McLellan TraceyHealthDr TRACEY McLELLAN (Chairperson of the Health Committee): Thank you Madam Chair. It's a pleasure to lead off the debate for the annual review 2021 for health. As chair of the Health Committee I'd first like to take just a couple of moments to thank the clerks attached to the Health Committee thank all of the officials who worked for and with the Health Committee and to the members of the committee for all of the mahi that goes into the annual review period. During the course of this annual review we like other select committees held a hearing with the then Minister of Health to cover the overarching issues in the sector and we thank the Minister for the chance to discuss the results of those appropriations. We also held individual hearings with 12 particular agencies within that health sector. We were reminded during the course of this annual review that there had been in fact significant changes to the structure of the health sector during the period under annual review. On 1 July 2022 the Pae Ora (Healthy Futures) Act 2022 gave effect to a fundamental reform of the health and disability system. The 20 district health boards—DHBs—and the Health Promotion Agency were disestablished and two new agencies Te Whatu Ora and Te Aka Whai Ora were established. The functions of the Health Promotion Agency have also been incorporated into Te Whatu Ora.As part of this review process when we heard from the Ministry of Health in particular—the Ministry of Health as a little bit of background sets out the direction and policy for the health system it advises the Government on funding and system settings regulates the health system and monitors health outcomes—the Auditor-General assessed many of those functions and found that the system in general was working at a good level. It assessed the ministry's management control environment. It assessed its financial information and supporting systems and controls environment and the performance information and supporting systems controls environments. All of those were found to be working good. It did make some recommendations for improvements as to be expected with regards to procurement: in particular with regards to information technology and with regards to inventory management. The Auditor-General also recommended that it was appropriate at least for the ministry to consider ways in which the health system would measure its performance following these significant health reforms. Indeed we heard that several mechanisms had been introduced to understand whether the system was heading in the intended direction. Te Pae Tata Interim New Zealand Health Plan is one such example as were other mechanisms including the ministerial advisory committee who work outside independently who review the whole system and the processes of the reforms to ensure that the system is heading in the right direction.Other structural changes were made; in particular the Public Health Agency—within the ministry—which is responsible for operation of public health policy strategy and intelligence and which essentially brought together the previously 12 public health units. We also spoke about the fact that one of the challenges with public and population health is that it actually could take many many years to see the fruits of those labours and to see the outcomes that are sought. But we were informed during the course of this review that the focus on determining the social determinants of health such as housing and education and working with partner agencies was an absolute priority of this group. We also note that the response to COVID-19 offered some really good models of work particularly with Māori with Pasifika and with other vulnerable communities. We asked during this review process to be assured that the ministry and the agencies were acknowledging that and had learnt those lessons and were inculcating those lessons into future work which they assured us that they were. Workforce planning came up. The director-general identified it as a really critical issue and said that it was the number one priority across the system and gave us several examples of initiatives that were being utilised to help in that area. We also heard about the 16 mental health infrastructure projects that had been undertaken the trend that New Zealanders were living longer than ever before and the fact that the gap had been narrowed but not by enough between Māori and non-Māori. So with that said the Health Committee recommends that the annual review for health 2021 be accepted.