Speech Notes on Health Bill Green MP Sue Kedgley August 17, 2000

The Green Party welcomes the opportunity to consider the Health and Disability bill.

We support greater democracy and accountability in our health system, and we support in principle the establishment of district health boards which have locally elected community representatives on them and which meet in public.

We support the decision to use an STV voting system for elections to the District Health Boards and are confident this will ensure a good cross section of the community are elected onto the DHB's.

We hope the establishment of these boards will bring to an end the secrecy and divisiveness that have characterised the health sector for the past decade, and will lead to much greater transparency, greater accountability and more local community input into our health system.

We believe that similar openness and accountability is necessary at a central government level as well and we have concerns about whether some changes at central level work in the opposite direction. "Trust me, I'm the Minister" is not enough.

We have many unanswered questions and some real misgivings about this bill.

The health system has been in constant turmoil for over a decade, with wave after wave of restructuring.

We can see no point in putting the system through yet more turmoil, through yet another wave of reforms, unless we can be sure that the reforms will deliver a better health service.

By 'better' we mean a service which is consumer and community focussed; a service which ensures that national quality standards are implemented and rigorously monitored across the entire health system; a service which is flexible enough to meet local needs and aspirations; a service which is focussed not just on treating people once they have become ill, but on preventing people from becoming ill in the first place, and on removing the underlying causes of illness; and a health service which moves away from a narrow medical paradigm and takes a much more holistic approach to health and well-being.

Regrettably, as the bill is drafted at the moment, we cannot be certain that health reforms will deliver on these goals. Nor do we see much that guarantees openness and transparency or ensures national quality standards across the entire sector.

We need to be convinced that the DHBs will not be dominated by hospitals at the expense of community and public health, and we need to be convinced that changes resulting from this legislation build on the best that has gone before. We want to ensure, in particular, that the many positive, community-based, iwi, union, pan Maori and other local health providers and initiatives are not sacrificed in the reform process, but are allowed to survive and thrive in the new environment.

We support the inclusion of clauses relating to Maori and the Treaty of Waitangi in the bill. We are aware that there are critical debates taking place within Maoridom about these issues and consider it essential that enough time is allowed in select committee for these debates to take place.

We welcome the Minister's acceptance of the Green Party's initiative to set up a complementary healthcare Advisory committee which will advise the Minister on ways of recognising and integrating complementary healthcare into the existing health services, and we want to be certain that complementary healthcare will be able to be integrated into the new structures.

We are concerned that mental health, long the cinderella of the health system, is not somehow lost in the new structures. There are still severe shortages in acute care and of supported accommodation for the mentally ill and we want to be sure that mental health funding will not be siphoned off for other health purposes, under the new structures, as has routinely happened in the past.

We also want to be sure that more holistic mental health services have adequate access to funding. Counselling and other forms of therapy, for example, have long been the poor cousin of pill-based mental health because of the dominance of the medical model.

Another concern is the absence of monitoring and accountability mechanisms set out in the new legislation. We want to see monitoring and accountability provisions included in the bill. And we want a lot more thought on how to create genuine and effective monitoring and accountability at a community and national level.

Intangibles matter a great deal in health. The last ten years have seen a massive decline in, for example, the amount of time nurses are able to spend talking with patients, as the focus has gone on more measurable aspects of the health system. We need to be able to show that these reforms will improve the quality of health care.

We have concerns at a technical level as well. These include the uncertainty caused by annual funding rounds, the exact nature of any population based funding, and the way providers who deal with more than one DHB will be treated. We also wonder, for example, whether Health Funding Authority information will be passed to DHBs or end up buried in the bowels of the Health Ministry.

We are also concerned that while there are some sections of the bill which are very detailed -- which discuss, for example, whether DHB meetings can be held by teleconference, for example -- there is very little detail at all in other sections of the bill which read like a skeleton which needs fleshing out.

For example, the bill requires that each District Health Board set up a committee to improve the health of the local population.

With our focus on preventative and community based health, we obviously support the establishment of these committees, and the shift in direction it implies --but we're concerned at lack of detail, and the extremely narrow functions that are assigned to these important Health Improvement committees. Their functions, at present, are simply to give advice on the needs of resident populations of the DHB and to set priorities for the use of the limited health funding available.

Those limited functions hardly constitute a mandate for improving the health of a population. If we really want to improve the health of a local population we would give these committees a mandate to look far beyond waiting lists and statistics on disease, and ask them to identify the underlying social and environmental causes of ill-health in their areas, and to make recommendations on how to improve the nutrition and well-being of their local populations and nurture a culture where 'good health' is seen as a central goal of all central and local government action in an area.

Matters such as employment, education, housing and transport policy have a significant impact on health. We await with interest the Government's explanation of how DHB's will be able to influence these.

Numerous studies have implicated air pollutants, vehicle emissions, pesticides, heavy metals, agricultural and industrial chemicals and toxic wastes, in illnesses that affect our immune, nervous and hormonal systems, and diseases like cancer.

But under the legislation as it is drafted at present, DHB's would have no power to intervene or make recommendations in these areas. All they would be charged with doing is setting priorities for the use of the limited funding available to their district.

>From our perspective, there is little point in creating community health institutions which have little or no influence over the health of communities. Nor is there any point in continuing to spend billions of dollars treating people who have become ill, but only a relatively tiny amount trying to prevent people from becoming ill in the first place.

I'd also like to restate here our commitment to greater equity in the treatment of accidents as compared to illness. As just one example, we consider it odd that consumers can get access to some forms of complementary healthcare under ACC but not through the public health system. We will watch closely for opportunities to advance this issue here and in Phase II of the ACC reforms.

This Bill is presently a mere outline. It reserves important powers and details for Executive Government and regulation. This is a tempting course of action for a minority government but it is not one which finds favour with the Greens. This Party and this Parliament must not be rushed into voting on flawed or incomplete legislation on a such a crucial subject.

We believe that many of our concerns with this draft legislation could be addressed through the select committee process, and through amendments which give flesh to the bill in these important areas. We will support this bill going to select committee, we will listen attentively to submissions and we shall propose amendments which will, we hope, address our concerns and ensure this bill lives up to its stated purpose.

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