Reti ShaneDr SHANE RETI (National): In this contribution I will speak firstly to the Health reforms generally and then to the Māori Health Authority. The trail of Pae Ora through the select committee process is a story that starts with disrespect and ends with deception. The creation of a special select committee to discuss a purely health bill disrespected the standing Health Committee. The Labour members' majority was an early signal of the deceit that would follow which I will describe in detail here. The warning signs for a poll-driven watering down of the bill were there when the very first part of the bill was changed by the Labour-majority select committee. The very purpose of the bill—the purpose of the bill—was changed from reducing health disparities to striving to eliminate health disparities—a tragic reduction in ambition and a clear indication of a poll-driven watering down of this bill. These health reforms will fail and they will fail on a number of grounds. I will describe six areas of failure. Number one: Labour knows best" centralisation. Retrenching of local health voices to Wellington under the ideology of "Government knows best" is the same sort of disenfranchising that we have seen with polytechnics and three waters. This is all about control and not about health services. Wellington does not know what is best for the people in North Hokianga. Local people know what is best for them and they want this Government's heavy hands out of their lives and out of their pockets. We despair the loss of local autonomy under these reforms.Number two: timing in the middle of a pandemic. We had a Government official tell the select committee that the timing of the reforms in the middle of a pandemic was optimal—this timing is far from optimal. If the Government hadn't noticed the sector is exhausted because Andrew Little failed to build a health workforce. The waiting lists are as big as they have ever been in history because Andrew Little didn't build enough ICU beds to protect the health system during COVID. Nurses are burnt out because Andrew Little didn't keep his promise to fully implement the Safe Staffing Accord a promise made in June last year. Critical care nurses are in short supply because after announcing the botched Kiwi Health Jobs recruiting programme in November last year Andrew Little wasted four months before starting it and it only employed three nurses to last month. Infrastructure hasn't kept up because Official Information Act documents show that last year Grant Robertson told Andrew Little to cut the health budget to a "minimum viable package" so that he could fund the health reforms. People are therefore rightfully devastated with wasted spending when Andrew Little let more than $21 million of vaccines expire while also botching measles shingles and flu vaccination campaigns. The timing of these reforms is terrible.Three: no rural voice. Where is the rural voice in the health reforms? What about the half-million people who live in rural areas with less access to GPs laboratories and after-hours services? Where is their voice and recognition of their unique needs in these reforms? Rural people are invisible. The Labour-majority select committee didn't even want to include or contemplate rural people in this bill. What about exhausted rural GPs? GPs and in fact primary care don't even have a representative on the Health New Zealand board. Despite the fact key solutions in the reforms are keeping more people at home that's primary care. Kicking people out of hospital earlier—also known as reducing length of stay—that's primary care also; that's where they go to. Yet primary care doesn't even deserve a place on the Health New Zealand board. The rural voice is invisible. The last Budget actually signalled the hidden agenda for how this Labour Government will deal with rural communities. In a terrible mistake last February the Ministry of Health released to me an unredacted copy of a Budget briefing from Ashley Bloomfield to Andrew Little. In that unredacted briefing one of the options to manage cost pressures was "rationalising specialist services—example: consider the scope and function of provincial hospitals." That is code for removing rural and provincial services. This is the hidden agenda of these reforms for rural areas—decentralised decision-making and reducing provincial hospitals—and this Government got caught out by their own mistake.Four: a track record of more money more bureaucracy worse outcomes. The evidence to date is that this Government has spent more money on health but got worse health outcomes. All of the national health targets are worse now than when we handed over in 2017 and COVID cannot be used as an excuse because they were getting worse even before COVID. What we are seeing with these reforms is layers and layers of bureaucracy that are being built. Two weeks ago Andrew Little made an announcement hailing the start of the bureaucracy—locality commissioners locality coordinators and 80 locality networks. The real message was that nowhere in his announcements was a single targeted health outcome. It was all about bureaucracy—more money more bureaucracy worse outcomes. How could one possibly believe that these reforms will be financially viable when in March last year Cabinet documents showed the benefits projected to be $1.5 billion over 15 years and yet barely six months later the benefits had ballooned to $3.8 billion over 10 years. This is simply not credible; no one believes it.Number five: inability to deliver the reforms. Even if the reforms did have some merit it is not possible for a ministry and a Minister who gets a D from the Treasury for investor confidence rating to deliver these sorts of reforms.And number six: no outcomes. Show me the outcomes Minister. Five years before any benefits from the Māori Health Authority and I challenge you to shout at me again like you did in select committee when I asked you to name a single health outcome that will happen in the first year. No one cares about your layers and layers of bureaucracy; they just want their hips knees and cataracts done. National is interested in health outcomes. New Zealanders are interested in health outcomes. Show me the outcomes. In their entirety then we reject these reforms as a centralised command-and-control grab that diminishes the local voice and completely misses the vital democratic utility of health systems which is health need. The changed financials are not credible and this Government cannot and will not be able to deliver anything other than layers of bureaucracy which New Zealanders will pay for. I will now turn to the Māori Health Authority. National does not support a Māori Health Authority as a separate health system. I will set some context around the Māori Health Authority before seeking to detail three key reasons why a Māori Health Authority will fail and conclude with 10 signals why under this Māori Health Authority Māori are being thrown under the bus.Firstly Labour did not campaign on a Māori Health Authority of this type and context; they did campaign on a Māori Health Authority but under the Simpson review it did not have veto rights it was not commissioning and it was not in the context of a complete removal of all DHBs. The comment that nothing has been done for Māori health for 180 years those that say that a Māori Health Authority is needed because Māori Health has failed—how dare you disrespect the work of those Māori doctors who along with others took Māori from a life expectancy of 30 years in 1840 to the 73.4 years today. Māui Pōmare Peter Buck Tūtere Wī Repa Edward Ellison Richard Grace Louis Potaka Golan Maaka Henry Bennett Nītama Paewai and Tom Kawe—we stand on the shoulders of these 10 Māori doctors the first Māori doctors and many others who have followed. Do not disrespect their work by saying nothing has been done for Māori. Shame on you for demeaning their memory. The better question to ask is not why Māori health hasn't improved over the past 180 years but why there is a difference today in health outcomes for Māori and non-Māori. This is the problem we must solve. A Māori Health Authority will fail; it will fail for several reasons. Firstly it is based on a Treaty response and not health need. A health system that does not place health need as its core principle will fail; it will fail as it is corroded by conflicts of interest and distributive justice. A commissioning Māori health system will fail. Heather Simpson has said that she did not envisage the architect of the reforms did not envisage a Māori Health Authority as a separate health system which it will be if it is commissioning and it will cause a lack of cohesion in the system. There will be competition for scarce resources. There will be provider complexity. Parliamentary questions demonstrate that a GP can hold two contracts: one with the Māori Health Authority; and one with Health New Zealand. That will definitely increase complexity. There is a terrible conflict of interest. The Māori Health Authority not only is a monitor of health inequities but a provider of health services. It is marking its own exam and that eventually will corrode the Māori Health Authority. There are 10 signals that Labour are throwing Māori under the House with this Pae Ora bill. The Māori Health Authority veto has gone the veto that Andrew Little said in this House was vital for inequities—gone. The only redaction in all of the Government papers is in the Māori Health Authority in the financial statements. The Māori Health Authority is not a Treaty partner. Treaty principles are not included in the Pae Ora bill. The Māori Health Authority can be dissolved easier than Health New Zealand. No benefits to the Māori Health Authority in the first five years. The commissioning part has an unfixable conflict of interest. The role of iwi-Māori partnership boards has been watered down. You have been vacated; you are deleted with a red line by this Labour Government and you will now apply. And finally there are deleted powers to undertake functions. The Māori Health Authority no longer has complete powers; there are many holes in this bill."