Clark David; Rurawhe AdrianHon Dr DAVID CLARK (Minister of Health): Parmjeet Parmar's bill is a nice idea in theory but it's clear when you look at it more closely as many members did in the Health Committee that it really lacks substance and unfortunately will not achieve what it sets out to do. It's not a resourcing issue; it's simply not an effective way to achieve the thing it says it wants to achieve. The bill would legislate for outcomes that are already expected without putting any levers in place to achieve them without any consequences for their not being achieved. It's completely toothless. It's a well-intentioned bill. It's a nice idea but I think the facts speak for themselves.If the previous Government had thought this was a priority and was the way to do things the previous health Minister would have adopted the idea and would have put the legislation through the Parliament. But in the previous Government clearly the health Minister thought this was not the most effective way to do things. It was not a priority. He was happy to let it sit in the ballot and then make its way slowly through the members' bill process because he could see it was a reasonably hopeless way of trying to achieve what it said it was wanting to be achieved.I think members in this House can appreciate that legislation is not always the best way to solve an issue. Legislating for something that is already required doesn't make anybody want to do it any more; and if there's no consequence and it's already required legislating and having no consequence isn't going to make any difference either. It just uses up parliamentary time.Dr Parmjeet Parmar: The Minister wants to punish parents.Hon Dr DAVID CLARK: I can understand the member's disappointment and I can hear her across the House expressing that disappointment and frustration loudly. This was I guess meant to be her moment in the sun. But we have to look at the facts and we have to make a rational decision about what the most sensible way is to achieve these goals. This Government believes in improving outcomes for young children; that's why we passed the $5.5 billion Families Package. It was the first action of this Government actually—the biggest change in income distribution in this country since 1991. Our priority is with children: $60 a week more in the family will make a big difference to those vulnerable families. That is the priority of this Government. That's why the targets for improving child poverty have been set down. That's what this Government is about. This Government cares about making a difference. Tweaking something to make it a law when it's already an expectation and making that law have no consequences is nothing but window dressing and it's unfortunate window dressing.We are more ambitious than that. We as a Government—we on this side of the House; this coalition Government—are more ambitious than that. We don't just want one enrolment; we actually want a GP practice in there we want a Well Child provider we want them to be on the National Immunisation Register and we want a dental programme. It's called quadruple enrolment" and if you talk to clinicians up and down the country they say quadruple enrolment is the way to go. So we're looking at ways to incentivise that to make sure that primary health organisations (PHOs) are incentivised to actually deliver that to make sure that the cultural supports are in place and to make sure that midwives are given opportunities. Actually this bill would undermine the role of other health professionals like midwives in newborn enrolment and their particular role and place. The particular set of time frames could actually undermine midwives' role in caring for young children and in making sure that they go through those early stages and that mothers are supported to get those right enrolments and to have the right things happen at the right time for that child's development.It would place also an administrative burden on GPs because of the requirements laid down in the bill and these are already stretched GPs.Dr Parmjeet Parmar: Oh so who is supposed to provide support to GPs?Hon Dr DAVID CLARK: I hear the member saying sarcastically "Pity for the GPs!" Well they are burdened. The GP workforce works very hard and they do try to make this happen and they do support this already. Legislating without any consequence achieves nothing in this situation. So I'm afraid that this bill is not one that we can support on this side of the House. We actually think we need to take real steps to improve the well-being of young children. We need to make sure that families are supported that they have the incomes to make sure that those children can be looked after that they should actually have quadruple enrolment and that expectations should be put on PHOs and mechanisms put in place to make sure that happens in PHO service agreements. We're already working to make that happen. We think the district health boards should be more accountable. There are a number of mechanisms for making this happen that don't require legislation—toothless legislation well-meaning legislation that the previous Government wouldn't even support its own member to get through the House. We believe in making a real difference in people's lives rather than window dressing.The suboptimal newborn enrolment rate—and let's admit that things are not as good as they could be—is something we need to tackle in a serious way not through window dressing not through a bill that the member's own Government the previous Government wouldn't support through the House not in a bill that might potentially undermine the role of midwives in newborn care not through putting extra administrative burdens on the GPs who already try to support these young people these young families as they wrestle with these issues. So we think that we should get the quadruple enrolment as I said. We don't think this is the most effective way to improve newborn enrolment.We do extend our sympathy to Parmjeet Parmar who of course had the frustration under the previous Government of a Government that wouldn't fund healthcare properly. I understand that; we were frustrated with that when we were in Opposition because we saw the effects of it. We saw the effects of an underfunded health system. We saw that health system getting run down. We saw it getting harder to get surgeries that people needed. As MPs we saw people coming through our electorate doors complaining about the way the health system was being run down the burden being put on the workforce the lack of sustainability—we saw all of that too. We understand the member's frustration that her own Government wouldn't support her to make positive change. We understand that on this side of the House but we can't support it out of a sense of sympathy. We actually need to see the best policy rationale put forward. We need to put mechanisms in place that will actually work not just legislate for something that's already a requirement.I want to say also that there are other things that can be done to support this and that is making it more affordable and accessible for people to go to GPs so that they have relationships with their GPs. This Government in its Budget has just passed a measure that will ensure 540000 people will get access to a community services card that gives them cheaper doctors visits. For many people that will mean their doctors visit becomes $20 to $30 cheaper—for some it will be $50 cheaper. That will help them establish a relationship with their GP where they get the regular care they need. When their child is born they'll feel comfortable going to the GP for that enrolment. That will make more difference than this bill here—this resource going to primary care so that families are getting the support that they need.That Government had a report the Moodie report which recommended this kind of care and support—the community services card extension—but they did not act on it. They simply would not act on it to give people better access to GPs. Instead they'd rather legislate. The interesting thing is that they won't legislate to make it compulsory for parents to take their children along. There's no suggestion they'll do that; they just want to blame the GPs. They want an extra level of blame on the GPs; that's what they're calling for here. Well we can't support it I'm afraid. We supported it to select committee because of the intention. We thought that maybe out of this you could make something reasonable—that you could somehow put something together in a select committee that did achieve an outcome. We thought it needed a good looking over. It's the right thing to do. If a bill has good intentions you tend to support it to select committee but it really didn't stand up to scrutiny.It's well-intentioned and we have sympathy with the member that she couldn't get her own Government to make progress in this area. The frustration with the underfunding in the health system was something we shared too—the lack of leadership on these issues by the previous Government—but that won't stop us being more ambitious. That won't stop us supporting quadruple enrolment for young children. That won't stop us getting on and addressing the neglect of the health system making doctors visits more accessible making sure that hospitals that have got rot and mould in them are repaired so that we can have the health system and the health services that New Zealanders expect and deserve. This is a Government that believes in action not window dressing not good intentions. But let's get on and make New Zealand a better place where people can get the health services they need and where we actually see progress on having people enrolled.ASSISTANT SPEAKER (Adrian Rurawhe): I'm sorry to interrupt the member. This debate is interrupted and is set down for resumption next sitting day. The House stands adjourned until 2 p.m. tomorrow. Pō mārie.Debate interrupted.The House adjourned at 10 p.m."