Little AndrewHon ANDREW LITTLE (Minister of Health): We often get mistaken Michael Woodhouse and I. Thank you Mr Chairman. Thank you Mr Watts and Mr Woodhouse for their queries. Simon Watts raised three questions I'll see if I can dispose of those quickly. Mr Watts is right about—we all foresee the shifting age-profile of our population and therefore that is going to have an impact on health services. Part of what has driven the whole reform process is the need for sustainability knowing that in our current shape we'd be struggling with sustainability.As we look at 20 to 30 years out with an ageing population the way we deliver services is going to have to change. We will end up delivering more services in the home—that's not a bad thing; there's a lot of people who want to stay in their home. We know for Māori and Pacific populations actually they prefer to be in their home and be around family and whānau. We've just got to make sure that the health services and support that allow that to happen are there. And so that I expect will have to be part of the planning that goes on.But I can assure the member that—in terms of Government whether it's the Ministry of Health Treasury and others whose job it is to look out—thinking about what we need to be doing in 20 30 years' time is very much driving what we're doing. It's helping drive the structure and helping drive our thinking about what future financing looks like—because the problem's not going to go away.In terms of health workforce again the member and others in the debate so far in this committee stage have raised the challenge that we have with workforce that are being compounded by a number of issues. In terms of retention one critical factor is remuneration. We've seen the significant shift in remuneration for nurses. We've got admin clerical workers who now have agreed on and in fact have ratified their pay equity deal—so that will be implemented. We have allied health workforce about to vote on a routine collective agreement renewal but with commitments about pay equity and we're in the process of setting that up.Those things will help with retention. But I think the other point the member makes too is it's not just pay it's conditions as well it's the environment in which you work it's making sure that you're working in a health service that is fully staffed—or as close as possible to it. So filling the existing gaps and future gaps remains that challenge and that's why the workforce planning and development element of this—and I'm very pleased that the Pae Ora Legislation Committee added in those as statutory requirements for Health New Zealand and the Māori Health Authority to be planning for and be across; it's very important. So I think the bill covers those needs off.The third point that Mr Watts raised was just about aged care. I'm confident that we will see a change. There are some short-term challenges again around staffing. I think the big challenge that aged care has is the growing differential between the health workers—nurses health care assistants—who work in the public system versus those who work in aged residential care in the private system. I have made the commitment and we stand by it—we know we have a job to do in terms of pay parity and we're working on a plan to make sure that that happens. That's not something that can be dragged out for ever and a day but there is a commitment to see that through.To Mr Woodhouse's questions about meeting the obligation under clause 16 to be effectively fiscally responsible. Look the challenges that Mr Woodhouse raises are there today. In terms of capital spending that is heavily centralised anyway. Capital spend is the responsibility of a combination of the ministry and its capital investment committee. The ministry has their health infrastructure unit as well and the data and digital section of the ministry is responsible for the big IT system investments and what have you. So across the 20 district health boards and across the multiple hospital campuses we've got there is a prioritisation given; there's something of a national asset management plan—even if not fully developed—being developed. That sort of device will continue because it will need continue with Health New Zealand.I think the benefit of Health New Zealand—it can actually start to streamline some of these processes. It will still rely on those with front-end knowledge at each hospital campus. So many of those staff who are there processing payments and dealing with both capital spending and operational spending decisions—they will still be needed and they will feed into the Health New Zealand financial operations system that will be in place to make sure that there is good reporting good information and that both the board and the senior management of Health New Zealand are getting the information to make those decisions.In the end there is one entity. We will hold that entity to account for effective financial management. And it will leave Health New Zealand to internally manage the various cost centres that it will have. I'd be surprised if it discontinues cost centres around each hospital—it's essentially the way to set it up. But in the end that will be for Health New Zealand. And whatever Health New Zealand does in that respect they will be judged on the quality of the services given which will reflect the decisions made and the ability for relevant managers at all levels to make those decisions with confidence.So again I'm confident. When I look at the team that is assembling within Health New Zealand—and for that matter the Māori Health Authority—I'm confident that they will be completely across that. But we must have this discipline around financial management that we've struggled to get up to now. We have that now written into the legislation. I think that will help enormously.