4. District Health Boards—Emergency Department 6-hour Targets and First Specialist AssessmentsHon ANNETTE KING (Deputy Leader—Labour) to the Minister of HealthDistrict Health Boards—Emergency Department 6-hour Targets and First Specialist Assessments4. Hon ANNETTE KING (Deputy Leader—Labour) to the Minister of Health: On what date was the Ministry of Health first made aware of data manipulation of the six-hour Emergency Department target by district health boards?Hon Dr JONATHAN COLEMAN (Minister of Health): People have raised issues around the detail of the health targets on and off for 7 years. However when I was down at the emergency medicine conference in Queenstown last Monday clinicians told me that they strongly support the 6-hour emergency department (ED) target because it has improved the quality of care right across our hospitals. As shown by recent Auckland University research the ED target has reduced crowding in emergency departments by 50 percent and very importantly it has literally saved 700 lives per year since its introduction and that is a very real achievement.Hon Annette King: I raise a point of order Mr Speaker. My question was on notice and it was specific: On what date was the Ministry of Health first made aware of data manipulation of the six-hour Emergency Department target by district health boards?". The Minister did not answer it.Mr SPEAKER: I listened very carefully to the answer given and my interpretation was that the Minister was saying that that information has been coming in on a very regular basis—I think he quoted over 7 years. The way forward is that I will provide the member with an additional supplementary question.Grant Robertson: I raise a point of order Mr Speaker. I also listened carefully to the answer. The Minister spoke about health targets in general and people making comments about health targets not this specific target.Mr SPEAKER: I have heard the point. I have invited the member to ask an additional supplementary question. That is the way forward.Hon Annette King: On what date was the Ministry of Health first made aware of data manipulation of the six-hour Emergency Department target by district health boards—on what date?Hon Dr JONATHAN COLEMAN: I reject the central premise of that question but as I said in my opening answer people have been raising issues around the health targets including the ED target on and off for 7 years. The fact is that the ED target has saved 700 lives a year and has reduced crowding in EDs by 50 percent across our hospitals. That is a major achievement.Hon Annette King: If he has been assured of the integrity of the health targets—that they are sound as he has claimed publicly—why is he asking officials to investigate?Hon Dr JONATHAN COLEMAN: Well whenever Mrs King raises an allegation I have found that it pays to go and check it. That is why.Hon Annette King: I raise a point of order Mr Speaker. I did not raise this issue; it was raised by research by Dr Peter Jones. So to say that I raised it is completely wrong and not telling the truth.Mr SPEAKER: Order! That now becomes a debating matter not a point of order. I invite the member to continue with her supplementary question.Hon Annette King: Does he disagree with Dr Jones' finding that data manipulation occurs mostly in sites that were inadequately resourced to match the pressure put on staff in district health boards (DHBs) to meet his target?Hon Dr JONATHAN COLEMAN: I do not think Dr Jones has said that. I mean I can quote you here what Dr Jones has said. He said: "The length of time people stay in hospitals across the country has reduced on average by about 7 hours since the target was first introduced." He said: "Emergency department stays for all patients have reduced by over an hour and for patients needing admission to hospital by about 3 hours." He said: "Where I work at Auckland City Hospital the average time it takes for patients to get to the ward from the emergency department once the decision to admit them to hospital has been made has been reduced significantly from eight hours to … one and a half hours." and then it goes on to say—he says this direct quote: "We found the introduction of the six-hour target was associated with a substantial 50 per cent reduction in the number of patient deaths in emergency departments—that's about 700 fewer deaths than predicted … This result mirrors the 50 per cent reduction in emergency department crowding." And I can tell the member that I was a house surgeon with Peter Jones. I know him well and he is a big fan of this target—a big supporter of it. He said when it first came in that he was initially sceptical but now he says it is one of the best things the Government has done for EDs.Hon Annette King: Who has directed Waikato District Health Board to shuffle resources around to focus on first specialist assessment at the expense of follow-up appointments and elective surgery leading to fewer elective hip and knee surgeries with 831 performed in 2015-16 compared with 966 the year before?Hon Dr JONATHAN COLEMAN: Look what I can tell that member is that actually Waikato DHB has performed extremely well on elective surgery over time. There has been more and more money going into that particular DHB and the idea that Waikato is not producing more appointments more operations and better access to services for people in the Waikato DHB catchment area is completely incorrect.Hon Annette King: I seek leave to table an Official Information Act (OIA) response dated 25 November 2016 for Waikato District Health Board showing that it did fewer hip and knee elective discharges in 2015-16 compared with the year before as I said in my question.Mr SPEAKER: Order! The last part is unnecessary. Leave is sought to table that particular OIA response. Is there any objection to it being tabled? There is none. It can be tabled.Document by leave laid on the Table of the House.Hon Dr JONATHAN COLEMAN: I seek leave to table the increase in Waikato's elective surgical discharges also in its hip and knee discharges progressively over the last 8 years.Hon Annette King: I raise a point of order Mr Speaker. Mr SPEAKER: Well I need to put the leave. Does the member—[Interruption] Let me put the leave first. We will tidy that. Leave is sought to table that information of output by Waikato District Health Board. Is there any objection to that being tabled? There is none. It can be tabled.Document by leave laid on the Table of the House.Hon Annette King: I raise a point of order Mr Speaker. The document that I am tabling goes back to 2002 right up to 2015-16 so in fact when I was given approval to table it I was already tabling what the Minister wants to table.Mr SPEAKER: When the member sought leave to table her document she quite specifically compared 2015-16 with the year previously. That is the information that I put to the House and it decided to table that information.Hon Annette King: Is he saying that orthopaedic clinical director Stewart Hardy was not telling the truth when he told management of Waikato District Health Board that "My other concern is that individual surgeons are now being approached to cancel their operating lists to do FSA [First Specialist Assessment] clinics."?Hon Dr JONATHAN COLEMAN: Unlike the member I do not go around accusing other people of not telling the truth."