Scott Lynda: Appropriation (2003/04 Estimates) Bill — Third Reading Imprest Supply Debate 
Scott Lynda: Appropriation (2003/04 Estimates) Bill — Third Reading Imprest Supply Debate 
[Volume:610;Page:7697] 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 What an absolutely pathetic speech from Clayton Cosgrove! Members can tell that the seabed and foreshore issue is absolutely hurting this Government and it is not going to sort it out; it is just going to do deals. The issue is a very easy one. I come from Marlborough and the line in the sand is the Marlborough foreshore and seabed. That is the line in the sand and New Zealanders know it. It is not a complicated issue. It is not complicated at all. The Maori Land Court should apply to land—not foreshore not seabed; just land. All the Government has to do is define “land” as land. If the Government did that then when it wanted to talk about it title would remain in Crown ownership. It is very easy to solve that problem. Government members talk about other issues but the problem of title is easy to solve. Yet this Government cannot do it. Helen Clark came out and said she would but she has backed off every day since because they cannot sort out a deal with the Maori caucus. The Government can spin this all it likes but people throughout New Zealand know that this is a line in the sand and they are not going to tolerate it. 
 But actually I came down to the House tonight to talk about health. I am going to talk about primary health organisations because $165 million is being allocated in the 2003-04 year to that experiment. Every superannuitant out there who cannot get a hip replacement cannot get a cataract done and has been bumped off the waiting list—every one of the 25000 people in the 2003-04 year alone; every one of the 10000 in Christchurch—has to wonder where the money is going. Why have the points—the hurdle that people have to get over to get an operation—been put up? It is because a lot of the money is going to primary health organisations. The Government is also pouring money into district health boards which is like pouring money down a black hole because the governance structure and the management structure are failing New Zealand. That is why we had the highest ever deficits last year and it is why they will be higher this year. 
But I come back to the issue of primary health organisations. The Minister of Health has actually stated that she wants to be remembered for primary health organisations. What are they? They are untrialled they are rushed they are uncoordinated they will not deliver on expectation they are expensive they are heavily bureaucratic they are hated by general practitioners and they are race-based. That sounds a bit like the Minister of Health actually. A problem list as long as that takes a major increase in the number of health officials to sort it out. We have to wonder why the Government decided not to build on the independent practice associations that were developed by doctors who thought they were doing a good job for New Zealand. All the things that the Ministry of Health says it wants to achieve with primary health organisations—better diabetes treatment better access for Maori better screening programmes more immunisation better management of pharmacies and laboratories—were being done by independent practice associations. 
So why destroy a system that was working just to create a race-based system of targeted funding on location? How can it possibly make sense to put $165 million into funding based on location? Ten main issues have been raised regarding the establishment of primary health organisations. Funding is based on location not on need. A primary health organisation needs 50 percent of Maori Pacific Island or low deprivation but the fact is that the other 50 percent do not have to have high health needs or be Maori Pacific Island or low decile. In the South Island there is nobody on cheap health-care whereas other areas get cheaper care. It does not make sense and when we ask the ministry it says that over 10 years it will roll it out to everybody. But what will happen during those 10 years? People in the wrong location will not get cheaper access to care whereas wealthier people in the right location do get that access. It is ridiculous. 
The Government did not build on the independent practice association model. Instead a whole new system was set up. The public has to enrol but nobody actually knows about enrolment. People have not been told that they are supposed to enrol with just one general practitioner practice. So what happens? People move—they live in one area and they work somewhere else and if they get sick they go to the local doctor down the road. What happens to the funding? The funding does not stay with the general practitioner they normally see; it gets moved. Capitation funding is causing massive funding flows for general practitioners and it is affecting their ability to practise. So with capitation the cross - primary health organisation flows are really detrimental and people are finding it very difficult. 
The fluctuations that are occurring in the incomes of primary health organisations is huge. The ministry has allowed small primary health organisations of 5000 to 7000 patients to develop. 
 They know that they will not survive. They know that they cannot continue on the funding that they have. They know they will fail. Why were they allowed to be set up in the first place when the management and administration costs are so high? Every primary health organisation has to have a board and there is concern from the ministry that there is not enough Maori involvement in the governance. That is what this is about. It is more about getting Maori and Pacific Islanders involved in governance structures than about delivering care on objective measures. We have to look at how much it will actually cost to have the bureaucracy and the administration of these primary health organisations. It will be huge. In the past we have had deficits in hospital-level care. We have never heard about deficits in primary care but that is what we will get. 
The Government is pouring $165 million in $20 million of it for primary health organisation establishment funding and a whole lot of that will disappear and primary health organisations will be back to the Government with their hands out asking for more money. That has not happened in the past. The general practitioners have worn the cost and they have delivered because they have done it on a public and private system. One gets public money plus private money. That pays for primary care. Funding can be an issue. No one denies that funding can be an issue for people when they need to see their doctor but why not target it on need? In relation to the independent practice associations the doctors all got together and said that there should be a care-plus system where those with high health needs and low incomes get better access. The Ministry of Health agrees with that but how much money is it putting into them? It is putting in $2 million as opposed to $165 million into primary health organisations. No one disagrees with more money going into primary health care but the way it is being done is confusing to the public. It will not deliver on its aims and unfortunately it will be waste a huge amount of money. 
Today I talked to a consumer of mental health services. Mental health services have continued to be a problem in this country. The lady I am talking about lives north of Auckland in the Waitemata area. Waitemata looks after all the forensic services for Auckland. She said that the doctor who was to discharge her brother was not signing his discharge letter but was instead signing his death certificate because there were no acute beds for her brother to stay in. This man had tried twice to kill himself but out he was going that day because there are not enough mental health beds. If the Government wants to do some good it should put more money into mental health beds. We have gone too far with our lack of beds for those who are acutely unwell. The police have had enough. They were trying to help. People were being kept in police cells—illegally actually—and the police have now been told that they have to stop doing that and that 6 hours is enough. However there are no acute beds for those patients. That means that they are a risk to their family and to themselves. We need more mental health beds. The situation is so stressful that the staff leave because they are under so much pressure. We are nowhere as near to the blueprint funding as we should be. This is one area where we could be looking at putting more money. Also if we look at how much funding Phamac has been allocated we see that its funding has reduced. That means lack of access to new medications. Primary health organisations get all the money and they will not deliver.