Blue Jackie: New Zealand Public Health and Disability Amendment Bill — Second Reading 
Blue Jackie: New Zealand Public Health and Disability Amendment Bill — Second Reading 
[Volume:667;Page:14382] 
Dr JACKIE BLUE (National) 
: 
 I am pleased to speak to the second reading of the New Zealand Public Health and Disability Amendment Bill. This bill proposes legislative changes that are a result of the earlier ministerial review group report which I must admit is a landmark document and congratulations need to go to Murray Horn and his team. They put a huge amount of work into that report. They travelled up and down the country looking at the sector and interviewing people who worked within the sector and made over 170 recommendations. It was a comprehensive review and I think it is a landmark document. 
The ministerial review group found a number of problems that had a common theme. The problems were that we have an ageing population with more long-term health problems and greater health care will be required in the future. There were issues with the health workforce with high dependency on overseas-born and trained staff in a world of growing health workforce shortages. We cannot compete internationally with salaries; we have to compete with the way in which we treat our staff and what we can offer them in their working conditions. The group found that the hospital services in some areas were quite vulnerable to staff shortages particularly in some of the smaller district health boards. There were mixed health indicators when compared with other OECD countries and waiting times and volumes of elective surgery were of concern to the public at large. There were concerns about preventable errors and the quality of care. The group was concerned about the financial viability of the public health system. Despite the billions of dollars that have been poured into it district health boards were still running at a deficit. 
The ministerial review group made a number of recommendations: it wanted to look at new models of patient care—more important at stronger clinical management—and I am pleased to say that that has become a cornerstone policy. I think that the work done as a result of the report and that is strongly supported by the Minister is now translating into efficiencies and a better working environment for clinicians in the public health sector. The group wanted a sharper focus on patient safety and quality of care to ensure better results for patients and of course on identifying services that were really needed and looking at duplication. A change of culture is needed but a change of culture is something we cannot legislate for. Clinical leadership as I have said has been the cornerstone policy which has translated into new ways of working. 
I will make a point here about the six health targets that the Minister of Health has brought in. A previous speaker commented that we are measuring outcomes. Well yes it is good to have targets because it focuses the mind but also the achievement of those targets does not happen just overnight; it involves clinicians working together to make efficiencies to achieve those targets. 
The targets of elective surgery have been phenomenally successful in the last couple of years. In relation to cancer treatment waiting times not a month or week went by in the last term of Parliament when there was not some blowout in radiotherapy oncology waiting times. Patients were either waiting or being shipped off to Australia and it was totally unsatisfactory. 
Emergency departments are considered to be the barometer or the shop window of a public hospital and when emergency department waiting times blow out we know something is going wrong in the system somewhere. So the target of 95 percent of patients being processed within 6 hours really has made a big difference. Many district health boards are achieving that target and we can see that fact in the quarterly league tables published in the national papers. There have been some comments about publishing those types of tables and that it is not a good thing to do. But in actual fact we heard a comment from Dave Gellar a clinician in his own right who advises the Minister of Health. He said that clinicians actually welcomed those tables. They wanted to have benchmarks and the tables mean that they can compare themselves with colleagues in other district health boards. It can be seen that initially there were patchy performances with some district health boards doing well on some targets and others not. But over time the game has been lifted and that is because the data is being presented in a uniform way. 
This bill is not about a major restructure; it is about making things work more efficiently. We have had a system of 21 district health boards doing work in 21 different ways which is basically reinventing the wheel in 21 different ways. One provision of the bill is to provide shared administrative support and procurement of services across the public health system including additional powers such as ministerial direction to enhance services and ministerial ability to require greater system collaboration and the use of shared services. The Minister of Health has already made some changes in the way to improve the health sector. 
The Clinical Training Agency was established to help to unify workforce planning. We have a crisis in the workforce. In the last term of Government there were 40 or 50 health work reports one after the other all saying that there was a problem but there was not much happening about it. Well the Clinical Training Agency headed by Professor Des Gorman is making changes and already those changes are impacting on the health workforce in this country. 
This bill is about getting our district health boards working more efficiently and about reducing the number of committees. It is about reducing bureaucracy and about getting better value for money; I make no apology for that. It will ensure greater national and regional cooperation in the sector and that can only be good for the patients who are at the centre of the health system. Thank you. 
Bill read a second time.