit of paper in front of me—and just mention some of those DHBs that are going to miss out because this is really significant and those people living in those areas should be concerned.Counties Manukau—if you live in the Counties Manukau area on Budget day the announcement was that you got a little bit of extra money. It was not enough to meet the current needs because we know there is $200 million short-funded across the sector anyway but now you are going to get $6 million less than you thought you were going to get—$6600000. Southern DHB down where I live—it is going to be $5.7 million worse off than it was on Budget day. Capital and Coast DHB—it is going to be $3.7 million worse off than it was on Budget day. Midcentral DHB is going to be $5.4 million worse off than it was on Budget day. Hutt Valley DHB is going to be $3.6 million worse off than it was on Budget day. Taranaki DHB is going to be $3.4 million worse off than it was on Budget day. Canterbury DHB is going to be $2.7 million worse off than it was on Budget day—and we know the struggles that are going down in Canterbury as they struggle with mental health and other issues and years of underfunding under this Government. Hawke's Bay DHB—nearly $2 million worse off. Wairarapa DHB—$1.5 million worse off. South Canterbury DHB—$1.2 million worse off. West Coast DHB—$780000 worse off. Whanganui Bay of Plenty and Nelson Marlborough DHBs—also many hundred thousand dollars worse off than they were going to be on Budget day.This is a huge concern. When those basic things are not got right in the Budget when the Minister who is responsible to this House—the Minister who is responsible to this House—for Budget spending cannot get the basics right we have a real concern.I have found as I have gone around the health sector in the short time I have been the health spokesperson for the Labour Party that everybody—everybody in the sector—will agree that Tony Ryall was interested in the sector. They say he ran the sector from his cellphone. He was on the phone. Many people did not like him but none of them will say he did not care about the sector or that he was not in touch with the sector every day. Yet everywhere I go people say: "Jonathan Coleman—he is arrogant he is out of touch and he does not care about the health sector." That is the story I am hearing around New Zealand when he does not show up for public events when I am opening conferences because the Minister has turned them down again and again and again.I have never seen such a disengaged Minister and when you get a disengaged Minister like this mistakes are made. Those things are put in front of him; he is not even looking at them. Clearly if he is making mistakes this basic he is not even reading his papers and that should be a serious concern to all New Zealanders not just people sitting in this House. This is public money that is being spent Minister Coleman and you Minister are responsible and accountable for that public money and the muck-up that has happened here. Hang your head in shame Minister.There is much more to come on this one I must say. There is plenty more to come on this because the ministry is in a spiral and the Minister knows it. There is more to come on this and the Minister knows it. We will come back to the House tomorrow. We will hear more on this picture but first the Minister needs to explain how this bungle was made; who is right the director-general or him on the call for a resignation; why the money is going to be clawed back and what the Minister is lacking that he could not get a decent amount of money for them in the first place; and whether he is content to watch the sector wither—a managed decline under his watch—because of underfunding year after year after year.I have not got time to cover the Auditor-General's report—Mr DEPUTY SPEAKER: No you have not.Dr DAVID CLARK: —which covers a myriad of faults in terms of DHB asset management—because DHBs are underfunded and they are stretching their assets. I just want to say that this Minister needs to be held accountable and he needs to do a much better job pay attention to what is going on and make sure that health services are properly funded so that New Zealanders can have access to the affordable quality healthcare that they deserve and that the Labour Party will deliver."