Hague Kevin: Crown Entities Reform Bill — In Committee 
Text is incorporated into the Bound Volume 
Hague Kevin: Crown Entities Reform Bill — In Committee 
[Sitting date: 23 May 2012. Volume:680;Page:2345. Text is incorporated into the Bound Volume.] 
KEVIN HAGUE (Green) 
: 
 I am going to start where Iain Lees-Galloway left off. I think it is fair to say that I agree with everything Iain Lees-Galloway said which has happened before on several other measures. In the debate on Part 1 of the Crown Entities Reform Bill I talked about the dodgy rationale for Part 1 that had been advanced by Chris Auchinvole and I said that combining functions did not necessarily produce the kind of efficiency gains that those promoting the combination expected. That has definitely been our experience in the health sector. So in the case of Part 2 I wonder what on earth can possibly be the rationale for the change that is proposed because here is definitely a case where a topic mental health which has achieved a significant focus through the Mental Health Commission will clearly be receiving less focus if the commission is folded into the Health and Disability Commissioner’s office as is proposed without any benefit in terms of efficiency. There is no upside and some significant downside already in the loss of focus.  
But it goes further than that because on Part 1 the Green Party supported what the Government intended to do. The functions of those various agencies that are being combined into the Health Promotion Agency are at least congruent. By combining them into a single agency a significant gain in terms of integrating their functions is achieved. In the case of these two agencies the Mental Health Commission and the Health and Disability Commissioner’s office the functions are not congruent at all. The Health and Disability Commissioner has done over the years a fantastic job but the way that that office works is not by taking the big helicopter view but rather by focusing on individual cases—the individual who complains about a particular aspect of the service that they have received. The complaint is investigated in considerable depth and then the commissioner uses that opportunity to provide justice and some measure of closure for the person who has received services that they believe to have been inadequate or to have breached their rights in some other way and also to try to draw from that single incident some learning that may be useful for similar services or for other parts of the health services. On both of those things—actually providing a justice process for individuals and learning from individual cases—the Health and Disability Commissioner has contributed a considerable amount to the New Zealand health sector. It is really important that that office continues to focus in exactly that same way.  
But just as the Health Quality and Safety Commission a new entity that replaced the Quality Improvement Committee which replaced the EpiQual committee which was in the original Act was not set up as a subdivision of the Health and Disability Commissioner’s office because actually the function is a totally different one requiring a different set of skills and an entirely different focus so it is with the Mental Health Commission. The Mental Health Commission absolutely must take that helicopter view that considers the entirety of mental health services and plans out for the entire sector for not only the short term but also the long term and it must monitor against that plan. Those are also incredibly important functions but they are entirely incongruent with those that the Health and Disability Commissioner is providing for. As Iain Lees-Galloway has said certainly the intent was that there would be a finite term for the Mental Health Commission but the job is not done. Therefore that job needs to be extended out into the future.  
As Iain Lees-Galloway has pointed out the origins of the commission were indeed with the Mason inquiry. That inquiry focused on a particular part of mental health services and noted a woeful inadequacy around mental health services. The initial focus for the Mental Health Commission was on remedying that part of health services. Those were services at what we would call the serious end of mental illness because that is the end where the most severe harm is caused to particular individuals and the end that the Mason inquiry demonstrated was incredibly underfunded and poorly focused on by health services at the time.  
The Mental Health Commission established its blueprint which achieved very considerable support and endorsement from right across the health sector—appropriately so. Successive Governments have looked to properly resource that blueprint with ring-fenced funding and mental health services have moved from being what I have described as Cinderella services within the New Zealand health sector to being services that are seen as an integral part of at least the secondary health services. Within hospitals at the serious end of mental illness and in specialist-provided services mental health has made considerable progress towards that blueprint. It is not there by any means. There is still a distance to go even in that area. When we look at the performance of district health boards against the indicative volumes of services that the mental health blueprint sets out the vast majority of district health boards are still failing to produce even those serious secondary mental health services at the volumes the Mental Health Commission has indicated are appropriate. There is a growing problem with ring-fenced mental health funding leaking out of mental health and being used in other areas. Those are still areas of particular importance for the Mental Health Commission to focus on.  
But there is a whole other area that was not a focus in Blueprint I and that is the area of community-based services. There is an interaction between in-patient services provided within hospitals and community-based services. What we see are acute units in our hospitals still struggling to provide space for people with acute illness—serious illness—who require in-patient care. They are struggling because our acute services are still blocked up with people who largely have non-acute needs. They have ongoing mental health needs that need to be dealt with in community settings but those community services are not yet at that level. So we have a problem with meeting the need for secondary services because community-based services are not yet adequate. The Mental Health Commission needs to focus on that area as well as on the primary mental health services that are required by people with mild to moderate mental illness.  
There is an awfully long way to go when we see the World Health Organization predicting depression to be the most serious chronic illness faced by the world’s population. Actually what that is saying to us is that our health services need to focus very strongly on the primary care required in mental health services. Currently there is a bit of work going on there. It needs to be a major focus of Blueprint II and we need as a country our Mental Health Commission to be focused on that area. We need an organisation with the capabilities that the Mental Health Commission has to do that work not the capabilities that the Office of the Health and Disability Commissioner has. Both organisations play really important roles but they are separate roles that are not congruent. This is the wrong thing to do.