Little AndrewHon ANDREW LITTLE (Minister of Health): I'll try to take the member's questions seriatim and if I've forgotten anything the member will have to remind me in a later call and I may need more than one call to do this. In relation to Pharmac and the recent issue about decision making particularly in relation to paediatric oncology I make this point. Pharmac had commenced a review on that issue in 2019. It had seen and had had drawn to its attention that even though its decision making and the number of patients it is making decisions about is very small when compared to the whole range of things Pharmac has to deal with and the budget is comparatively small compared to the now over a billion-dollar budget a year that Pharmac deals with—it nevertheless considered there was an inconsistency in the way it was making decisions about those medications compared to everything else. It didn't regard it as particularly urgent because of the numbers but it nevertheless commenced the review; COVID interrupted and it suspended the review. It then resumed the review once it got notification of an allegation of discrimination that was made to the Human Rights Commission and the Human Rights Commission commenced an investigation.As that member will know and would expect if a Government agency is under investigation for a claimed breach of its statutory duties it is at the very least morally obliged to act appropriately. In this case it was to resume its review of its decision-making actions and powers to ensure that they were compliant or at least not in breach of its obligations under the Human Rights Act. Notwithstanding that the Human Rights Commission has yet to make a finding on that and I should point that out. No decision has been taken about how Pharmac might treat paediatric oncology in the future although it appears from its public comments to consider that it feels obliged to try to regularise its decision making. I would add a couple of riders to that. I have sought assurances and Pharmac has given assurances through officials to me and publicly that any treatment that is currently funded by Pharmac whether it's been approved by Pharmac or not or gone through the exemption process will continue regardless and will continue to be available now and in the future. So the issue will be about new treatments and whether or not it changes its process for new treatments is yet to be determined. But the second point I would make is to the extent that some people are concerned that the time that Pharmac often takes to make a decision can be very lengthy that is precisely the objective of the review that we've commissioned in relation to Pharmac which is to look at the timeliness and agility of its decision making. I think there is some justified criticism of Pharmac not making decisions in a timely enough way when new technologies are available and we want to see improvement in that regard. But let's wait to see what the outcome of that review is before we get too concerned about them.Moving on to the health and disability reforms which is the theme of the member's remaining questions in particular about the Māori Health Authority let me go through some of the questions. The cost to disestablish DHBs and establish Health NZ: obviously when you are in transition from one system to another one there will be some cost. To date I think the cost of the transition unit has been a little over $1 million and there will be additional cost to be incurred as the transition unit gears up to be an implementation unit and goes through the process of transitioning DHBs and parts of the Ministry of Health into Health NZ. There will be a cost to that and the member will in two weeks' and two days' time see the Budget and it will be provided for in the Budget yet to be handed down.The member asks about two separate health systems one with a veto. Well he's got that wrong. Both parties to the system have a right of veto. What this is about is reaching agreement and I'm not quite sure why the member refers to it as two separate health systems. There is only one system but there will be two partners to it and the member confuses independence with separatism. The member will understand there are plenty of relationships in which there are independent parties who come together two independent parties who are capable of thinking separately for themselves but joined together in a common ambition in a common set of principles and a common endeavour and a common enterprise as it's sometimes referred to who act in partnership. That is what we are doing. That will be the New Zealand health system of the future—a Māori health authority under which Māori can provide leadership for their people and their issues. Because the reality is as they and many others have pointed out the performance of our health system as it is at the moment is leaving Māori woefully behind. That's not acceptable any more. Our forebears signed up to the Treaty of Waitangi. It had a very clear principle about partnership about equality and that is what we must strive for and we must find vehicles and arrangements to achieve that and this is what we are trying to do. This is what this is about. It is not two separate systems; it is one system with two partners. The member asks How much funding?" That is yet to be determined. There are future funding issues largely looking at current funding models. That is the next big chunk of work and decisions on that will be 12 months or so away. The member asked about competition between Health NZ and the Māori Health Authority and I reassure the member there is no competition. This is a system which will require agreement between the Māori Health Authority and Health NZ because we all enter this on the basis of the Treaty principle of partnership. We all have the same ambitions. We all have the same aspirations about the health of New Zealand and the health of New Zealanders. We are all in this and Māori will provide leadership for their people. Health NZ will be the other part of the system. Those entities will reach agreement for the benefit of the whole system and all our people and they will make great decisions and they will reach agreement. And that will be the health plan and that will be the basis too on which decisions are made. The member asked if he is in general practice and he does some work under Health NZ and some under the Māori Health Authority—it does not work that way. So the way a locality planning network operates is that all relevant partners in that area health providers iwi other community representatives—and they will be local body representatives—will come together to work up the health plan for that locality and that would be the basis of the commissioning decision by the regional branch of Health NZ. Commissioning decisions will be made to ensure good health services are available to all New Zealanders. And whether it's a kaupapa Māori health provider who is providing health services to a region as happens now to Māori Pākehā and anybody else that will continue. Nothing will change in that respect. Ngāti Hine health doctors do not sit there thinking "Oh how much of a Ngāti Hine are you? How much of tangata tiriti are you?" They don't make that call now and they won't in the future.The member asked about alignment with He Puapua. I have to say in all my considerations with my colleague Peeni Henare I have not considered He Puapua. I have not read the document. I do not know what it says and no doubt I will eventually get to have a look at it. I haven't considered the health restructuring from the late 2000s or 2009. That was under a different Government of a different hue. But if they restructured in 2009 I mean let's look at it now because it ain't working. It's not working for Māori and it's not working for a lot of the rest of New Zealand either. Is there going to be funding in the 2021 Budget? Well that is a question for two weeks' and two days' time and the member will see that then.Can I conceive of a situation which the Māori Health Authority would exercise a veto? No because I don't have to because the Māori Health Authority and Health NZ will be reaching agreement. That is what the system will require. And they will reach agreement because we all have the same ambition. We want a healthy New Zealand and we want the populations in New Zealand to be healthy. And we want Māori to exercise their rights under the Treaty and the Crown to fulfil its obligations under the Treaty which is to allow for tino rangatiratanga some leadership some control some decision-making rights. That is the direction we're going. Do I expect consultation between the Māori Health Authority and Health NZ to be useful to I think improve Māori healthcare? Absolutely. Because when you look at the health outcomes for Māori at the moment—shorter life expectancy the fact that more Māori struggle to get access to healthcare and those who do get inferior results as a consequence—that's got to change. And that will change when the brilliant Māori health leaders that I know are right across New Zealand get a chance to exercise some leadership and do great stuff."