Roy Heather: New Zealand Public Health and Disability Amendment Bill — Third Reading 
Roy Heather: New Zealand Public Health and Disability Amendment Bill — Third Reading 
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Hon HEATHER ROY (ACT) 
: 
 I rise to speak to the third reading of the New Zealand Public Health and Disability Amendment Bill on behalf of the ACT Party. We will be supporting the bill as I think every party in the House is. I congratulate the Minister of Health on this bill. I think it makes some very pertinent changes to the public health sector. 
The initiatives in the bill have been pretty well traversed by many of the speakers who have preceded me and I will mention a few. The establishment of the Health Quality and Safety Commission is a very good move and I think we can expect to see some good things come out of it. It allows elected district health board members to be appointed to other district health boards. It makes a good deal of sense and we have already seen some people be appointed to more than one district health board because they have the right skills ability and experience in the health sector to make meaningful decisions and in many respects lead the discussions that need to be had. 
The bill amends district health board planning requirements to provide for planning and accountability frameworks that take into account national regional and local requirements. The speaker who preceded me the Green member Kevin Hague mentioned that very pertinent things are happening at a local level but there are times when regional and national initiatives are needed usually because of geography or because of the sheer size of the issues being looked at. 
The bill increases ministerial powers to direct district health boards to enhance the use of shared services in the health system. For many years now we have been seeing boards cooperating and collaborating to establish shared services. The result is nearly always greater efficiency and a much better utilisation of scarce resources particularly financial resources and we want to see much more of that. 
We are seeing much better cooperation and collaboration between district health boards particularly since the change in Government. We have seen a significant emphasis on the regionalisation of services where that is appropriate and it too has brought greater efficiency to the sector. As a result patients are being seen in a much timelier manner and waiting lists in many areas have been reduced. That is exactly what we need to see. I think there is a lot of scope yet. 
This bill has brought about much better cooperation between the public and private sectors. The private sector is able to gear up when it has certainty of contracting to be able to provide services particularly where there are significant gaps long waiting lists or whatever in the public system. We should not get caught up in the debate or the philosophical blinkering of the ills of the private sector or the ills of the public sector; we should be striving day in day out to break down those barriers so that we consider health care health services and the health workforce as an umbrella. It does not really matter to a patient who is ill where the services come from as long as that patient is able to receive timely quality services. That should be the aim. 
The health sector workforce was also mentioned by the Green Party member. If he had not mentioned it I was going to launch into that. We have seen in the last week a report saying that shortages of health professionals in the short and long term are significant issues. One of the things that I talked about a lot when I was the health spokesperson for the ACT Party in Opposition was the fact that we are very good at training health professionals from physiotherapists and occupational therapists to nurses and doctors but we are not good at keeping them in New Zealand. I used to talk about training our health professionals for export. Sadly there is far too much of that happening and we need to find ways to combat that phenomenon. Recruitment and retention are still significant issues for the health sector and will be increasingly so looking into the future. 
Iain Lees-Galloway talked about Australia. There are some impressive things happening in Australia. He talked particularly about primary care and I think there are some lessons to learn there. He talked about the focus on obesity tobacco and alcohol. But he did not tell the House about the other side of that equation—that is the Australian private health sector has much greater involvement in the overall health picture. More Australians belong to health insurance schemes. The Australian Government also makes a significant effort to contract with the private sector. Those things make a significant difference to waiting lists or waiting times—whichever we want to use as a measure—and they are much better at matching quality medical services with patients in a timely manner. 
We have to pay attention to our economy. This Government is making significant gains in this area. I think we could be making faster significant gains if we were prepared to make some tougher decisions particularly about tackling Government spending but that is really a matter for another day. 
I am in favour of this bill; the initiatives are very good but I wonder whether the initiatives are just about tinkering with the public health sector rather than looking to make significant and meaningful change. One of the things that I think has been a lost opportunity with this bill is related to grappling with the way that we elect and run district health boards. We have just had local government and district health board elections and one of the questions that I would like the Minister to address is why we have district health board elections. Most people have absolutely no idea whom they are expected to vote for. There is a cost to the elections; I asked the Minister in the House the other day what the cost was of running the elections to select people for district health boards and what the cost was of running the boards. I think we need to look at the sense in doing that. I ask whether we need 11-person boards when in fact a three- or five-person committee might do just as good a job. I ask whether it would do the job more efficiently. I ask what the saving to the taxpayer would be and how much that saving would translate into health services. That is something we need to look at very seriously. What is gained by having elections? What is the percentage of people who actually voted? The figures are not in yet from the latest round of district health board elections but we need to look at the percentage of people who voted. Do voters know anything about whom they are voting for? Are we electing the right people or are the district health boards heavily reliant on the Minister’s four appointees to each board for the skills that are needed? Personally I think we would be much better off with a three- or a five-person committee appointed by the Minister to run each of the district health boards and that would bring about significant savings. 
I will finish there. I reiterate that the ACT Party supports this bill; we think that these are good initiatives that make a good deal of sense particularly in relation to the running functions and organisation of district health boards but the bill is an opportunity lost because it could have been an opportunity to look at whether things could be run much more efficiently. 
I acknowledge the points that the Labour and Green members made about looking to the future in terms of our health services. We need to take seriously the workforce issues and the use of the public sector particularly in promoting primary care. We need to take seriously those issues as our population continues to age and I look forward to continued debates on those issues. Thank you.