Clark DavidHon Dr DAVID CLARK (Minister of Health): I want to start today with some congratulations. I believe from being an avid member of the Hansards that it is the Hon Michael Woodhouse's 26th wedding anniversary today. As he is my counterpart from Dunedin and also my counterpart as the Opposition health spokesperson I want to wish him all the very best. From reading the Hansards I also know that he begrudges spending too much money on flowers for these anniversaries because around Valentine's Day the price of flowers goes up. But I want to say to that member the Hon Michael Woodhouse congratulations—26 years is no small feat—but I also think he should buy his wife an extra large bunch of flowers this year to celebrate that anniversary. His wife—whom I've met—is a lovely person and she will now be having to endure him being around the house a little more. So an extra big bunch is in order and some congratulations at the same time. This Government is motivated on ensuring that we are tackling growing inequalities and that we are improving incomes housing health and education in this country. We know that one of the symptoms of a growing gap between rich and poor is an increasing number of children living in poverty. It doesn't sit right with us as Kiwis to read reports from the OECD like the one that came out in 2014. There was a recent one that confirmed that growth in inequalities in New Zealand over recent decades has outstripped other Western countries. It's something we can do something about. It's why we're so proud of the Families Package that we brought in as a coalition Government because it's at the heart of tackling inequality which does not sit well with us as Kiwis. We are absolutely committed as a Government to building a fairer society and we will lead because we are committed to making change that matters. I want to speak a little bit of course about our healthcare system. I want to speak about primary care. I want to speak about critical facilities and mental health. These are the priorities that this Government is taking forward. It is hard to understate the importance of primary care and early intervention for good health outcomes in our health system. We have as a Government already made doctors visits more affordable for around 540000 community services card holders. We've made them more affordable by about $20 to $30 on average because we know that in this situation where we've had this growth and inequalities under the previous Government and where they haven't looked to make sure that prosperity is shared around 585000 New Zealanders—according to the New Zealand Health Survey—can't go to a doctor for reasons of cost and that's not right. That's not right. We know that if people get to the doctor and intervene early with health conditions they can get the help they need. It keeps them out of hospitals and it means that they can enjoy better health. So we are absolutely convinced that introducing that on 1 December will make a real difference for New Zealanders in terms of making sure they can access our health system and get the healthcare they need and deserve. We've also advanced other initiatives including making healthcare free for 13-year-olds—for 56000 thirteen-year-olds. I want to thank New Zealand First for that because that's a part of our coalition agreement as a Government. New Zealand First and Labour—we have made free doctors visits for 13-year-olds. That is a step forward. So for around 600000 New Zealanders last year doctors visits got either significantly cheaper or were made free. We've also put more nurses in schools because that makes sure that needs are met early when we see the first signs of trouble. But we've got further ambition. New Zealand First again have put forward a free health check for seniors so that's something that we're working on as well. We're making primary care more accessible because we know it leads to better health outcomes for New Zealanders. Hon Ron Mark: It's for Nick Smith. Hon Dr DAVID CLARK: Oh I can't comment on that one Mr Mark. Of course when people do need hospital care we need to have hospital facilities that are up to scratch and again the underfunding under the previous Government's watch means there is a big job to do right there. In our first Budget we put forward $2.2 billion of new funding to make sure that those hospitals were able to operate better to actually meet the need that has been growing in that underfunded environment. But the buildings—the buildings—sadly we know many of them have struggled. We've heard about the rot and the mould in the walls at Counties Manukau and so we've allocated some money to address that issue. We've heard about leaks in operating theatres in Dunedin Hospital. When it rains they've had to cancel surgery in the past. It is absolutely outrageous that we've come to this point in our health system and we as a Government are determined to get on and fix the mess that we have inherited. In our first Budget we put aside $750 million worth of capital to start addressing those critical infrastructure needs in our hospital system and so far we've spent money. There has been money allocated including $275 million for Auckland District Health Board (DHB) to address significant infrastructure challenges; $200 million - plus for a new elective surgery unit at North Shore Hospital; $80 million for four projects at Counties Manukau DHB including the one I mentioned to get the rot and mould out of the walls; $45 million for the new Wellington Children's Hospital; $24 million for endoscopy and cardiac capacity at Whangarei Hospital; $20 million for the new Buller Hospital integrated family health centre; $8 million for a new secure mental health unit at Porirua for our most high-needs intellectual disability and mental health patients; and $7.1 million for the second phase of development at Bay of Islands Hospital. One thing that we also need to do—and we are getting on with—is planning longer term. We are going to make sure that we don't end up long term as a country where our infrastructure is run down every time we have a Government that takes its eye off the ball. We as a Government are committed to putting in place a national asset management plan—in fact it's outrageous that as a country we haven't had one for our health system—and while I'm not about to make any Budget announcements today I can assure this House that this Government is committed to making sure our health system is funded better that we're addressing that historical underfunding that the previous Government brought in and that we will address the mess we've inherited with our buildings that were neglected under their watch. We also want to do some things in the area of mental health. We know that we need to. Every person in this House and all New Zealanders I would hazard know someone in their family or in their circle of friends who has wrestled with a mental health challenge. Demand is one measure of what's been going on and demand on our mental health services increased by 70 percent during the previous Government's time but funding went up by less than half of that amount. So we know that the demand is there and the pressure is on our system. It is a personal priority for me—mental health—but it's also one of the Government's priorities for the upcoming well-being Budget and of course we had started with this journey before we were even in Government. All of the parties now in Government campaigned on having an inquiry into mental health. This coalition Government has been concerned about mental health for some time and the inquiry was launched in our first 100 days in office. It has made substantial and considered recommendations and our response will be substantial and considered and I expect to make announcements about that next month. But in the meantime we have got on with investing because the need in mental health is so great. We've put an extra $200 million in our first Budget into DHB services. We launched the Mana Ake programme in Canterbury and Kaikōura to make sure we had mental health workers in primary schools and secondary schools there. We extended the nurses in schools programme to make sure that all schools up to decile 4 in New Zealand have a nurses in school programme and we also have announced the construction of new drug and alcohol detoxification facilities in Auckland. I've mentioned already the cheaper doctors visits and we know that for many New Zealanders their GP is the way into the mental health services they need. Making those doctors visits cheaper will mean that not only will those people have cheaper doctors visits drugs but they will actually be able to afford to go to get the help that they need to intervene when they have challenges that are mild or moderate before they become more developed. So we're very proud of the progress we've made already but there is so much more to do in mental health. Just this last week Julie Anne Genter and I travelled to Porirua. The Greens have in their agreement with the Labour Party a new integrated therapies pilot and so we launched a programme now known as Piki which means to support another and to ascend which will provide free mental health support to an estimated 10000 eighteen- to 24-year-olds—10000 with mild to moderate health needs—and we will be scaling that up according to demand. We know that three-quarters of all lifetime mental health cases present by 24 years of age. We need to move earlier on the mild to moderate stuff. This is a Government that is people-centred and determined to grow the economy and share the prosperity.