Clark David: New Zealand Public Health and Disability (Southern DHB) Elections Bill — First ReadingText is incorporated into the Bound VolumeClark David: New Zealand Public Health and Disability (Southern DHB) Elections Bill — First Reading[Sitting date: 08 December 2015. Volume:710;Page:8609. Text is incorporated into the Bound Volume.]Dr DAVID CLARK (Labour—Dunedin North): This bill cancels the 2016 triennial general election for the Southern District Health Board. It is not a bill we should passing lightly. Democracy was suspended at the district health board 6 months ago and so far as far as outputs go we have not seen a lot from the commissioners.We have got a one-page strategic planning document that looks more like a Christmas card than a plan and that is it. The partnership group which was supposed to be appointed a long time ago has only finally received its last member in recent weeks. It has been asked by this Minister of Health to produce very little and it seems to be obliging.This Government has been slow to act in the Southern District Health Board given years of deficits and months of adverse publicity—months and months that have turned into years. Perhaps the most surprising thing about the appointment of the commissioners was the fact that it took the Minister so long to act.I guess that is the problem. This Government has been struggling with this district health board amongst many for such a long time. It has tried to maintain the façade of an arm’s-length arrangement. The Minister always chooses the board chair and five out of 12 board members. He has effective control of the board. He had a Crown monitor on there or his predecessor had for nearly 6 years before this commissioner group was appointed and still the Minister and his predecessor made no progress.The Minister is now tied to the outcomes. I made this point in an earlier contribution to the House. Any remaining impression of ministerial distance from decision making was sacrificed with the appointment of the commissioner. I imagine the Minister now has a few sleepless nights because he now has a commissioner team in place and New Zealand and particularly those in the south is expecting results. Mr Coleman has nowhere to hide. He can no longer blame the board.Fixing the Southern District Health Board will not be easy. The cultural challenges indeed are well canvassed and some departments have some work to do to work out how to work together since the boundary between the southernmost district health board and the Otago District Health Board was removed along with $30 million of cross-border funding.Of course funding matters—funding matters. The inquiry that Jonathan Coleman launched into the national health funding model is entirely narrow. It seems designed to fit public demand for some kind of inquiry without delivering a result. There is certainly a prima facie case to reform the funding model. It seems to have an adverse effect on some district health boards and particularly in the south.We know that the health workforce training appears to be more expensive than the compensation given to the Southern District Health Board. It takes a long time to treat patients whilst training students at the same time. We know that having the largest geographic area in the south—a district health board the size of Belgium—is not matched with the largest rural funding component. That needs some explaining. We know that old buildings—and this one is over 50 years old—force less-efficient older ways of operating.It is there for the explaining and the Government does need to front up and have a full review of the health funding formula. It has been 10 years since the last review and Labour was in power then. It is time the health funding formula was reviewed and made more transparent.The glacial progress under the commissioner team towards a hospital rebuild should bother us all. Delays are a big deal. The hospital has lost accreditation across a number of areas. It has lost Medical Council training accreditation for house officers it has lost orthopaedics accreditation it has lost intensive care accreditation for training—and the latter being directly attributed to old buildings.This loss of status has a knock-on effect: it harms the medical school it harms the university and it harms the city of Dunedin and the district right across Otago and Southland. It also means that we cannot attract the calibre of staff that we would want to. There is so much uncertainty in the district health board that specialists around the world are going to think twice before they move to the south.This Government needs to give some certainty of direction. It needs to give assurances it needs to put capital up front and it needs to outline a credible plan for an appropriate rebuild. The Beca Group consultancy report last year confirmed that the clinical services building is outdated and that the ward and clinical layouts are beyond their use-by date.The modern clinical services buildings that are being built across Australasia have a wider footprint. They have more ceiling space to allow for ducting and modern surgical equipment to be housed in them. It just means that everything happens a little slower in the old buildings and that carries a cost which adds to all the other costs that the Southern District Health Board is carrying and the depletion in the funding that it appears to have. These problems are not going to go away overnight but the Government needs to act credibly. It needs to lay out a plan and it needs to stop dilly-dallying and duck-shoving.We need the urgency. The signalled appointment of the partnership group was delayed time and again. The Southern Partnership Group appointments the last of which has just occurred are now in place but the deliverables are minimal. The previous Minister of Health Tony Ryall indicated he expected a business case to go Cabinet this year for a hospital rebuild the current Minister Jonathan Coleman indicated in February he expected it by the end of this year and now the latest timetable has merely a scoping report by the Southern Partnership Group being delivered at the end of next year.The time frames continue to slip and there is no indication once this strategic business case is completed of a time frame for that to go to Cabinet for decisions to be made and for people in the south to have assurances about their health system. The Minister simply must step up. It is not good enough that previous assurances that a business case would be considered this year have been pushed out into the never-never. The only thing we have certainty of now is that it is not going to happen this year. We have got an amorphous promise of a rebuild being completed in around 10 years’ time. Without a concrete start date and committed capital the promises and assurances the Minister is giving amount to little more than duck-shoving making the rebuild the problem of some future Government.The real test of commitment from this Government is a guarantee that before this term of Government ends in late 2017 there will be bricks and mortar being built—that there will be a rebuild under way during the term of this Government. I very much look forward to the speakers who follow me confirming that.Perhaps those who are in the south—and I expect some of them to speak; perhaps Mr Barclay opposite will speak—will assure us that this will happen because the Minister has said they have been very supportive. Well I have heard nothing but sycophancy from them. I want to hear the concrete steps that will be taken to deliver a hospital to people in the south. I think it is shameful—shameful—that members down south are parroting the Minister’s words and offering platitudes and obfuscation to the citizens whom they represent.Those members need to step up. They need to encourage their own Minister to get focused get on with the rebuild and give some assurances to the people of the south that they are being taken seriously that their taxes matter and that the rebuild will get under way. Affordable access to decent health care should be something every Kiwi can count on but something that we have come to expect of right is becoming harder and harder to access under this Government.We have had an independent report done that shows $1.7 billion worth of underfunding under this Government’s watch—$1.7 billion of health underfunding. That is why when Jonathan Coleman admits—and he has admitted to this House—that he is not funding the health system to keep up with cost pressures New Zealanders are now seeing the level of health care declining. That is the reason why the Prime Minister is saying that Pharmac will not fund Keytruda. That is why the Government is dancing on the head of a pin when it comes to every health question.If you underfund a system by $1.7 billion it is no wonder that health care is suffering and that New Zealanders are suffering in a way that they have not before. This Government is simply not committed to public health and here we have a bill that suspends democracy and no assurance from this Government that it will not do the same thing if it is re-elected for another term—that it will not suspend democracy further.We have seen it do it with Environment Canterbury—we have seen it do it with Environment Canterbury. It has pushed out democracy and pushed out democracy and pushed democracy with no respect for the community representation that comes through with that. And now we have a similar situation here. We need assurances from the Minister—