Little AndrewHon ANDREW LITTLE (Minister of Health): Thank you Mr Chairman. And I'll just grab my notes. I just want to thank Maureen Pugh and Shane Reti for their latest contributions.Maureen Pugh has first of all asked about the functions of Health New Zealand—and I think they're pretty clearly set out in clause 14 of the bill—and referred to the West Coast the clinics that are owned by the district health board (DHB). That is correct. That was in order to ensure there were good primary care services. The DHB frankly had to step in where other primary care providers particularly GPs in private practice were not prepared to go. And they've developed what in my observation is an excellent model where they can train aspiring GPs in the hospital and put them out into their practices and they can move them around as needs must. So I think—and I see Ms Pugh nodding—she should be very happy. I think there's a great set of services there. Not to say they're not under pressure because I think like everywhere they are.I think the question Maureen Pugh raises about primary health organisations (PHOs) is—I mean it's interesting; I've done a number of meetings roadshows and PHO representatives have been there so I'm not quite sure what's happened to the PHO on the West Coast. But here's the thing: PHOs are not recognised in current legislation. They were a beast that kind of evolved under the current legislation under the DHB model. They offered themselves as the ability to support multiple GP practices and to help them in back-office functions provide a bit of coordination and all the rest of it. Some PHOs have done an excellent job. There are some that have done a pretty darn hopeless job to be honest and really are in the business of ticket-clipping.We haven't recognised PHOs in this legislation. What happens with them in the system is really entirely up to them. No one is abolishing them but actually we're not giving them statutory recognition because they haven't had it before. But it'll be up to them. Now some PHOs I think will step up and be able to do what is required of them. I know for a fact that there are PHOs saying We would like to be the locality planning coordinator for our area." and they are the PHOs who've got good leadership they've got good data and they're well connected not just with the practices that they're responsible for in channelling the funding to but connected with other health services as well. And that's what we want. Ultimately what we want is health providers in communities being supported and connected with each other and offering services that are coordinated and joined up.So I guess I would say to Ms Pugh it's really in the hands of PHOs what they are prepared to do. There are opportunities there for them but if they're not prepared to step up and be part of the local locality planning process then they may find there is no role for them. Our critical objective is to get support particularly for primary care. We want to beef-up primary care because it's being underdone at the moment. Yep we've got some major workforce challenges but we've got to create a primary care working environment that is attractive to more medical graduates to work in primary care and to be GPs. So that's what we want it to do.To Shane Reti and his concern about iwi-Māori partnership boards: let's be clear iwi-Māori partnership boards are not recognised statutorily at the moment and they weren't previously. They weren't in the 2001 legislation which is the current legislation and even though they've been around for a while the previous Government—and nor this Government; well we weren't because we were looking at reforming the sector anyway. But certainly the previous Government took no steps to give them statutory recognition. We have because we think iwi-Māori partnership boards are a vital component to what we want to do in terms of enriching the Māori voice when it comes to health decision-making. But we need to leave it to Māori iwi and urban to come together and make their judgment about how best they think that can work. That's how the Treaty partnership works. We don't have the Crown telling them "Right we'll have one here and we'll have one there and it'll be you and it'll be you." Actually we need to empower iwi Māori and urban Māori to make those decisions themselves as in fact they have done up to now without the benefit of any statutory recognition.However because they are an integral part of the future of the system and will be supported by the Māori Health Authority and because we've appropriated money to support them and give them a bit of capacity it is appropriate that we do accord them their existence in a schedule. But once we know who they are who they cover what they do—in terms of which areas they cover which they will determine—then they will appear in the schedule and they will be given the recognition that they seek."