van Velden BrookeBROOKE VAN VELDEN (ACT): Thank you Madam Speaker. I rise tonight on the Pae Ora (Healthy Futures) Bill in opposition to the second reading. I want to start by acknowledging the submitters who took the time to submit to the Pae Ora Legislation Committee. I also want to acknowledge the select committee's staff—many of whom worked on the Health Committee as well; who were doing enormous roles of not only sitting in the morning with the Health Committee but also sitting throughout the afternoon with the Pae Ora Legislation Committee too. I want to commend them for all of the work that they did to help bring it to the House today.It is a mammoth task to reform the health system and there were many people working behind the scenes. But I want to make a very clear point that is: it's still not clear what the different outcome is from having this bill seen to under the Pae Ora Legislation Committee than would have been the outcome from having it seen to under the Health Committee. Because we have a Health Committee; this is a health reform and yet there is no better place to look at health reform than in the Health Committee. But the Government felt the need to make the Health and Māori Affairs Committees merge for the purposes of this bill.The Minister at the time said This bill is about meeting Treaty obligations." and implied that somehow it is not possible for the current Health Committee to do that. And it's because of a belief system that has crept into Parliament that says that membership to a group should be based on race and that is more important than what unites us as our common humanity. He essentially said that people on the Health Committee can't do an adequate job at looking at health reform because of our ethnicity. He set an ugly precedent in this Parliament that says that even though elected officials and elected representatives might have the ability to analyse to debate and to reason that doesn't matter. What matters more and what is more important is what identity group you subscribe to what group that you belong to. He put administration over outcomes. All of that shows you that it's a symbol of what's wrong with this Government.The administrative reform of Parliament's select committees was important—in the same way that we're seeing governance and administration change but not as much focus on outcomes in the Pae Ora legislation. There is the same fundamental problem in this bill. I spoke to mental health workers about the Pae Ora legislation and I asked "How will this actually change the job that you do on the day to day?" And they said "We have no idea. We cannot point to a single thing that we think might actually change."I talked to doctors who laughed when I asked whether they thought that this would actually make their jobs easier whether they'd see more patients whether there'd be any change in patient outcomes because they're still not clear what this change will actually effect in real people's lives. I talked to patient groups who said they don't know how this will change in any way the types of drugs that we have access to in New Zealand because it doesn't—medicines access is completely outside of the scope of this bill. I've talked to rural doctors who say "We have no idea how this makes it better for access to care in rural areas." because what is a locality that they fall under under this bill?This bill changes administration but it doesn't answer the basic questions of whether we'll get better treatments faster and for more people. So what does this bill actually do? Well it removes the 20 district health boards and it replaces it with Health New Zealand and the Māori Health Authority and there'll be five to eight board members on both. One of those board members sitting on the Māori Health Authority will also be able to be a member of Health New Zealand. Now these two separate entities will be able to come together to create and carve up New Zealand into locality plans but there is an issue here that iwi-Māori partnership boards must also be consulted on these plans. It says that a locality plan is made when it's agreed to by Health New Zealand the Māori Health Authority and the relevant iwi-Māori partnership board.Now the real difficulty is that last week the Minister of Health stood up and said there could be up to 80 different localities. He said there might be nine now and it's so up in the air what that actually is. Now the iwi-Māori partnership boards will be able to help design the delivery of services. This is a huge issue because we have three Ngāpuhi members in our caucus and it's very unfortunate that when it comes to the issue of Treaty settlements Ngāpuhi have been unable to come together to negotiate who will be in charge of Treaty settlements. Are we saying to the vulnerable people of Northland that their locality plans—the service the design the delivery of their services in Northland—could be in jeopardy because they have to have the Māori Health Authority Health New Zealand and the relevant iwi-Māori partnership board whoever that is to be established all agree to a locality plan? This risks being ineffective and divisive.Now the real issue here is that when they can't come together on a locality plan they have to be arbitrated by a Minister who is also in charge of the health strategy the Pacific health the disabled people women's health strategies and it's not clear that getting rid of any of these DHBs and putting in place this mess of a system is going to create anything that's not simply bureaucratic and a nightmare to deal with.Now ACT has multiple solutions that we are putting forward in three Supplementary Order Papers (SOPs) to make sure that we can have an effective modern healthcare system that acknowledges that all people are equal in New Zealand and they all deserve good health outcomes under the law. Now we have created firstly a rural health strategy because it's ridiculous that under this entire bill the rural populations of New Zealand have been forgotten. There are 700000 people living in rural and remote areas of New Zealand. They were mentioned 80 times in the health and disability system review that brought this bill to Parliament and yet they've been completely forgotten—forgotten. The rural populations of New Zealand are quite often forgotten completely by this Government and the ACT Party is here to bring them back into the fore. So we would like to see a rural health strategy for the people who provide so much for us in New Zealand.We also have a medicines strategy because we cannot truly reform the healthcare system if we don't discuss medicines and medicines has been completely removed from this bill. We need to know that if we're truly having a once-in-a-generation reform we're discussing how medicines can help keep people healthy as well. So we are putting in place a medicines strategy. The third that we are bringing to the House is an SOP to completely remove the Māori Health Authority from this bill because quite frankly it is divisive. We need to make sure that people get the healthcare that they truly need and deserve not a system that increases bureaucracy and red tape through division. This amendment would remove the Māori Health Authority because we want to strengthen the healthcare system and not divide it.I would ask my colleagues in the National Party to support us on all three of these amendments so that we can actually make sure we have real change. I would also ask my colleagues in Labour to question the errors of their ways to make sure that we don't divide our country that we make sure that we acknowledge the inherent dignity and humanity of all New Zealanders that we make sure that we're reforming the healthcare system in a way that puts health at the centre of healthcare and not an exercise in co-governance. It is a divisive bill. We oppose it but we hope that we could make it some bit better. Thank you Madam Speaker."