Craig LizDr LIZ CRAIG (Labour): Thank you Madam Speaker. It's an absolute pleasure to be speaking on the first reading of the Pae Ora (Healthy Futures) Bill but also to acknowledge the huge amount of work that's gone into bringing the bill to the House to date. I just want to look back at the Health and Disability System Review which we undertook in our first term and just the huge and compelling need for change that it highlighted. So what it highlighted was just the significant amount of duplication of effort that was happening in the system. It talked about the postcode lottery in health. It talked about the huge inequities for different groups within the community for Māori and Pacific peoples for those in rural communities for those with disabilities and those living in poorer areas. And it basically suggested that there was a compelling need for change.I just think back to my own work when I was working as a public health doctor monitoring the health of our country's children and young people before becoming an MP. I think one of the tasks I had to do was develop a consistent national framework for monitoring child and youth health around the country. What we really had to take a look at is what can you do centrally once and well versus what needs to happen at the local community level. I think just an example thinking through you didn't need 20 DHBs all doing an evidence-based review on what works in childhood obesity prevention but you certainly did need to make sure that if you were going to implement anything on the ground then you had local input local engagement and those that knew what was happening. So I think basically this bill gets the tension right about what we need to do centrally to provide that strategic direction but also making sure that we get local input at the community level.And just thinking also about some of the other examples of the need for change drawing back to my previous work in monitoring child health. At one point we were just really grappling with a lack of information on children with chronic conditions and disabilities so basically things like autism epilepsy and cerebral palsy. The problem was if you don't have information then the DHBs can't look at developing decent health services and plans for meeting the needs of those children and young people because there's not any data there. The issue we were having was that most of the children with those chronic conditions were actually accessing their care either through their GP or in the outpatient setting. And in the outpatient setting there was no coding of the diagnoses for people as they came in; so unlike hospital admission data where you could look at thousands of children coming in for asthma and then think asthma's a really important issue therefore we need to plan services for children with asthma. Because there was a lack of information these children were falling below the radar.So what we went and did is had a talk to the DHBs and said Look what are you doing to improve information access for these children and young people so that you can actually meet their health needs?" And one of the DHBs said "Well we've actually created this nice little system for coding in outpatients and we've got a couple of different broad high-level diagnoses that we use." Another DHB said "We've got this amazing system we've developed over the last few years. We've got about 20 to 30 of the most common codes that we've looked at and we consistently can monitor that over a period of time." Another one said "Well we actually use ICD-10 and so we've got access to thousands of codes." And that was fine they could get all their own information but then when they went to actually talk to their neighbours and say "Well how do we do some joint planning here?" there was no common information there was no common language. And I think the other problem is then you couldn't aggregate that up at the national level to actually figure out what was going on.So the issue we've got is that's just one little example but it's also happening across workforce planning; it's also happening across how DHBs are planning that they manage the flow of patients with different conditions. And so there's just this huge duplication of effort. And yet all the time that DHBs are putting into that they're also grappling with in the DHBs we were working with thousands of kids coming in with potentially preventable conditions: asthma pneumonia. They were working with workforce shortages—very big shortages—in terms of things like mental health staff paediatric pathology rheumatology because there was no central strategic direction. And so what we need is a health system that does things once and well where it's efficient to do so centrally but also incorporates that local level community involvement where you implement things on the ground. And I think this is where this bill achieves both and it creates that really great balance.So what does this bill do? Well firstly what it does is it does disestablish our 20 existing DHBs but it creates some new entities. So it creates Health New Zealand and the Māori Health Authority. And basically Health New Zealand and the Māori Health Authority will work in partnership to plan commission and deliver health services across the country. So that common approach means we're getting rid of a lot of the complexity and duplication in the system. Basically the issue though is that in addition to that central approach we're also looking at localities and local communities. And so basically what it also develops is localities. So basically the Māori Health Authority and Health New Zealand will work together to define particular localities where we want to look at specific local planning. I think of my own DHB the Southern DHB and if you think about the health needs of those living in Dunedin they're very very different to those living in Queenstown to those living in Invercargill and to those in rural Southland. I think that's that ability to think through how do we look at different localities and plans for those communities and how we engage our local communities in that planning and this bill takes that into account.I think one of the other important things this bill does is it creates a public health agency within the Ministry of Health. And I think when you look at the incredible significance of our public health response to COVID-19 and the way we've had that national-level planning and also just acknowledging the huge input of our health professionals in the public health workforce having a single public health agency within the Ministry of Health to coordinate that strategic leadership and approach is going to be incredible valuable moving forward.The other thing I think is that what this bill will do is create a whole lot of strategic documents which are going to be essential for making sure that we've got a consistent approach and that the priorities that we've got as a Government are implemented well across the country. So we've got a new Government policy statement in health and that's going to set out the Government's overall direction priorities and objectives across the health system over three years. But it's not just about the strategy it also sets out the funding envelope as well and how the system's actually going to deliver the outcomes and how that's going to be monitored. Again just doing a review I remember during my public health days thinking through the approach we had previously where we had strategies but none of them were actually funded and so thinking through how effective they could be. So linking that in with funding I think is incredibly important.It's also got a New Zealand health plan. And what that will do is it provides a three-year costed plan that talks about and sets out those health services how they're going to be delivered within the Government across that three years. So again just looking at that practical implementation.And then also—I've already mentioned—locality plans where we're going to be looking at different localities and what those area's health needs are and having some engagement with the local communities about what local communities see is their priority. Certainly where I'm based down in Invercargill after-hours access to GP services particularly free access for children after hours is incredibly important as a local priority—so being able to have those conversations about how do we have the best configuration of health services in local communities.Also there's the New Zealand Health Charter and what that's going to be looking at is the common values principles and behaviours for the entities within the new system and also the people employed by them—so making sure that that's very very clear from the outset.But also there are a range of things that won't be changing. And so within the legislation there are provisions to ensure that the New Zealand Blood and Organ Service and the Health Quality and Safety Commission can just continue on with their current functions although making sure that they are subject to the accountability and monitoring requirements within the system.So I think this is a substantial reform. I mean it's obviously the most substantial reform that's happened since DHBs were created back in the early 2000s. I think it's going to continue to shape the health and access to health services for New Zealanders for years and years to come. But I also think as I said before it gets that balance right. So what it makes sure is that we've got a common strategic approach and we're not spending a lot of time reinventing everything from the ground up 20 different times around the country; we've got a common approach we do things once and well where we need to. The Māori Health Authority will provide the ability to work in partnership with Māori and to think about how health services for Māori communities are commissioned and delivered. And we've also got the capacity to make sure within our localities that there's a level of local input into service delivery and planning. So I'm very very happy to commend this bill to the House."