King Annette: Questions for Oral Answer — Questions to Ministers Questions to MembersText is incorporated into the Bound VolumeKing Annette: Questions for Oral Answer — Questions to Ministers Questions to Members[Sitting date: 22 August 2013. Volume:692;Page:12758. Text is incorporated into the Bound Volume.]11.Hon ANNETTE KING (Labour—Rongotai)to theMinister of Health: What recent reports if any has he received on an increase in pressure on DHBs and health professionals in providing health services in New Zealand?Hon TONY RYALL (Minister of Health):I have received a wide range of recent reports including a number of district health board annual plans which for the most part reflected increased provision of publicly funded health services and increased funding. We want New Zealanders to receive the best possible health care and we do put pressure on boards to deliver this. We have increased health operational funding by an average of around $500 million a year but as the member knows and has said herself it has always been and will continue to be an ongoing challenge for district health boards to live within their means.Hon Annette King: Has he been informed of nurses working at Starship hospital for 15 hours a day because of nursing shortages at that hospital being paid for only 12 hours and being told not to record 15 hours on their time sheets; and if he has not been informed will he investigate the nursing shortages and overwork at Starship before children are put at risk?Hon TONY RYALL: If that member has that information please make it available to me. I would have to check the information in light of previous claims made by that member but the latest information I have is that our nursing staff at the Counties Manukau District Health Board is up some 400 in the last 8 years.Hon Annette King: I raise a point of order Mr Speaker. I think the Minister might have misheard. I said Starship not Counties Manukau.Mr SPEAKER: That is not a point of order.Hon Annette King: I raise a point of order Mr Speaker. Well in light of his answer then he did not address the question. I mentioned Starship not Counties Manukau.Mr SPEAKER: Order! There were two parts to the member’s question. The question was addressed. I invite the member to ask a further supplementary question.Hon Annette King: Has he been informed of growing pressure faced by general practitioners which has led one to write on Tuesday this week that general practitioners face a whole tsunami of issues with district health boards including not having basic access to ear nose and throat dermatology neurology renal services ultrasound orthotics timely discharge summaries etc. etc. and that the Minister’s targets are often set with minimal or no recompense; if so why is this occurring in light of his claim that general practice is better off?Hon TONY RYALL: Well I would have to check the veracity of that member’s claim because I am aware of some documents that have been doctored in order to justify some of the press releases of the member. But what I would say to that is that our Government has in fact put a lot of extra money into primary care. We have increased for example the ability of general practitioners to refer patients directly for diagnostic tests without having to go through a specialist. We have also improved the access that general practitioners have to refer their patients to specialists. As I said in answer to a question earlier in the House today we have had a really significant boost in the number of first specialist assessments which are really the gateway to additional services that general practitioners often refer to.Hon Annette King: In light of that answer has he seen a copy of the letter that district health boards are now sending out to patients who have been referred to a specialist by their general practitioner which reads: “Unfortunately your clinical priority is such that we are unable to offer you a specialist appointment within the current resources and capability.”—even though the person’s condition could include osteoarthritis of a major joint with significant pain and restriction or significant functional loss and pain—and patients being told that their conditions must be urgent before they can get an appointment?Hon TONY RYALL: I would have to verify those claims. They could be like the claim the member put out recently that people were—Hon Annette King: I raise a point of order Mr Speaker. On three occasions he has been doubting the word of me as a member of Parliament and I thought you might have pulled him up—[Interruption ]Mr SPEAKER: Order! This is a point of order. The member can start her point of order again.Hon Annette King: My point of order is that on three occasions now or perhaps it is four he has doubted my word as a member saying that he has to check my figures or the veracity of what I am providing. I am prepared to table the letters in a moment. I find that unacceptable. He should answer the question.Hon Gerry Brownlee: Point of order.Mr SPEAKER: No I do not need the assistance of the Leader of the House. Can I ask the member the Hon Annette King to look at Speaker’s ruling 165/6: “The Minister being questioned is perfectly at liberty to dispute the quote. That is the risk that members take when they include a quote in a supplementary question that has not been validated.” That was a ruling recently given by the Hon Dr Lockwood Smith.Hon Annette King: Supplementary question Mr Speaker.Hon TONY RYALL: You want an answer—Hon Annette King: Supplementary question Mr Speaker.Mr SPEAKER: Did the member not—Hon Annette King: No he just said he doubted my word so I got the answer.Mr SPEAKER: OK. Supplementary question—Hon Annette King: Does he think that refusing 35 percent of orthopaedic patients referred by their general practitioner for a first specialist assessment at Waitematā District Health Board in this last year because of the level of funding provided gives them better sooner more convenient health care; if so how?Hon TONY RYALL: As the member knows the Waitematā District Health Board has provided more orthopaedic service for patients in its area. The member knows that. Some patients have been referred and have been unable to be provided with an appointment but that has always been the case. As I said earlier on in the piece the activity and the ability of district health boards to provide more services for their patients have been increasing quite dramatically.Hon Annette King: I seek leave to table information from the Waitematā District Health Board that shows that 35 percent of orthopaedic patients in this last year were refused a first specialist assessment—Mr SPEAKER: Leave is sought to table that document. Is there any objection? There is none. It can be so tabled.Document by leave laid on the Table of the House.Hon Annette King: Has he seen a copy of the letter that district health boards are now sending out to patients after they receive their first specialist assessment—something that he was wanting to boast about today—a letter that reads: “You have been recommended by your surgeon for surgery. Although it is clear you would benefit from surgery and your surgeon and your GP would prefer this happened now it is not possible to provide it to you at this time because of limitation of resources.”? Could the Minister explain why it is good news to get a first specialist appointment to tell them that they need an operation and then to receive a letter that tells them they are out of luck?Hon TONY RYALL: Because—and I cannot believe this question was asked—40000 more people are getting operations this year than in 2008.Hon Annette King: I raise a point of order Mr Speaker.Mr SPEAKER: Order! I apologise to the Minister.Hon Annette King: You heard the question. There was nothing about what happened in 2008. I asked him whether he had seen a copy of the letter.Mr SPEAKER: And we do not need—Hon Annette King: I read out what was in the letter.Mr SPEAKER: Order! We do not need the question repeated. The question in essence was whether the Minister has seen a copy of the letter.Hon TONY RYALL: I have not seen a copy of that letter but I would have to check because I have seen press statements and documents that that member has distributed where the figures provided were doctored.Hon Annette King: I seek leave to table a copy of the letters that are being sent out from district health boards—Mr SPEAKER: Order! That is all that is needed. We have had the letter quoted to us. Leave is sought to table that letter. Is there any objection to that course of action? There appears to be none. It can be so tabled.Document by leave laid on the Table of the House.