Hon TONY RYALL (Minister of Health)
: I move,
That the New Zealand Public Health and Disability Amendment Bill be now read a second time. This is the second reading and report back of the New Zealand Public Health and Disability Amendment Bill, which has come back from the Health Committee, and I acknowledge the contribution from members on all sides of the House towards the bill. The bill proposes legislative amendments necessary to support the improvements following the recommendations of the ministerial review group earlier last year. It would be fair to say that this is not a major restructuring of the health service; it is really about trying to
get the health structure working more effectively. The proposed changes represent a major drive to better value for money in our public health service to enable greater national and regional cooperation in the sector and to reduce duplication and bureaucracy. The changes enable us to improve efficiency and move resources to improve front-line services.
The main provisions of the bill are a new objective for district health boards to seek most effective and efficient delivery, which is a way of ensuring that we move beyond the silo mentality that is such a fixture of so much of anything that central government does, in order to ensure that we meet our local, regional, and national health needs. It has new functions for district health boards to collaborate to work together to ensure the most effective and efficient delivery of services to meet those different levels of community needs.
As the House will be aware, the Government has also established a shared service organisation, Health Benefits Ltd, to harness the power of bulk purchasing, procurement, and supply chain management in order to free up cash that could be used elsewhere in the public health service. Fundamental to that is the ability to ensure that the major participants in the public health service, the district health boards, assist in that cooperative approach, and that where there are roadblocks to that happening there should be ministerial direction that is transparent to enhance the Government’s ability on behalf of taxpayers in order to ensure greater system collaboration and the use of shared services.
It also provides for a new planning framework. The bill amends the current requirements that district health boards have a reporting structure that involves statements of intent, annual plans, district annual plans, and so much that is duplicated and not really read by participants. We need to not only streamline that reporting process but also take into account the fact that we are moving towards a more regional cooperative approach in the way district health boards work, and that needs to be facilitated in the whole reporting infrastructure. It needs to be slimmed down, the duplication removed, and made much clearer.
There is very strong consensus across the health service for the establishment of a Health Quality and Safety Commission to advise the Government on health epidemiology and quality assurance matters, to determine quality and safety indicators, and to promote better support and better quality in health and safety. We know that if we can improve the quality of the care that people in our public hospitals receive, like making sure they get the right medication, making sure they are seen at the right time, and making sure the tests arrive in the right format, not only does that mean that people are treated better, recover better, and get home sooner but also that we save money that can be used elsewhere in the public health service. A very significant role of the Health Quality and Safety Commission will be to work with the sector to provide better-quality services right across aged care, primary care, and our public hospitals.
The bill also provides the power to appoint elected district health board members to other district health boards, which is consistent with trying to use the very best people we have in the public health service to meet our objectives.
The bill was introduced in May. As I did earlier, I thank the select committee, and I commend it for its work and its valuable recommendations. Thirteen individuals and organisations also made submissions. The committee recommended a number of amendments, which I will go through. The committee recommends, and the Government agrees, that the bill should be amended to clarify the commencement date. That change means that parts of the bill will not be brought into force by Order in Council but will come into force 6 months after the date it receives the Royal assent. The change responds to the recommendations of the Regulations Review Committee.
Secondly, in recognition of the readiness of district health boards, the Ministry of Health, and the National Health Board to implement changes to the district health board planning framework, the Health Committee has recommended a change to the start date for the streamlined planning requirements, bringing those forward a year, and the Government supports that recommendation.
The committee has also recommended that we provide further clarification on the application of the Crown Entities Act to the new direction powers for shared services, and the all-of-district health board direction powers. That recommendation makes a lot of sense, and the Government is supporting it too. Fourthly, the committee members made a number of recommendations relating to the objectives and functions of the Health Quality and Safety Commission, and the Government thinks they are also very sensible. Namely, the recommendations were that the commission should take on the objectives and functions previously performed by the National Health Epidemiology and Quality Assurance Advisory Committee, which was previously known as the Quality Improvement Committee, or QIC, and that where it is appropriate, the commission should be required to work with the Ministry, the Health and Disability Commissioner, providers, health professionals, and consumers, and that the wording in the bill be amended so that the description of the commission’s functions is consistent throughout the bill.
A number of public submissions on the mortality review committees expressed support for the transfer of responsibility for the appointment of those committees from the Minister to the commission. The committee recommends, and the Government supports the amendment, that the details of the objectives, powers, and functions of the mortality review committees remain the same. The Health Committee also recommended a number of minor amendments to the bill to correct terminology and grammatical errors, remove unnecessary wording, and ensure consistency.
Finally, many submitters to the bill wanted to understand more about how and when district health boards would be required to consult the public. The Government is keen to promote public participation in district health board decision-making where it is effective, and as such the Government is proposing a set of planning regulations that district health boards will be required to comply with under the Act. Those regulations will describe the details of the plans that they will be required to prepare and contribute to. They will include a requirement to consult with the public where the Minister considers that district health boards are proposing changes to service eligibility, access, or the way services are provided that will have a significant impact on recipients of services, their caregivers, or providers. That is quite a step forward from where we are at the moment.
The Government supports the amendments recommended by the Health Committee. It is important to understand that the bill is not about major restructuring of our district health boards or the public health service; it is about the Government’s desire to make sure the system we have currently works as effectively and efficiently as it can, in the interests of New Zealand patients and the public health service as a whole.
Hon RUTH DYSON (Labour—Port Hills)
: I am pleased to follow the Minister of Health, Tony Ryall, in this debate, and I add my commendation to the chair of the Health Committee, Paul Hutchison. Dr Hutchison tries very hard, after he has worked out how to turn on his computer, to ensure that we have a constructive working relationship within the committee, and I pay genuine tribute to him for that, because that was certainly the case in respect of the New Zealand Public Health and Disability Amendment Bill. As the Minister has indicated, the purpose of the bill is primarily twofold. The first primary purpose is to set up the Health Quality and Safety Commission, and the second is to ensure that the district health boards work better
together. That is the summary of the many points made within this legislation. The boards will have a mandate for collective purchasing and will be required to develop plans in unison. I certainly hope they are able to get their district annual plans presented to the public on time in future.
I was gobsmacked to see that several of our district health boards have just gone through an election for members of their district health boards without making publicly available their district annual plans. That is an outrage. It is totally unacceptable that New Zealanders have to vote for a representative for their local district health board without knowing what the district annual plan for that very health board says. I hope that the requirement for district health boards to plan together—and I agree with the provision and think it is sensible—does not further restrict their ability to make public the district annual plans in a timely way. That problem has certainly been the case this year, and it has caused a lot of concern for people.
Right from the beginning of this process, we supported the introduction of the bill and its referral to the select committee, for two reasons. The first reason is that the primary purpose is that which I have just outlined, the establishment of the Health Quality and Safety Commission, which sounds good in theory and we hope is good in practice. The second reason relates to the mandate for better collaboration between district health boards, which is something that no sensible person would argue against. So we supported the primary purpose, but we also wanted to make sure that members of the public, particularly those who are intricately involved in working within our health system, had an opportunity to make a submission. Members of the public often see things from a different perspective from those of us in Parliament.
One of my great interests at the select committee and through listening to the submissions was to consider what people thought were the cost benefits of this legislation. The Minister is very good at saying how many millions of dollars will be saved by various initiatives. In fact, he does it a little too often for his own good, because he has been caught out, on many occasions, exaggerating the amount of saving. In recent times he has got to the point of saying there will be savings when clearly there are costs associated with the new bodies that are being set up, so I was very interested in what submitters had to say about costs and savings.
My concern about the exaggeration of benefits was borne out by the concerns of some people, and others referred to the establishment in the last 18 months alone of new bureaucracies such as the National Health Board. I understand that Murray Horn, who made an earlier report on our health system, is getting around $1,500 a day, which is quite a lot of money to be paid to do something that was already being done by the chief executive of the Ministry of Health prior to the establishment of the National Health Board. It is even more frustrating and puzzling to see somebody being paid that sort of money to do a job that was already being done, when we see people up and down the country, particularly elderly people, having their meagre couple of hours of home support cut right back to nothing. It really does not seem to me to be a logical or a fair choice to have a new bureaucracy established, in the National Health Board, undermining the Ministry of Health and the independence of Public Service advice.
The people running the National Health Board are being paid huge amounts of money, and they have stolen a whole lot of the previous Ministry of Health people and called them consultants, so they are getting paid far more to do the job they used to do as Ministry of Health officials. At the same time, we are seeing cuts to home support, Meals on Wheels, and to the support that I think our elderly, particularly, are entitled to in order to make sure they have quality of life. That concern was repeated in the submissions about whether the cost-benefit analysis had been rigorous, or political, and
I consider that there is a large amount of political spin in whatever has been coming from Tony Ryall in that regard.
I move on to an area the Minister briefly alluded to, but which I feel warrants a bigger debate at this stage, and it certainly will be raised again in the Committee of the whole House. It concerns a blatant move to remove the community voice as part of our health decision-making process. New section 38 removes the need for district health boards to consult on strategic plans. The whole point of having a district health board is that it is representative and connected to its community, has expertise in health governance, and, because of its understanding of its community, can use the strengths of its community to further promote better health outcomes within that community. But that voice has now formally been cut out. It is not just a consequence, it is not just a by-product, and it is not an unintended outcome of this legislation; it is a deliberate, considered move that the Minister of Health signed off on. Tony Ryall said that section 38 should remove the voice of the community in district health boards’ strategic plans and preparation. I think that that is wrong. I do not think that the community should have its voice cut out in that way. The Minister made some vague reference to making sure that people will have an opportunity to contribute, and to bringing in some regulations. But it is very hard to see how regulations can be consistent with primary legislation—which they are required to be—when the primary legislation specifically removes the role of the community in the strategic planning process.
How can we have primary legislation that says the community will not have its voice? That is what Tony Ryall has said—that the community will not have its voice heard in district health boards’ strategic plans. But then, in the regulations, he has said we will have some process by which the community can contribute. I do not think that that would be acceptable in the regulations review consideration. We cannot have regulations that are at odds with the primary legislation. If the Minister had a commitment to making sure that the voice of local people was genuinely heard, he would change section 38 and ensure that the processes we have now could be continued.
A number of organisations raised considerable concern about this breach of democracy in this legislation. I know that the New Zealand Public Service Association raised concern in its submission, as did the New Zealand Council of Trade Unions and the Women’s Health Action Trust, to name just three. It does not seem consistent with the spin that the Minister puts on his health announcements that there will not be major restructuring, and that the purpose of the district health boards having elected and appointed representatives is ensuring the voice of communities is heard in making decisions about health that have an impact on those people. I think that that is all untrue. I think that it is just spin from the Minister, and this clause proves that. It is a deliberate and considered decision to take local voices out of health decisions. I will be putting forward a Supplementary Order Paper during the Committee stage of this bill in order to rectify that.
I challenge the Minister to table the regulations that he referred to during his second reading speech, because I predict that National will—like sheep jumping over a cliff—vote against my Supplementary Order Paper on the basis of what Tony Ryall has said, but I bet that not one single National member has seen the proposed regulations. I would bet good money on the fact that not one single National member has seen those regulations, and it is just not credible for us to take the Minister at his word, with regulations that will be at odds with the primary legislation, unless we have seen them.
I conclude, Mr Assistant Speaker, by just acknowledging you and Southland, and I thank you very much for giving us back the shield at the weekend. We deserved it.
Dr PAUL HUTCHISON (National—Hunua)
: It is a pleasure to speak on the New Zealand Public Health and Disability Amendment Bill. One of the most profoundly
important things about it is that 13 out of 13 of the submitters supported its intent. When those submissions cover such a spectrum—from the Council of Trade Unions to the Public Service Association, the New Zealand Medical Association, and the Nurses’ Organisation—it certainly says something.
I think it is timely to thank the members on the Health Committee for very constructive collaboration during the hearing of submissions. I also thank the officials for their very helpful advice.
I note that in the first reading of the New Zealand Public Health and Disability Bill 2000, Annette King said that district health boards would be expected to work together and enter into cooperation and collaborative arrangements to ensure service delivery to their populations. Sadly, that has failed to happen over the last 9 years; we do not see good collaboration between the various district health boards. Sadly, also, Annette King missed out of her speech the fact that district health boards should have ensured efficient and effective service delivery. Instead, over 9 years, we have seen a burgeoning bureaucracy, poor productivity in the health sector, disempowered clinicians, and a huge amount of money put into health with very little to show for it in terms of increased elective surgery. This bill is all about redressing that. It is about making the current system work better without revolution or major restructuring. That is why it is supported by all submitters, and I sincerely hope that it is supported by all other parties in the House, as it was in its first reading.
In essence, the changes are about having more effective coordination on a local, regional, and national level. It is about freeing up back-office bureaucracy so that services can be put to the front line and resources can be used more effectively. It is also, very importantly, about empowering clinicians and clinical networks so that they can once again take charge of running our health system, after a long period when they have felt, in many respects, very helpless.
One of the interesting things about this bill in terms of its support from all submitters—and, hopefully, from all political parties on this occasion—is that over the last 25 years, and over the electoral cycle, we have seen huge turmoil and restructuring in the health system. Way back in 1987, Helen Clark organised the Hospital and Related Services Taskforce report, which was known as the Gibbs report, and there was a realisation that we must have better monitoring and measuring. At the time, there was no measuring of outputs or outcomes, or of quality of service, but there was an attempt to put that into place. It was the beginning of things happening. Sadly, by 1989 things had become so dysfunctional that the Auckland District Health Board was actually disbanded by Helen Clark—and her own husband was a member of the board.
The 1990s saw some radical changes, not all of which were good. But by the end of the 1990s, the Health Funding Authority, which was run extremely skilfully by Dr Graham Scott, had become a very effective, efficient contracting agency. It was very sad in some respects that once again in 1999, with the change of Government, there were radical changes and restructuring that led to massive bureaucracy, the fragmentation into 21 district health boards, and the disempowering of clinicians. This bill sets out to redress those problems.
It is a huge worry that we have seen Murray Horn identify it as impossible to increase spending on health by 8 percent a year over and above inflation. It is just impossible for New Zealand to be able to sustain that spending. We have to drive efficiencies into the system.
The Health Quality and Safety Commission is a very, very welcome change, and it is being ably led by Professor Alan Merry. As far back as 2002, Peter Davis pointed out that something like 12.9 percent of people admitted to New Zealand hospitals suffered an unintentional injury caused in the management of their conditions. That has huge
repercussions, both in terms of personal harm and the cost savings that could be attributed. In the order of $500 million a year to $800 million a year has been estimated as possible savings if the quality measures can be brought in successfully.
During the Committee stage we will have the opportunity to debate issues that have been brought up by the New Zealand Medical Association, such as an overarching health strategy, clinical leadership, and public consultation, which, I believe, the Minister of Health very ably addressed in his earlier speech.
It is vitally important that this bill is supported by all parties in this Parliament, as it was by all of the submitters. I very much look forward to the Committee stage.
IAIN LEES-GALLOWAY (Labour—Palmerston North)
: I start by allaying Dr Hutchison’s fears about the Opposition’s support. Let me be quite clear that we will support the New Zealand Public Health and Disability Amendment Bill through to the Committee of the whole House, although we look forward to that opportunity to offer some amendments to the bill. As has been described by speakers so far, the bill sets out to establish the Health Quality and Safety Commission, to introduce a mandate for collective purchasing across district health boards, and to arbitrate when district health boards have conflicts over shared services. This is in an effort to share procurement opportunities in order to reduce costs and bureaucracy in the health system. These are all noble objectives, which the Opposition supports, but let us dispel a few myths.
Collaboration in the health system is not a new thing, as the previous speaker, Dr Paul Hutchison, would have us believe. In my own part of the world, in Palmerston North, the MidCentral District Health Board and the Whanganui District Health Board have been working together for some time. They currently have an alliance in place whereby they are looking to share more and more services. That sharing of services and that collaborative approach came into effect long before the election of the current Government. The same can be said of the entire lower North Island region, in fact. The boards in the whole region—the Hutt Valley District Health Board, the Capital and Coast District Health Board, the Wairarapa District Health Board, and the Hawke’s Bay District Health Board, as well as the Whanganui District Health Board and the MidCentral District Health Board—have been working together on a regional basis and collaborating in that way. Yes, both sides of the House support this approach, and, yes, previous Governments have supported it. It is not a new thing. It is not some wondrous new invention created by the current National Government.
Let us also talk about the concern many people have, and this Government seems to have, with cost blowouts in the health sector. First of all, I would like to draw to the attention of the House exactly where New Zealand ranks internationally in total health costs per capita, both public and private spending. The OECD estimated that in 2008 New Zealand spent—and this is in US dollar purchasing-power parity terms—US$2,683 per person. That compares to Australia at US$3,353, Canada at US$3,867, the UK at US$2,990, and the US at US$7,538. New Zealand ranks extremely well against other countries we like to compare ourselves with. So when we are talking about exactly what health care costs in New Zealand, let us be honest.
It is important that we try to find more efficiency, reduce bureaucracy, and make our dollar stretch that much further, but let us start off with an honest conversation about what is actually happening in this country. Yes, there has been growth both per capita and as a proportion of GDP over the last decade, as there has been in all other Western countries; everybody is facing this challenge, but growth in spending in New Zealand has been fairly steady. Dr Hutchison mentioned a rate of over 8 percent, but if we look at the OECD figures we see that we have never reached over 8 percent. The most recent was about 6 percent, and it has not been steady at 6 percent over each year, either; it has been a lot less than that. So although we support this bill, there are some underlying
myths espoused by the Government as to why this is so important, and it is important that we explore some of those.
New Zealand does very well because of the structure we have in place. We have a publicly funded health system, and we can have single purchasers and collaboration between providers. That helps them to reduce costs. A very good structure that is a very good example of this is, of course, Pharmac. We get fantastic reductions in comparison to, say, the US system because we have a collaborative approach to purchasing. It is good news to hear from the Minister that he does not want to see a massive upheaval in the health system, and the Opposition will be listening very carefully to make sure the Minister sticks to his word on that. We have had a lot of upheaval over the years and we need a stable system. Upheaval by stealth will be uncovered by the Opposition and we will hold the Government accountable if it attempts to do that. We have a good system and we need to maintain it.
The real cost savings in our health system are to be found in a proper, realistic, and substantial approach to public health. Unfortunately, this Government seems to have eschewed public health and put it to one side. It is fantastic that we are debating a health bill in the House; however, there is another one that has been languishing on the Order Paper for ages, which is the Public Health Bill. When this term of Parliament started that bill was quite close to the top of the Order Paper, but it has been buried further and further down. Public health is not a priority issue for this Government, probably because there are not too many sound bites in it. It is a little bit hard to sell; I do not think Crosby/Textor has come up with any good sound bites for public health. But that is where the real savings in health care are to be found: in a proper, long-term approach to diabetes, cardiovascular disease, and mental health; and in reducing smoking, alcohol, and drug-related diseases. It is a focus on well-being. It is a focus on keeping our people well and keeping them out of hospital, not waiting until they end up in hospital and all the costs that are associated with that. But that approach is too big for this Government. That is too forward-thinking and too far off in the future. The Government is not worried about the well-being of our country in 20 years’ time; it is worried about next year’s election—let us be honest.
The other thing that we could be doing to improve the health and well-being of our nation is to reduce income disparity. There is an absolutely clear link between income disparity, low socio-economic status, and poor health outcomes. What has this Government done? It has increased those disparities by giving tax cuts to the very well-off, those who need them the least, and increasing GST, which affects those who have the least the most, thereby increasing those disparities and giving our nation a larger health bill in the long run, further down the track.
The Health Committee’s report notes that some members, i.e. the Opposition members, have some concerns about the removal of the requirement for district health boards to consult with the public. We have nothing to fear from consultation with the public in this country. We have a very strong Parliament, we have very strong public institutions, and we have very strong district health boards that are able to progress their policy initiatives, their strategies, and their plans, and are able to roll those out. There is nothing to fear; there is nothing to slow us down from having proper public consultation. Public consultation will achieve better policy making and better strategies that will respond to what our local communities need. This was brought up time and time again by a number of the submitters, and Woman’s Health Action summed it up quite well. It said: “Consultation with communities should not be viewed as a nicety but rather as a fundamental part of the public health and disability system that ensures health and disability services are appropriate for, and responsive to, those who need them.” I could not agree more.
The erosion of that consultation process erodes the ability of not only the public at large, but also non-governmental organisations and the clinicians. We hear so much from the Government about its concern that clinical leadership has been eroded from the health system; those clinicians are having their say eroded as well by this removal of the requirement for the district health boards to consult with the public. The New Zealand Nurses Organisation brought up the issue of nursing leadership down in the Southern District Health Board. It said that since the amalgamation occurred between the two district health boards down there it had seen an erosion of nursing leadership.
We will support the New Zealand Public Health and Disability Amendment Bill. We support its aims and objectives, and we look forward to the Committee of the whole House, but let us have an honest debate about public health care in New Zealand.
KEVIN HAGUE (Green)
: I begin, as others have done, by thanking the officials who assisted the Health Committee in our consideration of the New Zealand Public Health and Disability Amendment Bill. I thank the submitters who, I think it would be fair to say, put in 13 splendid submissions, and I thank my colleagues from the select committee. I share Ruth Dyson’s praise for the role that Paul Hutchison as chair played. I also want to single out, given the circumstances this afternoon, one of our colleagues from the Health Committee, the Hon Luamanuvao Winnie Laban, and say to Winnie a big fa‘afetai lava to thank her for everything that she has done, and give her best wishes for her future.
The Green Party supported this bill at first reading and will continue to support it. In particular, we support the underlying intent of the bill, but we do so with some reservations. Enhancing quality and safety through the creation of the Health Quality and Safety Commission is a good idea and enhancing the effectiveness of the New Zealand health care system through greater collaboration is also an important idea that everybody shares. In relation to the Health Quality and Safety Commission, if I could begin there, I had the good fortune to represent district health boards on the Quality Improvement Committee, so I was part of the development of a number of these quality improvement projects, and I certainly welcome this exciting development—a great enhancement of this area of work.
There are two reservations I want to voice in this debate. The first of those picks up on a point made by the IHC in its submission to the select committee. One of the things that has happened in the field of disability, in particular in the field of intellectual disability, is that we have focused on what the goal of disability support services might be. A groundbreaking report from the National Advisory Committee on Health and Disability called
To Have an ‘Ordinary’ Life
set out a goal for intellectual disability support services of ordinariness—ordinariness is the goal of those services. IHC was saying to us that a residential service that has the intent of providing an ordinary living situation for people with intellectual disability is a very different kind of service from a clinical service intended to repair illness. So I think it will indeed be a challenge for the new commission to think through what quality and safety means for a service that has such a different goal from that of the clinical services that will make up the bulk of its work. That is one reservation.
The second reservation is a more deep-seated one and will be the subject of an amendment from the Green Party in the Committee stage: it concerns the intent set out in clause 13 of the bill for the Health Quality and Safety Commission to become self-funding. We believe that that is fundamentally wrong and that although the argument for self-funding, which is that this will increase the relevance of the commission’s work and buy-in to that work from the health sector, is an admirable argument and one that we would support, the danger is also great. The danger is that if the commission is set up to become self-funding it will pervert and change the actions both of the commission
and of service providers, so that the commission will focus on those projects that lend themselves most readily to generating income and providers will tend to pick up those projects that are free or do not incur a cost. Neither of those behaviours is necessarily what we want, so the Green Party will move an amendment to remedy that situation.
I come to collaboration. I enjoyed Paul Hutchison’s journey through the changes in the health sector over the last several decades. I had the dubious pleasure of living through most of them while in positions in the health sector, and that history shows us several things. First of all, for me, it reinforces the adage that structure should follow function. In the health sector we have seen a lot of structural change that has not been driven by that principle, but is, instead, the result of ideological change or ideological belief. I think it would be disappointing if we were to see more of that kind of change in the sector. So what kind of function or service do we require in the New Zealand health sector? I suggest that public health services, which Iain Lees-Galloway has talked about, and primary health services lend themselves to highly localised structures, whereas other services such as tertiary and quaternary services, the most specialised services, lend themselves to much bigger units of organisation. I have previously in the House set out my view that that suggests that what we need for structure is an intelligent network of locally organised structures that are able to aggregate where function determines that that is a sensible thing to do. I think we are moving towards it.
I do not agree with Paul Hutchison’s view that collaboration has not been occurring in the sector. It has been occurring. There have been important gains. But it has been limited by a few things. It has been limited by what I call asymmetry of need, where smaller district health boards have required collaboration and larger district health boards, in general, have not. It has been limited by an interpretation of the principal Act that suggests that each district health board should act only in its own interest and so there has not been a driver that it is in the interest of the overall New Zealand public.
We support the idea of greater collaboration that can be directed by the Minister, which is in this bill. We think that is the appropriate way to go. But we share the concern set out by Labour members about the other thing this bill does, which was not signalled in the first reading debate: it diminishes the requirement for consultation imposed on district health boards. Certainly we will be talking with our Labour colleagues about the Supplementary Order Paper they intend to put forward and we intend to work for a change to the legislation in the Committee stage. There are a couple of reasons, really. One is that the approach outlined by the Minister of Health in this debate of setting out the requirements for consultation through regulation is bad law. It is bad law. The consultation requirement ought to be set out in the Act itself, and the interpretation of the Act should guide the proportionality of the consultation that then occurs, because this is what the Government members say. They say that if we have the consultation requirements spelt out in the Act, then district health boards will be forced into consultation that is out of proportion to the issue involved. In fact, that is not the case. The Court of Appeal has already set out the law that applies here, and it imposes precisely the kind of proportionality we would want to see. So there is no good reason for not including it in the Act, and we will be working for that in the bill.
In summary, the Green Party will support this bill until its Committee stage, but we will be working for some significant changes to the bill in the Committee stage. We hope that it will be possible to eventually pass a bill unanimously in the House. Thank you.
RAHUI KATENE (Māori Party—Te Tai Tonga)
: The New Zealand Public Health and Disability Amendment Bill amends the New Zealand Public Health and Disability Act 2000 to face the challenge of providing high-quality health care and disability support services that are affordable. The goal of the legislation is, therefore, pretty
straightforward. The bill amends the Act. It encourages or forces district health boards to work together with the ambition of creating and achieving cost efficiencies. It allows the Minister of Health to step in and sort out conflicts between district health boards to enable those powers to have wider application, particularly where there are disputes between district health boards about how national, regional, and local requirements are best provided for.
In the aftermath of other recent legislation suggesting that there be extraordinary and exceptional powers for Ministers, such as the case of the Canterbury Earthquake Response and Recovery Act or the Rugby World Cup 2011 (Empowering) Bill, I have to say that we looked into these new amendments to the New Zealand Public Health and Disability Act very deeply. We welcome the move from the Health Committee to clarify the directive powers of the Minister, and to amend the respective sections to clarify that the Minister has the same directive power that he or she has under the Crown Entities Act 2004, which is, essentially, that the Minister cannot become involved in operational matters.
But there is another section of the bill that we want to give particular priority to, and that is the district health board public consultation requirements. The select committee’s view was that the bill would likely weaken the consultation element of the Act being amended. Presently, the Act requires the same standard of consultation as in section 83 of the Local Government Act 2002. The bill will require consultation, but the standard of consultation is not defined. That weakness, as the committee reported it, worried us, and it worried Women’s Health Action. Women’s Health Action told the select committee that it held “serious concerns about the fate of public consultation in the proposed changes to the Principal Act outlined in [this] Bill … Women’s Health Action strongly recommends that consideration be given to strengthening consultation requirements in the Bill.” The New Zealand Council of Trade Unions also shared those concerns. In its submission it noted: “The CTU recommends that the consultation requirements on DHB annual plans are retained and that there are provisions in the Bill to ensure that the Ministerial power of direction is used sparingly.”
The bill as originally drafted determined that “The Minister may give a direction to all DHBs to comply with stated requirements for the purpose of supporting government policy on improving the effectiveness and efficiency of the health and disability system.” Before giving any direction, the Minister must consult all district health boards and any persons who may represent the interests of people likely to be substantially affected, but only if the Minister considers it necessary in the circumstances. So we come to the crunch issue that the bill could, if the Minister so desired, be implemented in such a way that serves to undermine a district health board’s consultation with its community. There is no specific clause to require district health boards or the Health Quality and Safety Commission to consult with mana whenua.
Another aspect of that issue relates to consultation with disabled people and their families. The submission from IHC provided a very strong statement about the relationship between the models proposed in the bill and the model that might work for disabled people. It stated: “IHC is concerned that the proposals for change contained within the Bill infer that the same approach will benefit both the health and disability sectors on an equal basis. IHC cautions against this approach. Given the social model of disability and the aspirations for disabled people to live an ‘ordinary life’ we believe that the medical context and models proposed within the Bill may not be appropriate for disabled people.”
The Māori Party supports the proper recognition of disabled people and their families in the context of whānau ora. We believe that disabled people have the right to participate in decision making, to be protected by law, and to have control of their lives.
The IHC’s submission is a reflection of the disability sector’s view that if the model does not fit, this bill may not benefit the sector as much as it could. We note that although some select committee members have concerns about the whole aspect of consultation, they were satisfied that new section 92(1)(g), inserted by clause 16(1), would impose sufficient procedural requirements for consultation. I have to say that we will be watching this issue very closely.
A key development in this bill that we are very interested in is the establishment of the Health Quality and Safety Commission. We support the intention of the select committee to elevate the status of this commission by including specific information in the bill that itemises key functions. These key functions include providing advice to the Minister on health epidemiology, quality assurance, mortality, how to improve quality and safety, determining quality and safety indicators, providing public reports on quality and safety, promoting and supporting better quality and safety, and disseminating information about quality and safety.
We note the strong support from both the Council of Trade Unions and the Medical Association for this commission, and it is an area that we in the Māori Party also support. We have canvassed strongly on this issue in our policy manifesto
He Aha Te Mea Nui? He Tangata, He Tangata, He Tangata. We have promoted the policy line that the community must receive accurate information about the performance of hospitals, public health organisations, and district health boards, including having adverse events reported publicly within 3 months.
I remember a
Lancet article a few years ago, in 2006, of a study of a sample of 6,579 patients who had been admitted to 13 hospitals in New Zealand. That study concluded that Māori patients had a higher risk of preventable adverse events in hospital than patients of non-Māori, non-Pacific origin. In fact, the study concluded that Māori were more likely to receive suboptimal care. They received poor-quality practice that harmed patients. That could, and should, have been prevented. Our biggest concern with this report was the impact that such information has on Māori confidence in the public health system. On that basis we argued that adequate information about health status must be a priority that the health system should attend to.
We will be supporting this bill, but I alert the Minister to what will be a key focus for us—how this bill affects the appointment of Māori representation in regionalisation. Our policy is that we support the separation of the funder and provider roles of the district health boards. We also entered into Government with the position that we sought to review the duplication of corporate and administrative functions between hospitals, public health organisations, and district health boards, and to see whether any savings were available if duplications were removed. Efficiency, effectiveness, quality, and accountability all matter to Māori and to the Māori Party. But, most of all, I return to our key policy mantra: he aha te mea nui o te ao? He tangata, he tangata, he tangata. Our longstanding concern will remain with the people.