Ryall Tony: Questions for Oral Answer — Questions to Ministers 
Text is incorporated into the Bound Volume 
Ryall Tony: Questions for Oral Answer — Questions to Ministers 
[Sitting date: 27 February 2007. Volume:637;Page:7663. Text is incorporated into the Bound Volume.] 
4.  
Hon TONY RYALL (National—Bay of Plenty) 
 to the  
Minister of Health 
: Has he received the series of reports on the three Auckland district health boards confirming hospital productivity has been declining despite huge funding increases and what action is being taken as a result of these reports? 
Hon PETE HODGSON (Minister of Health) 
: 
 Yes. Although they certainly do not prove the conclusions that the member asserts they are a valuable resource for learning how to further improve value for money. 
Hon Tony Ryall 
: If these reports do not support the conclusion of falling service for increased funding does the Minister agree with the Labour Party appointee and deputy chairman of all three Auckland district health boards Ross Keenan who said: “The reality is yes we accept decline in productivity is a huge concern given the huge increases in resources this Government has thrown at health.”—how does the Minister explain that one? 
Hon PETE HODGSON 
: The reason the deputy chair of the three district health boards expressed his concern is that the district health boards are keen—and in fact are required—to pay attention to value for money. An example of this is the $15 million per annum laboratory contract that the three district health boards have undertaken—a saving of $15 million per annum prospectively—opposed almost unbelievably by the National Party. 
Ann Hartley 
: What recent reports has the Minister received from the Auckland district health boards? 
Hon PETE HODGSON 
: I have received a number of reports recently. The first is that since 1 July the Auckland District Health Board has improved its forecast financial position by $45 million per year. Secondly so far this year Waitemata District Health Board has achieved a 4 percent growth in volume of work with a 2 percent increase in staffing. Thirdly in Counties Manukau District Health Board acute hospitalisation rates for children have declined by 5 percent over the past 2 years. Mortality rates have decreased for both children and adults. What better sign of improved value for money can there be than that I ask. Finally in the first 6 months of this calendar year over 1000 additional elective operations will be completed between Waitemata District Health Board and Counties Manukau District Health Board with a further announcement for further increased surgery from Auckland District Health Board still pending. 
Barbara Stewart 
: Would he concede that the boards’ productivity is likely to be further reduced by their mismanagement of negotiations relating to the laboratory services contract which has so far cost them $1 million in legal fees; if not why not? 
Hon PETE HODGSON 
: I just make two points. First of all this matter is before the court and commenting on the court case is unwise. Secondly the court case was not taken by the Auckland district health boards; they spent money responding. 
Heather Roy 
: As the Minister of Health did not answer the question from the Hon Tony Ryall I ask again whether he agrees with the deputy chairman of Auckland’s three boards when he said: “The reality is yes we accept decline in productivity is a huge concern given the huge increases in resources this Government has thrown at health.”; and how many more secret reports need to be written questions asked and denials issued before Labour comes up with a prescription for health care that is more than just dumping sick Kiwis off waiting lists? 
Hon PETE HODGSON 
: You see the primary question could have been asked: “… confirming hospital productivity has been declining because of huge funding increases.” It was not so long ago that New Zealanders were concerned that doctors were treating and diagnosing patients when really their first and foremost need at that moment was to get some more sleep. Productivity can be improved by having nurses and doctors run more quickly down corridors but it is not a sustainable way to go. 
Hon Tony Ryall 
: There is a problem. 
Hon PETE HODGSON 
: We are pleased that there has been an increase in doctors—in fact I will tell the member what the increase is. On page 6 of the third report on productivity from the Auckland district health boards it is stated that there has been a 19 percent increase in doctors and a 14 percent increase in nurses. One would think that therefore the increase in the bureaucracy from the stuff that you hear from the National Party would be the sum of those two figures. But let us have a look at the administration and management personnel increase—oh it is 6.4 percent! So another prejudice has been disturbed. The member needs to invent new prejudices. 
Rodney Hide 
: I raise a point of order Madam Speaker. I ask you to reflect most carefully on what we have just seen here in Parliament which is that a basic question was actually asked twice. We saw the Minister of Health stand up and give quite a long speech that might go down all right at a Labour Party conference where the people attending are rather uncritical. But the Minister stood up framed the question himself then answered it. Well actually what we have in this House is a question time where other parties ask the questions of the Minister. That does not give a licence for the Minister to get up say what the question should be put the question and then answer it. 
Madam SPEAKER 
: I thank the member. I understand his point of order. As the member knows Ministers do not have to give yes or no answers. The Minister did respond by giving his view of the matter and as such complied with the Standing Orders by addressing the question. 
Hon Tony Ryall 
: Does the Minister recall last week dismissing Treasury’s warning on declining productivity because out-patients were not counted and now that these Auckland district health board reports do include both in-patient and out-patient discharges and still show the number of doctors and nurses increasing but the number of patients being treated falling what excuse will he use now? 
Hon PETE HODGSON 
: The member forgets—even though it is only a few days ago—that the primary finding of that Treasury report is that productivity is hard to measure. These benchmarks are an attempt to improve the measurement. Actually we are going to do some benchmarking in some more district health boards too because if we get better at it we will be able to identify how productivity can improve. One really interesting thing is that one cannot have good benchmarking across district health boards unless one has a cooperative framework in which to operate. This is a recent phenomenon. During the 1990s there was no cooperative framework. [ 
Interruption 
] Crown health enterprises competed against one another; they competed against one another for doctors services and everything else. You see that is why there was a 42 percent increase in health expenditure in the term of the National Party and 89000 New Zealanders on the waiting list when it was thrown out of office. 
Rt Hon Winston Peters 
: I raise a point of order Madam Speaker. Could you please tell me what is so special about Tony Ryall that he can sit through an answer like that having his mouth constantly open interjecting the whole time the answer was given and never being stopped. Frankly there are members in this part of the House who remain reasonably quiet during question time and hear the questions and answers. But I do not see why certain members who are far more junior than others in this House and who have been here only 5 minutes can get away with that sort of behaviour. That was a very good example. It was not just Tony Ryall by himself; seven other people over there were shouting out as well. 
Madam SPEAKER 
: I thank the member. As the member knows interjections are permitted. However persistent interjections can in themselves be disruptive. In that particular instance the Minister’s answer was considerably lengthened by his responses to the interjections. That is what happens if we get this chit-chat. 
Rt Hon Winston Peters 
: I raise a point of order Madam Speaker. You do not get my point. I am asking what is so special—[ 
Interruption 
] There it goes again. It is a point of order. You have five people shouting out there. All should be exited from the House because of that. That is what the Standing Orders state. That is what Speakers’ rulings state. But again we have a certain group getting away with something in this House that the rest of us are not allowed to indulge in on any occasion. The constant shouting out and interjecting is going on as I speak now. I want to know what is so special about them. It is not because the answer was long that he was entitled to interject from the start to the finish. At the start he could not have known that the answer was going to be long. We at this end of the House want to know why they are getting away with what looks to be—I am not accusing you of this is an adverse way—like special treatment for the National Party. 
Madam SPEAKER 
: I have ruled on the matter. But the member does raise a good point that persistent interjections in themselves can be considered disorderly. So I just remind members of that particularly when there is a running commentary and Ministers are trying to respond to the question that is asked by the member who has asked it. 
Hon Dr Michael Cullen 
: Is it correct that two of the factors that can be cited here are improved working conditions and increased pay; if so has the Minister received any reports of any occasion on which any National Party spokesperson has opposed any claim for increased pay or increased working conditions as opposed to going out on the steps of Parliament House to greet every group that has ever arrived asking for more spending for health and promising to give it? 
Hon PETE HODGSON 
: No I cannot. On the contrary I find that the National Party is usually very very keen for the Government to get out its second cheque book and write a cheque in order to get this that or the other strike settled. 
Hon Tony Ryall 
: Does the Minister recall telling the House last week that productivity reports could not be relied on because the bulk of hospital work is in medical discharges and how can he say that more is being done in Auckland when these district health board reports show the number of doctors and medical services has grown by 20 percent but the amount of care provided has fallen by 6 percent? 
Hon PETE HODGSON 
: There are several ways to answer that question. The first is to repeat that it is not a bad idea for doctors to get some sleep. The second is to point out to the member that in the life of this Government we have built a new hospital at Waitakere. There has been a new hospital opened in Auckland. A super-clinic has been expanded in South Auckland. Green Lane Hospital has entirely shifted from one site to another. All of these things happen whilst the hospital must continue operating; and of course during those periods there can be a different productivity. Interestingly Waitemata District Health Board in the first 6 months of this calendar year has got an increase in volume of 4 percent and an increase of staff of 2 percent. 
Hon Tony Ryall 
: If Treasury says district health board productivity is falling the Minister of Health says district health board productivity is falling the Minister of Finance says district health board productivity is concerning and Labour appointee Ross Keenan on behalf of the district health boards in Auckland says productivity is falling does the Minister think district health board productivity is falling and what makes him so prescient? 
Hon PETE HODGSON 
: I think productivity should be sought throughout the health system or better value for money should be sought— 
Madam SPEAKER 
: I must say Mr Ryall I find it very distracting that once you have asked a supplementary question you then keep on asking questions when the answer is being given. I thought I had given a warning before so I am doing it quite explicitly now. You have the misfortune I know of sitting close and having a loud voice but interjections of themselves can in fact be disorderly. Thank you. 
Hon PETE HODGSON 
: This Government will always seek better value for money. One of the things we need to do is to benchmark district health boards—only possible in a cooperative model. To the extent that we are able to measure productivity we can learn lessons from it. But the member does need to reflect on the fact that this particular benchmarking involved a little over 10 percent of the entire activity of the district health boards in question. 
Ron Mark 
: I raise a point of order Madam Speaker. I do not wish to labour the point but my leader the Rt Hon Winston Peters has raised the issue with you. You have watched and adjudged and given Mr Ryall a warning yet as you looked to your right whilst that answer was being given he continued to constantly interject and heckle. How much more defiance of your rulings are you going to allow this House to witness? 
Madam SPEAKER 
: I thank the member. He is labouring the point. 
Dr Jonathan Coleman 
: Does the Minister agree with Dr Cullen when he wrote to the Minister of Health that the Treasury report— 
Ron Mark 
: I raise a point of order Madam Speaker. Your role is to protect all members of this House equally. As Speaker it is assumed you will ensure that all members of this House are treated equally. Your attempt to belittle and demean my very valid point of order and your reluctance to deal with Mr Ryall demonstrate unfortunately that you are not prepared to do that. 
Hon Dr Michael Cullen 
: The member is further back in the House; I am much closer to Mr Ryall and I think perhaps he was not aware that while Mr Ryall’s mouth kept moving and flapping no sound was actually coming out. I took it as some form of adoration of the Minister actually rather than anything else. 
Madam SPEAKER 
: I thank the member. Mr Ryall’s interjections were certainly not heard by me and that is my objection to it because it creates disorder. If he wants to mumble that is fine as long as it does not create disorder. But the member had my ruling and if he makes one more implication like that on my rulings he will find himself not in this Chamber. 
Dr Jonathan Coleman 
: Does the Minister agree with Dr Cullen when he wrote to the Minister of Health that the Treasury report  
Value for money in health—the DHB sector 
 “does raise concerns about declining productivity in DHB hospitals.” and that “Improving hospital productivity is an important way of freeing up money for services outside hospital and for other priorities.”; and does the Minister realise that the $35 million currently being wasted across the Auckland district health boards would more than pay the Herceptin bill for all New Zealand women? 
Hon PETE HODGSON 
: Yes I do agree with Dr Cullen. The member does not seem to have seized the point that that Treasury finding 2 years ago is where this benchmarking activity and a whole lot more activity in the health system came from. We are not short of our intention to get better value for money on our health system. We are very pleased with our health system—very proud of it—but we can always do better.