Dyson Ruth: New Zealand Public Health and Disability Amendment Bill — Second Reading 
Dyson Ruth: New Zealand Public Health and Disability Amendment Bill — Second Reading 
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Hon RUTH DYSON (Labour—Port Hills) 
: 
 I am pleased to follow the Minister of Health Tony Ryall in this debate and I add my commendation to the chair of the Health Committee Paul Hutchison. Dr Hutchison tries very hard after he has worked out how to turn on his computer to ensure that we have a constructive working relationship within the committee and I pay genuine tribute to him for that because that was certainly the case in respect of the New Zealand Public Health and Disability Amendment Bill. As the Minister has indicated the purpose of the bill is primarily twofold. The first primary purpose is to set up the Health Quality and Safety Commission and the second is to ensure that the district health boards work better together. That is the summary of the many points made within this legislation. The boards will have a mandate for collective purchasing and will be required to develop plans in unison. I certainly hope they are able to get their district annual plans presented to the public on time in future. 
I was gobsmacked to see that several of our district health boards have just gone through an election for members of their district health boards without making publicly available their district annual plans. That is an outrage. It is totally unacceptable that New Zealanders have to vote for a representative for their local district health board without knowing what the district annual plan for that very health board says. I hope that the requirement for district health boards to plan together—and I agree with the provision and think it is sensible—does not further restrict their ability to make public the district annual plans in a timely way. That problem has certainly been the case this year and it has caused a lot of concern for people. 
Right from the beginning of this process we supported the introduction of the bill and its referral to the select committee for two reasons. The first reason is that the primary purpose is that which I have just outlined the establishment of the Health Quality and Safety Commission which sounds good in theory and we hope is good in practice. The second reason relates to the mandate for better collaboration between district health boards which is something that no sensible person would argue against. So we supported the primary purpose but we also wanted to make sure that members of the public particularly those who are intricately involved in working within our health system had an opportunity to make a submission. Members of the public often see things from a different perspective from those of us in Parliament. 
One of my great interests at the select committee and through listening to the submissions was to consider what people thought were the cost benefits of this legislation. The Minister is very good at saying how many millions of dollars will be saved by various initiatives. In fact he does it a little too often for his own good because he has been caught out on many occasions exaggerating the amount of saving. In recent times he has got to the point of saying there will be savings when clearly there are costs associated with the new bodies that are being set up so I was very interested in what submitters had to say about costs and savings. 
My concern about the exaggeration of benefits was borne out by the concerns of some people and others referred to the establishment in the last 18 months alone of new bureaucracies such as the National Health Board. I understand that Murray Horn who made an earlier report on our health system is getting around $1500 a day which is quite a lot of money to be paid to do something that was already being done by the chief executive of the Ministry of Health prior to the establishment of the National Health Board. It is even more frustrating and puzzling to see somebody being paid that sort of money to do a job that was already being done when we see people up and down the country particularly elderly people having their meagre couple of hours of home support cut right back to nothing. It really does not seem to me to be a logical or a fair choice to have a new bureaucracy established in the National Health Board undermining the Ministry of Health and the independence of Public Service advice. 
The people running the National Health Board are being paid huge amounts of money and they have stolen a whole lot of the previous Ministry of Health people and called them consultants so they are getting paid far more to do the job they used to do as Ministry of Health officials. At the same time we are seeing cuts to home support Meals on Wheels and to the support that I think our elderly particularly are entitled to in order to make sure they have quality of life. That concern was repeated in the submissions about whether the cost-benefit analysis had been rigorous or political and I consider that there is a large amount of political spin in whatever has been coming from Tony Ryall in that regard. 
I move on to an area the Minister briefly alluded to but which I feel warrants a bigger debate at this stage and it certainly will be raised again in the Committee of the whole House. It concerns a blatant move to remove the community voice as part of our health decision-making process. New section 38 removes the need for district health boards to consult on strategic plans. The whole point of having a district health board is that it is representative and connected to its community has expertise in health governance and because of its understanding of its community can use the strengths of its community to further promote better health outcomes within that community. But that voice has now formally been cut out. It is not just a consequence it is not just a by-product and it is not an unintended outcome of this legislation; it is a deliberate considered move that the Minister of Health signed off on. Tony Ryall said that section 38 should remove the voice of the community in district health boards’ strategic plans and preparation. I think that that is wrong. I do not think that the community should have its voice cut out in that way. The Minister made some vague reference to making sure that people will have an opportunity to contribute and to bringing in some regulations. But it is very hard to see how regulations can be consistent with primary legislation—which they are required to be—when the primary legislation specifically removes the role of the community in the strategic planning process. 
How can we have primary legislation that says the community will not have its voice? That is what Tony Ryall has said—that the community will not have its voice heard in district health boards’ strategic plans. But then in the regulations he has said we will have some process by which the community can contribute. I do not think that that would be acceptable in the regulations review consideration. We cannot have regulations that are at odds with the primary legislation. If the Minister had a commitment to making sure that the voice of local people was genuinely heard he would change section 38 and ensure that the processes we have now could be continued. 
A number of organisations raised considerable concern about this breach of democracy in this legislation. I know that the New Zealand Public Service Association raised concern in its submission as did the New Zealand Council of Trade Unions and the Women’s Health Action Trust to name just three. It does not seem consistent with the spin that the Minister puts on his health announcements that there will not be major restructuring and that the purpose of the district health boards having elected and appointed representatives is ensuring the voice of communities is heard in making decisions about health that have an impact on those people. I think that that is all untrue. I think that it is just spin from the Minister and this clause proves that. It is a deliberate and considered decision to take local voices out of health decisions. I will be putting forward a Supplementary Order Paper during the Committee stage of this bill in order to rectify that. 
I challenge the Minister to table the regulations that he referred to during his second reading speech because I predict that National will—like sheep jumping over a cliff—vote against my Supplementary Order Paper on the basis of what Tony Ryall has said but I bet that not one single National member has seen the proposed regulations. I would bet good money on the fact that not one single National member has seen those regulations and it is just not credible for us to take the Minister at his word with regulations that will be at odds with the primary legislation unless we have seen them. 
I conclude Mr Assistant Speaker by just acknowledging you and Southland and I thank you very much for giving us back the shield at the weekend. We deserved it.