King Annette: Budget Debate 
King Annette: Budget Debate 
[Volume:618;Page:13563] 
Hon ANNETTE KING (Minister of Health) 
: 
 I am proud to support this Budget. This is a Budget that is good for families. Family health is the cornerstone of any progressive Government’s agenda. The health budget is about extending health to our families. It is about extending health to our older folk. It is about providing affordable primary health care and ensuring our older folk get access to timely services particularly orthopaedic operations. It is about ensuring that our children and those who are chronically unwell get access to affordable primary health care. 
This is a good Budget for New Zealanders. When we look around the world we see that many countries face huge problems and at times it is difficult not to feel almost overcome by the sheer enormity of global health issues. No health system anywhere in the world is perfect. Therefore it is important that New Zealand remains at the forefront of developing innovative approaches to ensure we use effectively and well the dollars we put in and achieve the best possible health system. 
This Budget puts almost $10 billion into health. Although we often hear about funding in terms of hospitals a lot of that money is ensuring that we reduce costs for people accessing primary health care. It has always seemed silly to me that it is free for people to have an operation in a hospital but they pay top dollar to get through the door of their local general practitioner. Surely we ought to have been looking at how we can get them into the system earlier to screen them for disease to ensure that we keep them healthy and well for as long as possible. We needed to shift the emphasis away from always looking at the hospital end to looking at prevention and early intervention as a better approach. 
This Budget shifts new funding into primary health care. It builds on the work we have done in other Budgets. It takes us further forward and in the next few years we will totally implement the primary health care strategy which will provide affordable primary health care for all New Zealanders regardless of their wealth. It will be dependent on their health need not on their financial situation. I am very proud that we have committed ourselves to a strong primary health care approach. 
In my speech today I want to emphasise the orthopaedic project announced in the Budget. A package of $70 million a year will be permanently going into increasing the rate of operations we do for major joints—hips and knees in particular. At the moment New Zealand’s rate of intervention is about 1.2 operations per 1000 population. That is well below the international average across countries that we like to compare ourselves with—the United Kingdom Canada the US and so on. 
With the money that is going into the orthopaedic project in this Budget we will see a doubling of the number of major hip and knee operations we will be doing. That money will not go in just as a one-off—like we saw in the past when as a one-off hit money was put into reducing waiting times but then the waiting lists grew again. Rather it will go in year in year out retaining a level of 2.4 operations per 1000 population which is higher than the level in Australia at 1.9 and the UK at 2.3. We will be right up there amongst the best in the world. The Government has committed itself to that position because when it comes to quality of life one of the best operations we can carry out for our older folk is major joint-replacement surgery. 
There would not be a member in this House who works with his or her community who has not had people saying they have been waiting too long for major hip and joint operations. It took us a year of hard work working with the Orthopaedic Association the district health boards and the health sector to put in place an approach that has been agreed upon by everybody. We agreed on the access criteria. Right now people in some parts of New Zealand can get an operation much more quickly than those in other parts of the country because of the different criteria. If people are lucky enough to be in an area where not so many operations need to be carried out then they will get into the system more quickly and the level of acuity will be lower than for people in Auckland or Christchurch for example. So the criteria for the types of operations that will be carried out were agreed on with the Orthopaedic Association. The standard will be nationwide and therefore whether or not people live in Whangarei the Bluff or the Wairarapa the same criteria will apply. 
We also reached agreement that we would maximise all the capacity we have to carry out these operations. We would utilise all the capacity in our public sector but where needed we would also utilise what capacity there is in the private sector. 
This has been an extremely encouraging piece of work undertaken with our doctors nurses and district health boards. I am pleased it has come together as an ongoing project. The most important part of the accountability of this project is that we pay the money to district health boards after an operation has been done. One might ask why we would do that and not just give them the money and let them do the operations. Well history has taught us—and I see Edwin Perry nodding because he knows this only too well—that in the past the money has gone into the boards. They have been asked to do more operations and when the audit has been done maybe 2 or 3 years later— 
Ron Mark 
: What about eyes? 
Hon ANNETTE KING 
: —I will get to that later; it is found that the money has gone into propping up the operation; it has not gone into performing the operations. 
Ron Mark 
: Into the bureaucracy. 
Hon ANNETTE KING 
: No and I must answer that interjection. In fact I will provide the member with the latest information showing that the growth in bureaucracy in the health system is very low indeed. The growth in the number of doctors and nurses in our health system has gone up considerably over the last few years. That is necessary. We need doctors and nurses in order to undertake initiatives like the orthopaedic project. 
The other area where work is now being done—and I am sure the member interjecting wants to hear this—is in cataract operations. They are another one of those quality of life operations. In many areas of New Zealand people do not have to wait long for a cataract operation but in many other areas they do have to wait too long. That matter is certainly on my work agenda this year. It does mean we have to get cooperation from ophthalmologists and to ensure we are able to carry out those procedures within the capacity we have. 
Over the last 3 years a lot of money has been committed to reducing the cost of primary health care—more than $400 million. But over the next few years almost as much again will be put in to ensure we are able to provide affordable primary health care. We started with our old folk. Last year we increased the money to the under-sixes. We then added the under-18s. Now on 1 July older people over 65 who are part of a primary health organisation will pay a reduced fee to their primary health provider. They will pay reduced costs for their prescriptions—no more than $3. That is a real commitment to primary health care. 
I am proud of what we have been able to achieve in this Budget. There will always be demands. There will always be things that can be done better. I hope that over the next year we will see very good use made of the dollars we provide. We certainly make sure that our district health boards are accountable for the money they get. 
We want to retain our workforce. We want a workforce that people enjoy being part of and are committed to. Over the next year we will see a lot of effort going into workforce retention and so on. 
This is a good Budget for families and a good Budget for health. What I do not understand is that when the Government provides support for families through the family support package that is seen as a handout but when it provides support to elderly people so they can have operations that is OK. Why is it not OK to support families but OK to support operations? I support both those things.