Hague Kevin: Budget Debate 
Text is incorporated into the Bound Volume 
Hague Kevin: Budget Debate 
[Sitting date: 30 May 2012. Volume:680;Page:2682. Text is incorporated into the Bound Volume.] 
KEVIN HAGUE (Green) 
: 
 Every society around the world is facing challenges in its health services because health services are some of those services that people look to their Governments to provide. They are one of the core things that Governments provide. Yet the capacity of technology to provide more and more health services greatly outstrips the ability to pay for those services. So every country is facing big challenges around how best to put up the money that is required for health services how best to distribute that money and how to decide what it is used for.  
In this country there has been for some decades actually a consensus that investment in health services should be rebalanced towards public health services designed to keep people well in the first place and primary-care services designed to deal with people’s health needs in the community and as early as possible in their disease progression. This is for a variety of reasons. It is best for the individuals to not get sick in the first place or to be treated early but it is also because all of the evidence from the health economists suggests that investment in that part of the spectrum of health services provides the best return in health gain on the dollar spent.  
There has been a consensus to do that and yet in this Government with this Minister of Health that consensus has been thrown out the window because this Minister of Health is driving the investment in the other direction. Tony Ryall Minister of Health at the point that he leaves that job—I think that will be in 2014—might well be advised to seek a career on the stage as a magician. He accomplishes that magician’s trick of diverting attention away to this glittering prize over on his right-hand side while at the same time with his other hand he is pulling away the nut below the cup that is left on the table—out of sight out of mind. That is what he has done with health.  
When Tony Ryall was the Opposition spokesperson on health—and as Chris Auchinvole I think was saying earlier in this debate—he made a great job of talking about elective services. He talked about waiting times for elective surgery and about the number of people waiting. He made it seem as if that was the main thing that health services provide. In fact it is about 5 percent of what health services do. What he has done since he has become Minister is he has actually and I agree with Craig Foss seen more resource go into elective surgery. There has been more elective surgery done. People are waiting less time for elective surgery. In this Budget he has done the same thing again. In some places around the country district health boards practically have to ambush people on the streets—to pull them in—to give them elective surgery! But certainly more people are getting it. Indeed there is more money for cancer services and more money for cardiac services. But that is accomplished at the expense of everything else in the health sector. That is the cost. The cost is less service and in particular less service in the areas that we know provide more health gain.  
The broader context is that health services are faced not only with the Consumers Price Index but also with medical inflation which tends to be somewhat higher. They face wage settlements that are higher than the average wage settlements because of the workforce crisis that we are experiencing and the higher rates available overseas. They face one-off hits like the unfunded changes to KiwiSaver that the Government made in its Budget last year. They face the costs associated with an ageing population and we know that older people need more health services and we need to spend more money on providing services for that group. We face a growing population with all of the costs associated with that.  
When we learn that Vote Health has increased by just 2 percent—in other words basically the CPI—we know the subtext is that health services have been underfunded. The careful calculation of all of those factors that I have just listed suggested that for district health boards to tread water to be able to provide essentially the same set of services at the same intensity as they have been doing in this Budget they required another $465 million. That is an increase of about 4.4 percent. What the Government actually delivered in this Budget was an increase of $319 million leaving district health boards basically $150 million shy of where they needed to be to retain the same level of service. The Government says that that will be met by increased efficiencies trimming the fat and increased productivity but what everybody in the health sector knows is that that will be met by cuts to health services.  
Every day we dig further into the individual budget lines in the health budget and we come up with new gems that illustrate some of the detail of that service erosion—for example in the area of clinical training. I have already mentioned the workforce crisis that health services face yet in that environment the only area in which training received a significant increase was midwifery training. Most other areas of clinical training essentially were unchanged. So medical training is essentially unchanged which will be astonishing for those working in the medical profession. For those working in the nursing profession the news is worse. The money for nursing training is actually decreased in this Budget—actually decreased. The money for Maori workforce development is actually decreased. Those are some of the ways that the Government is funding that increased elective surgery.  
Some of the cuts are going to be the axing of whole programmes and we have seen that in the past few years. That is one of the things the Government does. Whole organisations that have been providing services are no longer doing it. Their programmes are completely gone. But a lot more of it will be in the area of what we might call slow-burning cuts where gradually the cost of providing services is transferred from the State to the people who need those services. In this House—I guess technically it was last Thursday—we were debating the Government’s unheralded change to the asset-testing threshold for aged residential care. That is one of the ways in which the Government is subtly and behind the scenes trying to transfer its responsibility on to private citizens.  
Another example was the increase in the cost of medicines. It may seem like a small increase but for the families that are really struggling and wait until lots of their kids actually need services before they go to the doctor and who try to get multiple conditions for each of their kids dealt with they will find that that prescription with multiple items—each of which is going to have the increased cost—will put them back into the situation where they have to decide which of the things on the prescription they get filled and which ones they decide to leave.  
 So this is a Budget that will see increased cancer services but also a cut to the services designed to stop you getting cancer. It is a Budget that sees district health boards $150 million short but $150 million being provided for the refurbishment of the high commission in London. It is a Budget that sees no action on the workforce crisis. It is a Budget that sees no action on the increasing rates of preventable hospital admissions particularly for Maori and Pacific Island people. It is a Budget that actually locks in inequality and sows the seeds of poorer indicators of illness of disability and of death in generations to come. It is a failed Budget.