Wall Louisa: Estimates Debate — In CommitteeText is incorporated into the Bound VolumeWall Louisa: Estimates Debate — In Committee[Sitting date: 30 July 2015. Volume:707;Page:5547. Text is incorporated into the Bound Volume.]LOUISA WALL (Labour—Manurewa): Tēnā koe te Māngai o te Komiti ngā mihi ki a koutou katoa te kaupapa te hauora o tō tātou iwi o Aotearoa.[Thank you Mr Chairperson and greetings to you all. The health of our New Zealand tribes is the matter at hand.]I am a proud member of the Health Committee and as a member of that select committee it is my responsibility with my colleague the Hon Annette King to hold the Government to account. In holding the Government to account what we have done is we have commissioned an Infometrics report that has revealed a $485 million funding shortfall in the health sector. That shortfall is actually not only incredibly relevant to the 40000 staff within the health and care sector but it has huge implications in respect of service cuts. I want to focus my contribution on what those service cuts may be.One of the worries or concerns I have is that school-based health services will be cut. The latest evaluation of those school-based health services has actually highlighted the benefits to the year 9 assessments and particularly to our young boys. Part of that assessment not only looks at their home life education issues what sort of activities they are engaged in drug and alcohol issues and sexuality issues but also focuses quite clearly on suicide and depression. As we know as a country suicide is a big issue particularly for our young people and particularly for young boys so I have a huge issue if part of the Government’s shortfall of $485 million is going to mean a reduction in school-based health services. I do want to contribute that the Minister of Health reassured us that there would be no cuts in this area but it is something that I am particularly interested in and will be keenly watching.The other area that I want to highlight is the provision of maternity services. Unfortunately in Aotearoa New Zealand we have over 660 children who die every year of perinatal mortality. These are babies who die before 28 days of age. In the Counties Manukau District Health Board area where I am from what that represents is 27 deaths that were avoidable—27 deaths of children. This is particularly relevant in my electorate where there are high concentrations of Māori high concentrations of Pacific people and high concentrations of Indian members of our community. Of particular relevance is that 34 percent of the babies who died had mothers who smoked. That is a really significant statistic as we know that smoking is also a cause of perinatal mortality. One of the other areas that I will be focusing on is whether or not the Government plans to cut—like it did in 2010—any smoking cessation programmes. What we know is that in 2010 there was a $12 million reduction in smoking cessation programmes and I hope that that was not a factor in terms of the fact that there were 126 babies in New Zealand who could have been saved from avoidable deaths.I also want to focus my contribution on hospice funding. The Government has been really really interesting because it has been crowing about this investment in hospice funding. Again I want to highlight one of the commitments that the Minister of Health made at the select committee. He committed to 70 percent of hospice funding coming from the Government. That is the social contract—I want to call it that—that the Government has with hospice providers and there are 29 hospice providers round Aotearoa.In the South Auckland area we have two hospice providers: we have Totara Hospice South Auckland and we have Franklin Hospice. Both of those hospice providers I believe are doing a fantastic job. Again it is my responsibility to hold this Government to account for the 70:30 funding split. One of the things that I know in engaging with my hospice providers is in fact that currently Totara Hospice receives only 49 percent funding from the Government. So the community of South Auckland is having to find 51 percent of its $8.4 million budget from a community that has high Māori high Pacific and high Indian populations and that has actually got socio-economic challenges. Our community is expected to provide 51 percent of the funding whereas in fact the Government says that that is not the case.I will be holding the Government accountable to that funding formula and to that social contract because it is something that it has committed to me in written questions. It is something that it has committed to me and my colleagues on the Health Committee in our select committee hearings. So if that is not going to be one of the commitments that this Government holds to then I am sure that I and my colleagues on the Health Committee will make this Government accountable to that issue as well.As a member of the Health Committee I too want to reiterate that some of the issues that we have been dealing with have actually been driven by the community. We saw some women come to us this week whose children through their birth circumstances have had to be tube-fed. One of the issues that we have in New Zealand is that we have a cohort of children who through no fault of their own—premature births—have been fed by tubes some for up to a year. When they leave hospital believe it or not there is no further intervention and engagement with not only the child but the parents. So we have children who are dependent on being fed by tubes with no specific support.In New Zealand we know that there are over 330 children in this circumstance and there is no response from the Government to meeting the needs of these parents and children. So children may leave at 1 year of age and one of the scenarios that was presented to us was children at 3½ or 4½ years of age still being—well not tube-fed but having—what did they call it Barbara?Barbara Kuriger: The Mic-Key button. The Mic-Key tube.LOUISA WALL: The Mic-Key tube. So this Mic-Key tube essentially means that these children are being tube-fed because they have had dependency. Because of the circumstances of their birth they are unable to eat and they are gagging and obviously there are communication issues there are psychological issues and there are behavioural issues. These children are dependent on being fed by a tube and what do we do to support these children and families? We do nothing. I think New Zealanders would be horrified to think that we just leave parents to their own devices.So what we are seeing more and more of within the Health Committee because we have got such an unresponsive system is communities mothers and people who are affected by a lack of support and a lack of care coming to the Health Committee and saying: “Please help us. Please hold the Ministry of Health accountable.” Unless they can get our support and unless we as a select committee hold the Ministry of Health to account it is actually not meeting the needs of our New Zealand citizens. I think as I have said we are seeing a growing number of our constituents and our citizens using the petition process to highlight deficiencies in the health system.I actually think it is a sad indictment on the health system because we should have a more responsive health system. We should not have to rely on citizens having to go through a democratic process. But in saying that I am incredibly grateful that I live in a democracy where citizens can directly engage and citizens can stand up and advocate. And in the instance of those three women it was not just for their children; it was for other New Zealand children who are yet to be born or who are living in the circumstances that they are living in. I think collectively we as a Health Committee were incredibly proud—or I was—of their advocacy their professionalism and the fact that they cared so much that they were so passionate and that they were prepared to make sure that our health system is responsive to the needs not only of their children today but of our children in the future.So I hope that we as a select committee are going to do all that we can to make sure that our best practice is about ensuring that children who have a premature birth and who are tube-fed actually then have the ability to fully participate in life. At the moment those children are not able to fully participate in life. Their parents are not able to fully participate in life. It is going to affect their education. It is going to affect a whole lot of things unless we get it right. And what I see at the moment is that we have got a system that actually just wants to tick all the boxes so we have you know the Better Public Services targets and we have—