Little AndrewHon ANDREW LITTLE (Minister of Health): Thank you Madam Chair. I'll take this opportunity to respond to the first handful of contributions to date to the extent that there are questions in them. I note in relation to Supplementary Order Paper (SOP) 160 that Dr Shane Reti is effectively seeking to legislate for health outcomes and unfortunately it simply is not possible credible or realistic to legislate for health outcomes.The role of the Government and the role of Government agencies is to put in place measures that seek to achieve particular outcomes but there can necessarily be no guarantee about that. The measures we're putting in place the structural reforms give us a much better chance to get better decisions better resource allocation greater consistency and greater coherence across the health system to ensure that there are better health services and ultimately that more people have access to health services particularly those who don't currently have access to them—that is the basis on which we can improve health outcomes. Simply legislating to say we will achieve equitable health outcomes doesn't do it. You've actually got to have measures.We know that the problem the National Party has is getting to grips with wanting a particular outcome and then being prepared to back it with action and resources. We know that their fundamental problem—and their track record in Government—is that they underfund and under-resource health and they cut taxes and wonder why everybody else is left to pick up the pieces. So we won't be supporting SOP 160. It is meaningless and does not help.I see that members have referred to the rural health strategy in my SOP and although that applies to a different part of the bill I will address some of the comments that have been made. I can say that the one party that has the strongest rural representation in Parliament is the Labour Party. We have a very strong rural caucus with whom I meet regularly and have met and they pointed out an obvious thing—the bill having been reported back from the select committee with the addition of a women's health strategy. When you look at the provision in the Government Policy Statement on Health the policy statement in the original draft bill and indeed in the draft that was reported back to Parliament referred to a number of population groups: Māori Pacific disabled women and rural communities. Rural communities were always specifically and explicitly identified in the bill. When the select committee recommended an addition to the range of discrete strategies that should be in the bill and added women to it the only community that was listed in the Government policy statement provision that was not then the subject of a discrete strategy were rural communities. That was an obvious inconsistency and the very dynamic and very influential rural caucus in the Labour Party caucus came to me and pointed that out and we agreed that that is an anomaly and it is the right thing to make sure that rural communities were provided for.I can say however that I'm satisfied with the practical provisions in this bill particularly around locality planning as rural communities will be way better served under this set of reforms than they have in the health system previously. Rural communities will know that Labour Governments fund health. They don't de-fund health which is what the previous Government did. Labour Governments fund health infrastructure not de-fund it like the previous Government did. Labour Governments back communities to determine their own health needs not turn their back on communities whether it's those with mental health issues or those rural communities. Labour doesn't turn their back on them like the previous Government did—and it left this Government to pick up the pieces.To our colleague Rawiri Waititi who has raised this issue I know that Te Paati Māori would like to have a reference to tino rangatiratanga or rangatiratanga—and I'm now turning to Part 1 of the bill—but the reality is that when you put language in legislation we have to assume that the courts will understand it and know it and apply it and the reality about terms like rangatiratanga" and indeed "kāwanatanga" which is the counterpart to "rangatiratanga" is the courts have demonstrated increasingly and most recently in the Ngāti Whātua Ōrākei case that the Pākehā courts are reluctant to apply Pākeha interpretations to te reo terms. So we would be entering a period of considerable uncertainty if we were to use that language. In reality what's most important is that when we articulate and adumbrate the principles that we want to adhere to it's the practical provisions that actually make the difference and when you look at the architecture of this bill and the architecture of the systems we're putting in place this is about embracing mātauranga Māori giving Māori a seat at every table in the health system partnering with Māori with a combination of Health New Zealand and the Māori Health Authority to make decisions and to fundamentally change the approach we take to ensure that health services to Māori are more accessible achieve better health outcomes and lift the health of Māori in general.So that is what we're doing. I know that our colleague Rawiri Waititi referred to the statutory independence for the Māori Health Authority. The Māori Health Authority without wanting to break into other parts of the legislation is a statutory body. It is not a Crown entity. It's a statutory entity although it will adhere to some of the obligations of entities under the Crown entities legislation.To my colleague Brooke van Velden who notes the addition of the rural health strategy to the list of discrete strategies that will be provided for again I reiterate that the reason I have agreed to make that change is on the advocacy of the rural members of the Labour caucus who said there was glaring inconsistency. Every other group referred to that was required to be the subject of elements of the Government policy statement had a discrete strategy but not rural communities and that was an inconsistency that on the face of the bill could not and should not stand and that's why that gap has been filled. I'm very thankful to the members of the Labour caucus—those with rural electorates and rural responsibilities—for their advocacy in that respect.I reiterate what I say: when you look at the way we're setting up the locality networks of the first nine that we are now in the process of developing seven of them have substantial rural elements to those areas and we will continue to roll out that and that will make a difference to health services in rural areas. To Dr Shane Reti's apparent criticism of me for criticising the business models of some rural health providers I say that that is a challenge we had. Some of those business models are not sustainable and we had to find different ways of providing services—and not only providing services but attracting the health workforce into rural communities and it will not be in some of the health services or health organisations that are in those rural communities at the moment. So that is a challenge to rural health leadership.There's a new organisation that's going to be launched soon and when you set yourself up to be a leader of a community what goes with the claim to leadership is the need for responsibility and responsibility to those communities. Any claimed rural health leader who says that nothing needs to change is not a leader and they would be an obstacle to leadership and to positive change for rural communities.Now I'm a Minister; I listen to advocacy groups. I spend a lot of time with advocacy groups. I don't always agree with them. Sometimes I disagree with them quite vehemently but the interests of advocacy groups should not get in the way of an objective and sensible analysis of what the challenges are now and the reasonable steps that need to be taken to address those challenges. This bill does that and gives the impetus to the health administration to enable us to lift health services and health outcomes for all New Zealanders."