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First Reading, NZPHD Bill

Today is an historic day in terms of New Zealand health because it marks the formal beginning of a return to a genuine public health service in this country. I am proud to be Health Minister in a Government that is determined, through this New Zealand Public Health and Disability Bill, to restore public ownership of the health system. That said, the enormity of the job ahead, in creating a health service that works and that New Zealanders can trust again, cannot be overestimated.

As a New Zealander, I was dismayed by what happened to our health system during the 1990s. It seemed that the one consistent health outcome in which the previous Government was interested was the colour of the bottom line on hospital balance sheets.

But if I was saddened and dismayed by what happened, I was still staggered by the level of disillusionment and the lack of morale I discovered right across the health sector when I became Minister. Apart from those who had a vested interest in continuing to make money out of the market model for health, almost every professional I met wanted the public reinstated in the public health service.

No wonder we have found so much support from the public and health professionals for the changes this Bill puts forward. Health professionals are in the health system to deliver health, and most understand this Bill will empower them to do so again.

The New Zealand Public Health and Disability Bill sets out to:
 Rebuild New Zealand's public health service
 Restore community involvement in, and ownership of, health at a local level
 Restore the public confidence that has been battered and bruised by the previous Government's ideological experiment, an experiment that has cost some New Zealanders their lives
 Restore the confidence of health professionals in a system they have been leaving in depressed and disillusioned droves.

It is highly ironic when members of the Opposition, particularly their spokesperson on health, raise issues of shortages in the health workforce. The appalling shortages will take years to overcome properly. They are appalling because we have been through years when the basic principle behind workforce planning consisted of letting the market determine the need.

There may have been some token efforts at workforce planning in areas such as nursing, but health professionals have lacked confidence in such initiatives. They will have confidence, however, in the Health Workforce Advisory Committee set up under this Bill, because this powerful committee will advise the Minister on long-term planning. This is a considerable divergence from the finger in the dyke approach needed as a result of the lack of planning in recent years.

This Government is committed, through the Bill, to achieving the best health and disability outcomes for New Zealanders and to reduce disparities between population groups, particularly the disparities affecting Maori, Pacific peoples and lower socio-economic groups. The Bill will enable the development of the New Zealand Health and Disability Strategies to guide the sector in future years.

The Bill will ensure a population health focus, and allow local communities to have input into District Health Boards through elected representation, and through locally-conducted assessments of community health needs.

Through this Bill the Government is creating a new structure for the health and disability sector based on 21 District Health Boards and the Ministry of Health. DHBs will gradually assume responsibility for funding or providing services for geographically defined populations and will be responsible for public hospitals and other related services currently owned by companies called Hospital and Health Services.

Many of the Health Funding Authority's responsibilities for needs assessment and funding will be transferred to DHBs. The Ministry of Health will continue with its current functions and also be allocated some of the roles of the HFA and CCMAU (health), although the latter transfer of functions is undertaken by mechanisms outside this Bill.

DHBs will be established as Crown Entities, as statutory corporations, not as companies. Each DHB board will have up to 11 members, seven elected every three years, and up to four appointed by the Minister to ensure the best mix of skills and knowledge on each board. In recognition of the Crown's partnership with Maori, each board will have at least two Maori members, or a greater number if Maori make up a higher proportion of the DHB's population. In areas where Pacific people form a large part of the population, the DHB will need the appropriate skills to consider the needs of Pacific people.

Part of each DHB's accountability will be to ensure communities are involved in the board's deliberations as much as possible. DHB board meetings will be open to the public, and DHB performance information will also be publicly available. DHBs will have a population focus, and will be responsible for working to improve, promote and protect the health of their populations and the independence of people with disabilities. They will need to consider all needs and services, including prevention, early intervention, treatment and support.

DHBs will also be obliged to establish three core advisory committees to manage any tension they may experience in their dual roles as funders and providers. The three committees, the Health Improvement Advisory Committee, the Hospital Governance Advisory Committee and the Disability Support Advisory Committee, cover the entire range of the health sector. DHBs will also be expected to work together and enter into cooperative and collaborative arrangements where appropriate to ensure service delivery for their populations.

Because DHBs are new entities, this Bill allows the Ministry to take responsibility initially for existing service contacts until DHBs become sufficiently experienced to assume greater levels of responsibility.

One of the most important areas of this Bill concerns the Crown's partnership with Maori. The partnership approach will ensure the engagement of Maori at all levels of the health sector. Provisions for the partnership, including reference to the Treaty of Waitangi, are set out in the Bill and will also be set out in DHB accountability documents. The new public health service must as a priority work alongside Maori to turn around tragic Maori health statistics.

The partnership relationship builds on progress by the previous National Government. That is why I am somewhat surprised some Opposition members, including the former prime minister, have been claiming the Treaty provision will create two classes of patients based on skin colour. I am extremely disappointed in Mrs Shipley playing the redneck race card instead of engaging in rational debate, particularly given her own party's previous Treaty partnership with Maori.

The previous health system created two classes of patients, those with money and those without. The new public health service will make health accessible to all, regardless of where they live, how much money they have, and certainly regardless of their skin colour.

I know prominent former National Party ministers, including Sir Douglas Graham and Hon. Bill English, share our belief in the importance of the Treaty as a guiding partnership document.

When Mr English was Health Minister, he was proud of partnerships he forged with Maori providers. Under National, the HFA, the funding organisation National set up, established Treaty relationships with iwi organisations. An HFA report published this year stated that about 50 percent of Maori health providers interviewed in 1999 considered the HFA was committed to the Treaty. A draft memorandum of understanding between the Ngai Tahu Development Corporation and the HFA in August last year agreed the Treaty offered both parties the opportunity to establish a "partnership relationship", with the principal objective an improvement in Maori health status.

Sir Douglas Graham, in his 1997 publication, Trick or Treaty?, called for a redefinition of the relationship between Maori and non-Maori and a recommitment to "build a co-operative friendship so that everyone can benefit". He wrote: "If we have learned anything from the past it is that where Maori are likely to be affected by government policy they must be consulted. And to avoid mistakes it may be time to establish a joint council". Sir Douglas also pointed to a statement from the President of the Court of Appeal that perhaps "too little emphasis " had been given "to the positive and enduring role of the Treaty".

Fearmongers have already begun arguing that inclusion of a Treaty clause in this Bill opens the possibility of Maori being able to go to court and argue they should be considered differently, regardless of clinical advice.
The reality, of course, as they know, is that because the Treaty has already become so strongly embedded in the health partnership in the past few years, that anyone wanting to take such extraordinary action could do so whether or not there is a Treaty clause in this Bill.

The clause is included because this Government agrees the Treaty has "a positive and enduring role". If we want a better New Zealand, a healthier New Zealand, we need to build on the partnership that already exists. We need to believe in our own healthy future, not to live in fear of committing ourselves to a better life together.

Accountability mechanisms are proposed for DHBs commensurate with their service and fiscal responsibilities. The mechanisms include a strategic plan with a five to ten year focus, an annual plan and regular monthly and quarterly reports against the annual plan. Plans must reflect the full range of services needed in each area, prudent management of Crown-owned assets, and include specific initiatives or priorities communicated by the Minister. There may be times when sanctions need to be applied against either individual board members or the board. The most serious sanctions are included in this Bill.

The Bill has appropriate non-commercial arrangements for organisations like Pharmac, and the Bill also allows two new committees to be established. I have already discussed the Health Workforce Advisory Committee. The other, the Mortality Review Committee, will review and report on specified classes of death. Initial priorities will include child and maternal mortality and perioperative death.

The Bill also includes provision for the Minister of Health to establish advisory committees for specific purposes and to undertake inquiries into particular issues. It also allows for the transfer of staff, assets and liabilities from the HFA and HHSs to DHBs or the Ministry of Health, and makes necessary consequential amendments to other Acts.

The Opposition health spokesperson claims New Zealanders have not been properly informed about the health changes. They certainly weren't informed at all in advance about his Government's reforms, but I doubt if New Zealanders have ever been as well informed about major legislation as they have been about this Bill.

The major elements of this Bill have been our policy for most of the past decade, and throughout this year the public has been kept informed through the release of cabinet papers and through health forums conducted around the country.

I am proud of the way Ministry and HFA staff and health professionals have kept the health sector running as usual at the same time as they have been called upon to work on the new public health service as well. In fact, they have worked more efficiently than ever. I thank them for all they have done. There is a resolve across the whole health sector to produce a public health service people can trust and rely upon. It may take years before all the legacies from the past can be remedied, particularly in terms of workforce skills and numbers, but this Bill sets New Zealand health on a different and committed path. I am confident that what we are setting out to achieve with this Bill will provide New Zealanders with an open, accountable and fair health service without all the inequalities and unhappy disparities that have beset it for far too long.

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