Estimates Debate — In Committee 
Estimates Debate — In Committee 
[Volume:648;Page:17641] 
Estimates Debate 
In Committee 
Debate resumed from 29 July on the Appropriation (2008/09 Estimates) Bill. 
Vote Education Review Office agreed to.  
Vote Health 
Dr JONATHAN COLEMAN (National—Northcote) 
: 
 I tell members that if there is one area that best sums up the way that this Government is failing it is health. If we look at Vote Health we see that nothing in it will make any difference. Expenditure on health has increased from $6 billion a year to $12 billion a year under this Government yet people still are not getting the care they need. 
We heard of several great examples during question time today. At 9 o’clock this morning there were no neonatal intensive care cots available throughout the country. The Government spends $12 billion a year yet we cannot make one cot available for the most sick most vulnerable babies born in New Zealand today. That is absolutely disgusting. 
Then in question No. 11 today we heard my colleague Paula Bennett ask the Minister of Health how many times the Waitakere Hospital accident and emergency department had been closed in the last year and the Minister answering on behalf of the Minister of Health got up and said none. Paula Bennett then said to the Minister that actually it was closed 52 times. That is absolutely incredible. The Waitakere Hospital accident and emergency department which is the department that the constituents of the Minister of Health have to go to was closed 52 times in the last year. There is $12 billion of health expenditure a year and the Government cannot even keep the Waitakere Hospital accident and emergency department open. 
Do members know what this Government does? When that department is closed patients are given vouchers to go down the road to a White Cross facility. Can members believe that? Despite the Government spending 12 billion bucks a year Labour goes to the ACT party for health policy! It is absolutely disgraceful. 
Let us look at what has happened in elective surgery. The Minister of Health has consistently told us he is going to provide more and more operations. Do members know what? In the area that I represent which comes under the Waitemata District Health Board less elective surgery was performed last year than in the first year of the district health board structure—actually fewer operations. When we consider that the population in the Waitemata District Health Board area has gone up by 14 percent over that time we can see that people are getting even less surgery on a per head basis than they were getting 6 years ago. That is the legacy of the Labour Government in health. 
I totally agree with the surgeon in Dunedin whom we heard about yesterday who said that the real tragedy about the health system under Labour is that working-class people cannot get access to the operations they need. If Labour members are not here to deliver a good health system for working-class people I do not know what they are here for. All the Labour members over there are just reading their notes; they know that what I am saying is absolutely true. They are failing in providing elective surgery and they are failing in providing neonatal intensive care. 
I can tell members where else the Government is failing: it is failing absolutely dismally in mental health services. What has the Minister’s response been? It has been to launch another strategy. Last week the Minister launched his latest effort  
Te Puawaiwhero 
. He gave exactly the same speech that was delivered the last time Labour announced a strategy which was 2 years ago. Under Labour mental health provision has been nothing but strategies plans and frameworks. Meanwhile ward 27 at Wellington Hospital represents another broken promise under Labour. This Government said that that ward would definitely be rebuilt and refurbished. What is happening? It is off the drawing board. What is happening? More and more people in the Wellington region are not getting the acute mental health services they need. 
I have today lodged a written question for the Minister to answer: how many people have committed suicide since that plan was scrapped? I will be very interested to see the answer because the reality is that when acute mental health services are not available things start going off the rails. People need to be able to get into hospital in their time of need. In terms of mental health provision there have been plans strategies and frameworks but not the services that people need. 
This Government cannot continue to make excuses because basically the spending goes up and the care goes down. People cannot get the care they need when they need it under a Labour Government. I tell members that when I talk to people in my electorate the Northcote electorate I find that they are saying that this Government has not delivered. They may have voted for it last time but they say that they will not make that mistake again because under Labour promises are broken. The state of play of elective surgery is absolutely disgraceful. Labour promised more and more operations and in actual fact we are getting fewer each year. The extra spending just has not worked. The people opposite have lost control of the situation. They have gone through three Ministers and each one is more desperate than the last. Meanwhile there is less elective surgery more people cannot get access to mental health care and there are no more neonatal intensive-care beds than there ever was. The situation is completely untenable. Things have got to change. 
BARBARA STEWART (NZ First) 
: 
 On behalf of New Zealand First I am pleased to take a call in the estimates debate and in particular on Vote Health. We are very pleased to see the continued investment that the Labour Government has made in health. We know it inherited a system that had become very run down under the National Government to the extent that there were tills in hospitals. Most people who went to hospital were horrified to find that they could not afford to pay for their treatment. It does not fill us with a great deal of confidence when we hear Sir Roger Douglas say that when he comes back to office he will do to the health system exactly what he did to the railway system. That is not a nice thought for the people of New Zealand. 
Dr Jonathan Coleman 
: Well he isn’t coming back with us. Is he coming back with you? 
BARBARA STEWART 
: No he is not coming back with us; he is expecting to come back under an ACT-National arrangement. 
New Zealand First is very pleased to see the extra investment in health. We know that people need some certainty about their health care and timely access to treatment. We hear from members opposite that the queues are larger than they ever were but under the Labour Government there has been some movement towards dealing with that. 
However we were disturbed to read in the  
Dominion Post  
that Ministry of Health figures show that the number of babies born in New Zealand to non-resident mothers more than quadrupled between 2006 and 2007. The figures show an increase in births in our hospitals of 3248 in the previous 12 months. We wonder why. If one does the figures one sees that 76 such births a week are happening in our hospitals. That is a quite significant number. We have to ask why and for what benefit our hospitals are being used in this particular way. We in New Zealand First believed that the loophole had been closed and that the numbers of such births would be dramatically reduced but for some reason they have not been. The automatic right to citizenship for babies born here stopped in 2006. Now at least one parent must be a New Zealand citizen before any newborn is granted a Kiwi passport. We applaud the action that was taken on that front. For a long time there were maternity safaris to New Zealand under National and at last that has stopped. 
Although we are fully aware that it is up to the individual district health boards to recover costs from non-resident mothers who have used our hospitals we know that that is very difficult and can be very challenging because most district health boards do not have the resources to follow up on this particular area. It is not uncommon as we read in the  
Dominion Post 
 for a woman’s maternity bill including the cost of a baby’s delivery to spiral above $12000 particularly if the baby is premature and needs to stay in a neonatal unit. We know that the district health boards are funded to provide maternity services only for mothers who are New Zealand citizens or residents or who have appropriate working visas or refugee status or who fall under the reciprocal agreements with Australia and Britain. The women I am talking about fall outside of these parameters and the matter needs to be followed up. We need to be sure that we can offer health services to our own citizens. I was pleased to hear Minister Chadwick say today that she will look into the situation with neonatal babies and find out how many foreign mothers who come to New Zealand are using neonatal units. Quite honestly we do not want New Zealanders to miss out in this particular area. 
We know there are no simple solutions to the many and varied difficulties that are confronting the health system. We have to be realistic and face the realities of an ageing population. Improving technology and medicines are increasing life expectancy and of course this places unique demands on the health system. We are very aware too of the workforce shortages that are being experienced. That is a big challenge and the World Health Organization also pointed it out. We are also becoming overly dependent on foreign-trained medical personnel and the increasingly costly use of locums. 
SUE BRADFORD (Green) 
: 
 After looking at the mental health portion of Vote Health I believe that the Government has to take a whole lot more seriously the signs of crisis evident in regard to psychiatric services—in some parts of the country at least. I was not at all comforted by answers I received in the House on Tuesday from Minister Jim Anderton to questions I posed around recent events involving Auckland’s and Wellington’s acute psychiatric units. 
For a start I find it astonishing that the Capital and Coast District Health Board announced last week that it has postponed indefinitely plans to replace Ward 27. That is 4 years after the district health board promised in 2004 that plans for a new ward would go ahead urgently. In recent years the ward has been renowned for its overcrowding and staff retention problems and for a number of serious incidents involving patient injuries and deaths. For example Chad Buckle died after walking out of the ward with no one apparently noticing his departure. 
Most recently there has been the tragic case of Nicole Maconaghie who died in June not long after being discharged from Ward 27. Her mother said and I quote from the  
Herald on Sunday 
: “I was told $80000 had been spent on her and ‘we can’t account for any more money; she just has to get on and live the best life she can.’ ” Her mother is further reported as saying that she tried to tell those caring for her daughter that she would not be able to look after herself but that she “felt like she was disposable from [the doctor’s] point of view.” 
I am sure that the hospital and the district health board will contend that the family’s statements are not accurate and that their apprehension of the situation is all wrong but whatever the exact details are in this case I believe there is an underpinning truth to the mother’s statements that this district health board’s acute unit like some others is often under stress; that staff do at times—and probably quite frequently—push people out into the community when they are perceived to have stayed in the unit too long; that there is an inadequacy of care once they are out there in the community; and that there is also a reluctance to listen to or to really hear the voices of family members who are desperately trying to tell staff about the real situation for their loved one. 
The reason that both the Minister and the Capital and Coast District Health Board give for not building a new unit when one is so manifestly needed appears to be that a new 10-bed house for people with mental illnesses will open in Wellington this year. Using this as an excuse for not building a replacement unit is ridiculous; both are needed. 
I turn now to the Auckland District Health Board and I believe that the crisis there is even worse. The Te Whetu Tarewa mental health unit at Auckland is chronically overcrowded and/or has patient numbers at its maximum. A number of deaths have been associated with the unit in the past year. There is pressure on staff to discharge people who are still very unwell. There is an inability to discharge people to adequate step-down or rehabilitation accommodation and health services. Waiting lists for the one in-patient rehabilitation unit in Auckland at the Buchanan Clinic are long and of course sadly many people will never access the benefits of its care. There are allegations by staff that there is an inability within Te Whetu Tarewa to keep male and female patients sexually safe and that there are cases of sexual abuse within the unit. There is an apparent lack of recognition of the true levels of need in the Auckland District Health Board district and there must be more resourcing appropriately spent even to begin to make the systemic changes needed. 
The Minister is correct that work has been done on a proposal for structural change within the Auckland District Health Board mental health services. I do not know whether the document resulting from this review is the one he referred to in the House on Tuesday as being under injunction but from what I know of the review—if it is indeed the one to which he referred—it is very unlikely that its recommendations will in any way shape or form go to meet the concerns surrounding both the operational and resourcing issues with Te Whetu Tarewa. 
I call on the Government to take some responsibility for what is continuing to happen in our mental health services. There is not enough resourcing. Mental health continues to be the poor cousin of physical health. The problems are systemic and they are acute. People are dying. District health boards should not be left unaccountable in any genuine way for the deficits in their approaches. People with or recovering from mental illness their families and the staff who care for them deserve a whole lot better than what is going on right now. 
JO GOODHEW (National—Aoraki) 
: 
 I rise in this estimates debate to speak about rural health. How interesting it is that in the appropriation for Vote Health there is $5 million for rural health. One might think that that would perhaps address some of the issues in rural health which include the safety of rural patients being compromised by shortages of general practitioners and long waits for people to see general practitioners. Can members imagine the situation in some parts of New Zealand—it does not sound like a New Zealand setting but it is true—where patients wait 2 weeks to get an appointment with a general practitioner? Is that the sort of system we are happy to accept? Of course it is not. There is a very heavy reliance on locums and rural health services have been described in a report by the New Zealand Institute of Rural Health as being in a “fragile” state. 
The institute has pointed out that despite any input by this Government—despite the doubling of Vote Health over the past 9 years—it has not resolved the most significant issues present in the rural health sector today. We may think an appropriation of $5 million might be quite useful but guess what? There is no idea in the Ministry of Health or on the part of the Minister as to what that money is for. It was just a way of saying to the sector: “Go away and keep quiet for a while.” That is not what the sector asked for or what all the recent reports have suggested is required. Those people are not quite sure what to do with the money. They know that the rural health sector needs money to be invested in it but they know also that this is not what they asked for. In fact they have completely lost faith in this Government. They used to think the Labour Government looked after rural health but they have most certainly changed their minds. 
Let me give one example of a symptom. When the Associate Minister responsible for rural health went to a conference recently where he was to be the lead speaker on one side of the debate up against myself on the other side he deferred to a medical student at the very last minute. What does that tell us about the Associate Minister’s confidence to address the issues in rural health today? He deferred to a medical student to be the lead speaker in that debate. That says a lot does it not? 
So what has this Government been doing for rural health? We know that three reports directly affecting the sector are still outstanding. The first is a report into the PRIME system—primary response in medical emergencies. The second is a report into the rural ranking scale which has been buried since the rural sector commented on it; it has been buried since last October. The latest we have heard from the Minister is that it will be out in November. That is funny—the election will be over by November so I find that rather strange. The third is a report on the after-hours service. This Government says it has prioritised the after-hours service and that it is right up there—so much so that it still does not have a full complement of district health boards reporting on what they are going to do about it! So it is now 3 to 5 years later in the case of each of those reports yet we do not see progress. 
But the Ministry of Health is doing something! We should not worry because on the ministry’s website we find 54 reports listed that deal with workforce issues! We would think that something must be happening but no nothing is happening. 
Lindsay Tisch 
: How many? 
JO GOODHEW 
: There are 54 reports on the website. 
Let me talk about the National Travel Assistance Policy. That policy was introduced in 2006 and was intended to deliver travel assistance to the rural people of New Zealand so that they can access health care. How has that policy been described? It has been described as “complex cumbersome and slow”. It is no wonder my constituents ask how to fill out the forms and how to access the money. Honestly most of them just give up and go away. But that must be what this Government intends them to do. 
National has some ideas though. We have had good support for our idea of voluntary bonding—note that I said “voluntary”—in return for student loan write-offs for doctors who agree to work in hard-to-staff areas. There was some confusion at first about the fact that it was to be voluntary but it was welcomed once we explained our intention that it would be voluntary. Ever since it has been shown to work internationally we have supported the immersion of medical students in rural areas for their training. It has been shown to bring extra general practitioners into rural areas. 
Hon DAVID CUNLIFFE (Minister of Health) 
: 
 It would be very interesting if the National Party had a constructive contribution to make in this debate. That party has no health policy unless of course one refers to the supposed phone book - sized book of policy that the party’s geniuses have been dreaming up in the background but have not deigned to put into the public domain. I wonder—and I ask Opposition members to confirm—when National will give that phone book to the public. When will it trust the public with its 10 million good ideas for solving all the problems of the health system? 
I was at the general practitioners’ conference in Queenstown 2 weekends ago. When Jo Goodhew was answering questions from the general practitioners she gave the same answer to all four questions. I will tell members what she said: “Why don’t you GPs tell us what you would do? We’re looking for your ideas.” The first time it sounded humble the second time it sounded vacuous the third time it sounded desperate and the fourth time it sounded tactical. 
It is the same with accident compensation. The only reason the public knows National’s accident compensation policy is that one of John Key’s former workmates at Merrill Lynch—[ 
Interruption 
] I raise a point of order Madam Chairperson. There is a constant barrage of drivel coming from the other side and the public does not need to hear that. [ 
Interruption 
] 
The CHAIRPERSON (Hon Marian Hobbs) 
: Sit down please; I think I can deal with this myself thank you very much. There has been a barrage from both sides actually. Members are meant to make pithy points not repetitive ones but it is not helpful to make a judgment about the interjections. Thank you. 
Lindsay Tisch 
: I raise a point of order Madam Chairperson. My colleague Jo Goodhew spoke on a matter of health; the Minister has deviated from health to talk about accident compensation. The debate is on the appropriation regarding Vote Health. It has nothing to do with accident compensation. The Minister should confine his comments to health and not talk about other subjects. 
The CHAIRPERSON (Hon Marian Hobbs) 
: I think the reference to accident compensation was a passing reference. The debate has been on health. We will continue. 
Hon DAVID CUNLIFFE 
: Accident compensation and health are of course intertwined because people require both. The point I am making is that the only reason the public has any knowledge about one National policy is that it was leaked by a company that helped to write it. That stands in contradiction with the situation regarding its health policy because either National does not have one or it does have one but is not telling ordinary New Zealanders about it. I do not know which is worse. Personally I think it is worse to have one and not be frank with the democratic process because whether one votes for Labour votes for National or votes for anybody else what is important is that one makes an educated decision. The public deserves to know whether National has ideas. How about it telling the public during the estimates debate which is forward looking and is occurring just months from the election what its policy is? Would not that be a good idea? But no National members will not do that. 
The reason they will not tell us their policy is that the last time they were in Government their experiment in market health services was a dismal failure. Why cannot health services work as a competitive private market? Well firstly because profit is not a good motive for health care and secondly because patients depend upon health professionals for their services. So there is an information problem that one cannot overcome with a market price. 
Our vision is for a health system that is collaborative that is patient centred and that is geared up through investment in each of capital development workforce development and service development and that is exactly what we have done in the last 8 years. The public know that they can trust Labour with health care—they always have been able to and they always will be able to—because our record is very different from National’s record. Our record is one of consistent investment and consistent improvement. 
Sixty percent of health costs are workforce costs. We have invested very strongly in the health workforce. Nurses doctors care workers radiologists Public Service Association workers—all the way through the sector—almost every workforce claim is now settled. Only one is outstanding and that is the junior doctors’ claim. We know what that is about and it is not about the money. 
Ladies and gentlemen the issue for the health service is where we go to from here. The public of New Zealand do not want to know just what we have done; they want to know where we are going. I will not pretend that there are no issues to be confronted but I will say that Labour has an active and consistent plan for getting there. On the workforce front we will build a nationwide demand-supply forecasting engine within the Ministry of Health that ensures we can predict well in advance where shortages will come. We will be working with each of the health workforce groups to ensure that we have a combination of short-term medium-term and long-term measures— 
Jo Goodhew 
: But you’ve had 9 years. 
Hon DAVID CUNLIFFE 
: —actions not reports—that will solve not only the workforce problems of today but also those of tomorrow. 
A health system also runs on money. There are no two ways about it. One can have all the fine theories one likes but if one is not funding the system properly one cannot do anything. Eighty percent of the health budget—and $2 billion of the $3 billion extra that we announced this year—goes into the district health board system to build health services that we can trust. I tell New Zealanders to line up the National Party members look them in the eye and ask whether they will keep increasing the health budget as quickly as Labour has increased it. What answer would they get? “I do not know; John Key has not told us yet.” Where is the phone book - sized book of policy and what does it say? I ask what those members’ policy is and whether they have a bright idea to save themselves. I do not think so; if they did why would they not tell it to us? 
To run a health system we need a workforce and we need money. What is the other thing we need? We need health information. We need information to be able to follow the patient through the system. Labour is investing in information systems in the health-care sector so that we can do things smarter. We have an ageing population. We have to look forward to the future. How do we balance rising public expectations an ageing population and limited growth potential in the health budget? We do it by working better by working smarter by cutting out waste and by having clinicians spend more of their time in front of patients and we enable that by assisting them with good business planning and good information that follows the patients through the system. Those are some of the strategic enablers that we are working on. 
Of course there is work to be done in mental health care but let us ask who has helped out there. The Government has been investing to fund the mental health blueprint over the last 8 years. It has been consistently funding— 
Sue Bradford 
: Well why don’t you make sure the money is spent properly? 
Hon DAVID CUNLIFFE 
: My colleague asks whether it is all done yet. No it is not. But when I walk around places like Waitakere Hospital and I see its brand new mental health ward I know that consistent investment is being made year on year. Ms Bradford asked a question about the Capital and Coast District Health Board. I look forward to the day which I hope is not very far away when ward 27 will be rebuilt. I know the Buckle family I know about that tragedy and I want to see that ward rebuilt. But I respect the governance decision of the district health board which has to balance that demand against the cardiac waiting list against obstetrics and gynaecology services against maternity services and against getting the new regional hospital up and running. Given the situation that the district health board has found itself in I think it is building a responsible forward plan and I know that it wants mental health services to be part of that plan too. That is very important. 
In respect of primary health care someone said to me that National was copying all of Labour’s policies. What is the difference? The difference is whether one wants Labour or “Labour-lite”. National for the first time that I can remember has actually put the words “primary” and “health care” into the same sentence. But all that those members could come up with was so-called integrated health centres—giving the problem to the general practitioners and letting them solve it. National members would not know a strategy if they tripped over one. Although the general practitioner clinics are—[ 
Interruption 
] If Jo Goodhew had had a good idea it would have been a good thing to tell it to the general practitioners’ conference instead of asking them to come up with the solutions. General practitioners are essential but they are not the only answer; the answer is to ensure that there are good linkages between primary health care delivery with low-cost access and population and public health policies that are working. That is why we are investing in Healthy Eating - Healthy Action. That is why we have been reducing the incidence of smoking. That is why we have campaigns against youth alcohol abuse. We are taking down the drivers of ill health in order to keep people well. 
How many New Zealanders now find that cost is a barrier to their accessing health services? According to the latest New Zealand Health Survey which was released just a few weeks ago the answer is 1.7 percent. Under that lot opposite with their market health-care system it would have been about—goodness me—50 percent 30 percent or something like that. The working-class which National has finally discovered suffered for a decade under that lot. They suffered in employment they suffered in welfare they suffered in health and they suffered in education. That is why the people of New Zealand sent us into Government and whatever they decide at the election we know that we have been good to our word and good to our programme. We are honestly putting our programme before them with plenty of detail and then it is up to them to choose. That is how democracy works. They get to choose and we respect their decision. But we can contrast that I say to the ladies and gentlemen who are listening with the position of the National Party. Either its members have no policy which is frightening or they have a phone book - sized book of policy that they are not telling people about. 
TE URUROA FLAVELL (Maori Party—Waiariki) 
: 
 Tena koe Madam Chairperson. Kia ora tatou katoa. The first sentence of the report of the Health Committee on the 2008/09 estimates for Vote Health should have made us feel pretty good. According to the Minister health expenditure has doubled in the past 9 years and New Zealand is beginning to see the results of this investment. Although that is great and I am all for results the funny thing is that the word “Maori” did not come up in the Health Committee report. Why should Maori be noted distinctively in this report? Because Maori are 18 percent more likely to get cancer and twice as likely to die from it; heart disease kills nearly twice as many Maori but they are only one-third as likely to have angioplasty; avoidable death rates are almost double for Maori than other New Zealanders; and on average Maori die 8 to 10 years earlier than non-Maori. Tema Whero—team Labour—is constantly crowing that the Government spends 1 in 5 tax dollars on health. So why is it that Maori obtain fewer referrals fewer diagnostic tests and less effective treatment plans? 
The Maori health statistics I quoted earlier paint a lousy picture. Where is the plan to address it? That is the question. The report of the Health Committee happily covers district health board deficits inherited deficits and operational deficits but the biggest deficit of all appears to be missing—that is the systematic deficit that we might call racism. There was perhaps one vague suggestion of this in the transcript of the discussion that took place on 25 June with the Minister and his merry men of the ministry—well to be fair there were a couple of women there as well. When responding to questions about the aged residential care industry the Minister raised the issue that wage rates are so low that turnover is very high and he concluded that there are “some very valid concerns about working conditions for the workforce many of whom tend to be Pasifika or Maori and that is not a situation which is either sustainable or proper.” We will give the Minister the benefit of the doubt and presume that it was the working conditions that were neither sustainable nor proper not the fact that the workforce is dominated by Pasifika and Maori. It is indeed neither sustainable nor proper that such gaping inequalities and levels of deprivation and deficit characterise Maori health within our national health system. 
What can be done to urgently turn the situation round? Well first off we have to get to grips with the reason why the Maori population is overwhelmingly dominant not only in the low-wage sector of the health workforce but also in every negative statistic across the health system. To help Dr Matire Harwood the director of Maori health for the Medical Research Institute suggests that the basis for such inequalities is found in the fact that racism is thriving in the health system. She describes three levels of racism that must be confronted. There is the systematic racism that drives inequalities and health determinants there is the one-on-one racism within the doctor-patient relationship and finally there is the level of internalised racism that is observed in individuals—in this case Maori feeling as if we do not deserve to have certain procedures. 
Although the media profiled these revelations of racism which Dr Harwood talked about just this morning on Radio Waatea the faces of racism are not exactly unknown to the State. I am thinking back to the report some 20 years ago called  
Puao-te-ata-tu 
—Day break 
 and it is fitting to refer to that ground-breaking report today on the day that Tuhoe have come to Parliament to sign an agreement with the Crown to settle their historic grievances. The group that produced  
Puao-te-ata-tu 
 was of course chaired by John Te Rangianiwaniwa Rangihau of Ngai Tuhoe who made a major contribution to the renaissance of tangata whenua through his work with Government departments as well as through the wananga he founded in culture and history for the people of the Tuhoe nation and wider.  
Puao-te-ata-tu 
instructed the Government that the most destructive form of racism is institutional racism—the outcome of monocultural institutions that simply ignore or freeze out the cultures of those who do not belong to the majority. Why is it that 20 years after Parliament received this report we are still witnessing the desperate statistics that constitute the crisis in Maori health care yet the Health Committee’s report neglects to even speak the name Maori out loud? 
Hon DAVID CUNLIFFE (Minister of Health) 
: 
 I take just a quick call to say that I was very tempted to take a point of order on the grounds of my taking offence at the use of the word “racism”. 
This Government cares very deeply about inequalities and about reducing those inequalities and is very passionate about the health of Maori people. Investment in Maori health runs to the tune of many billions of dollars under this Government; under the population-based funding formula Maori have significantly higher funding per capita than non-Maori. Some of these improvements are showing up in the fact that for example under Labour infant mortality has declined in the total population by 28 percent yet has declined in the Maori population by 43 percent. Infant mortality for Maori has declined by 43 percent during the life of this Government—that is nearly double the rate for the general population. 
Of course there is more to do but neither the member nor the public should be in any doubt that the Government’s heart is in the space of wanting to help Maori and work with Maori. That is not about paternalism; it is about understanding that the way to reach Maori communities is through iwi hapu whanau and using Maori providers—by Maori for Maori. That is why in this year’s Budget we have brought in a much larger funding stream for Maori provider development. That funding is on top of the money that is going to Maori health through the district health board system. 
So this is just a short call to say that. I do not want to disagree with the member—I think Maori health is essential. Apart from anything else—apart from the ethics and apart from the principles of the Treaty that we adhere to—there is a reality here that by 2020 one-third of all New Zealanders will be Maori or Pasifika in origin and if we do not have all our people healthy educated and productive we will all go down the economic toilet together. 
TE URUROA FLAVELL (Maori Party—Waiariki) 
: 
 I raise a point of order Madam Chairperson. I was not sure whether the Minister took a point of order. 
The CHAIRPERSON (Hon Marian Hobbs) 
: No he did not. He called to speak which he is entitled to do. He can take multiple calls. 
TE URUROA FLAVELL (Maori Party—Waiariki) 
: 
 I raise a point of order Madam Chairperson. With regard to the statement made by the Minister around the word “racism”— 
The CHAIRPERSON (Hon Marian Hobbs) 
: I warn the member to be very careful. That is a debating point. Are you going to enter into debate? If so you will have to take another call. 
TE URUROA FLAVELL 
: No I just want to say that that reference was taken out of Dr Harwood’s report; that is all. 
The CHAIRPERSON (Hon Marian Hobbs) 
: Thank you. 
Dr JACKIE BLUE (National) 
: 
 I say to the Minister that National has an idea and a policy that we would be really happy for him to copy. It is to free up money so that women can get 12 months’ supply of Herceptin. We would be very happy for the Minister to take that up right now for women; they need it. This is a critically important issue for women and their families. 
When I was speaking as a new MP this issue came to the forefront and began with such hope and such excitement. The results of large international trials were coming through and they were showing that breast cancer recurrence rates—that is coming back in the bones the brain or the liver—were reduced. Let us face it. When cancer comes back in those organs there is a very poor outlook and it is not surprising that the studies were also showing that there were improved survival rates. Medsafe moved really quickly and New Zealand was the first country in the world to register 12 months of Herceptin usage. A few months prior to that in December the pharmaceutical company had made an application for funding for 12 months’ supply—a decision that Pharmac turned down outright without consultation. That was the basis of the April decision by the High Court to direct Pharmac to re-consult and to review its decision. 
Since 2006 we have had to sit back and watch 33 other countries one by one fund 12 months’ supply of Herceptin. I go back to 2006. The issue bounced around the various Pharmac committees but it was clear over 2006 that Pharmac had become very interested in a very small Finnish trial that gave women only 9 weeks of Herceptin. The results were interesting—yes they were interesting—but they were not statistically significant. But Pharmac did not seem to be bothered by that at all. In fact Pharmac seemed to become quite fixated about the idea of 9 weeks of Herceptin so from July last year women were funded to have 9 weeks’ supply only. 
I have not met one cancer specialist yet who is of the opinion that 9 weeks is the standard of care and has the evidence to back it up. Pharmac even made an application to Medsafe for the 9-week regime but Medsafe turned it down because it lacked the clinical evidence. It also agreed with the cancer specialists but did not have the clinical evidence backing it at all. So to give the 9-week Herceptin regime some legitimacy Pharmac decided to give women a clinical trial whereby half the women would get 9 weeks of Herceptin and the other half would get 12 months. It proposed that women would enter the international short-or-long-duration trial. But it does not seem as though that trial is going to get off the ground. It needs 3000 women. Pharmac started recruiting in January this year but until May this year— 
Jill Pettis 
: Jackie say it like it is. National cannot both give tax cuts and supply Herceptin for 9 months. 
Dr JACKIE BLUE 
: I am telling the member how it is. Only 39 women have been recruited internationally and the preliminary result presuming the researchers can get 3000 women—they want 600 from New Zealand—will not be available for another 7 years. This is really important. Women with aggressive HER2 breast cancer do not have 7 years to wait for these results to come through. They do not have the luxury of waiting for 7 years to see whether the 9 weeks is a goer. 
None the less we have the situation that from 1 July women are getting only 9 weeks of treatment. It is an unproven course there is no trial and I do not think there will be a trial in my opinion. Here and now women with HER2-positive breast cancer are being advised by their specialists that 12 months is the best standard of care internationally. Specialists have told me that they feel they have a moral duty to tell women all the facts. The facts are that 9 weeks is not proven and 12 months is the better option. We can see what is happening. Women have been told the truth and the fortunate few who have had the resources the community support or the house to mortgage are doing that to raise money desperately. They want to live and they want to see their children grow up. A fortunate few can do it but hundreds and hundreds of others do not have the community support do not have the house to mortgage and do not have the resources to do it. 
This is the most vulnerable time in these women’s lives. Can members imagine being diagnosed with the most aggressive form of breast cancer and being told that 12 months of treatment is the better course but they can be given only 9 weeks? They want to live—boy do they want to live. Make no mistake these women who have a suboptimal treatment of Herceptin face an uncertain future. They do not know whether the 9 weeks will be a goer. There is no proof that it will be. They want the best insurance and the best insurance is 12 months of Herceptin. 
Pharmac reviewed this decision yesterday. We understand that a decision is coming out next week. Pharmac called for submissions and there have been over 300. I read the submission from the New Zealand breast cancer special interest group which represents the majority of breast cancer specialists in New Zealand and it overwhelmingly backed a 12 months’ supply of Herceptin. 
Hon DAVID CUNLIFFE (Minister of Health) 
: 
 I had not intended to take another call right now but there were some significant factual inaccuracies in Dr Jackie Blue’s contribution. For the sake of New Zealand women particularly those who are vulnerable and worried because they have Herceptin-positive breast cancer— 
Hon Dr Nick Smith 
: I would trust Jackie Blue any day. 
Hon DAVID CUNLIFFE 
: The public would not trust Dr Smith; nor would the courts. I suggest he just cans it. 
The facts of the matter are that the FinHer trial is statistically significant for disease reduction. That is not in contention. What is also not in contention is that the mean efficacy of the FinHer trial is very close to—actually slightly better than I understand—the mean efficacy of a number of the 12-month trials. What this debate boils down to is a technical debate about the additional value of additional sample size. It is an extremely complex debate and I think that is why it is very good that we have an independent technical body that is advised by clinicians and that goes through a transparent and rigorous process to answer those questions. It is not about politicians debating in the House and saying “Oh I think the wind is blowing that way.” It is about serious rigorous analysis as it should be because this is about the lives of New Zealand women. 
Pharmac is consulting. I understand that Pharmac will be making an announcement next week and the Government will have something to say at around that time. 
Hon Dr Nick Smith 
: You will have to eat some humble pie because Jackie is right. It will be time for humble pie. 
Hon DAVID CUNLIFFE 
: I guess Dr Smith must be a doctor of philosophy not a doctor of medicine; otherwise he would not be making such a fool of himself. 
The facts are that this is a complex debate. The facts are that we have a very robust process under way and I understand that Pharmac has been working very very hard on this issue for some considerable time now and has heard all sides of the story. We will all have to wait to see what the announcement will be next week. Thank you. 
JILL PETTIS (Labour) 
: 
 One of the things we have to be really careful of in the health sector—and most of us who have worked in the sector are aware of this—is not to exploit the vulnerability of a group of people who think they will get everything they want delivered to them. That member over there Jackie Blue who has worked in the health sector and in the area of women’s health knows that National cannot deliver the tax cuts it is promising to New Zealand and deliver 12 months’ supply of Herceptin. I do not believe that at all—not for one single minute. National is not telling the women of New Zealand the truth and I think that is despicable. National is telling them tattle and telling them that repeatedly. I despise it when vulnerable women are exploited for political purposes. I say to those 5-minute Tories over there—most of whom were not here in the 1990s when the health sector was decimated by National—that they should give us a policy. I ask them to give us a policy—just one. There is none—absolutely no response at all. 
I can tell the people of New Zealand who care about health issues—and a large number of New Zealanders do care about health issues—that under National the cash registers will be back in the hospitals again. There will be an increase in private insurance take-up—as there was when National was last in power because people were fearful of never getting their treatment. They were fearful they would never see it so the health insurance take-up rate increased. Health insurance rates will increase again. National members’ mates in the insurance industry know that; they are rubbing their hands with glee knowing that their profits will increase. 
Under Labour health spending has increased to $13 billion and we are delivering more services than National did. There are lower doctors’ fees—it costs $22 less than it did previously for most families to see a doctor now—and prescriptions are down to $3. We remember what it was like in the 1990s when people left prescriptions sitting on the chemists’ shelves because they could not afford to pick them up. There have been 5000 more elective surgery discharges this year alone and those of us who actually run constituency clinics—those of us in Labour who actually see people—know that. We do not have to write letters to the hospitals asking when Mr Brown or Mrs Smith is to receive his or her surgery. People know when they will receive their surgery because the waiting lists are not a sham like they used to be under the former National Government where people were just dumped on to waiting lists. People now know once they are on the waiting list when they will have their operation. National hid people on waiting lists; it gave them the panacea of being on a waiting list saying “You’re going to get your operation Mrs Brown.” Then Mrs Brown lived in totally false hope because she did not understand that she was being manipulated and used by the former National Government. 
As for cancer treatment I remember—I am not a 5-minute MP like those 5-minute Tories over there are—that the former National Prime Minister Jenny Shipley ignored the advice of the cancer health specialists the non-politicians about the dramatic capital expenditure that was required on linear accelerators in order to treat the increasing number of people who required treatment against cancer. Jenny Shipley and the National Government of that time in which Nick Smith was a Cabinet Minister ignored that advice. When we came into Government we found that massive capital expenditure on linear accelerators and on getting cancer treatment equipment into our key hospitals was required. The National members did nothing. They played politics. They played Russian roulette with the most vulnerable people in New Zealand. 
We know what it is like to have friends and family members die from cancer. We know what that is like and we know how vulnerable our nieces nephews and sister-in-law were when they lost their father and partner at the age of 41. We know what that is like. We do not play politics with vulnerable groups of New Zealanders and I say the National members should not do that either. 
Vote agreed to. 
Vote Communications agreed to.  
Vote Environment 
Hon Dr NICK SMITH (National—Nelson) 
: 
 We have an extraordinary situation with the Ministry for the Environment. After 9 years of the current Government the Minister comes to the Local Government and Environment Committee and tells us that the ministry has a lack of focus serious problems in meeting its objectives and major operational difficulties. The question one has to ask is: who has been in charge for 9 years? If we look at each of the key areas where we should be making progress on the environment we see that the Government is in a very serious pickle. Let us look at an area like climate change. The Government came into office promising to reduce emissions by 20 percent. In fact we have found out that emissions are actually up by 20 percent on what they were when Labour came into office. If we look at an area like water quality we see the Ministry for the Environment’s new chief executive describing the Government’s programme of action on water quality as a programme of inaction. Is that not unreal? The incoming chief executive to the Ministry for the Environment says that this much-vaunted programme of action is actually a programme of inaction. 
Hon Shane Jones 
: You’re making it up. 
Hon Dr NICK SMITH 
: Shane Jones says it is not true. Well I have to say that Jim Anderton accepts that it is true. The Minister in the chair Trevor Mallard nods his head and says it is true. So we see splits in the Labour ranks already. Shane Jones does not even accept the view of the Minister. 
Then we come further down the picture to what is a very serious issue which is that in the report from the select committee the Government says the successful clean-up of Mapua should be noted. Successful? Well the Parliamentary Commissioner for the Environment has said this: double the time double the money and breach the resource consents. Here is the Ministry for the Environment which is in charge of the Resource Management Act breaching its own consent. It said that it ignored requests from the local council to clean up and to comply with the consent. It refused and ignored the advice of the auditor and of its own review team. What really concerns me about the situation of Mapua and the Parliamentary Commissioner for the Environment’s report is that the Minister is in denial. The Minister has not accepted the key conclusions despite the Parliamentary Commissioner for the Environment doing a 2½-year review of that particular clean-up. What worries me is that if the Minister is in denial how do we know that the same mistakes will not be repeated all over again when it comes to the Tui mine. I say to the Minister in the chair Trevor Mallard that he owes the people of Mapua an apology. 
Hon Trevor Mallard 
: If one person owes an apology it is that member. 
Hon Dr NICK SMITH 
: Well for the Minister in the chair that seems to be a standard line. Labour has been the Government for 9 years but everything is the fault of the National Party! When was the Mapua clean-up done? It was done in the years 2005-06. How is it possible for anybody other than this Government to have responsibility? The problem with this Government is that it is always everybody else’s fault even though the decision to have the resource consent held by the Ministry for the Environment was a decision of the Minister. 
I say to the Minister in the chair that he owes an apology to the people of Mapua for the botched clean-up. The Minister owes an explanation as to why the advice of the local council the local authority was ignored when it advised that the consent conditions should be complied with. They need to provide an explanation as to why more than 5 tonnes of copper sulphate without a consent was used in the clean-up process. An explanation needs to be provided to the local residents who wrote to the Minister and said they were getting sick. There were doctors’ reports of people getting sick and the ministry ignored them. I say that Mapua is another sad chapter in the environmental failure record of this Government. 
Hon TREVOR MALLARD (Minister for the Environment) 
: 
 If there is one person who should be apologising for the Mapua clean-up it is the former member for Tasman Nick Smith. He is the person who put inordinate pressure on the local council to get it moving. He is the person who put inordinate pressure on it to set up a scheme with conditions. 
Hon Dr Nick Smith 
: The Minister is never responsible. Who’s the Minister? 
Hon TREVOR MALLARD 
: There was no Minister responsible for the Tasman District Council making its application for a resource consent. But there was a lot of pressure from the local member Nick Smith for that to happen and he should stand up— 
Hon Dr Nick Smith 
: Where’s that in the report? 
Hon TREVOR MALLARD 
: It is not in the report; it is a matter of fact. When it became clear that the council could not meet the conditions and that the whole scheme that the member had helped to design was falling apart that member said: “Oh we can’t do it this way. Please take it over Ministry for the Environment.” He ran crying to the Ministry for the Environment and asked it to take over the existing consent that he had pressured the Tasman District Council into obtaining. 
Sue Moroney 
: He stuffed up. 
Hon TREVOR MALLARD 
: Well “stuffed up” is a very nice expression for it. I would say it was the height of a word beginning with “h”. Hearing him complain about it now— 
Hon Dr Nick Smith 
: Tell the truth for a change. 
Hon TREVOR MALLARD 
: I raise a point of order Mr Chairperson. I object to that. The member made an unparliamentary remark and I ask him to withdraw and apologise. 
The CHAIRPERSON (Hon Clem Simich) 
: Dr Smith would you please withdraw and apologise. 
Hon Dr Nick Smith 
: The words I said to the Minister were “Tell the truth for a change.” because everything he has said to date is a fabrication and is untrue. 
The CHAIRPERSON (Hon Clem Simich) 
: I think that is playing with words although that may well be what you said. I object to the words too so would you withdraw and apologise. 
Hon Dr Nick Smith 
: I withdraw and apologise. 
The CHAIRPERSON (Hon Clem Simich) 
: Thank you. 
Hon TREVOR MALLARD 
: If anyone is responsible for people in Mapua being sick it is that member Nick Smith. It does not matter how much he denies it it does not matter how often he denies going to the then Minister for the Environment and saying that the Government should not give all the money that it was proposing to give for the clean-up and that it should give only half of it; that is what Nick Smith said. 
Hon Dr Nick Smith 
: Not true. 
Hon TREVOR MALLARD 
: Oh he says that is not true. That is now on the record and it will be the subject of a breach of privilege. That member has clearly misled the House in an interjection because we have already had a statement in this House from a very honourable member that that was the case. Nick Smith approached Marian Hobbs asked her to halve the amount that the taxpayer was putting in and suggested that the district council should be required to put in the balance. That is what Nick Smith did. I think he might have spent far too much time too close to that clean-up. There is certainly some sign of an effect on his memory of the whole sad procedure. When this story is fully told it will be another nail in the coffin of Nick Smith. Maryan Street will be cleaning him up. 
NICKY WAGNER (National) 
: 
 New Zealanders identify very closely with the natural environment. They want to live in a country that is truly clean and green and they look to the Government to deliver on the big environmental issues of the day. But this Government has failed and it has failed in many ways. Yes the Government talks of sustainability and yes it pays lip-service to looking after the environment but it simply does not deliver. The Ministry for the Environment struggled to deliver last year. For months it was distracted from its core business and it showed. As Dr Nick Smith has already commented the Minister himself acknowledged that the ministry did not deliver on its key objectives. The Minister blamed the small size of the ministry but it would seem to me and most New Zealanders that a ministry of 262 employees with a budget of $64 million—going up to $84 million in 2008-09—should be able to make some progress on our pressing environmental issues. These environmental issues are important and pressing such as the management of fresh water environmental sustainability and climate change. 
The Local Government and Environment Committee at estimates time was particularly concerned about the delays in the management of fresh water. We are still very impatiently awaiting a national environment standard for the measurement of water takes and a national environment standard on ecological flows and water levels. They are well overdue. However the long-awaited national policy statement for fresh water management was released last week and that was a real disappointment. The draft national policy statement was quite rightly slated by several non-governmental organisations including Fish and Game New Zealand the Royal Forest and Bird Protection Society and the Water Rights Trust from Canterbury. The final statement was no better. It is vague it is wishy-washy and any improvements to water quality will be a long way away and extremely expensive. In fact believe this or not at estimates time the Minister confessed that improvements in water quality may not be seen for up to 50 years—50 years! Worse than that in some areas it is likely to get worse before it gets better. That is not what the people of New Zealand expect from this Government. 
Time and time again constituents tell me that water quality is the most important and pressing environmental issue for them. I come from Canterbury and the region has real issues with water quality and water quantity. It has been identified that the “first in first served” method of water allocation under the Resource Management Act has proved an insurmountable barrier to better water management. Therefore looking for alternatives to the “first in first served” method is important and extremely urgent. So it is a real disaster that the Cabinet paper concerning the water plan of action due in March 2007—I shall say that again: due in March 2007—is still missing in action. It is no wonder that the Minister does not expect any improvement in water quality for up to 50 years. 
Again in Canterbury but also throughout the country the public is concerned about the effect of intensive farming particularly dairying on water quality. One would expect the ministry to be very focused on this important issue but no the baseline report on the environmental outcomes of dairying and the Clean Stream Accord which was due to be completed in 2007—I shall say that again: it was due to be completed in 2007—is still not available. 
It is no wonder that the Minister does not expect any improvements in water quality for up to 50 years. We had hoped that in 2003 when the Sustainable Development Programme of Action was launched with much fanfare we would get some real action and some subsequent improvements in the environment. 
Hon TREVOR MALLARD (Minister for the Environment) 
: 
 In case the member Nicky Wagner had not noticed—and I know that there was not a lot of publicity about it although a former Minister for the Environment Simon Upton seemed to notice it—the draft national policy statement was released last week or possibly even the week before. I know that it is a bit much to expect that member to stay up to date but to criticise people for not releasing something when it was released so recently is really— 
Hon Dr Nick Smith 
: No the issue was the Cabinet paper on allocation. 
Hon TREVOR MALLARD 
: Dear oh dear! 
I want to refer to the Canterbury problem because there is certainly a problem with the allocation of water in Canterbury. The core of the problem is that the Canterbury Regional Council does not have an operating plan—unlike I think every other regional council in the country. Some of them are up to their second iteration; they are on a renewal 10 years on. Unfortunately because of a lack of competence on the part of past district councillors in the Canterbury region there is not a proper operating plan. There is a very real problem. It can certainly be argued that there already has been an over-allocation of water in Canterbury. That is bad for the economy and there are dangers to the environment—certainly in terms of recreational aspects. There are lots of problems as a result of that. 
I find it slightly interesting that the member is criticising the problems with water in Canterbury and blaming them on the Government when it is my understanding that that member was a member of the council that did not do the work that it was meant to do. 
Hon Dr Nick Smith 
: She was a very good member. 
Hon TREVOR MALLARD 
: She was a very good member of a group that was not competent and did not do the job in the way that other— 
Nicky Wagner 
: 50 years! 
Hon TREVOR MALLARD 
: The member cannot say 9 years to me. That member— 
Nicky Wagner 
: Nothing is ever his fault! 
Hon TREVOR MALLARD 
: Actually I refuse to take responsibility for the Canterbury Regional Council not putting a plan in action. Maybe I should sack its members. I have the right to sack them for not doing it. But the trouble is that I would be sacking the people who are trying to fix it up now whereas it was other people who should have done the job and did not do so. One of those people is sitting opposite me in the House and she had the cheek and the gall to raise the issue now. I do not know whether she has been spending too much time with Nick Smith sharing the same air as him—I do not know what the problem is—but I regret the fact that the National Party gives such a low priority to environmental matters that it appoints those two people to do the job. 
MOANA MACKEY (Chairperson of the Local Government and Environment Committee): 
 I am happy to stand in this debate on Vote Environment. I thank the Minister for the Environment for the very good session that we had at select committee. It is true that the Ministry for the Environment has come under increasing pressure with its workload in particular because of the importance that this Government has placed on environmental issues. I thank the Minister for the very frank and honest discussion we had at select committee. I noted with amusement the comments from Dr Nick Smith that the Minister never takes responsibility for anything; I think that at select committee the Minister very much took responsibility for some of the things that had not gone right in the past in the ministry and said he was prepared to work on fixing those and making them better. So I do not think at all that that is a fair reflection and I look forward to the work being done in the Ministry for the Environment in the future to make sure it can deliver in this increasingly important area of Government policy. 
I have to say it is a bit rich being lectured by the National Party on environmental issues—a bit rich. If National will slash public servants across the board in all the ministries then I ask Dr Nick Smith: who will be doing this work in the Ministry for the Environment? Oh I am sorry; Judith Collins is right—National flip-flopped on that. It will not slash them any more; it will have a sinking lid—a sinking lid of public servants in ministries regardless of what is needed. We have yet to be told a single job title that is included in this area—a single person who will be slashed. Somehow they are basing all their spending promises for the election on public servants who may or may not be out there and now we have the sinking-lid policy. Well that is very interesting given that a number of the issues are due to the overextension of the Ministry and given that environmental issues in this country will only get greater and have a greater need for people working on them. 
I say to the National Party speakers who tried to somehow suggest that a National Government would be better in the area of environment than a Labour Government that theirs is the party whose leader did not believe in climate change and theirs is the party that has opposed every single piece of meaningful environmental legislation that has come through the House. My colleague Sue Moroney talked about the drinking-water standards bill. Apparently we have to be lectured by Nicky Wagner about the quality of water yet they voted against that bill. They are voting against the emissions trading scheme and they are voting against the Biofuel Bill—they find some reason to vote against every single piece of meaningful environmental policy that comes into this House. 
To stand up in this Chamber and somehow suggest that a National Government would be better for the environment is absolutely laughable. I want to know how good it will be for the environment to have a Government like National which says it will gut the Resource Management Act. Judith Collins says yes—they will gut the Resource Management Act and somehow they will protect our natural resources and our natural environment! Well that just shows the double-speak we are hearing from that party over there. If members talk to anyone who has had environmental concerns where industry has tried to run roughshod over the rights of individual people or to people who are concerned about their local environment they will see that the recourse they have is the Resource Management Act. The National Party should tell us exactly how much it will rip the guts out of that important environmental legislation. I think many of the National Ministers of the past who put that legislation into place and thought it was good legislation would be very unhappy at the prospect of it having its guts ripped out. I know there are many people in the community— 
Judith Collins 
: Why do you have to be so crude? 
MOANA MACKEY 
: Well I say to Judith Collins that that is what her party has said. That is what National has said. This is par for the course for the National Party—when we tell the truth and talk about policy they claim we are being rude and personal. I am not. The National Party has said that it will tear the guts out of the Resource Management Act. That is what it says when it is in front of its industry and farmer groups that want them to do it; when it gets in front of environmental groups that might not like it it probably softens the language a little bit. Crosby/Textor has obviously told them to do that to tailor their message to their group so it will get through a bit more and they will get everyone’s votes. I am sure that that is what they have been told. 
It is astonishing. We can even look at the case of Mapua where National members have voted against every single appropriation for the remediation of contaminated sites that has come before this Parliament. Then they get up in this House and criticise the work that this Government has been doing cleaning up the remediated sites. This is an area I used to work in. I was a team leader in a persistence organic pollutant lab. I worked on the remediation of Homebush Bay in Sydney so I know that this is not easy. I think sometimes people need to appreciate that the remediation is not nice and easy and that there are nasty chemicals involved. Everyone knows that but one makes a call that environmentally it may be better to do that than to have these awful chemicals lying in the ground and leaching into our water tables—that is a call one makes. But the point is that for National members to get up in this House and criticise this Government when they come from such a flimsy base as the National Party is absolutely—absolutely—abhorrent. 
Vote agreed to. 
Vote Labour 
Dr WAYNE MAPP (National—North Shore) 
: 
 One of the extraordinary features that we have seen over the last few weeks is the panic that has beset the union movement and the Labour Party. Certainly the Minister of Labour speaks from the unions’ play card whenever he speaks. Frankly I am quite— 
Hon Trevor Mallard 
: I raise a point of order Mr Chairperson. The suggestion that outside people dictate our actions in the way that the member has just suggested has long been ruled out of order. I think anyone who knows my relationship with the union movement knows that it is absolutely untrue. 
The CHAIRPERSON (Hon Clem Simich) 
: That was the suggestion that the speaker was implying. Would you withdraw it please. 
Dr WAYNE MAPP 
: I withdraw. I can only say that there was a remarkable similarity between the press release sent out by the Engineering Printing and Manufacturing Union and the words used by the Minister. I guess readers will draw their own conclusions from that. 
I have to say that when the Employment Relations (Probationary Employment) Amendment Bill was introduced Mr Little debated the issue quite responsibly and was quite considered and deliberate. But now that we are much closer to an election and his union has been registered as supporting Labour—that is why it has been registered; for being an affiliate of the Labour Party—panic has set in. Extravagant language is being used by him. 
But I want to remind members what this is all about. National’s proposal was actually about boosting employment opportunities. The one thing that small-business people want—and this is what their working party has been saying to the Government—is more flexibility so that they can employ more people. What does the Government say? It says that it could not possibly do that. Do members know the ridiculous position that the Government has got itself into? It has got itself into the position of saying it wants to be the only OECD country that does not have any form of probation period. Members of the Government scream out from the top of their lungs that a probation period would be like having the ability to fire at will. Does the Minister of Labour seriously believe that the Scandinavian countries—so beloved by this Government—would actually have such a policy? No they do not. 
I suggest to the Minister that he looks at the bill and indeed the amendments in the bill as it was reported back in 2006. We understand that we have to be fair to people. We proposed that if there were a breakdown in the relationship in those 90 days there would be mediation. The cant and the untruths being spoken by various people in relation to sexual harassment and so forth are simply completely false. No one would suggest taking away people’s procedural rights under either the Human Rights Act or indeed employment legislation on such fundamental human rights. 
We know that Labour is desperate when it throws up spurious arguments that suggest that National has some terrible agenda even though the Norwegians the Swedes the Danes and indeed the Finns find our proposal perfectly reasonable. Those social democrat countries which are beloved of Labour find our approach perfectly reasonable. I say to the Government that it should take a lesson from the countries that it is always holding up in this House and elsewhere in the nation as an example and adopt best practice because those countries have faster growth rates and higher levels of prosperity and skill than New Zealand does. One of the ways they do that is through more flexible and appropriate labour law. 
I guess the Government is a little bit like the mother looking at her young son marching with others in the army and saying: “You know Johnny is the only one in step.” Is that not exactly the case with this Government? We are apparently the only country amongst the 30 members of the OECD that has got it right. How can the Minister seriously suggest that to the public of New Zealand? How can he seriously expect New Zealanders to take that as a legitimate proposition? 
Editorials in the newspapers view our policy as a very sensible and reasonable measure. We chose 90 days precisely because it was a reasonable measure. I say to New Zealanders that National’s employment relations policy is reasonable and considered. National understands that the majority of people do not want to return to the Employment Contracts Act. We understand that the way to deal with the next 10 years is not to look back 20 years but to look forward and to follow best practice. We understand that some rebalancing was done with the Employment Relations Act. We understand that that took place in the year 2000. The Employment Relations Act has been reasonably effective. We do not want to throw out all of that work. However we do want to improve it. Is Labour seriously suggesting to the nation that its employment law is as good as it gets and that we are the only country amongst the 30 advanced economies that should not legislate for a reasonable probation period? And I have to say that a probation period of 90 days is at the shorter end of the scale. 
I say to the Minister of Labour and to Andrew Little that they should calm down. I know that an election is only a few weeks away and that they are getting desperate—hence the hyperventilating in the press releases; hence the hyperventilating by the Minister when he is on his feet in this Chamber—but they should take a step backwards because the scaremongering and hysterical language are seen for what they are which are indicators of a Government in panic. I guess when one is 20 points behind in the polls one might panic. But if the Government wanted to do itself a favour it would show a certain amount of coolness under fire—something that it is unable to do. Panic is the byword and the public will see through that. 
The public will see that National’s policy is balanced it is reasonable and it takes a fair approach to the interests of employers and the interests of employees. It builds on the better features of the Employment Relations Act. I concede that some features of the Employment Relations Act are acceptable. That is why we are not proposing a repeal. We are not suggesting that we should go back 20 years for solutions. That is the Labour way. Labour always looks back to the past. It thinks it can win the election by saying that the public of New Zealand need to think about what things were like 18 years ago—that that is the future of New Zealand. Well the public are not fools. They know that our policies are balanced and reasonable. One has only to look across the range of our policies to see that we understand what New Zealanders have voted for over the past 9 years what they have embraced and what we need to go forward. We understand that things are progressive. [ 
Interruption 
] I say to the member who is trying to interject Mr Burton—who I guess will have some time next year to contemplate his retirement—that New Zealanders can recognise balanced reasonable policies that fit within the broad spectrum of the OECD. 
When a country is at 22 in the list of OECD countries it has to do some things to get itself up the scale—things that make employment opportunities more efficient and more effective. Our policies will do precisely that. National members are looking forward to the contest. It might be one that is causing a certain amount of angst amongst Labour and its allies in the unions like the Engineering Printing and Manufacturing Union at this time but the truth is that I trust New Zealanders to take a reasonable and considered approach to our policies and to look forward to the next 10 years. People know that we have to do better than sit at No. 22 in the OECD and that the only way we can improve vis-à-vis Australia is to have a balanced approach to employment relations policy and indeed to a whole range of policies. Unlike the Government we are looking forward to the next 10 years for this nation. 
SUE MORONEY (Labour) 
: 
 We now know the words that Crosby/Textor has given to the National Party to use for its industrial relations policy—“fair and reasonable”. How many times did Dr Mapp feel forced to say those words in that 5-minute speech—that tirade about how terrible things are in industrial relations here in New Zealand. Well look—all New Zealanders know I tell Dr Mapp that peace has broken out in industrial relations in New Zealand under Labour. Not only have we had the most peaceful workplaces we have had for a long time in this country under Labour and the fairest workplaces we have had for a long time but we have also managed to bring the unemployment rate down to the second lowest in the OECD. When the member talks about Labour and industrial relations he is taking his words from Crosby/Textor and talking about “fair and reasonable” as often as he can. But how fair and reasonable can it be to take away workers’ rights in the most vulnerable time of their employment which is the first 90 days of employment? 
Oh but National will do that only for small businesses. Well I do not know whether National members have spoken lately to any people who operate small businesses around the country but they must be completely out of touch because when I talk to those people can members guess what they say their No. 1 problem is? Their No. 1 problem is getting skilled staff to apply for their jobs. I ask Dr Mapp whether that is right. Their No. 1 problem is getting skilled staff for their jobs. But under National’s policy—guess what? Can members guess what will happen under National’s policy? People who are skilled will determine not to apply for jobs with small employers because they will know that under National they will lose all their employment rights for the first 90 days. That is National’s big plan to help out small businesses but it will take those businesses further backwards. How out of touch is that? It is not only out of touch with what small businesses need but also out of touch with New Zealanders and their understanding of fairness and reasonableness. They know that a business having the right to sack workers for no reason at all—for any reason or for no reason at all—during the first 90 days is not the New Zealand way I tell Dr Mapp. It is not fair it is not reasonable and New Zealanders do not want that type of unfairness in their workplace. 
What New Zealand workplaces have thrived on is the types of fair policies that have been brought in under this Labour Government the ones that we are continuing to bring in and the ones we are still looking for such as making sure that workers actually get their legal entitlement to have meal breaks and rest periods and that they are also able to breast-feed in the workplace. These are the sorts of progressive polices that workers and employers are looking for in their workplaces—not those old-style “take away workers’ rights” policies that have always been the National Party’s view of how productivity is driven up. Last time National was in power it thought the way to increase productivity was to drive up unemployment. That was its plan for increasing productivity and it put a wage freeze on in this country. That is in fact what happened during the 1990s. I used to represent low-paid workers whose wages went down over the course of the 1990s because the National Government took their penal rates away. The penal rates of low-paid women workers were taken away by National. 
Those are just the tired old worn-out policies that that party is bringing back. National will take away workers’ rights and reduce their incomes all in the name perhaps of pretending to increase productivity. Well we have been there before we know what it looks like and New Zealand workers and workplaces do not want it. And small businesses do not want to get into a position where no one will apply for their jobs because those workers are so concerned about being sacked for no reason at all in the first 90 days. 
A party vote was called for on the question that Vote Labour be agreed to. 
Ayes 60 
New Zealand Labour 49; New Zealand First 7; United Future 2; Progressive 1; Independent: Field. 
Noes 49 
New Zealand National 48; Independent: Copeland. 
Abstentions 9 
Green Party 5; Maori Party 4. 
SUE MORONEY (Junior Whip—Labour) 
: 
 I raise a point of order Mr Chairperson. In relation to the vote that was just recorded for Gordon Copeland I tell the Committee that Labour holds the proxy vote for Mr Copeland on this legislation. 
Hon TREVOR MALLARD (Minister of Labour) 
: 
 This is a very serious matter because on a confidence vote if a vote has been cast directly against the wish of the member by a member who has no right to cast it I think it could well be a matter of privilege. I think we need a very quick apology in order for that not to occur. 
TIM GROSER (National) 
: 
 I withdraw the vote recorded for Gordon Copeland Mr Chair. 
The CHAIRPERSON (Hon Clem Simich) 
: Thank you Mr Groser. Is someone going to speak for Gordon Copeland? 
SUE MORONEY (Junior Whip—Labour) 
: 
 One vote in favour. 
The CHAIRPERSON (Hon Clem Simich) 
: One vote in favour. 
A party vote was called for on the question  
That Vote Labour be agreed to. 
Ayes 61 
New Zealand Labour 49; New Zealand First 7; United Future 2; Progressive 1; Independents: Copeland Field. 
Noes 48 
New Zealand National 48. 
Abstentions 9 
Green Party 5; Maori Party 4. 
Vote agreed to. 
Vote State-Owned Enterprises agreed to.  
Vote Community and Voluntary Sector 
JUDY TURNER (Deputy Leader—United Future) 
: 
 This year we have seen some very important changes for the community and voluntary sector. It is interesting and should be noted that the drivers for much of that change have been the fulfilment of the 2005 supply and confidence agreement the Labour-led Government has with United Future. From 1 April this year all donations to registered charities from individuals are able to have a 33.3 percent tax refund with no cap on giving. The only limit on companies is a company’s own net income. Unlisted companies can now participate and Maori authorities can now participate. That single policy gained by United Future has the potential to deliver a level of support and cohesion in New Zealand communities that is unprecedented. 
Civil society is not solely reliant for its health on Government action. It is also sustained by strong families and connected communities. The community and voluntary sector provides us with all the chances to belong to to contribute to and where necessary to be the recipients of caring community networks. We have not finished just with that and in this recent Budget our party also continued our support for the charitable sector—the community and voluntary sector—by introducing some mechanisms to make payroll giving a possibility so that people who give on a regular basis to a registered charity can enjoy receiving the rebate in their pay packet that week rather than having to accumulate details of their donations and put those in with their tax return at the end of the year. That is the first bit of good news that has been happening for that sector and the response and feedback that we have had has been substantial. 
The second reason the sector has much to celebrate is that the new Community Partnership Fund over 4 years has been established. The Government is prepared to invest in strengthening the operations of community and voluntary organisations around their information and communications technology capability and that is a very good thing. But even more substantial is the $446.5 million announced by the Prime Minister to fully fund contracted essential services delivered by New Zealand community organisations for vulnerable families children and young people. That includes $133.1 million of reprioritised spending and those organisations will also receive regular funding increases to reflect changes in cost and changes in demand. Although I do not want to throw any dampener on the great gain that that has been for the voluntary sector it is unclear yet what will happen to the new projects that typically arise within a community in response to needs as they arise from time to time. 
What I celebrate and United Future celebrates about the new investment in the community and voluntary sector is the greater emphasis that is being placed on fostering more collaboration within local communities so that the safety nets that should characterise our communities do not have holes in them. If anybody had asked me 8 years ago about contestable funding I would have been a great supporter of it for this sector but now I am not a supporter of it. I have witnessed firsthand the devastation that was caused as we pitted service against service and provider against provider. The discord that that brought into local communities as groups competed with each other for the few precious Government dollars is still yet to be repaired I believe. Therefore the need for collaboration in communities and the emphasis on that in the funding are very important. I will be interested to see how the Government implements that because it is not an easy task. The requirement for agencies to work collaboratively together now when in the last 5 or 6 years up till now they have actually competed against one another—often very aggressively—for the precious dollars that were available is a tall order. 
PAULA BENNETT (National) 
: 
 I personally think this sector is the most vital third sector in New Zealand when we look at what it does with the resources that it gets. It works throughout New Zealand and across the board in such a range of services from the volunteers at surf lifesaving clubs and in sports and clubs with our young children to the volunteers who work in essential social services. They do it without a doubt better than the Government can every time. When we are in our communities and look around we see people who are addressing the needs and the wants of their community in a way that no Government can and no Government should in my view. The Government has a role to play in leadership direction and in some of the resourcing. It is quite interesting because in looking at these estimates and from what I hear from the sector they were so grateful to John Key when he raised in January last year the role of the not-for-profit sector and what a vital role it will play in New Zealand. 
They needed to have a wake-up call. Someone needed to deliver it. They needed to hear what the issues were and all of a sudden we have had John Key in what was possibly his most important speech—his first speech as leader of the National Party—saying he would stand up and put a stake in the ground. He said we could not deliver what we needed to deliver for New Zealanders without the not-for-profit sector. We cannot do it without that voluntary and community sector; it is absolutely vital and critical to this. We need to bring in a level of trust and a full funding model and we need to address a lot of the discrepancies. I would like to take my hat off to United Future which has stepped up and said we need to fix some of the payment and the tax stuff and we are delighted to see our policy coming through like that. 
We are equally delighted to see full funding being part of the language finally. It has taken a while to get there. It was certainly John Key who turned round and said in January last year that it was a key focus and that that squabbling should not be happening. The example we often use is if we pitch for a service and it is something that has to happen then why would we say that 60 percent or 80 percent of the funding for it to happen is enough? It simply is not. 
We hear it everywhere we go. In my role as the spokesperson on community affairs and the voluntary sector—which I love; I just think I am the luckiest member of Parliament because I have that role—I get to go out there and talk to people in these services. I constantly hear from people out at the coalface and who are doing some pretty gut-wrenching jobs to be honest. They are certainly often working with people around abuse stuff. They do some counselling and it is pretty gut-wrenching. We hear about the contracts they have and they say there is no way it is anywhere near covering the actual cost in some cases to provide counselling and trauma services to young children. 
So they often fudge those sorts of numbers. We all hear those stories and I know that the Minister in the chair the Hon Ruth Dyson would not be surprised to hear these stories as well. People in these services say their contract is to see 15 children for X number of hours and because they are not for profit and they care—which is the main reason they are doing it—they then turn round and see say 25 children during a lot more hours that do not fit into that funding but their commitment to deliver that counselling is to the community so they do it. 
We have a responsibility to step up and acknowledge that and to make sure that the funding the support and the resources are there. We do not do it for either of the other two sectors we have in society. In fact what we do with the Government sector is to put more money into it. We put more and more people in and we grow the bureaucracy. We grow the bureaucracy to such an extent that it is stifling and crippling the not-for-profit sector which is what it is doing at the moment. I had someone from a not-for-profit group talk to me just on Friday who spends half the time introducing a bureaucrat from one department to a bureaucrat from another department just so that the two bureaucrats will talk in order to make the funding and resourcing of that not-for-profit group easier. For example when volunteers are talking about a health contract with people from the mental health services they will also talk to other people about housing issues which steps into the area of the Housing New Zealand Corporation. They do not see people from those agencies talking together so they step in. 
Hon RUTH DYSON (Minister for the Community and Voluntary Sector) 
: 
 I am delighted to have the opportunity to take a call on the community and voluntary sector part of this debate because it is an opportunity to pay tribute to the 75 percent of New Zealanders who say that they volunteer in our communities in one way or another. There are 97000 community organisations operating in New Zealand. If it were an Olympics we would win gold medals for setting up and operating community organisations—97000 of those organisations run entirely by volunteers. That is a huge commitment from New Zealand citizens to supporting their community in one way or another and I do not think it is something this Committee should take for granted. I think it is something we should respect and value and we should ensure that our central government policies work alongside those people in our community who give so much of their time their energy and often their money—either through lost opportunity or through direct giving. This debate is a very good opportunity to pay that respect. 
At the end of 1999 when Labour was elected to lead the Government we made a clear conscious decision to try to rebuild the relationship that central government had had with the community and voluntary sector. We set up a representative group—a working group of people throughout the country—to tell us how we could rebuild that relationship. The Pathways to Partnership report that came back indicated to us that the sector was burnt out frustrated and bordering on angry. There was a high level of mistrust between the community and voluntary sector and central government because the late 1980s and the entire 1990s had been fuelled by an individualised personal success model rather than by collaborative community-driven respectful relationships. The competitive tendering that Judy Turner from United Future mentioned was a critical part of that frustration and mistrust. It pitted one organisation against another. I am very pleased to have seen the developments that were driven by that working party’s report to the Government; it has led us to many changes. 
We established the Office of the Community and Voluntary Sector so that we had ongoing engagement between central government and the sector that would drive changes not just in our relationship but also in the behaviour of all Government departments. That is underpinned by a public document called the  
Statement of Government Intentions for an Improved Community-Government Relationship 
 which drives the relationship between the work of central government and that of the community and voluntary sector. We are carrying on that work now. In fact the Association of Non-Governmental Organisations of Aotearoa has recently been commissioned to review the implementation of the recommendations in the  
Statement of Government Intentions for an Improved Community-Government Relationship 
 so that we can be confident that it is delivering in the way that was originally intended. 
Judy Turner also mentioned some of the legislative changes that have come about as a result of United Future’s agreement with the Labour-Progressive Government. The change to the tax incentives for donations is a recent one and next year we will see the introduction of payroll giving which will not just see more direct support being given to those organisations through financial contributions but also help to generate better respect from us as individuals for the people who do that community work so well up and down the country in a variety of ways. 
Judy Turner also mentioned the Pathways to Partnership investment in essential social services. The points she made are extremely relevant and valid in that the collaboration and the rebuilding of capacity within the social services sector will really change the nature of the operations. I can say that from my many discussions with social service providers throughout the country they are more than up to having that debate and to changing the way that they operate. They were driven in the 1990s to change the basic value and principle system of their organisations to try to meet a contracted need when actually what all of them are set up to do and what drives them to operate is to provide what the community needs—not what a contract might deliver. 
I conclude this contribution by commenting on National’s policy because Paula Bennett continues to misrepresent it to the House. I think she does her leader a disservice when she misrepresents what he actually said. There has never been a commitment from National or from John Key to full funding of essential social services. What John Key actually said in his Plunket speech which I have tabled in Parliament is that National would encourage community organisations that put in a bid in a competitive tender round to put in that bid at a fully funded level. That not only demonstrates the completely different perspectives within the National Party on its policy—Paula Bennett saying National supports full funding and John Key saying it would encourage bids made as part of a competitive tendering round to be on a fully funded basis—but also demonstrates that he knows nothing about the community and voluntary sector or social service providers let alone how an organisation might win a bid in a competitive tendering round. Every single provider knows that it would not win a contract subject to a straight competitive tender if it put in a fully funded bid without knowing what the other organisations were likely to do. We know that with competitive tendering organisations underbid and that would end up driving the quality of services down to the level they got to in the 1990s. 
Progress reported. 
Report adopted.