Craig LizDr LIZ CRAIG (Labour): Thank you Mr Speaker. So it's a pleasure to stand and rise in support of this the New Zealand Public Health and Disability (Waikato DHB) Elections Bill. Before I start talking about the actual bill itself I just want to talk about that broader context which Mr Woodhouse had just briefly mentioned before because where we are at the moment is the whole nine years of under-investment of the health system. We've been talking about it for a time and the problem is that it is actually real. The problem is that it is having a huge impact on our health services and the ability for our district health boards (DHBs) to deliver. Over nine years what we had was under-investment in basic salaries so our staff weren't keeping up. A lot of my colleagues over that time actually got jobs offshore because the pay was better. What we've found is a whole lot of buildings where the DHBs were trying to balance their budgets. So they deferred the maintenance and now all of a sudden we've got billions of dollars that have got to come back on to the DHBs' books to sort out and figure out how we do that. As a Government we're moving forward with that investment and we've put a huge amount of money into DHBs and into primary care and we will continue to do so over the next number of years because it's going to take that long to get this thing back up and running again. But what I want to talk about today is this bill because it's actually a very very simple bill. It's only got eight clauses but it's a very simple bill that's actually got to deal with a huge complex situation. So what the bill does is it's got two key clauses. What clause 7 basically says is that the triennial general election for the Waikato DHB in 2019 is cancelled. So that's the core element of what it does but then clause 8 goes on to say that this legislation will be repealed on the day that the new board is elected in 2022. So what it does is it cancels that one election but then it repeals it so that it basically is only a one-off election and that will give us time to turn this situation around. Why are we cancelling the 2019 election for the DHB and why are we only doing it over one term? Well basically because in May this year the Minister of Health informed the Waikato DHB of his decision to appoint a commissioner to replace the board and this is not a decision that anybody takes lightly because we do believe in local democracy. We believe that communities should have a say in the running of their health services—that's crucially important—but there were some really big things that the Minister had to consider when he was making that decision and the first of them was just the deteriorating position of the DHB. What they reported in the 2017-18 year was a deficit of $37.2 million and then what they were forecasting was a $56.1 million deficit for 2018-19 and those weren't one-off deficits. They were projecting that those deficits would continue for a number of years and that's something that a Minister of Health has to take very very seriously because you need to be able to have a viable financial situation to be able to make those prioritisation decisions and to move your DHB forward. The other concern was that there was instability at the governance and the leadership level and so if you've got issues in terms of governance and leadership it's very difficult when you're trying to balance deficits of that nature to then be able to do that. So it's quite a complex situation. Then there were also the issues around service performance and there were some concerns being raised there. So this is not a decision that the Minister took lightly when basically he decided to replace the board with a commissioner. It also occurred despite the best efforts of a Crown monitor who was appointed in August 2018 and unfortunately that monitor was able to make limited progress because of some of those issues around the instability at that time. As I was saying in May the Minister announced that former Director-General of Health Dr Karen Poutasi would take the commissioner's role. She's had many many years in the health sector and is an incredibly experienced and excellent pair of hands to be able to take this DHB forward. But the issue is that under the current legislation she could only have held office until the next DHB board came in under the next election and the problem was that with the timing of this it meant that she would only have very few months to try and turn this really complex situation around. What she would have had to do in those few short months was make significant changes so that she could turn around the financial performance and the clinical performance of that DHB and that was seen as just not being long enough to be put into a position where you were trying to make leadership changes in terms of the ongoing financial performance and to then turn around and be replaced again by a board within very few months. So what this bill does is it just cancels that one-off election in 2019 and that means there's another three years for the commissioner to continue to work with the team to make those significant changes. The issue in terms of those changes was that at the Health Committee we had three people come and submit to us and what all of those people that made the submissions were concerned about was just the loss of local democracy and the community not being able to have their say in terms of the board and then via the board in terms of the DHB. But our view was that that needed to be weighed up against needing to get the DHB back financially and into operational aspects where it was functioning properly so basically we put the bill through with no changes because on balance we felt that it was more important to get those changes made and put those structures in place in order to get back the stability of the DHB over the next three years. Basically what we've got now is a position where come 2022 when the next board comes in what we're hoping for is that we will be in a much better financial position for the DHB so that they can come in and actually be making some decisions with a well-functioning DHB with basically sufficient resources to be able to move forward. At the same time it's also important that those crucial leadership roles and especially relationships with the community and with local iwi are maintained and strengthened so that they can continue forward under the board once they come back in. While these issues are really complex they sit within that broader framework of under-investment and under-resourcing that's happened over the last decade and the problem is that if you've got a DHB that has got no financial buffers then if you do hit the point where you do hit problems sometimes this is the situation that results. Having said that the Minister has also made it very very clear though that he expects DHBs to manage the finances they do have responsibly and to balance those budgets and work within the resources available to them. But having said that as well our Government is completely committed to funding our health systems in an appropriate manner. So in the Budget last year we put an extra $2.2 billion into DHBs over four years which is the biggest increase in operational funding over the last decade and we've put another $750 million into the health capital works because we've got those issues with our health infrastructure where many buildings are getting to the end of their lives. Many buildings just haven't been replaced and need to be and there's that basic maintenance and what we've done in this year's Budget is we have put more resource into that. One of the other things in terms of balancing the books for many DHBs that we're also hearing about as a select committee is just that huge acute in-patient demand that's coming in through our DHBs and through our hospitals. So as a Government we're also investing in a range of other things that will impact on that and in particular there are the investments we're making and moving forward in terms of housing in terms of social housing and in terms of regulations to make sure that over time we're going to be having decent heat sources in rental properties good insulation and getting rid of damp mouldy housing. They're going to have huge impacts in terms of the number of people coming into emergency departments and in terms of them thinking through that flowing through into DHBs' bottom lines. So as a Government in addition to some of the changes we're putting in place with this bill we're going to be changing those broader measures which will mean that over time acute in-patient demand in DHBs should start to reduce particularly in those areas of acute infectious and respiratory diseases. We're also putting back significant investment into that basic infrastructure so that we can get on and build not just our hospitals like Dunedin Hospital but also other hospitals we can look at earthquake strengthening and we can look at just investing in fit for purpose facilities. Also with our investments in primary care many people can go to the GP rather than turning up to the emergency department. So basically what we've got with this bill is we are allowing Waikato DHB to have a new approach and to get on top of some of these issues around financial management and we're looking at governance leadership and also our service delivery and giving the breather of a three-year period where we can have a commissioner in place to work with the community and work with iwi leadership to get that done. Then we can move on to that new board coming in in 2022 and really moving forward so that we can have an effective well-functioning DHB. Therefore I commend this bill to the House.