New Zealand Public Health and Disability (Southern DHB) Elections Bill — Third ReadingText is incorporated into the Bound VolumeNew Zealand Public Health and Disability (Southern DHB) Elections Bill — Third Reading[Sitting date: 12 May 2016. Volume:713;Page:11082. Text is incorporated into the Bound Volume.]New Zealand Public Health and Disability (Southern DHB) Elections BillThird ReadingHon Dr JONATHAN COLEMAN (Minister of Health): I move That the New Zealand Public Health and Disability (Southern DHB) Elections Bill be now read a third time. I thank the House and the Health Committee for the speed with which it has considered this bill and I would also like to thank the parties including the Labour Party that supported this legislation. I would also like to acknowledge the officials at the Ministry of Health for their dedicated work in preparing the legislation. But most of all I would like to thank commissioner Kathy Grant and her team for the work they have done so far in the southern region.This is an important bill. The effect of it is to allow for the term of the Southern District Health Board commissioner to be extended from December 2016 until the triennial election scheduled for 2019. That provides the commissioner with sufficient time to develop oversee and implement a financially sustainable plan for quality health services for the people of Otago and Southland. Without this legislative change the commissioner would have had less than 18 months to improve the Southern District Health Board’s position.Back in June 2015 I dismissed the board of the Southern District Health Board because of my dissatisfaction with its performance and in particular with its management of the finances. I had lost confidence in its ability to deliver on its strategy for the region including delivering much needed capital redevelopments at Dunedin Hospital. The Government needs to be able to invest with confidence in the health infrastructure of the southern region.The commissioner has developed a work plan that has begun to address the financial and service challenges which she has been consulting on with the district health board staff and Southern District Health Board communities. At the same time the Dunedin Hospital redevelopment is being quickly progressed through the new Southern Partnership Group. I note the district health board is currently performing better than budget for the 2015-16 year. These are the first steps in achieving the sustained financial performance improvements and I look forward to the continuation of such improvement over the commissioner’s extended term.In parallel with the work undertaken by the commissioner on the district health board’s financial and clinical sustainability the Government is working with the district health boards on two streams of capital development. This includes $22.5 million for urgent hospital maintenance as well as facilities upgrades in gastroenterology audiology and the intensive care unit. These projects will ensure the immediate demands around delivery of services continue to be met while the planning for the major redevelopment of Dunedin Hospital progresses.The Health Committee examined the bill and recommended it be passed without amendment. From public submissions the committee raised a concern that Ngāi Tahu felt their access to decision making was diminished under the new governance arrangements. The committee strongly urged the commissioner to engage with Ngāi Tahu to ensure Māori can contribute to district health board decision-making and the principles of the Treaty of Waitangi are upheld. This concern was also raised by some members in the debate in the second reading of this bill.I understand that the commissioner is currently in consultation with the chair of the district health board’s iwi governance committee regarding the provision of nominations for Māori representation on the district health board’s statutory advisory committees. The commissioner has previously affirmed the status of the district health board’s Treaty relationship agreement with local iwi groups. Through this relationship agreement and other established communication mechanisms the principles of the Treaty will continue to be recognised and applied.The committee also encouraged the commissioner to consider how the district health board’s work can be made more transparent and recommended the commissioner sets goals and targets and reports on these to the public at the end of each year. Public meetings of the district health board’s statutory advisory committee meetings have now been advertised by the commissioner and the first of those meetings will be held later this month.Although welcomed public meetings are not the only contribution to transparency. The 2016-17 district health board annual planning process is currently under way. Initial goals from the commissioner’s plan which was published back in December 2015 are expected to be included in this document. This is the key district health board accountability document and a statement of intent that forms part of it is publicly reported at the end of the financial year. The district health board’s annual plan is also available on its website. The annual report which is also publicly available provides information on key aspects of the district health board’s performance.At its second reading some members raised concerns that the bill would affect local democratic rights to elect the board of a district health board. The select committee considered whether a requirement to consult with the community should be added to the bill to overcome the perceived reduction of democracy. I understand the concerns about democracy but I do not propose the cancellation of a local district health board election lightly. This is a serious case where correcting the financial situation is important to allow for quality health services to be delivered in a more sustainable way to the local population. That needs to happen sooner rather than later. The bill therefore impacts on only one election at the Southern District Health Board and will help to ensure the next board to be appointed as part of the 2019 local body elections will begin its term on a more secure financial footing.I agree there is a need for the commissioner to work closely with local communities. When appointing the commissioner I asked her to ensure that she was working closely with all stakeholders in the district. This expectation continues during this extended term. I know that since her appointment the commissioner has held meetings and forums with a wide range of stakeholders and she regularly updates the public on district health boards through updates in local newspapers on television via the radio and via the Southern District Health Board website. I note that the committee considered that there were appropriate mechanisms for public consultation and that no change to the bill would be required. The introduction of public advisory committee meetings provides additional opportunity for the public to better understand how decisions in their local district are being made.Continued work by the commissioner offers an opportunity to resolve the district health board’s financial challenges and helps secure more sustainable health services and health facilities for the people of the southern district. The commissioner has already begun to address the deficit challenge and it is important that she is given time to complete this important work. I want to thank Kathy Grant for that work. I also want to thank Richard Thomson Graham Crombie and Angela Pitchford—the other commissioners—for the role they are playing. I think we have got a very well-balanced team. I especially want to thank actually the people who work at the Southern District Health Board—that is the doctors the nurses the non-clinical people and the administrators. It has obviously been a time of stress and change there and they have been very supportive and welcoming of the installation of a commissioner.As I say it was not something that we did lightly; it was a step that was taken once all other options had been exhausted. We had had the district health board under intensive monitoring. We had had a Crown appointee on the board. In the end it had got to the point where everyone across the district regardless of political affiliation decided this was the right step. So I want to thank my National Party colleagues in the region for the support they are giving the commissioner. I also want to thank actually local MPs David Clark and Clare Curran for the support they are also bringing to bear down there. We may not agree on everything but we are very keen across this Parliament to see long-term sustainable health services restored for the people of the southern district. I commend this bill to the House.Dr DAVID CLARK (Labour—Dunedin North): We on this side of the House will be supporting the New Zealand Public Health and Disability (Southern DHB) Elections Bill as the Minister of Health indicated. But that across there is a Minister under pressure.Hon Dr Jonathan Coleman: Not from you buddy.Dr DAVID CLARK: The clock is ticking Dr Coleman—the clock is ticking. He says: “Not from me.” He makes it personal. This is actually an issue about the people of the south being able to access adequate health-care. That is why on this side of the House we are putting the politics aside for a while to give the Minister the opportunity to make real progress because his Government unfortunately has let the situation become so dire in the south.This problem that exists in the Southern District Health Board—where it has struggled to meet its financial targets where the building of a substitute hospital has been pushed out and pushed out and pushed out and where the Government itself has failed to commit fully to a rebuild—is an ongoing matter—and it did not start last year. It started with this Government years ago. It has had a Crown monitor on the board for 6 years. It appointed the previous board chair and five of the 12 board members. This Government has been all over the Southern District Health Board for 6 or more years and is worried about the status of the progress down there on the issues that matter for the south.Of course the Government must take some blame. The failed Health Benefits Ltd proposal which dragged capacity out of the south in terms of financial planning was an initiative of this Government. It failed in producing what was promised with that initiative and eventually it folded. But the damage was done. The capacity the management capacity the planning capacity that existed in the south—some of that was leached away during that period. The Government has only made the situation worse so far. And finally the Minister has said that this is starting to reflect badly on him—goodness knows why it took him so long to come to that conclusion—so he has appointed some commissioners to step in to try to rectify this situation.Of course some of the fundamentals that contribute to it the Government is not going near. The underfunding—this Government has underfunded health by $1.7 billion. That is independent analysis using Treasury figures which have determined that although the costs of health have been rising this Government has not funded it adequately and so health care around the country is suffering. That $1.7 billion is no trifling amount and it is no wonder that Kiwis are struggling to get the health care that they normally would get. Middle New Zealanders are suffering while the Government is more focused on the interests of those at the very top—the very wealthy the mega-rich. Middle New Zealand is suffering.So here we have finally an intervention that says: “Well maybe we do care about health.” It has come late and we support the fact that the Government is saying that it is going to do something. But it comes of course with strings attached. Our support is there because we want to see progress. Our support is there because we want to see good health-care for the south. The Minister is now under pressure the clock is ticking and we have not seen much progress to date—we have not seen much progress to date.In the Health Committee the issues of transparency were raised. On this side of the House we want to see measurable progress. We want to see measures put in place that we can measure progress against. So far the commissioners have produced a one-page strategic planning document that looks more like a Christmas card than a plan. We have got a partnership group in place that is supposed to be designing the new hospital and from it we have seen very little. It has been asked to produce very little to be fair to the group and it has obliged thus far. We have not seen real progress on the hospital rebuild. We have not seen a commitment from the Government in terms of capital and a start date for a rebuild. All we have heard about are some amorphous kinds of projections that a new hospital will be there in 10 years’ time. Well for goodness’ sake that is pushing out the obligation to a future Government.This Government does not seem fully committed to health care in the south but here is the Minister saying that he is going to do something about it. He has appointed his own people. They have been in place now for coming up on a year—it will be a year at the end of June; it will be a year—and then we will expect to see real progress. So far we have not seen much. So that is why that Minister is under pressure and he is feeling the heat and so he should be. Annette King has him under pressure every day in the House. The Government is failing to deliver and it is that $1.7 billion of underfunding that means that it is going to continue to struggle to deliver. But Mr Coleman has nowhere to hide. He is now tied to the commissioners he has appointed—he is now tied to those commissioners.Of course we know that the situation came about because in part when the Southern District Health Board came out of the merger of two health boards $30 million was lost with the removal of the boundary. We will hear shortly the member for Clutha-Southland Todd Barclay get up and say the funding is adequate. He will ignore his constituents who are concerned that they are not getting the operations that they ought to be getting. He is not concerned about middle New Zealand. He is not concerned about the people who need the health care but who are no longer getting it. He is not hearing those concerns. He says all his rich mates can get every operation they need whenever they need it. They can get private health-care if the public health-care system is not delivering. That is the increasingly out-of-touch Government we see opposite us.We know that funding matters and we on this side of the House also know that democracy matters. In the select committee stage the Hon Annette King—the formidable Hon Annette King—put forward a wonderful amendment that would have given the Government the opportunity through an Order in Council to restore democracy sooner if it thought real progress was being made. Government members declined that opportunity. They did not want to have that opportunity put in play. They wanted the full term. They will have the full term with this commissioner in place and we expect real progress as a result.We want to see the finances coming under control but we also want to see the delivery of services. We want to see structure and capacity rebuilt. We want to see good governance in our local district health board and we want to see capital commitment from this Government—capital commitment and a credible time frame that starts with a rebuild start date. When will the first sod be turned? Will the Government commit to a tertiary-level hospital of the same quality that Dunedin has historically enjoyed? And will we have services such as training restored? That has been removed because our buildings are decrepit and no longer fit for purpose. They were designed over 50 years ago so it is no wonder—modern hospitals are different. We would expect something different. It is Dunedin’s turn. It is the last major metropolitan centre in New Zealand to get its hospital rebuilt and this Government seems shy of committing to it.We know that the funding formula is flawed. It needs a deep and full review. For example the southern district covers an area roughly the size of Belgium but it does not have a sufficient rural funding component. South Canterbury has a much bigger one. How can that possibly be? It makes no sense. There are some anomalies that need a proper and full review. We know that older styles of building require more money to run because they are less efficient. The operations that are run are less efficient than the modern practices. There is no compensation for that in the case of the south.The major tertiary hospital is out of date and people are forced to make do. We know that leads to stretched staffing ratios and we know that leads to stress in the workplace. So we want to see some progress on the hospital rebuild and measurable time frames put around that and a commitment of capital up front. In the meantime we have got problems with asbestos in our local hospital and we have got concerned citizens who recognise that they are not getting the same service that those in other district health boards around the country are. This is a Minister under pressure. He is not addressing these issues as quickly as he should be.But we are supporting this bill. My colleague Clare Curran said—I read her comments in the newspaper the other day where she said them and she will correct me if I am wrong—that it was somewhat galling to have to support this bill. I think that captures it because here we are with a situation where democracy has been taken away from the people the citizens in the south because of this Government’s failures. It is very hard to support democracy being taken away even if only for a short period of time. It is hard for us to do that but we are doing it because we think it ties the Minister so closely to the outcomes.The Minister is under pressure—the clock is ticking. We want to see real progress on planning on financial stability on capacity on governance and on a rebuild. We need these commitments from the Minister and we need to see real progress. He is being watched in the south. Health care affects every New Zealander and it affects people in the south no less. For decades this hospital has been moving closer to its end date and the regional neglect of this Government is something that has only contributed further to that. In conclusion I want to say that people in the south pay their taxes and the Government cannot for ever put off the commitment to making sure the services that are desired and needed and reasonably expected in the south are delivered.SIMON O’CONNOR (National—Tāmaki): I am very pleased to take what will actually be a short and somewhat symbolic call because this is a very simple bill. In fact the purposes of the bill are so simple that all we have heard from the other side is the repetitious hollow rhetoric which we are getting used to and which is a bit disappointing because again this bill is simply about removing—Dr David Clark: So arrogant and out of touch.SIMON O’CONNOR: Oh and there we go—the usual tired lines. Look this is a very simple bill. I have certainly spoken on this many times in the House so no further clarity is really needed. There are just two points I want to make. One is to say thank you to all of those involved throughout the select committee process and the officials and to thank particularly the Labour Party for its support of this bill.I want really in many ways to provide more time to my colleagues from down south Todd Barclay and Jacqui Dean to speak. I think it is going to be important to have that local voice which is symbolic in many ways of the local voices that we heard when engaging on this bill. In fact I am looking forward to being down in the South Island this weekend talking on health issues and importantly hearing about health issues. That is going to be fundamentally important.It is a simple bill. It is allowing the commissioner to continue her work through to 2019 to sort things out with the Southern District Health Board. I really just want to thank as I have before all the staff within the district health board from the doctors to the nurses to the porters to the cleaners to the administrators—all of those people and more—for the important work that they do and to assure them from this side of the House that we have got their back and will continue to do our best to support them.CLARE CURRAN (Labour—Dunedin South): I think that all of the people listening to Parliament this afternoon particularly if they come from Otago and Southland certainly do not believe—and they will feel insulted to have heard the member who just spoke Simon O’Connor get up and say that the local MPs who are sticking up for them and for their regions are spouting hollow rhetoric. That is our job and that is what we are elected to do and I would remind any of the MPs from Otago and Southland that what they are elected to do is to stick up for their constituents and to stick up for making sure they have got a proper and adequate health service in our region. That is what they should be doing instead of getting up and spouting out-of-touch and hollow rhetoric of their own across on that side.We in Labour have reasons for supporting this bill and I will repeat that it does gall me to support it because it is a bill that removes democracy from our district health board elections for a period of time and that is a really difficult thing to support. But we have a serious situation for our health services in the southern area and it has to be addressed—and that is why we are supporting the bill—because of the pressure that followed the amalgamation of the two district health boards and the lack of work that went in at that time under this Government to establish what the financial implications of that were; the ongoing deficit issues it has had which have been unable to be fixed and instead have got worse; and the appointment of a Crown monitor. For almost the entire period that this National Government has been in power there has been a Crown monitor on that board and it has not been able to fix it. These problems have got worse.The issues led to a lack of confidence by the people in Otago and Southland in the district health board and then led to the Minister of Health’s lack of confidence in the district health board. Ultimately the call and the issues lay with the Minister. He did take action finally after being urged to do so by Annette King our spokesperson. We have to support this bill much as it galls us to do so because if the commissioners who have been put in there are to do their job then they have to be given the time to do their job. The Minister ultimately is accountable and becomes much more visibly accountable. That is what this bill does.However along with that goes a set of responsibilities and accountabilities to the Minister and those commissioners that there has to be a plan that the community can accept the plan and then that the plan is implemented. That has to be done within the time period that has been set down for this bill which is 2019 for the next round of elections. One of our concerns is that it may get pushed out again and we cannot support that because the only reason we are supporting this bill is that it does set a time limit.We utterly understand the concerns that some in the community have about the loss of democracy. The Labour Party fought very strongly to have democratic elections return to Environment Canterbury. In previous parliaments when Labour was in power when a district health board has been dismissed and a commissioner appointed we have reinstated democracy as soon as possible. That is why Annette King put up an amendment during the Committee stage to try to ensure that democracy could be returned as quickly as possible by trying to insert the word “postpone” rather than “cancel the election” so there could potentially be democracy restored by 2019 because it may be that that is the case. Unfortunately that did not get the support of the Government.We are supporting this bill but that is where it ends. We need a plan in the Southern District Health Board region and we need that plan to be expressed. At the moment as my colleague David Clark said we have something that looks like a Christmas card—really just a bunch of platitudes—and we need a financial plan. We need a plan for the new build of the hospital and the clinical services building. We need to know what the management structure is going to be. We need to know the situation for the tertiary-level status of our district health board as a teaching hospital. We need a commitment to increased reporting and we need that to be publicly increased reporting—and that needs to be real reporting and not just platitudes. We need time lines and we need them now because right now we are not getting them. We are getting very vague statements. We are getting things told to us that are then getting pushed out. I have been told recently by the commissioner Kathy Grant that the business case for the new build of the clinical services building is now not due until mid - next year. Well earlier this year it was going to be the end of this year so now it has been pushed out another 6 months.Todd Barclay: These things take time Clare. These things take time.CLARE CURRAN: Well what does that tell us about what lies ahead? So there are concerns.The MPs on this side of the House who represent their electorates well and represent our region will be speaking out. We will be making demands. I read the member Todd Barclay’s speech in the Committee stage and there were two things in particular that he said that really concerned me. He said that this was “a long-term piece of work with a long-term goal”. That rings warning bells for me because that is sort of like acknowledging that it might take longer than until 2019 that we will need commissioners. On this side of the House we will not be supporting that. The other thing that concerned me was Mr Barclay’s insistence—ill-informed insistence because clearly he does not speak to many of his constituents in his work—that the Southern District Health Board is not underfunded. He himself admits that a district health board that services 290000 people across an area the size of Belgium is a very difficult thing to do and the population-based funding model is not fit for purpose in our region. When is he going to acknowledge that? And when are the other National Party MPs who represent our region—The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! I am just going to ring the bell but I am going to ask the member for the last 2 minutes to come back to the bill.CLARE CURRAN: The bill is about removing democracy from our region and giving the commissioners a job to do in a limited period of time that requires a plan. Part of the issue is a financial sustainability plan. And if the commissioners cannot acknowledge and the National Party MPs cannot acknowledge that one of the core issues that underpins the situation that our district health board is in is that the population-based funding formula is not fit for purpose for our region then we cannot have a financially sustainable plan that will actually get us out of this hole. And what we need through this process is for that acknowledgment to be taking place.I do want to express some concerns about the tasks that lie ahead. The commissioners have had almost 1 year. They have got 3 years more. They are being vague. They have spent $240000 on a listening plan. Well they need to start taking some actions and putting some plans out there for the community to see. We need to see that they can manage contracts appropriately such as the contract with Compass Group which is providing the hospital food that is so controversial in our region where there are so many question marks about how that contract was drawn out; where there are still no key performance indicators even though that contract is now in place; and where we have questions about the level of governance around the management of that contract. There are so many questions. We have to keep monitoring the situation.JACQUI DEAN (National—Waitaki): In June last year the Minister of Health Jonathan Coleman wrote to the Southern District Health Board saying he no longer had confidence in the board. The board had a forecast deficit of $27 million a figure that had doubled over the previous 6 months with larger deficits over time projected to go to $42 million. As a result the Southern District Health Board had proposed a 5 percent cut in funding for the three small hospitals in my electorate Ōāmaru Hospital Dunstan Hospital and Maniototo Hospital in Ranfurly. All of those hospitals are community-owned and loved and all were performing well and within budget. Those communities rose up.For my electorate of Waitaki the news of the appointment of commissioners was greeted with relief and with hope—relief that the board’s plan for a 5 percent funding cut was halted and hope that the commissioners would be able not only to tackle the increasing deficit and reintroduce financial stability but also to refocus on health services to patients not only at Invercargill and Dunedin hospitals but also in our rural communities.My position has always been very clear. In the many meetings I have had with the previous board management and now commissioners my focus is on the Southern District Health Board providing funding and support to rural hospitals so that they can best serve their communities. The answer never was a 5 percent cut in funding across the board and I want to thank the Minister for listening to the many representations made by community leaders MPs and rural hospitals that led to his decision. The commissioners are now making good progress but the job is not yet complete. The commissioners badly need to redevelop Dunedin Hospital. They need to look up they need to look out and they need to seize the opportunity to better utilise the high performing rural hospitals.It is time to focus on what really matters here. The Southern District Health Board has made good progress on the new faster cancer treatment target which is up by 10 percent. The Southern District Health Board has surpassed the elective surgery target by 7 percent. There are some good health outcomes being achieved so it is time to get in behind the commissioners as they tackle some very significant issues. It is time to support the clinicians the medical staff the nursing staff and the management of Invercargill and Dunedin hospitals who look after our parents our friends and our families.There is always a place to highlight deficiencies in this service—this is after all a publicly funded service—but there is also a need to support the district health board as it works towards our expectation of having an improved deficit position and more importantly a cohesive region-wide delivery of good quality health services. I commend the bill to the House.JAN LOGIE (Green): I rise to take a call on this bill the New Zealand Public Health and Disability (Southern DHB) Elections Bill on behalf of the Green Party. The Green Party is continuing to oppose this bill at its third reading on the basis that it denies southerners the right to vote for their district health board in the 2016 elections. This is another piece of legislation that the Government has put before the House removing or compromising peoplein the South Island’s right to vote.I am a born and bred Southlander. My roots and family link strongly into Southland Otago and Canterbury and so to me this is an issue that affects my family. I believe passionately in people’s right to their democratic rights. I understand the issues that led to the appointment of the commissioners and the removal of the district health board and I will speak to that a little bit more. Our core objection is that although we understand the value of the continuation of the commissioners we believe that those commissioners could be ministerially appointed alongside an elected board. We have not heard any reason given by the Government as to why that could not happen. It has said that it is not legal although it has the power to appoint people to the board. It does not seem to make sense to me that they could not be appointed.I do object to this Government’s inferencethat southerners do not know what is best for them—you know I sometimes have cause to doubt that belief when I see National Party members elected in some areas while removing their rights—but I keep on going back to the fact that actually people do know what is best for their communities. Sometimes particularly with district health boards that can get confusing. It is hard to know who people are and to know who you are voting for. But the answer to that is not to remove people’s right to vote; it is actually to put more resource into supporting those democratic conversations and the connection between the democratically elected representatives and the people. We need more resources put into that in the country. I do think that although the system may not be perfect it is the best system that we have and it is what gives all of our processes legitimacy.So I would like to speak a little bit to the reasons that have been given and the focus of the work of the commissioner which is around the financial stability of the Southern District Health Board. It was thrown into instability and deficit and the Greens did have concerns about the district health board’s lack of strength in advocating to the Government for more resources and challenging the decisions that were being made from Wellington particularly when the district health boards were merged.These are massive areas you know—I think it was said in the example given earlier that there are 290000 people over a land mass the size of Belgium. The board is working under a funding system set up by this Government of population-based funding. We know that population-based funding works quite well for medium-sized populations—relatively dense populations. There are two key areas where it does not work so well. One is rural populations where the population is well spread out and you do not have that density of population. It makes sense. It is kind of obvious that it is going to be difficult to provide those core services across those areas under a population-based model. The other area where it does not work so well is in the tertiary-level service like our training hospital in Otago in Dunedin.In terms of the two things that compromise population-based funding the Southern District Health Board experiences both of those. It is affected by both of those core factors. So although we can put in commissioners and say that it is going to solve the problem and that that justifies denying the people the right to vote unless the Government addresses the core reason behind the financial instability we are not solving the problem and we are not serving the people.Everyone in this House knows that when you do a survey of people about where they want their taxes to go health and education come up every time. I just think of my dad living in a rural community in Otago. He has been given a diagnosis of glaucoma which is something that needs early treatment. He is waiting for his appointment. We do not know when that is going to be and while he is waiting that damage is accruing and it is irreversible. Health care and health services matter to every single family in the southern region in the cities and in the rural areas and it does not just affect the people who are facing illness or disease; it affects their entire family. As a country we need to do better.The Green Party does not believe that appointing commissioners and denying people the right to vote or to engage in the process of decision making around the funding and the use of funding is the best way to solve those problems. We believe that the best way to solve those problems in the south is to make sure that their funding model is appropriate to the region to have the experts sitting alongside the elected representatives to put more effort into transparency and engagement to make sure that those decision makers are delivering a service that meets the needs of the community to open up more pathways for people to be able to express what their needs and concerns are and to listen to these people and respond to them. Removing a level of democracy and saying “Actually we think Wellington’s vision of what is important and of what the needs of this community are is more important than yours.” is not the way to shift that system and make it more responsive to the needs of the community. It just does not make sense. If you need the expertise and you are concerned about potential deficits in expertise you put the experts alongside those elected members to be able to help. You do not remove that democratic right or that democratic process.So it is very unfortunate considering the massive issues facing the region and the importance of health to those communities—and to all of us—that the Government is sticking with its approach of: “We know best. We’ll sort this out. Don’t you worry your pretty little heads southerners we’ll sort it.” It has not worked so far and we do not have confidence that it will. Thank you.RIA BOND (NZ First): I am proud to rise on behalf of New Zealand First and speak on the New Zealand Public Health and Disability (Southern DHB) Elections Bill. This is because I reside in Invercargill I live in Southland and on behalf of New Zealand First it passionately opposes this bill. For those people at home or in their cars listening to this debate in the House tonight this bill seeks to cancel the 2016 triennial general election of the Southern District Health Board in order to provide until the repeal date for the continuation of the term of office of a commissioner for the Southern District Health Board.I have maintained throughout this process three main objections to this bill. First this bill is an appalling affront to southerners’ democratic right to vote for their own district health board representatives. Secondly we knew very little about the work done by the current commissioners back then but we were expected to take it on trust that they would do a great job and now it is expected that they will keep that job until 2019. New Zealand First does not believe in railroading the democratic process simply to fulfil a cost-cutting exercise that has already shown weaknesses in two areas: the lack of transparency and the questionable capability of the commissioners has not gone unnoticed. Thirdly the real culprit for the state of the Southern District Health Board’s fiscal woes is the Government’s terrible population-based funding formula and the amalgamation under that Government of the Southern District Health Board and the Otago District Health Board.New Zealand First believes strongly in holding the district health board fiscally accountable for the choices that it has made. New Zealand First objects to the Government taking away the power from the people—to the stripping away of votes from Southlanders by this National-led Government and the placing of all the decision-making powers with an unelected few. That really concerns us. New Zealand First respects democracy and this bill is an appalling affront to democracy. One of the basic principles in this country—look up and listen National—is the right to vote. That is what New Zealand First is protecting in the House tonight—the right to vote.This is another example of this Government putting all the power in the hands of a small unelected few because it believes it knows better. I maintain that the good people of Southland and Otago know their communities better. New Zealand First refutes the need to strip back democracy when an alternative solution exists. The Minister knows this himself—it was in the Minister’s original plan when he sacked the board. The Minister is quoted in the Otago Daily Times from a press conference he held on 18 June 2015 and again I feel the need to actually quote the Minister: “The plan is really for the commissioners to stay on as appointed members of that board and new elected members to come on at the local body election.”—in other words Minister Coleman a new board. So what happened? What happened to that? What happened to your plan?The Minister said in the Committee of the whole House that the Government is not legally responsible to follow through with his original plan that would have allowed the commissioners to be appointed to the board and the remaining number of board seats voted on in local health board 2016 elections. He said that there were no provisions in the New Zealand Public Health and Disability Act 2000. New Zealand First refutes that because this is a new board and the New Zealand Public Health and Disability Act 2000 provides the Minister with the authority to appoint members to a board—a new board—to positions that would otherwise be held by elected members. So I want to put that myth to bed and I want to say that my amendment would have given the commissioner the Minister southerners and the good people of Otago a win-win outcome but that the Government voted it down. This would have addressed the complex issues facing the Southern District Health Board and would have wiped out the need for this National-led Government to strip away the vote from the good people of Southland and Otago.There is a real fear—a real fear—in our communities that the Minister will not follow through with his promise and allow us to vote for our health board in the 2019 elections. Southerners refuse to be another Environment Canterbury case study under this Government—to be given empty promises that are not fulfilled and to be forced out of voting for 9 years just like the good people of Canterbury have had to swallow.New Zealand First questions both the transparency and capability of this commissioner. This commissioner claimed in her letter to the team leader of district health board relations at the Ministry of Health that her aim was to engage with the communities in which it operates across the district. She claims to have held meetings with staff throughout Dunedin Southland and Lakes District hospitals community and health leaders all major staff unions MPs and mayors throughout the district Mobile Health Solutions—and the list goes on. As a list MP for New Zealand First based in Invercargill I was not invited along to these meetings and nor was the public allowed to attend or observe any board meetings. So I refute the claim that the commissioner has been absolutely transparent. You can sit there and laugh Mr Barclay but this is not a joke—this is not a joke. I actually want to remind the Minister that the commissioner was appointed in June 2015 yet she failed to engage in any meaningful way with our communities until she was put under pressure by the Health Committee—and that was recently too—and then all of a sudden here she is getting out there holding all sorts of public relations sessions.The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! I have done it to two members previously—this is quite a narrow debate on this bill. It is not a debate to go over all of the issues and I know we cannot do that in the time anyway.RIA BOND: OK. I do want to point out that southerners are totally fed up with the slow process and the secret dealings behind closed doors that we have had to date. The real culprit for the state of the Southern District Health Board’s fiscal woes is the Government’s terrible population-based funding formula and the amalgamation under that Government’s watch of the Southland District Health Board and the Otago District Health Board. We know from Cabinet papers that were released that the rurally adjusted calculation did not adequately fund the Southern District Health Board and that the district health board has missed out on the correct funding for many years. The population-based funding formula does not support regional health care and it is the real culprit in terms of why the district health board and so many others are struggling to stay fiscally sound.With such a huge geographical region to service it is no wonder that the Southern District Health Board struggles to meet its services’ needs. What constituents are telling us and what they are telling me is that they are being bumped off the elective surgery list. That is one way to cut back the deficit—forget about looking after our elderly. And God forbid that you are slightly overweight and need a knee replacement because you will have to go home and lose the weight first. Another way to cut the deficit is to contract meal services out to private contractors like Compass Group with a 15-year contract to feed our patients in hospitals and members of our community through the Meals on Wheels contract. Despite the outcry from members of the public in Dunedin and Otago from doctors refusing to eat in the cafe—The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! I am going to interrupt the member again and advise her that she has to at least—it is a third reading; it is quite a narrow debate—somehow tie her comments to the bill.RIA BOND: OK. Well I will do that. This contract will not bring the $7.6 million needed originally to save the district health board. In a report released by the Medical Council just yesterday—it was printed in the Otago Daily Times—it stated that house officers at Dunedin Hospital were overworked and lacked supervision which has put the accreditation training of intern doctors at risk. I ask how is that competent?In closing this is a bad bad bill. It is bad for Southlanders it is bad for Otago people and it strips away our democracy. There are decisions that have been made behind closed doors and it does not deal with the real issue which is inadequate funding. In New Zealand First we have stuck to our guns and we have opposed this bill from start to finish. Two wrongs do not make a right. Thank you.BARBARA KURIGER (National—Taranaki - King Country): It is a pleasure to take a short call. This is not about removing democracy. This bill simply extends the term of the commissioner and her team. Turning round the board and achieving financial stability is a long-term process. It gives the commissioner time to implement the plans that are being developed and since the team has been out consulting constituency concerns have actually dropped considerably.This afternoon it is my very big pleasure to stand here and take a short call on behalf of the Health Committee and I have pleasure in commending this bill to the House. Thank you.Hon DAVID PARKER (Labour): I am going to begin by qualifying my knowledge of the health system across Otago-Southland. I was born in Roxburgh hospital which existed then—formed at the time when the power dam was built there. I was raised in Dunedin. I suffered a serious head injury when I was working on Stewart Island in the early 1980s and was flown to Invercargill hospital and from there to Dunedin Hospital. Some people say that is why I joined the Labour Party but I deny that. So I know the importance of Invercargill hospital. I lived for a period in Queenstown in the 1980s. I was the member of Parliament for the Otago electorate in the early 2000s and—Hon Annette King: Best one they’ve ever had.Hon DAVID PARKER: —oh thank you Annette King—I had a lot to do with health services in the three regional hospitals that were in the area that I was the MP for Ōāmaru Queenstown and Dunstan Hospital near Alexandra. While I was there the Labour Government funded the rebuild of the Dunstan Hospital. I lost that seat and since then I have lived at least some of the time in Dunedin.I believe that there are some ironies in this bill. Members do not have to have been here very long to know that Richard Thomson one of the commissioners was removed from his post by the last National Minister of Health when Tony Ryall chose to blame him for the computer rort that had been outed by Richard Thomson as chair who brought it to the attention of the authorities and caused the individual to be prosecuted—that was the Swann fraud. For doing his duty as chair he was removed as chair. None the less the then Minister appointed a chair from out of the region—from South Canterbury from memory—to be the chair of the board—Hon Annette King: Joe Butterfield.Hon DAVID PARKER: —Joe Butterfield—to sort out the finances which got worse. Not only did the Minister appoint the chair but the Minister also appointed Crown monitors. Stuart McLauchlan I think was the Crown monitor who was appointed and that Crown monitor could not sort it out either.I want to explore why it is that the rural population-based funding model which lies behind the funding deficit that led to this appointment and the extension of this appointment is wrong. New Zealand has forever been an outlier in the international statistics on the outcomes for rural people. Somehow we have been miraculously able to deliver health outcomes for rural populations as cheaply for rural areas as we can in city areas despite that not being achievable anywhere else in the world. And that feeds through to the rural adjuster because the rural adjuster assumes that it is not as expensive to service rural populations as in fact it is. Why is that? It turns out that it is because the way in which New Zealand collects statistics for rural populations is different from the rest of the population and the rest of the world—and it is wrong.So how does it work? Well small towns in New Zealand are classified as “urban” despite being serviced by rural hospitals. What that does is understate the cost of servicing rural populations because those rural townships are not included in the statistics for rurality. Instead they appear in the city population statistics and they average down the appearance of the—[Interruption]I have got the other call Mr Assistant Speaker. I raise a point of order Mr Speaker. I apologise if this has not been done properly but my understanding is that the Greens are not taking the other 5-minute call. Therefore I seek leave—The ASSISTANT SPEAKER (Hon Trevor Mallard): Sorry I had not picked up that you were doing both calls. In fact I saw a signal otherwise to your deputy leader earlier. I am not sure of the rules here as to extending calls—I know you can pass off calls but I am not sure you can extend them. I think probably the easiest thing to do—Hon DAVID PARKER: Well can I seek leave—The ASSISTANT SPEAKER (Hon Trevor Mallard): I will because I am not sure of the rules. I seek leave of the House for the Hon David Parker to take a 10-minute call being the 5-minute call that would otherwise be available in the next call to the Labour Party as well as this one that was available to the Greens. Is there any objection to that? There appears to be none.Hon DAVID PARKER: Thank you Mr Assistant Speaker I appreciate the way you handled that.So the cost of rural health is underestimated because our rural populations are included in cities and therefore it slightly averages down and hides the cost of rurality. The second point is that the rural people who live in lifestyle blocks around cities in New Zealand are counted as rural when in actual fact they are generally wealthy people who are getting their services from cities. So that is the second reason why we have mistakes in the rural adjuster in respect of truly rural populations. So the rural adjuster is problematic and the consequences of that are that district health boards that service rural populations are underfunded. And there is nowhere that that problem is greater than in the southern region in Otago-Southland.The second point I would make in terms of the issues that we have in the South is that there are some really important decisions that the commissioners have to take. Population densities are changing across Otago. We have strong population growth in Queenstown-Wanaka we have low population growth in Invercargill and Ōāmaru and it is not that high in Dunedin either—it is a bit higher than in Invercargill and Ōāmaru. The difficulty there is that decisions have to be taken now as to what is the future shape of tertiary hospitals in the South. I think it is obvious that whichever way you cut the numbers even though Queenstown is growing Queenstown is never going to be in the foreseeable future as large as the Dunedin centre of population. That means that the tertiary services in the South in Otago-Southland will still need to be provided from out of Dunedin.The worst of all outcomes is if we start to spread some of those specialist tertiary services to Invercargill Alexandra Queenstown and Dunstan because none of them will be big enough to support quality tertiary services. We would undermine the quality of tertiary services in Dunedin and increasingly those tertiary services would then be serviced from Christchurch which is not in the interests of anyone in the South. So I urge the commissioners to make that decision to give long-term direction to all of the hospitals in the South. Some people say you should count Wanaka and Queenstown together. You should not. That is a poor form of care because having Wanaka people going first to Queenstown means they would be going further away from the tertiary hospital in Dunedin to which they may need to be transferred. So the best route of care goes Wanaka Dunstan and Dunedin for those people who need it.Those decisions have to be taken. If they are not taken the viability of not just Dunedin Hospital is threatened—and there are some terrible things that have happened in Dunedin in recent years. It has lost its teaching status for things like the intensive care unit. I had an eye infection about a year ago—I had to go into the eye clinic—and my doctor sent me down there. The place is—you know I am amazed at the quality of service that they give out of a building that is very run down and shabby. It is under pressure from the number of people who now need eye services both because of improved technology but also because the ageing population means that there are a lot more people in the South needing eye interventions than used to be the case.So I am supportive of the extension of term. I do think that this is not going to be cured unless the rural adjuster is looked at. I also agree with some of the other speakers who say that teaching hospitals probably are not properly compensated either; and that is felt to be most pressing if you are in a small centre where you cannot spread the cost of teaching over as many people—which again reflects the Dunedin problem. Underfunding because of the rural adjuster in particular I think is the main cause of the problems.There will though be a need for an update of some clinical practice in Dunedin. I think that over time for some of the specialist services outside peak times there is going to have to be a slightly different model in Dunedin for the delivery of those services including more cooperation with probably the Canterbury District Health Board in respect of after-hours telephone cover for the registrars who are rostered on out of hours. That is the way in which people in Invercargill Queenstown Alexandra Dunstan and Ōāmaru currently get support and services delivered—through the telephone from specialists as well.So with those comments I support this bill. I do share Clare Curran’s concerns that it is bad that we have unelected representatives but I do not think there is any way of avoiding that. We have got to give these commissioners time to finish the job.TODD BARCLAY (National—Clutha-Southland): I rise to give my third speech on this particular bill and I am in support of it. Having spent a lot of time going around meeting with constituents and with health providers and other stakeholders in the southern region it really makes me wonder how much work some other members in this House have been doing with regard to that. What everybody in the South is finally saying is: “Good on the Government for taking a stance and taking a position to reform health care in this area and giving some certainty to us as constituents with regard to the health care that it is providing.”The extension of the commissioners’ term is absolutely critical to allow them to continue their piece of work. It would be absolutely untenable of us to put in commissioners—Kathy Grant Graham Crombie and Richard Thomson—and to ask them to fulfil a huge piece of work under huge public scrutiny and then after a year turn round and say: “No that’s it. Now you have got to report back.” We are extending their time giving them the ability to complete their piece of work and to reform the provision of health care for the better in this area. So with that I commend this bill to the House.Hon ANNETTE KING (Deputy Leader—Labour): Can I just say to the member who has resumed his seat Todd Barclay that less than 6 months ago David Clark and I did a tour of his electorate and I think probably crossed into some other electorates as well. We started in Timaru and then went to Ōāmaru Maniototo Queenstown Dunstan and Balclutha. We visited all the small hospitals there. They had not seen the member—[Interruption]The ASSISTANT SPEAKER (Hon Trevor Mallard): Order! That member will sit down. The member will stand withdraw and apologise.Todd Barclay: I withdraw and apologise.Hon ANNETTE KING: —and they had not seen the commissioners at that stage. We beat them on the tour of those small rural hospitals. I can tell that member that we have a very very good understanding of what is happening in rural New Zealand. I have to say what a very erudite speech we got from David Parker setting out the background to the problem of that amalgamated board of the Southern District Health Board. It was a decision made by a foolhardy petty highly political former Minister of Health who did not look at the costings or the savings or the service delivery.The big loser in that amalgamation I have to say was Invercargill because of the rural adjuster that should have been put in there as noted by David Parker who set it out very well and understands it—which I see quite a lot of members opposite do not. In fact I do not know why the member who resumed his seat did not speak about how disappointed he was that the rural adjuster for his area has not been changed. I do not know whether David Parker knows but the Ministry of Health has now done a review of the population-based funding formula. It was delayed because of the Christchurch earthquake and it does the review only after each census. So because of the earthquake there was no census so it did not do the population-based funding formula review. It has now been done.Has it changed things for the Southern District Health Board? No it has not. It is a very disappointing review indeed. I think the commissioners who have been put in there to fix the problem are really going to struggle. One of the good reasons why there is not an election for this district health board is that the accountability for what it comes up with sheets straight back to the Minister of Health—straight back to the Minister of Health for the accountability of what it comes up with.I just have to say that we have supported this bill. We have supported it because we understand that this district health board is in serious trouble and has been from 2009 when a Crown monitor was put in and when it went into intensive monitoring. I understand that very well because district health boards that have to have Crown monitors and intensive monitoring are in serious trouble. The board could not balance its budget. It was running a deficit—a big deficit; it was up to about $42 million. Joe Butterfield was the chair and Joe chaired the South Canterbury District Health Board right through the years that I was Minister of Health. He is a good man. He could not balance the budget. He could not in the end hold together the attitude and the feelings of the people of the South about what was happening to their health services.We did call for a commissioner much earlier. Maybe if the Minister had listened to what we were saying the board would not have had to delay this election because the commissioner would have had the time to work on whatever they were going to put in place to fix this problem in the Southern District Health Board. But he dithered and he dallied around and finally he put in a commissioner.That commissioner has been there for less than a year. It will be a year in June—next month. That is insufficient time for the commissioner accompanied now by three other commissioners to come up with an implementation plan to be able to fix the problems in the Southern District Health Board. So reluctantly we have to give it time to do that. I did put up in the Committee stage of this bill a Supplementary Order Paper and I thank New Zealand First and the Greens for supporting it. It was a sensible Supplementary Order Paper. It suggested that we postpone the election rather than cancel the election until 2019. We proposed to postpone the election of the district health board until the plan was implemented—which could be within a year it could be within 18 months. It could have by Order in Council had an election. It would not have cost any more because if you are delaying an election you have not spent the money and if you have it you would spend it. When it gets to the next election of course you spend for that election. The Minister was very charitable and smiled nicely but did nothing towards looking at it seriously.I pick up the points made by New Zealand First and the Greens. They opposed the bill at the first reading. We worked hard on it in the Health Committee—and I think perhaps there was some misunderstanding as to what came out of those deliberations because none of us opposed it at the select committee. But they have stayed with what they believed in. We have too—tried to amend it we have tried to make it better—but at the end of the day we do have to support it because we cannot leave the people of the southern part of New Zealand with health services that are not working and with plans that are not in place and then just put in elected members so that the Minister of Health can blame them. That is what it got into with the Southern District Health Board: a blame game.So these commissioners now have got a big lot of work to do. At the select committee we asked for greater transparency from the commissioners. We said that they have got to be much more open. Part of the problem for the Southern District Health Board is that it got more and more entrenched in its problems. It closed shop. It did not want people to see how bad it was. It is what happens when there are big issues. So we have said: “You cannot continue with that approach. You’ve got to be more open. Involve the public—they will understand and they will help you.” We at the select committee said that there ought to be more openness transparency and involvement of the public. Within days of us saying that at the select committee—and I have to say it came from the Opposition benches—the commissioners then announced that there would be more openness and transparency. Actually if they had read the New Zealand Public Health and Disability Act they would have known: even though they were commissioners they were required to have the statutory committees. They have then decided that they will have the statutory committees and open them up to the public. So I welcome that. But we are going to keep a very close eye on the transparency and openness and involvement of the public as the commissioners make their deliberations and they put forward their plan and implement that plan.So we just put them on notice that that is what we will be doing because we do feel that the right of people to have an election for their district health board is a really important one. We also understand that sometimes you have to do things that do not allow you to have an election at that time. But we are suspicious of this Government which is why we were trying to put in safeguards. I look at the Minister Louise Upston looking at me quizzically—the reason why Minister is that a promise was made to the people of Canterbury that they would have an election for Environment Canterbury. A promise—made by a Minister—written down said orally said on the television. And what happened? It postponed the election. It postponed it again and so trust in the Government’s word on whether elections would be held is very very low indeed.I can assure the people of the Southern District Health Board that when we lead a Government come 2017 we will be putting back in place a governance board; we will be ensuring those locals will be back again until they can have an election and they will certainly be having an election under a Labour-led Government. We brought back the democracy into district health boards. It was the National Party that got rid of elected area health boards and replaced them with a whole lot of outfits that had funny names: CHEs—big CHEs weak CHEs round CHEs; it had HFAs and RHAs you name it—acronyms for Africa. But it took away the right of locals to have a say on their health services. One of the first things that Labour did as a new Government the fifth Labour Government—we brought back elected district health boards. Seven members elected four appointed and that has been in place to this day. The people of the Southern District Health Board deserve to have that back and I can promise you that they will get it back.JOANNE HAYES (National): I commend the bill to the House.A party vote was called for on the question That the New Zealand Public Health and Disability (Southern DHB) Elections Bill be now read a third time.Ayes 95New Zealand National 59; New Zealand Labour 32; Māori Party 2; ACT New Zealand 1; United Future 1.Noes 26Green Party 14; New Zealand First 12.Bill read a third time.The result corrected after originally being announced as Ayes 95 Noes 16.