Clark DavidDr DAVID CLARK (Labour—Dunedin North): The Estimates hearings were a lively affair this year but before I speak about them I just want to acknowledge the Hon Annette King my predecessor and her huge contribution to health in this country as one of the best health Ministers this country has ever had. I want to say that as I go around the country and discuss health as a relatively new member in the portfolio—although I have been associate health spokesperson with Annette King for 3 years before that—the feedback I am consistently getting is that in the sector people miss the engagement they had with the Hon Annette King. They felt like they had a Minister who listened and now they express despair that the current Minister is so disengaged with the sector. In fact his disengagement is such that they are now starting to claim and believe that Tony Ryall was a fantastic Minister of Health because the contrast is so strong. At least Tony Ryall was on the phone he was regularly following up and he cared about what was going on in the sector and now they have an absentee Minister and they are frustrated.This came through in the hearings. The Minister in the hearings—and this was the most shocking thing of all; it was widely reported in the media because they could not believe it either—said he would have to check my figures when I suggested that there were 533000 people who could not afford to go to the GP in the previous year: 533000 people. The Minister said: I'd have to check the member's figures. I have never heard of that figure before. That's new to me." That is the Minister's own figure. That comes out of his ministry. The Minister does not read his papers. That is one of the major things that is going wrong in this sector. Well it is the kindest explanation for the blunders that are happening in the sector currently.I think we will see more to come. For example on the Budget blunder that was the Minister announced the wrong funding on Budget day. The Minister announced the wrong funding. I think this is unprecedented. I would challenge the Minister to give another example of a Minister announcing the wrong health funding on Budget day. I do not think it has ever happened. I think we will find out—I think there is still evidence that will come to light that will tell us that the Minister knew about this well before the Budget day and still chose to announce the wrong amount on Budget day. That is frightening. In this country if we have a Minister prepared to mislead the country about how many health dollars have been allocated and to whom—The CHAIRPERSON (Lindsay Tisch): Order! You cannot infer that someone has misled so just be careful of what you are saying. You can use other words but not "misled".Dr DAVID CLARK: Well I will not repeat what I just said but I have a deep concern that the false amount of money was announced to the public on Budget day in terms of the allocations to district health boards (DHBs). The fact that the Minister did not know how many New Zealanders could not afford to go to the GP even though it is in the major survey that his ministry publishes I think speaks volumes.In the hearing itself we asked questions of the Minister around mental health. We asked why the Government had failed to act to intervene when we have a growing crisis in mental health. We raised the issue of a 60 percent increase in the number of people taking up mental health services in New Zealand in the past decade and the fact that funding had increased only by 28 percent in the same period. The Minister when asked about funding increases in the mental health sector consistently says he does not know what the figure is. We have done the calculation. We can tell the Minister it is less than half the percentage increase in the demand for mental health services. He was prepared I will say in that hearing to answer questions on the failures of acute services in mental health because there had been a damning Auditor-General report recently released that showed that many people—mental health patients—are being released into the community without a plan in place to look after them. They were being released on the basis of least need—not that they were fit to go out again not that they were ready to go back into the community but that there were more patients desperately in need and that plans were not in place. They were going out in some cases into caravan parks and the DHBs concerned had no idea where they were going. So the Minister came prepared to answer questions on acute need in this sector but he did not have an answer as to when the solutions would be put in place.We have had ministry officials before select committee since and there will be more on that to come because I am afraid the answers that we are getting are not satisfactory in terms of acute care and they are not satisfactory in terms of providing a service where people with mild to moderate mental health needs can get the care that they need in the community unless they are wealthy and can independently access private services. We know that there is a huge gap there. That is widely acknowledged in the sector.The Minister however talked about a $25 million contingency that he had launched. He launched that we know a week before the Budget. He made a speech a speech that announced a review—which was not called a review which was going to be reviewed in 3 years' time if I remember rightly—around the quality of services. That was his only announcement a week before the Budget. This was because we know that he had been told he could not make an announcement about the mental health funding contingency and he said that he would make an announcement about that in due course; he was going to put a paper to Cabinet soon. Well the embarrassing thing that happened on Budget day was that the Minister got up again and delivered out these press releases saying he was going to deliver a Cabinet paper to Cabinet soon. It is the same story: the dog ate his homework. He has not prepared anything on a response to the growing mental health crisis.That Minister has not got any answers. He has got a contingency fund and we still do not know. The Budget was on 25 May and we still do not know any one thing that he is doing in the mental health area. That is outrageous. It is absolutely outrageous in a growing crisis in this country that the Minister has no plan and it speaks to 9 years of a Government that if it had any ideas it has run out of them or been convinced that they were too bold or too scary or something because there is no action on mental health.The Minister does not know his facts and figures. We assessed that in terms of the over half a million people—over half a million people—who could not access their GP. There have been studies of course since and I raised these with the Minister which show that one in four adults now cannot access the primary healthcare they need in New Zealand. That includes oral care that includes picking up their scripts and so on. That is the growing inequality under this Minister's watch. We have the primary health sector now in revolt as it is concerned about the lack of funding Budget after Budget after Budget and this Budget was no different. The sector got $9 million this year and 2 years in a row it has asked for more than double that because it knows there is a desperate need to fund primary care to keep people out of hospitals. Of course since then we have heard more about the injections and the skin lesion removals that are being used by the Government to pump up its elective surgery statistics instead of investing in the long-term care in the way that the Hon Annette King did when she was health Minister—long-term strategies to make sure that New Zealanders were getting the services they need that money was being invested in prevention rather than in meeting the short-term elective surgery targets that are made to try to make it look like the Government is doing something when we know it has cut money.This was another challenge I put to the Minister and I have to say he spent a lot of his prepared speech talking about the Labour Party's analysis of the shortage of money he has put in the system. He spent a huge amount of his time there trying to rebuff what he knows is a very challenging truth and that is that when an independent economic agency went and looked at the Treasury figures it found that $2.3 billion has been taken out of the health system and that is the money that would have been required to deliver the existing level of services in the health system. That $2.3 billion—that is what more would have needed to be put in since 2009 just to retain existing service levels.Of course in this story about the injections the eye injections and the skin lesion removals there we have the proof in the pudding. Case-weighted discharges as they are called are dropping—you know the number of surgeries being performed at that high end is not keeping up in many DHBs. We have seen a drop-off. If you take away the skin lesions if you take away the eye injections and if you take away those surgeries that could have been performed outside of the hospital there were actually fewer surgeries—fewer surgeries performed in the Auckland DHB fewer surgeries performed in the Counties Manukau DHB fewer surgeries performed in the Bay of Plenty DHB fewer surgeries performed in the Waikato DHB fewer surgeries performed in the Northland DHB. These are growing populations and year on year there are fewer surgeries being performed and that is because this Minister seems content to watch the demise of the Health Sector—"