King Annette: Estimates Debate — In CommitteeText is incorporated into the Bound VolumeKing Annette: Estimates Debate — In Committee[Sitting date: 28 July 2015. Volume:707;Page:5408. Text is incorporated into the Bound Volume.]Hon ANNETTE KING (Deputy Leader—Labour): I am going to pick up on the bits that the chair of the Health Committee Simon O’Connor left out of our report. I have to say however in starting my contribution that we have a very fair chair of the Health Committee and it is a committee that I very much enjoy working with. And to show what generous people we are the Minister of Health will know that we congratulated him on becoming the Minister and on the constructive way he had worked with the select committee. I know of course that he would rather be the Minister of Foreign Affairs but that is another matter.I did raise with him at the very beginning of my contribution my disappointment in the slowness of responding to Official Information Act requests and answering written questions and I said that the Tony Ryall school of thought had continued under the new Minister. I was very disappointed because I was expecting much more. The Minister said he wanted the best possible result but I have to tell you Minister it is slower than it was when you were before the select committee. So can I ask you to go back and speak to Mr Hundleby and others who hold up these Official Information Act requests and say “Pull finger.” because we deserve to have the information that we ask for.We then raised with the Minister the reports that I had had and an anonymous letter that I had received about bullying in the health sector. I have to say that since that issue was raised and it was raised in the media and picked up by many in the media I have been inundated with letters and comments about bullying in the health sector and it has come right from the top. I am not blaming this Minister because he is quite new but he does follow on from a former Minister who was very controlling indeed who put his fingers into every part of the health system and used threats and phone calls on a regular basis. The Minister of Health said he too would be very worried about bullying in the health sector but unfortunately he went away and absolutely nothing happened. That is why we continue to get reports about bullying particularly in the Ministry of Health in the very highest echelons up with the director-general and his office.We then raised the issue of cost pressures in the district health boards. We are constantly told by the Government that there is more money in health than there has ever been before. Well Minister if you put one dollar more in than you did last year there would be more money than there had ever been in health before. The question is: is there sufficient money going into health? Of course we have never been able to get this answer; we are just told how lucky we are to have the amount of money that we do.We had some work done on this by Infometrics. It is independent. These are not our figures—Infometrics did the work. It looked at these six Budgets that the National Government had provided in health. Four of those six Budgets including this one have effectively cut the health funding. We have an accumulative shortfall of $1.7 billion from 2010 to 2015-16. They are not my figures. They are not Labour’s figures. They are Infometrics’ figures. Using the Treasury figures it looked at how the change in core Crown health expenditure aligns with the growth in inflation and demographic characteristics. We now know that there is a shortfall. If the Minister wants to dispute the figures that Infometrics has provided he should put on the table—using the same data that Treasury uses—what the real figures are if the Minister does not agree. I suspect he will not because it is a terrible embarrassment—$1.7 billion has been removed from the health budget over the last 6 years. We now know that 11 of our 20 district health boards are showing a deficit.I then questioned the Ministry of Health on the cuts to its budget. It got $74 million not $79 million as it actually says in our report from the select committee. From Official Information Act requests and papers released by Treasury we know that the ministry asked for $170 million in early funding signalled in November last year. It wanted that to deal with the pressures of Vote Health. It then revised that down to $150 million according to the figures that we received. The Minister received advice in February that $74.9 million was necessary to maintain core services in the Ministry of Health.I want to quote what the Ministry of Health said to the Minister in February with regard to the provision of national services by the ministry. He probably went in to argue for more for the ministry but he was a loser in this respect because this is what the ministry said: “Easy wins had been exhausted and major service cuts and reconfiguration will be necessary to achieve further major savings.”So in fact the Ministry of Health had been asked to reprioritise $32.1 million in savings. It told the select committee the reason that it could now live on $74 million—not the $170 million it started with or the $150 million it then asked for and ended up with $74 million—was that it had revised its figures because Treasury’s inflation forecast was lower than what it had predicted. So what did it do? It adjusted the budget down by 50 percent. Did you know that inflation was running at 50 percent? Because that is the cut that came in the Ministry of Health’s budget. Based on wanting $150 million and getting close to $75 million because of the adjustment in inflation which was lower than it expected—we were expected to believe that claptrap; it is just a nonsense.The Minister if he was fronting up to this issue would say that his ministry is under huge pressure to be able to provide the core services that it has to provide let alone the manifesto commitments that have been made to that ministry. Of course what we got was flannel from his officials as they tried to make sure they looked all right in front of the Minister. We did not get the ungarnished truth about what is happening within the Ministry of Health.We then asked about pharmaceuticals and the money that goes into the Pharmac budget. We are told that Pharmac has got $800 million out of the $15.6 billion budget. It has virtually not moved in 4 years. The same amount of funding has been going into Pharmac and it is expected each year to make the savings for the Government. In fact the Government now relies on Pharmac to help it to pay for the health budget. At the select committee we raised how long that could go on. How long can we expect Pharmac to take the load for the cuts in the health budget? It deserves a reasonable amount of money to provide pharmaceuticals to New Zealanders in a timely and appropriate way in a First World way. We now know there are many drugs in this country that Pharmac cannot and will not provide because it cannot afford it. Minister we have real concerns that you are not in fact providing sufficient money in the Pharmac budget. It cannot be a cash cow for this Government continuously as it has been.There were a number of other issues raised in our examination of these estimates. For example we also raised the issue of social bonds. The Minister has been questioned on social bonds on a number of occasions. He has been unable to tell this House in question time whether the $28.8 million that has been allocated to social bonds will be paid on results as he said at the beginning or whether it will be payment along the way to the banks that are doing the funding. We have not had that answer from the Minister. Perhaps he would like to take the opportunity in this debate to tell the House whether the $28.8 million of funding will be paid once those social bond projects give the results back to the Government or are they going to have sweeteners along the way out of the $28 million to make them look better or even to say that they have worked? Was the Minister telling it straight when he said it is paid out on results—on outcomes? Well you cannot be paying out on outcomes after a few days or a few weeks if you are going to really measure whether mental health patients got a real job and stayed in that job.There are many things in the select committee that we raised. I am glad that the chair was able to be very positive about everything.