Lees-Galloway Iain: New Zealand Public Health and Disability Amendment Bill — Second Reading 
Lees-Galloway Iain: New Zealand Public Health and Disability Amendment Bill — Second Reading 
[Volume:667;Page:14366] 
IAIN LEES-GALLOWAY (Labour—Palmerston North) 
: 
 I start by allaying Dr Hutchison’s fears about the Opposition’s support. Let me be quite clear that we will support the New Zealand Public Health and Disability Amendment Bill through to the Committee of the whole House although we look forward to that opportunity to offer some amendments to the bill. As has been described by speakers so far the bill sets out to establish the Health Quality and Safety Commission to introduce a mandate for collective purchasing across district health boards and to arbitrate when district health boards have conflicts over shared services. This is in an effort to share procurement opportunities in order to reduce costs and bureaucracy in the health system. These are all noble objectives which the Opposition supports but let us dispel a few myths. 
Collaboration in the health system is not a new thing as the previous speaker Dr Paul Hutchison would have us believe. In my own part of the world in Palmerston North the MidCentral District Health Board and the Whanganui District Health Board have been working together for some time. They currently have an alliance in place whereby they are looking to share more and more services. That sharing of services and that collaborative approach came into effect long before the election of the current Government. The same can be said of the entire lower North Island region in fact. The boards in the whole region—the Hutt Valley District Health Board the Capital and Coast District Health Board the Wairarapa District Health Board and the Hawke’s Bay District Health Board as well as the Whanganui District Health Board and the MidCentral District Health Board—have been working together on a regional basis and collaborating in that way. Yes both sides of the House support this approach and yes previous Governments have supported it. It is not a new thing. It is not some wondrous new invention created by the current National Government. 
Let us also talk about the concern many people have and this Government seems to have with cost blowouts in the health sector. First of all I would like to draw to the attention of the House exactly where New Zealand ranks internationally in total health costs per capita both public and private spending. The OECD estimated that in 2008 New Zealand spent—and this is in US dollar purchasing-power parity terms—US$2683 per person. That compares to Australia at US$3353 Canada at US$3867 the UK at US$2990 and the US at US$7538. New Zealand ranks extremely well against other countries we like to compare ourselves with. So when we are talking about exactly what health care costs in New Zealand let us be honest. 
It is important that we try to find more efficiency reduce bureaucracy and make our dollar stretch that much further but let us start off with an honest conversation about what is actually happening in this country. Yes there has been growth both per capita and as a proportion of GDP over the last decade as there has been in all other Western countries; everybody is facing this challenge but growth in spending in New Zealand has been fairly steady. Dr Hutchison mentioned a rate of over 8 percent but if we look at the OECD figures we see that we have never reached over 8 percent. The most recent was about 6 percent and it has not been steady at 6 percent over each year either; it has been a lot less than that. So although we support this bill there are some underlying myths espoused by the Government as to why this is so important and it is important that we explore some of those. 
New Zealand does very well because of the structure we have in place. We have a publicly funded health system and we can have single purchasers and collaboration between providers. That helps them to reduce costs. A very good structure that is a very good example of this is of course Pharmac. We get fantastic reductions in comparison to say the US system because we have a collaborative approach to purchasing. It is good news to hear from the Minister that he does not want to see a massive upheaval in the health system and the Opposition will be listening very carefully to make sure the Minister sticks to his word on that. We have had a lot of upheaval over the years and we need a stable system. Upheaval by stealth will be uncovered by the Opposition and we will hold the Government accountable if it attempts to do that. We have a good system and we need to maintain it. 
The real cost savings in our health system are to be found in a proper realistic and substantial approach to public health. Unfortunately this Government seems to have eschewed public health and put it to one side. It is fantastic that we are debating a health bill in the House; however there is another one that has been languishing on the Order Paper for ages which is the Public Health Bill. When this term of Parliament started that bill was quite close to the top of the Order Paper but it has been buried further and further down. Public health is not a priority issue for this Government probably because there are not too many sound bites in it. It is a little bit hard to sell; I do not think Crosby/Textor has come up with any good sound bites for public health. But that is where the real savings in health care are to be found: in a proper long-term approach to diabetes cardiovascular disease and mental health; and in reducing smoking alcohol and drug-related diseases. It is a focus on well-being. It is a focus on keeping our people well and keeping them out of hospital not waiting until they end up in hospital and all the costs that are associated with that. But that approach is too big for this Government. That is too forward-thinking and too far off in the future. The Government is not worried about the well-being of our country in 20 years’ time; it is worried about next year’s election—let us be honest. 
The other thing that we could be doing to improve the health and well-being of our nation is to reduce income disparity. There is an absolutely clear link between income disparity low socio-economic status and poor health outcomes. What has this Government done? It has increased those disparities by giving tax cuts to the very well-off those who need them the least and increasing GST which affects those who have the least the most thereby increasing those disparities and giving our nation a larger health bill in the long run further down the track. 
The Health Committee’s report notes that some members i.e. the Opposition members have some concerns about the removal of the requirement for district health boards to consult with the public. We have nothing to fear from consultation with the public in this country. We have a very strong Parliament we have very strong public institutions and we have very strong district health boards that are able to progress their policy initiatives their strategies and their plans and are able to roll those out. There is nothing to fear; there is nothing to slow us down from having proper public consultation. Public consultation will achieve better policy making and better strategies that will respond to what our local communities need. This was brought up time and time again by a number of the submitters and Woman’s Health Action summed it up quite well. It said: “Consultation with communities should not be viewed as a nicety but rather as a fundamental part of the public health and disability system that ensures health and disability services are appropriate for and responsive to those who need them.” I could not agree more. 
The erosion of that consultation process erodes the ability of not only the public at large but also non-governmental organisations and the clinicians. We hear so much from the Government about its concern that clinical leadership has been eroded from the health system; those clinicians are having their say eroded as well by this removal of the requirement for the district health boards to consult with the public. The New Zealand Nurses Organisation brought up the issue of nursing leadership down in the Southern District Health Board. It said that since the amalgamation occurred between the two district health boards down there it had seen an erosion of nursing leadership. 
We will support the New Zealand Public Health and Disability Amendment Bill. We support its aims and objectives and we look forward to the Committee of the whole House but let us have an honest debate about public health care in New Zealand.