Reti Shane; Little AndrewDr SHANE RETI (National): Thank you Madam Chair and I thank the Minister for those replies. Two sets of questions—the first is: in October 2021 he was the lead sponsor in a substantial proposal to Treasury to amongst other things build 152 ICU beds and then three months later that had morphed into an announcement for 23 ICU beds. The question is what happened? He was the lead sponsor making application to the Treasury for a substantial amount of money and the initial reply to me from the Minister was Documentation relating to individual bids may be received by officials in a variety of formats from a variety of contributors. However it's a fundamental principle of our democratic system of Government that is for the elected Government of the day to decide what is or is not funded regardless of officials' preferences." Am I to take from that that it was officials who recommended 152 ICU beds be built and that despite having his name on the front as the lead sponsor he was unable to get that over the line with Treasury resulting in 23 ICU beds being announced in the Rapid Hospital Improvements Programme in December?The second set of questions is around the Whangarei Hospital build—$572 million put aside appropriated. And the question I have is some clarification of the chronology here. So $911 million was the preferred build that went to the Capital Investment Committee in June and was declined. They were told purportedly that there's $711 million of reserved funding. In the Budget documents there's I think $520 million put aside—is that balance of about $200 million - $250 million a contingency? And if so where in the Budget documents does that contingency sit?And can he confirm that to pull back from the preferred offering which was taken to the Capital Investment Committee and sit inside that reserved ring-fencing of $711 million that several things will need to happen. First of all the bed numbers will need to be reduced I'm hearing by about 128; that the ward tower will not be built; that the existing hospital will not be remediated; there'll be no changes except as required on level one of the medical wing to accommodate the link bridge; medical wards surgical wards and outpatients remain in the surgical wing while the emergency department and ICU are decommissioned—a substantial scale down from what was presented to the Capital Investment Committee.So a range of questions there. Can he talk through that chronology? Is it correct that they were talked down from the $900 million to $711 million? Is that ring-fenced funding? If so why did the books only show $500 million; where's the other $200 million? If he could talk to that range of things over two questions it would be much appreciated. Thank you.Hon ANDREW LITTLE (Minister of Health): Just on those two issues. I suppose the starting point is to be clear too that when it comes to infrastructure proposals what were previously the DHBs had their kind of preferred starting points. But with all these things and the reason why we had a capital investment committee we still have a capital investment committee and why Te Whatu Ora – Health New Zealand has an infrastructure and investment committee—and the process of establishing that will take over that role eventually—is precisely because the role of the Capital Investment Committee and ultimately its replacement is to evaluate proposals against need. And so it may well be the case that up to now and maybe even in the future when it's individual hospitals as part of the Te Whatu Ora – Health New Zealand network hospitals will put up what they would like. But it is for the financial decision makers to evaluate that against assessed need. And so when it came to for example the ICU bed expansion project we knew because of various evaluations and analysis that our per capita rate of ICU beds was lower than countries we often compare ourselves with and we knew that we needed to expand the number of ICU beds.I have to say a lot of this debate happened in the kind of febrile atmosphere of COVID and the Delta outbreak and whether we had enough. A crisis was declared by some people and in fact there was no a crisis. We managed through that process but it didn't get away from the fact that we did need and we do need additional ICU capacity. When the officials went through their assessment about what was needed and what was deliverable—not just in terms of creating physical space and the building that was needed but also building the workforce that was needed—we landed on an additional 85 beds which we thought we could achieve by 1 July 2024 and we could build both the physical structures and the workforce to go with that so that we had those fully staffed additional ICU beds. And that adds quite significantly to our share of ICU beds across the hospital network.In terms of Whangarei Hospital a similar sort of thing happened. We know that Whangārei Hospital is well overdue for replacement and the work on preparing for that and planning it and designing for it has been going for some time. The way the process works is that what was then the DHB was required to put up a business case—there's various stages of business case development that ultimately results in a final detailed business case and we're not there yet with Whangarei Hospital but there were initial kind of concepts put up or initial business cases put up and the role of the Capital Investment Committee was to question that and interrogate it and push back on what they thought was not needed. That has led to various iterations. It's now led to an amount being set aside in the current health capital envelope of about $711 million. And there's still ongoing work on developing the final design based on final assessed need for Whangārei. The advice I had at one point certainly was that in some of the original proposals that went out they actually were overspent. There was capacity being sought that certainly was not expected to be needed for some decades and there was a question about whether it was appropriate to make that investment now.It is true to say that in many of the large hospital builds it is increasingly the case that shelf space is provided for. That is to say a physical space—a concrete wall if you like a concrete shell—but not fitted out for immediate use simply on the basis that it is reasonably anticipated that maybe within 10 or 15 years that space is going to be needed on the basis of population growth. But it is cheaper to build the superstructure now and do fit out later as opposed to build for current capacity needs now and then when capacity is exceeded and new capacity is needed build another superstructure which is very time consuming and very expensive. So that approach is being used. I suspect it's being used in Whangārei as well. But there is still going to be an assessment about what is actually needed in the short to medium term and possibly in the longer term but without overspending on the investment in that respect."