Doocey Matt; Little AndrewMATT DOOCEY (National—Waimakariri): Thank you very much Madam Chair and I would like to thank the Minister for his time tonight taking us through his approach and especially he did mention in-patient care. It was interesting thinking about the drivers of getting people in in-patient facilities out into the community. But I would ask why is the focus not on just getting shovels in the ground to build these new facilities? Because when you look at the annual reviews each DHB pitched up with the same story of a new facility announced two or three years ago.If you look at Capital and Coast DHB last year and occupancy in their in-patient facility Hutt Valley DHB was from 82 percent to 99 percent occupancy. Capital and Coast was 92 percent to 110 percent occupancy. What we've got to remember is clinical patient safety guidelines is 85 percent occupancy for patient safety. So here we have all our in-patients blowing out but a common theme is there's just no shovels in the ground for these new facilities. This is with the backdrop of course of the Minister himself expressing frustration at in-patient facility builds. So he initiated an independent review—that was obviously conducted by his colleague Grant Robertson's Implementation Unit—that found good progress was being made and things were on track. So it would be helpful I think for the House if we can just find out why none of these projects have shovels in the ground three years later. Hon ANDREW LITTLE (Minister of Health): Madam Chair I think the thing that I can most help the House with is to get facts straight because the member who has just resumed his seat Matt Doocey seems incapable of doing that. So it was very important when we put together a complex and complicated programme to fix up a long-neglected problem like the emerging mental health crisis that we have had in this country that you do periodically review it part-way through. So we had the benefit of the Implementation Unit that is run out of the Department of Prime Minister and Cabinet—not run out of the Minister of Finance's office—who conducted that review. The focus of that review was on the Minister of Health end of the $1.9 billion—the Minister of Health end of that $1.9 billion is about $1.1 billion—and looked at the access and choice part of that which was the integrated primary mental health care end. It was that part of the programme that the Implementation Unit said was on track and making progress as expected. By contrast to the member's reading of that report the Implementation Unit did not say that the capital build programme was on track; they said the opposite. They said it was not on track and they identified a number of difficulties including lack of project management skills and capability within DHBs and that that work simply had not been given the attention that it should have done. Since then there have been changes in the Health Infrastructure Unit which is within the ministry and those changes are ongoing because that's now part of the interim Health New Zealand set up. But I'm confident now that there is impetus and momentum to get those projects under way. The single biggest one of those projects was the Waikato District Health Board Henry Rongomau Bennett Centre facility that is in poor shape. There have been a lot of critical reports about that facility. The design of that is now well progressed and is going through the decision-making processes. I'm confident that that is making good progress. I'm confident that the other facilities that are part of the scheduled programme will make good progress in the latter part of this year.MATT DOOCEY (National—Waimakariri): I thank the Minister for the response to that and I would point out the two reports from the Ombudsman received in the last week about facilities in MidCentral DHB specifically Palmerston North and of course in the Bay of Plenty DHB in Tauranga and Whakatāne where he was very critical that money had not been spent. Seclusion rates—and we saw that in several reports last year—have skyrocketed after declining up to 2016 and 2017 and now have peaked and I point that towards the Minister. I would like to finish with the Minister's comments about the co-response mental health service which Dr Liz Craig raised and whether the Minister now accepts that his Government's decision to cancel that in 2017 when coming into office—that has now had five years where that service could have been making a difference. As outlined in the annual review of the Ministry of Health why are DHBs expecting to fund that out of baseline funding? Because what that's driving is we only have one which is Wellington. And when we find and it's evidenced in the annual review report that we're looking at today for the Ministry of Health that police are not turning up to 50 percent of mental health acute call-outs last year—50 percent of the most vulnerable New Zealanders calling for help and they did not get an emergency response in mental health crisis call outs. Hon ANDREW LITTLE (Minister of Health): I'm not quite sure what the question there is—the member made a number of observations—except to say that there have been a number of approaches taken to provide better mental health support at the front line of our first responders both the police and ambulance workers as well. So Capital and Coast DHB has been running their pilot of putting mental health workers with police and with ambulance staff to see what difference that makes. We're still waiting to see a final evaluation of that. I think a programme that I've also seen is where mental health nurses were located in watch-houses of police stations particularly bigger ones and where assessments were able to be carried out of those coming into the police station and indeed those mental health nurses were then available for police officers in the front line actually out in the field while dealing with somebody who was mentally unwell and getting advice and that appeared to make a difference too. So I think we are all exploring different ways to make sure we provide the support and help that people who are mentally unwell need and in the different contexts in which that happens. That includes providing support within our emergency services to provide assistance for people they come across who are in mental distress and who need that help. There are some models emerging. In the end it comes back to some of the fundamentals the fundamental foundation that I think the He Ara Oranga report was talking about that needed to be laid: that the sooner people can get help for what are minor or mild to moderate mental health issues—the anxieties the low-level depression the distresses that people feel on a day-to-day basis—if they get help for those and learn some skills and some responses and build their own resilience then that can help long term to keep the pressure off other mental health services. There will be people whose mental unwellness is a consequence of factors that are not capable of being dealt with through talk therapies and what-have-you: that a pharmacological response might be needed or a more acute response and we need to make sure we have a system that is there available to respond to them. But for those for whom other more mild responses are needed those responses have to be in place too and that's why we've taken the steps that we have.