Reti ShaneDr SHANE RETI (National): Thank you Mr Speaker. Kia ora mai tātou. Labour has lowered the bar so low they will surely be remembered as the limbo Labour Government. The limbo-dancing Labour Government an image I surely don't want in my head but one that is useful to set a structure to describe broken promises looking back wasteful spending and an inability to deliver looking forward. When we look at broken promises first of all certainly in the health space the most obvious two that stand out are firstly a promise to deliver 20 mobile dental clinics by June 2021. Fail—broken promise. It doesn't even come close didn't even start wasn't even on the agenda didn't make the Budget plan—just failed. The second is free GP visits for those over 65 a big programme of about $385 million. Gone—shovelled under the couch shovelled under the bed. Gone completely removed for our older people. Two very clear broken promises. The clear failure to deliver in health spans many domains and this Government actually needs to own them all over these last five years. I'll certainly own every good and every bad of the National Government in health for the nine years preceding that but this Government owns the last five years. They had the ability and the privilege to appoint DHB chairs; they signed off annual plans. This Government needs to own the last five years. Every single National health target when we handed over in 2017 is worse today than it was when we handed over. Oh and by the way it was getting worse before coronavirus struck so we can't just blame coronavirus for that. When we handed over there were only several thousand people on elective waiting lists waiting for their surgery. Now there are 100000 who have had cancelled appointments there are 30000 who are waiting more than four months to see a specialist. While we are talking specialist services over this Government's five years can Mr Little explain to me please Taranaki DHB's reporting as an extreme risk 28 children between four to 16 years old who have obstructive sleep apnoea or positive oximetry tonsils grade two or above snoring and pauses in breathing overnight" who are waiting more than six months for an ear nose and throat appointment? This is affecting their growth development concentration and ability to learn and their behaviour. Every parent who has ever had a child with recurrent tonsillitis a sore throat snoring—that change in pitch that children have when their tonsils are enlarged—they will understand the importance of this measure. Minister Little you own this. Your DHB is already reflecting it as an extreme risk. You need to do something with this. Elective surgery is not the only area that this Government has failed to deliver. I've found it really interesting today; I was wondering how many people were going to stand up and talk about the 53 deaths under coronavirus. Every single death is tragic but mortality by itself is stark it is naked it is cold and it does not describe the fullness of the COVID consequences on New Zealanders. The British Medical Journal this week writes this: "Missed care for conditions such as diabetes cardiovascular disease cancer and mental health for example has short and long term implications for morbidity and mortality. Measuring the pandemic's effects only in terms of deaths due to COVID-19 fails to accommodate these important outcomes." We need to understand the wider consequences of coronavirus beyond—and I accept a very good—53 deaths that we've had over two years with each death tragic in its own right—absolutely. I don't want to diminish that. But that cannot be our performance metric by itself. It is too shallow. I want to focus on one particular aspect of health under coronavirus and that's cancer management. It worried me in the beginning it continues to worry me today and if we look back under the Alpha strain what we know from Te Ahu o te Kahu is that in that first week after Alpha or that first month after Alpha really hit us in April. If we particularly look at cancer diagnosis particularly bronchoscopy where we stick a telescope down the lung looking for lung cancer and gastrointestinal (GI) endoscopy where we put a telescope down the mouth generally looking for bowel cancers—what we know is that in the month of April compared to the previous year we had 70 percent less bronchoscopies and endoscopies. Now by October 2020 we'd actually caught up but that delay in those people who weren't able to get their endoscopy from April through to October has had a consequence. Then what happened? The health system failed to prepare for Delta across ICU beds nurses—you name it—and so when Delta struck on 17 August again if we look with the Government's own data on diagnosis of cancer we see thankfully less than what we saw with Alpha. But with Delta strain in that first month of August to September we see a 30 percent reduction in bronchoscopy and 30 percent reduction in GI endoscopy. Not clear if they've been caught up. Just want to mention bronchoscopy and lung cancer. It was a failure coming out of Alpha. It looks like it's still a failure coming out of Delta. Lung cancer's an area we need to do a lot of work in. I have little faith in the ability of this Labour Government to deliver on its promises to deliver new ICU beds by July to deliver 20-plus health infrastructure projects that the Prime Minister mentioned to build roads to improve housing to reduce poverty to support the cost of living and lower inequality. Not only do I not have confidence but you know the Treasury doesn't have confidence in this Government doing that either—their own agency their own agency reporting on Government the investor confidence ratings which came out a few months ago. Now investor confidence ratings: there's two tranches. First tranche was done in our hands around about 2017. Second tranche was done 2018 to 2020 so in this Government's hands. And if we look at what the investor confidence ratings do it's a Cabinet approval process for assessing agency investment performance and the level of confidence that stakeholders should place in the ability of an agency to manage its assets and investments. It is the confidence that stakeholders should place. Stakeholders? That's you and me; that's New Zealanders. This is the confidence we should have in these agencies.What happened here is Cabinet identifies 25 Government State agencies and puts them through an assessment process. They select these 25 agencies because they're responsible for roughly $100 billion or 75 percent of assets in the Crown's balance sheets. So we've got an investor confidence rating from Treasury and there were really important Government agencies—in our hands there were 16 17 and in this Government's hands there are 18 to 20; the two rounds of investor confidence ratings assessments. What do we see? Well the first thing we see is an interesting change to the weightings under this Government's hands. They reduced the weighting for project delivery from 15 percent to 10 percent. Too hard can't deliver reduce the weighting. That's not a good look. And then if we look across these 25 agencies several worry me but one that worries me particularly is the Ministry of Health who is one of the few that has gone backwards under this Government's management. They were a "C" in our hands which was average; I accept that. They are a "D" which the Treasury is reporting. In this Government's hands the trust that investors the trust that New Zealanders can have in this Government managing the Ministry of Health is a "D"; 40 out of 100 points in this Government's hands. It's unequivocal. This is Treasury reporting. Other agencies? A few have done well and I'll give credit to that. But across the board this is not a good report for the Government's handling or their ability or any faith we might have that they can deliver any of the fine and wonderful things they've said here today. Some predictions: firstly the health sector reforms in July will further damage workforce morale and the organisational change will result in a reduction in health services. Secondly the Government will fail terribly to meet health targets and so will shift the goalposts away from targets. Oh wait they've already done that. It's called health indicators—health indicators that today if you go to the website say there is no problem accessing GPs. That is a dream. That is a terrible terrible dream. Health indicators that say actually it's a plus 3 percent I think it is delivery of specialist services. That also is a dream. The third prediction I'll make and it's a warning is to Māori. To Māori in the Māori Health Authority I say this: kia tūpato—be careful. A Māori Health Authority will be underfunded under-resourced and vital planks in the policy will be walked back before 1 July. Mark my words we will see the true colours of the Crown-Māori relationship with this Government when key planks in the Māori health policy will be walked back before 1 July.Our leader has proposed a vision of a stable economy a productive economy enhanced by increased skills increased learning infrastructure that's actually delivered on time on budget and in scope. We know how to do that. National knows how to deliver infrastructure. We know how to deliver jobs of the future. We know the importance of raising people out of poverty reducing inequality—that progression that upward mobility that we need to talk about—and the fact that before we spend money on social services before we spend wealth on social services we've got to create wealth. National proposes a stable economy that will let us have it all. We can have at all. We just need to be prudent we need to be mindful we need to be thoughtful and this is the vision we bring to New Zealand. Thank you Mr Speaker."