Gilmore Aaron: Questions for Oral Answer — Questions to Ministers Questions to MembersText is incorporated into the Bound VolumeGilmore Aaron: Questions for Oral Answer — Questions to Ministers Questions to Members[Sitting date: 22 August 2013. Volume:692;Page:12751. Text is incorporated into the Bound Volume.]6.PAUL FOSTER-BELL (National)to theMinister of Health: What reports has he received on patients receiving better access to health specialists?Hon TONY RYALL (Minister of Health):Two days ago I told the House the positive news that a record 294000 patients had received surgical first specialist assessments in the last year. Today I am pleased to report to the member some more positive news. The total number of medical first specialist assessments in the 2012-13 year was a record 194000 extra patients 22000 up under this Government. This means that in the last year a record 487000 medical and surgical first specialist assessments were completed which is really equivalent to around one in every nine New Zealanders.Paul Foster-Bell: What does recent data tell us about access to first specialist assessments?Hon TONY RYALL: There have always been people who do not meet the threshold for access to first specialist assessment. However all patients referred to a specialist by a general practitioner are assessed by hospital-based clinical staff and those with the lowest clinical need are referred back to general practitioner care. Often the patient has not met the threshold for a full assessment. Some decide not to take up the assessment some move district and some may no longer need the treatment. This data has never been centrally collected. However copies of information received by my office indicate that around 45000 people are triaged back to general practitioner care by clinicians. With around 490000 assessments completed this number sits at less than 10 percent of total people referred and has been reasonably static.Kevin Hague: Why has the Minister taken no action to address the concerns of district health boards published in the Ministry of Health’s report into his elective surgery programme in June this year that the day-to-day pressure of pushing increasing numbers through waiting lists is “diverting resources from the robust consideration of the longer-term strategy and impact.”?Hon TONY RYALL: The Government sees itself as the agent of patients and patients tell us that they want improved access to the services that there are. This Government has put an average of $500 million extra into the health budget each year.Kevin Hague: Will he now confirm to the House that more than half of the 1000 new doctors he and the Prime Minister have been claiming to have recruited are in fact junior doctors and not specialists at all?Hon TONY RYALL: I think the Prime Minister and I have always been clear that the increased numbers refers to all doctors. In the term of our Government as that member knows through the large amount of Official Information Act material we have given him we currently think we are running at over 1200 extra doctors in New Zealand public hospitals.Kevin Hague: Given that all of the Government’s own district health boards and the Association of Salaried Medical Specialists have agreed on the need for at least 209 additional senior doctors every year how does he defend his underperformance in recruiting at less than three-quarters of that rate?Hon TONY RYALL: As the member will know we have over 1200 extra doctors working in the New Zealand public system since 2008. There is also a lot of information that shows that the most stable workforce in the entire New Zealand Public Service is the senior medical officers. So our Government has been investing very strongly in health. Turnover in staff numbers is down and we have more front-line staff than ever before.Kevin Hague: I raise a point of order Mr Speaker. My question related to the recruitment of senior medical officers. The Minister has not referred to that matter at all in his answer.Mr SPEAKER: The member should relook at his question. The essence of his question is how the Minister defended his underperformance in relation to that. The Minister gave a very justified answer to that.Kevin Hague: Well can the Minister then confirm that New Zealand still has the worst ratio of senior doctors to population in the OECD and explain why he has not taken steps to implement the plan agreed on by all district health boards and senior doctors?Hon TONY RYALL: I think the member will find that New Zealand’s ratio of senior medical staff to general population is relatively consistent in terms of international comparison which reflects the different models of care that we have in New Zealand. But look I have to say to the member that he can ask as many questions as he likes; it is not going to get away from the fact that we have got 1200 extra doctors on the public payroll because of the strong investment our Government is making in improving services.Kevin Hague: I raise a point of order Mr Speaker. The Minister has indicated he is happy for me to ask further questions and I would be—Mr SPEAKER: Order! That is not a point of order.Te Ururoa Flavell: Tēnā koe Mr Speaker. How do these results that he quoted in the initial response correlate to the significant disparity in outcomes for Māori especially hard-to-reach whānau—for example the number missing out on B4 School Checks?Hon TONY RYALL: I thank the member for the question. Yes a lot of effort is going in from district health boards to make sure that those people who are offered first specialist assessments are provided all opportunities to make sure that it is at a time that best suits them. In respect of the area of B4 School Checks the Government is working very hard to expand the number of B4 School Checks and particularly to improve performance on those most at-risk children in our community. I can report to the member that in most district health boards around the country—the national averages—we have been improving that performance particularly for our young people at risk.