Craig LizDr LIZ CRAIG (Labour): Thank you Madam Speaker. I'd just like to start my contribution with passing on my sincere condolences to the family of the woman who's led to the report that we're debating today. I'd also like to acknowledge the incredible work that those working in the emergency department do: the doctors and nurses who get up every day who turn up day after day to that make that difference in other people's lives.I spent a few years back early in my career working in emergency departments. I think it's really important that as health professionals you go there you sit down you spend a lot of time trying to sit down and understand where they're at and how you can provide the best care. Each patient you are speaking with or looking after is different. It's a really important role that our doctors nurses and other health professionals do and also for whānau. I spent a lot of time when my mum had leukaemia sitting in emergency departments and just the care and respect that they gave with mum and also later with dad when he had his stroke—it's a wonderful career it's very rewarding but it also can be incredibly demanding particularly at very busy times of the year.I think when events like what we're debating today happen within the health system it's important that we sit down and we undertake a review to try and understand what happened and what those circumstances were that led to this event.I think when I first started out in medicine there was a real framing—and we were as junior doctors quite anxious because often the framing back then was that it was an individual doctor's fault. But then as things have progressed there's a much better understanding that actually many things that happen have got underpinning circumstances and trying to understand the context in which these events occur. I'd like to just acknowledge those that undertook this review and the report that we're debating today. Basically I expect that Te Whatu Ora will be considering the findings in detail and also taking on board the lessons from the report. I also just want to talk a little bit about that broader context and thinking about the context in which our emergency departments have been operating over the last two years but also during the period when this event occurred. I think having worked again in child health during winter peaks every year we do see winter peaks and acute respiratory infections and emergency departments are very busy. But I think this year was particularly exceptional. We had the opening of the borders after two years of closure and very very low rates of influenza in the community up until that point. So what we were grappling with this winter was one of the largest outbreaks of influenza and the impact that that had on our emergency departments and also on our hospitals in terms of in-patient care. But simultaneously we were grappling with COVID. The Omicron surge we experienced not only meant that we got extra demand—people coming into hospital—but it also meant that our health workforce many of them were off sick. We were dealing with staff absences at the same time as incredible peaks. I just want to acknowledge again the staff and the role they played. When we were doing our annual reviews in the Health Committee a number of the district health boards (DHBs) were talking about how they realigned their teams and basically managed through those peak times and I just acknowledge the efforts that went in there.But I think while we're talking about the exceptional circumstances we've got to acknowledge that this situation didn't arise overnight; it also comes on the back of many many years if not decades of under-investment in our health sector. Again just thinking through my previous role of monitoring child health before I came into Parliament one of the things that we used to monitor was called ambulatory sensitive hospital admissions"—that was hospital admissions which could be prevented by better access to primary care. Every winter we see huge winter peaks in these conditions and I think a lot of the things about how we manage our emergency departments is not just making sure that they're staffed well but it's making sure that primary care our GP services are available because many many of the people that are presenting to emergency departments could have been managed in primary care. So when we first came into Government one of the issues and one of the big barriers that we were seeing was that people couldn't afford to go to the doctor. That's where we put in place the low-cost visits to doctors for community service card holders. So now instead of people having to pay $40 $60 they're paying a low fee—back then I think it was under $20 for a visit. I think that has meant that many more people can access primary care.I think one of the other things working in emergency departments—often where there are patients who need the most time from us as health professionals it is those presenting with mental health issues. So again what we've been doing more recently is putting aside things like the Access and Choice Programme in primary care. So basically people can turn up and see a health practitioner a health coach and start to grapple with some of those issues around mental health and addictions. So again thinking through how we can see people in primary care make sure they get the best care they need to without having to go to the emergency department.But looking ahead since coming into Government what we have got is the largest number of nurses and doctors working in the health sector that we have had. But basically we think that there's more work to be done. We're in a situation where internationally there are huge workforce shortages but we've got to make sure that as a country we can provide the workforce that we need. I think that's where there's been a lot of focus more recently. So basically Government looking at the number of GPs and working with the Royal New Zealand College of General Practitioners to increase the number of GPs trained from 200 to 300 each year. But also it's quite apparent that nurse practitioners again in primary care can manage a significant amount of the health demand that's coming in the door and so again basically doubling the number of trained nurse practitioners from 50 to 100 each year. So we've got our own workforce that's coming through the system but also nurses who may have left the workforce for whatever reason and thinking of those barriers for them coming back in—so again providing support and extra funding up to $5000 to nurses coming back into the system with their registration costs.We also are though competing in an international market. And I think this is where with the health reforms it actually potentially will make a significant difference because up until now thinking through each DHB trying to recruit their own health workers but now within Te Whatu Ora creating that one-stop shop where we can not only recruit health workforce bring people into New Zealand but also assist with a lot of the issues around getting registration for those who are qualified overseas.So the competency assessment programmes and things for nurses coming in to make sure that their qualifications are recognised here but also some of the time that's taken when you've got somebody that's got a medical qualification that then has to spend time here in New Zealand getting that registration acknowledged. So again financial resource and other support so that our health workers as we recruit them from overseas not only can come and a find a job be assisted with the processes of immigration but actually will make sure that their qualifications apply here.So there are a lot of things that we are doing to improve the health system and I'm optimistic that as we move forward with the health reforms that we've put in place we can be making a real difference not only in the development of our workforce but also thinking about how we can manage so that people can basically get to primary care and actually receive the care that they want. Because I think a lot of the rationale for the health reforms was about the inequities that we were seeing was about the fact that we had the postcode lottery. It's about the fact that if you turn up to an emergency department or try and a get GP it's very very different in one part of the country to the other. So I think what we're doing now is grappling with many issues that have been going on for several decades and it will take time to do that. But as a Government we're absolutely committed to reducing those health inequities and to making sure that people when they turn up whether it be to the GP to get the care they need whether they're got some concerns with their mental health they can turn up to a health improvement practitioner and have that conversation whether it be to turn up to A & E again that they'll get the care that they need.This is an important issue and just coming back to acknowledging the family and the woman that led to the report that we're debating today. Our Government is committed to improving our health system our workforce and making sure people can access the care they need when they need it. Thank you Madam Speaker.The debate having concluded the motion lapsed."